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The purpose of this study was to realize an automated volume measurement of abdominal adipose tissue from the entire abdominal cavity in Dixon magnetic resonance (MR) images using deep learning. Our algorithm involves a combination of extraction of the abdominal cavity and body trunk regions using deep learning and extraction of a fat region based on automatic thresholding. To evaluate the proposed method, we calculated the Dice coefficient (DC) between the extracted regions using deep learning and labeled images. We also compared the visceral adipose tissue (VAT) and subcutaneous adipose tissue volumes calculated by employing the proposed method with those calculated from computed tomography (CT) images scanned on the same day using the automatic calculation method previously developed by our group. We implemented our method as a plug-in in a web-based medical image processing platform. The DCs of the abdominal cavity and body trunk regions were 0.952 ± 0.014 and 0.995 ± 0.002, respectively. The VAT volume measured from MR images using the proposed method was almost equivalent to that measured from CT images. The time required for our plug-in to process the test set was 118.9 ± 28.0 s. Using our proposed method, the VAT volume measured from MR images can be an alternative to that measured from CT images., (© 2022. The Author(s), under exclusive licence to Japanese Society of Radiological Technology and Japan Society of Medical Physics.)

The study aimed to analyze the direction of non-recoverable strain and determine the optimal direction for anatomic capsular plication within four sub-regions of the inferior glenohumeral capsule following multiple dislocations. Seven fresh-frozen cadaveric shoulders were dissected. A grid of strain markers was affixed to the inferior glenohumeral capsule. Each joint was mounted in a 6-degree-of-freedom robotic testing system and repeatedly dislocated in the anterior direction 10 times at 60° of abduction and 60° of external rotation of the glenohumeral joint. The 3D positions of the strain markers were compared before and after dislocations to define the non-recoverable strain. The strain map was divided into four sub-regions. The angles of deviation between each maximum principle strain vector and the anterior band of the inferior glenohumeral ligament (AB-IGHL) or posterior band of the IGHL (PB-IGHL) for the anterior and posterior regions of the capsule were determined. The mean direction of all strain vectors in each sub-region was categorized. The direction of the non-recoverable strain in the anterior-band and anterior-axillary-pouch sub-regions was categorized as parallel to the AB-IGHL, whereas the posterior-axillary-pouch and posterior-band sub-regions were mostly perpendicular to the PB-IGHL. Clinical Significance: Plication of the anteroinferior capsule parallel to the AB-IGHL may be preferred during arthroscopic Bankart repair to restore anatomy; posteroinferior capsular plication may also be necessary and best performed perpendicular to the PB-IGHL. The direction of the capsular injury remains the same irrespective of the number of dislocations. This study provides the scientific and quantitative rationale for an anatomic approach to capsular plication., (© 2022 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

Background: The changes in glenohumeral joint stability after surgery in a clinical setting are yet unknown., Purpose/hypothesis: This study aimed to compare the anterior humeral head translation between pre- and postsurgical conditions using ultrasonography. It was hypothesized that ultrasonographic assessment would reveal decreased anterior translation., Study Design: Case series; Level of evidence, 4., Methods: A total of 27 patients (24 male, 3 female; mean age, 24.1 ± 9.7 years) with anterior shoulder instability were studied prospectively. All the patients underwent the arthroscopic Bankart-Bristow procedure under general anesthesia, and ultrasonographic evaluation was performed before and immediately after surgery. The forearm was fixed with an arm positioner in the beach-chair position, and the ultrasonographic transducer was located at the posterior part of the shoulder to visualize the humeral head and glenoid rim at the level of interval between the infraspinatus tendon and teres minor tendon. The upper arm was drawn anteriorly with a 40-N force at 0°, 45°, and 90° of shoulder abduction with neutral rotation. The distance from the posterior edge of the glenoid to that of the humeral head was measured using ultrasonography with and without anterior force. Anterior translation was defined by subtracting the distance with anterior force from the distance without anterior force., Results: The humeral head position was translated posteriorly immediately after surgery in all patients. Anterior translation decreased significantly after surgery at 45° (7.7 ± 4.3 vs 5.8 ± 2.0 mm; P = .031) and 90° (8.9 ± 3.4 vs 6.1 ± 2.2 mm; P < .001) of abduction, whereas there was no difference between pre- and postsurgical translation at 0° of abduction (4.9 ± 2.3 vs 4.0 ± 2.1 mm, P = .089)., Conclusion: Ultrasonographic assessment immediately after a Bankart-Bristow procedure showed the humeral head was translated posteriorly relative to the glenoid at 0°, 45°, and 90° of abduction. The surgery also decreased anterior translation in response to an anteriorly directed force at 45° and 90° of abduction., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.Y. belongs to an affiliation supported with research grants from Zimmer Biomet, Stryker Japan, and PRO Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Meniscal ramp lesion (RL) is the peripheral lesion of the posterior horn of the medial meniscus (PHMM) associated with anterior cruciate ligament (ACL) tear. The purpose of this study was to evaluate the accuracy of pre-operative magnetic resonance imaging (MRI) evaluation in diagnosing RL and to identify whether the difficulty in diagnosis differs depending on the location of RL., Methods: ACL-injured patients undergoing ACL reconstruction from January 2017 to January 2019 were enrolled. A methodical arthroscopic exploration to identify RL was conducted intra-operatively using three steps, namely, the anterior visualization step, the inter-condylar visualization step, and the posteromedial step. The location of the RLs was evaluated and classified into two types as follows: Red-red zone (RR) - a meniscal tear of the red-red zone of the PHMM. Menisco-capsular junction (MCJ) - a lesion at the menisco-capsular junction of the PHMM, which is more peripheral than RR. Furthermore, the accuracy of 1.5-T MRI evaluation to diagnose RL by two testers using sagittal proton-density fat-saturated images was calculated., Results: Of the 81 patients enrolled, 11 had RL: 5 cases each were at the MCJ and RR, and 1 case was at both locations. The sensitivity of MRI for detecting RL was 27.3-45.5%, whereas the specificity was 84.3-95.7% in total. The sensitivity of MRI in detecting RL at the RR and MCJ was 40.0-80.0%, 0-20.0%, respectively. The intra-observer reliability of the MRI evaluation was moderate (κ coefficient: 0.40-0.46), while the inter-observer reliability was fair to moderate (κ coefficient: 0.27-0.41)., Conclusions: A low sensitivity of the MRI in detecting RL at the MCJ was observed, and the reliability of the MRI evaluation for diagnosis of RL was not high. Therefore, methodical arthroscopic exploration is essential to diagnose RL even when it is not suspected on pre-operative MRI., Competing Interests: Declaration of competing interest None., (Copyright © 2021. Published by Elsevier B.V.)

Ultra-sparse-view computed tomography (CT) algorithms can reduce radiation exposure for patients, but these algorithms lack an explicit cycle consistency loss minimization and an explicit log-likelihood maximization in testing. Here, we propose X2CT-FLOW for the maximum a posteriori (MAP) reconstruction of a three-dimensional (3D) chest CT image from a single or a few two-dimensional (2D) projection images using a progressive flow-based deep generative model, especially for ultra-low-dose protocols. The MAP reconstruction can simultaneously optimize the cycle consistency loss and the log-likelihood. We applied X2CT-FLOW for the reconstruction of 3D chest CT images from biplanar projection images without noise contamination (assuming a standard-dose protocol) and with strong noise contamination (assuming an ultra-low-dose protocol). We simulated an ultra-low-dose protocol. With the standard-dose protocol, our images reconstructed from 2D projected images and 3D ground-truth CT images showed good agreement in terms of structural similarity (SSIM, 0.7675 on average), peak signal-to-noise ratio (PSNR, 25.89 dB on average), mean absolute error (MAE, 0.02364 on average), and normalized root mean square error (NRMSE, 0.05731 on average). Moreover, with the ultra-low-dose protocol, our images reconstructed from 2D projected images and the 3D ground-truth CT images also showed good agreement in terms of SSIM (0.7008 on average), PSNR (23.58 dB on average), MAE (0.02991 on average), and NRMSE (0.07349 on average).

Background: Thoracic outlet syndrome is more common in overhead athletes. The anterior and middle scalene muscles have been associated with thoracic outlet syndrome; however, the relationship between the elastic moduli of the scalene muscles and the overhead-throwing position has not been evaluated., Purpose: To investigate the elastic moduli of the anterior and middle scalene muscles in simulated throwing positions using shear wave elastography., Study Design: Descriptive laboratory study., Methods: We enrolled collegiate baseball players who underwent preseason medical checkups in January and February 2020. The anterior and middle scalene muscles were visualized in the short-axis view using ultrasound. In this view, the elastic moduli of the anterior and middle scalene muscles were measured using shear wave elastography in the following arm and neck positions: (1) adduction and neutral rotation of the shoulder (neutral), (2) 90° of abduction and external rotation of the shoulder (ABER), and (3) ABER with neck rotation toward the nonthrowing side (ABER+NR). Repeated-measures analysis of variance and a paired t test were used to compare the elastic modulus values among the 3 positions and between the 2 muscles, respectively., Results: Overall, 30 baseball players were included. In both scalene muscles, the elastic moduli were significantly greater in the ABER versus neutral position (anterior scalene: 14.4 ± 3.8 vs 9.4 ± 2.0 kPa, respectively [ P < .001]; middle scalene: 15.8 ± 5.0 vs 10.9 ± 3.4 kPa, respectively [ P < .001]). In the neutral position, the elastic modulus was significantly greater in the middle scalene than the anterior scalene (10.9 ± 3.4 vs 9.4 ± 2.0 kPa, respectively; P = .03). In the ABER+NR position, the elastic modulus was significantly greater in the anterior scalene than the middle scalene (18.1 ± 4.6 vs 15.8 ± 2.6 kPa, respectively; P = .03)., Conclusion: Because the ABER position was a simulation of the throwing position, these results indicate that this position could be associated with high elastic moduli of the scalene muscles, and both the anterior and middle scalene muscles may be involved., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Ultrasonography can be used to quantitatively assess anterior humeral head translation (AHHT) at different degrees of shoulder abduction. Risk factors for recurrent shoulder instability have been identified., Hypothesis: It was hypothesized that the number of dislocations or glenoid or humeral bone loss would be associated with more AHHT as measured using ultrasound., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 39 patients who underwent surgery for anterior shoulder instability were prospectively studied. Ultrasound assessment of AHHT was performed immediately after general anesthesia was induced. The upper arm was placed at 0°, 45°, and 90° of abduction, and a 40-N anterior force was applied to the proximal third of the arm. The distance from the posterior edge of the glenoid to that of the humeral head was measured at each abduction angle using ultrasound with and without a 40-N anterior force, and the AHHT was calculated. The differences in translation at each shoulder angle were compared. Additionally, the authors investigated the association between AHHT and demographic, radiographic, and clinical data., Results: Compared with the AHHT at 0° of abduction (5.29 mm), translation was significantly larger at 45° of abduction (8.90 mm; P < .01) and 90° of abduction (9.46 mm; P < .01). The mean translation was significantly larger in female patients than in male patients at all degrees of abduction ( P ≤ .036 for all). There was no correlation between AHHT at any abduction angle and number of dislocations, clinical data, or radiographic data (including bone loss)., Conclusion: Ultrasound assessment of AHHT showed larger amounts of laxity at 45° and 90° than at 0° of abduction. Anterior glenohumeral laxity was greater in female than male patients. Glenoid or humeral bone loss did not correlate with AHHT, thereby clarifying that bone loss has no direct effect on measurements of capsular laxity in neutral rotation., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Although the incidence of the various gynecological cancers has been increasing in recent years, long-term survival is now possible for many patients thanks to advances in multimodality treatment. When treating gynecological cancer in adolescent and young adult (AYA) patients who desire future pregnancy, it is necessary to preserve the reproductive organs and their function to prevent loss of fertility. However, because treatment targets these organs, in the large majority of cases, patients must have these organs removed. In the subfield of oncofertility, treatment of the underlying disease takes priority, and the main principle is preventing delay in treatment. Close cooperation between obstetricians and gynecologists involved in reproductive medicine and oncologists involved in cancer treatment is necessary. In addition, it is important that clinicians work closely not only with other specialists but also with such medical professionals as nurses and counselors so that cancer patients of the AYA generation can be provided the support they need to fight their cancer with hope. Herein, we describe the current status of fertility-sparing therapy for AYA patients with gynecological cancer (cervical cancer, endometrial cancer, or ovarian cancer). In addition, we explain points to keep in mind during a patient's pregnancy after fertility preservation, the latest findings on assisted reproductive technology, and the challenges and prospects of fertility preservation therapy for patients with gynecologic cancer., (© 2021. Japan Society of Clinical Oncology.)

Purpose: The side-to-side differences within an individual's suprascapular notch (SSN) and the clinical characteristics of an ossified superior transverse scapular ligament are unclear. Therefore, the morphological asymmetry of the SSN was investigated, and the factors associated with the ossification of the superior transverse scapular ligament were analyzed., Methods: Two hundred and seventy-six computed tomography images were retrospectively analyzed, which included those of both scapulae of Asian patients (mean age, 62.1 ± 19.1 years; males, 197) with high-energy injuries or respiratory diseases. Variations in the SSN were classified into six types based on Rengachary's classification using reconstructed three-dimensional computed tomography. The group with a type VI SSN (completely ossified superior transverse scapular ligament) in at least one scapula was compared with the other group for age, sex, and chronic comorbidities., Results: Among 276 patients, 95 (34.4%) had asymmetric SSNs and 15 (5.4%) had type VI SSNs. There were no significant differences in age, sex, or comorbidities between both the groups. However, on comparing age groups, the prevalence of type VI SSN was higher in patients aged > 70 years than in those aged < 70 years. Fifteen patients had type VI SSNs, which were unilateral in 10 patients., Conclusion: Asymmetric SSNs were observed in a third of the Asian patients. There were variations in SSNs between individuals and also within an individual. In the cases with suprascapular nerve paralysis, the difference in SSN morphology compared to a healthy side should be considered., Level of Evidence: III., (© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Purpose: The three-dimensional (3D) voxel labeling of lesions requires significant radiologists' effort in the development of computer-aided detection software. To reduce the time required for the 3D voxel labeling, we aimed to develop a generalized semiautomatic segmentation method based on deep learning via a data augmentation-based domain generalization framework. In this study, we investigated whether a generalized semiautomatic segmentation model trained using two types of lesion can segment previously unseen types of lesion., Methods: We targeted lung nodules in chest CT images, liver lesions in hepatobiliary-phase images of Gd-EOB-DTPA-enhanced MR imaging, and brain metastases in contrast-enhanced MR images. For each lesion, the 32 × 32 × 32 isotropic volume of interest (VOI) around the center of gravity of the lesion was extracted. The VOI was input into a 3D U-Net model to define the label of the lesion. For each type of target lesion, we compared five types of data augmentation and two types of input data., Results: For all considered target lesions, the highest dice coefficients among the training patterns were obtained when using a combination of the existing data augmentation-based domain generalization framework and random monochrome inversion and when using the resized VOI as the input image. The dice coefficients were 0.639 ± 0.124 for the lung nodules, 0.660 ± 0.137 for the liver lesions, and 0.727 ± 0.115 for the brain metastases., Conclusions: Our generalized semiautomatic segmentation model could label unseen three types of lesion with different contrasts from the surroundings. In addition, the resized VOI as the input image enables the adaptation to the various sizes of lesions even when the size distribution differed between the training set and the test set., (© 2021. CARS.)

Lassa virus (LASV)-a member of the family Arenaviridae -causes Lassa fever in humans and is endemic in West Africa. Currently, no approved drugs are available. We screened 2480 small compounds for their potential antiviral activity using pseudotyped vesicular stomatitis virus harboring the LASV glycoprotein (VSV-LASVGP) and a related prototypic arenavirus, lymphocytic choriomeningitis virus (LCMV). Follow-up studies confirmed that CP100356 hydrochloride (CP100356), a specific P-glycoprotein (P-gp) inhibitor, suppressed VSV-LASVGP, LCMV, and LASV infection with half maximal inhibitory concentrations of 0.52, 0.54, and 0.062 μM, respectively, without significant cytotoxicity. Although CP100356 did not block receptor binding at the cell surface, it inhibited low-pH-dependent membrane fusion mediated by arenavirus glycoproteins. P-gp downregulation did not cause a significant reduction in either VSV-LASVGP or LCMV infection, suggesting that P-gp itself is unlikely to be involved in arenavirus entry. Finally, our data also indicate that CP100356 inhibits the infection by other mammarenaviruses. Thus, our findings suggest that CP100356 can be considered as an effective virus entry inhibitor for LASV and other highly pathogenic mammarenaviruses.

Purpose: Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) has high diagnostic accuracy in the detection of liver lesions. There is a demand for computer-aided detection/diagnosis software for Gd-EOB-DTPA-enhanced MRI. We propose a deep learning-based method using one three-dimensional fully convolutional residual network (3D FC-ResNet) for liver segmentation and another 3D FC-ResNet for simultaneous detection and classification of a focal liver lesion in Gd-EOB-DTPA-enhanced MRI., Methods: We prepared a five-phase (unenhanced, arterial, portal venous, equilibrium, and hepatobiliary phases) series as the input image sets and labeled focal liver lesion (hepatocellular carcinoma, metastasis, hemangiomas, cysts, and scars) images as the output image sets. We used 100 cases to train our model, 42 cases to determine the hyperparameters of our model, and 42 cases to evaluate our model. We evaluated our model by free-response receiver operating characteristic curve analysis and using a confusion matrix., Results: Our model simultaneously detected and classified focal liver lesions. In the test cases, the detection accuracy for whole focal liver lesions had a true-positive ratio of 0.6 at an average of 25 false positives per case. The classification accuracy was 0.790., Conclusion: We proposed the simultaneous detection and classification of a focal liver lesion in Gd-EOB-DTPA-enhanced MRI using multichannel 3D FC-ResNet. Our results indicated simultaneous detection and classification are possible using a single network. It is necessary to further improve detection sensitivity to help radiologists., (© 2021. CARS.)

Purpose: High-grade pivot shift in the anterior cruciate ligament (ACL) injured knee is a risk factor for postoperative residual pivot shift. Procedures in addition to ACL reconstruction such as anterolateral ligament (ALL) reconstruction have been performed for patients with a high-risk of residual pivot shift. The aim of this study was to investigate the effect of the addition of ALL reconstruction to primary double-bundle ACL reconstruction in patients with preoperative high-grade pivot shift to improve stability as evaluated by quantitative measurement., Methods: Patients with ACL injuries who showed preoperative grade 3 subjective pivot shift and who underwent primary double-bundle ACL reconstruction combined with ALL reconstructions were retrospectively enrolled. Anterior tibial translation (ATT) in the Lachman test, and acceleration and external rotational angular velocity (ERAV) in the pivot shift were measured as quantitative values. Quantitative values before surgical intervention for ACL-injured knees (ACLD) and uninjured contralateral knees (intact), after temporary fixation of the isolated ACL grafts (ACLR), and subsequently after temporary fixation of both ACL and ALL grafts (ACLR + ALLR) were measured with the patient under general anaesthesia., Results: In total, 18 patients were included. The ATT was lower in ACLR and ACLR + ALLR than in intact (P = .008 and .005), while there was no significant difference between ACLR and ACLR + ALLR (P > .05). The acceleration of ACLR + ALLR was lower than that for ACLR (P = .008), while there was no significant difference between intact and ACLR or ACLR + ALLR (P > .05). The ERAV of ACLR was higher than that of intact (P < .001), while that of ACLR + ALLR was lower than that of ACLR (P < 0.001), and there was no significant difference in ERAV between intact and ACLR + ALLR (P > 0.05)., Conclusion: According to quantitative assessment of the pivot shift, the addition of ALL reconstruction to primary double-bundle ACL reconstruction improved residual knee instability and restored knee stability during surgery. Combination of ALL reconstruction with primary double-bundle ACL reconstruction was effective for patients with ACL injuries exhibiting a preoperative grade 3 subjective pivot shift., Level of Evidence: IV., (© 2021. The Author(s).)

Background: Tearing and insufficiency of the ulnar collateral ligament (UCL) of the elbow result in valgus instability, which can lead to pain while throwing and decline in performance in overhead athletes., Purpose: To assess the clinical results of a modified UCL reconstruction technique using 1 bone hole in the ulna and 1 bone tunnel in the humerus in baseball players., Study Design: Case series; Level of evidence, 4., Methods: The inclusion criteria were medial elbow pain preventing effective playing, clinically medial elbow laxity, and magnetic resonance imaging results consistent with UCL injury. Patients who were engaged in other sports and in other positions in baseball except pitchers were excluded from this study. Our modified Tommy John procedure was performed via a muscle-splitting approach and an original single-bone-tunnel technique, using a suture anchor. After a minimum of 24 months, patients were evaluated using the Conway scale and the Timmerman-Andrews score., Results: Of 31 patients, 20 baseball pitchers (20 male: 5 high school, 5 collegiate, 8 nonprofessional, and 2 professional pitchers) were reviewed. The mean patient age at the time of operation was 21.9 years, and the mean postoperative follow-up period was 35.1 months (range, 24-66 months). The mean Timmerman-Andrews subjective score improved significantly from pre- to postoperatively (from 68.3 to 98.3; P < .05); the objective score also improved significantly (from 81.1 to 96.4; P = .01). No complications were detected at the latest follow-up. Overall, 19 patients were able to return to their preinjury level of sports or higher., Conclusion: UCL reconstruction with 1 bone hole in the ulna and 1 bone tunnel in the humerus demonstrated satisfactory results in baseball pitchers. Our modified technique was safe and achieved satisfactory clinical results, with a 95% rate of return to sports., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

The purposes of this study are to propose an unsupervised anomaly detection method based on a deep neural network (DNN) model, which requires only normal images for training, and to evaluate its performance with a large chest radiograph dataset. We used the auto-encoding generative adversarial network (α-GAN) framework, which is a combination of a GAN and a variational autoencoder, as a DNN model. A total of 29,684 frontal chest radiographs from the Radiological Society of North America Pneumonia Detection Challenge dataset were used for this study (16,880 male and 12,804 female patients; average age, 47.0 years). All these images were labeled as "Normal," "No Opacity/Not Normal," or "Opacity" by board-certified radiologists. About 70% (6,853/9,790) of the Normal images were randomly sampled as the training dataset, and the rest were randomly split into the validation and test datasets in a ratio of 1:2 (7,610 and 15,221). Our anomaly detection system could correctly visualize various lesions including a lung mass, cardiomegaly, pleural effusion, bilateral hilar lymphadenopathy, and even dextrocardia. Our system detected the abnormal images with an area under the receiver operating characteristic curve (AUROC) of 0.752. The AUROCs for the abnormal labels Opacity and No Opacity/Not Normal were 0.838 and 0.704, respectively. Our DNN-based unsupervised anomaly detection method could successfully detect various diseases or anomalies in chest radiographs by training with only the normal images., (© 2021. The Author(s).)

Capsular injuries can occur during multiple shoulder dislocations. The purpose of this study is to evaluate the location and magnitude of glenohumeral capsular injury following multiple dislocations. We hypothesized that the magnitude of capsular injury would increase and the location of peak injury would vary depending on the number of dislocations. Seven fresh-frozen cadaveric shoulders were used. A 7 × 11 grid of strain markers was affixed to the anteroinferior capsule. Each joint was then mounted to a six degree-freedom robotic testing system. Marker tracking was performed following 1, 2, 3, 4, 5, and 10 dislocations to determine the nonrecoverable strain as capsular injury. Following each dislocation, the magnitude of the maximum principal strain representing the nonrecoverable strain in the inferior glenohumeral capsule was quantified by comparing the strain marker positions following each dislocation. The peak value of nonrecoverable strain statistically increased with the number of dislocations in five of seven specimens (p = .0007). The capsular location that had the peak value of nonrecoverable strain varied according to the number of dislocations, and from specimen to specimen. The nonrecoverable strain was identified in the posterior capsule and anterior axillary pouch, which increased with the number of dislocations compared to the other regions of the capsule (p = .001-.012) by up to 16%. Clinical significance: While plication of the anterior axillary pouch is important following multiple dislocations, a more extensive anterior capsular shift may be necessary with an increased number of dislocations in addition to a posterior capsular shift when appropriate., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

Background: Abnormalities in hip rotational motion (HRM) are risk factors for throwing injuries. To evaluate hip rotational motion, it is necessary to assess the torsion angle. However, no studies have investigated the femoral torsion angle (FTA) in baseball players., Purpose: To investigate differences in hip FTA of adult baseball players through use of ultrasonography to evaluate the relationship between the FTA and HRM., Study Design: Cross-sectional study; Level of evidence, 3., Methods: A total of 149 elite male baseball players (mean age, 20.0 ± 1.8 years; 64 pitchers, 85 position players) were enrolled in this study. Ultrasonographic assessment of FTA was performed based on the tilting angles of the anterior surface of the femoral neck and condylar axis. The hip internal rotation (HIR) and hip external rotation (HER) were assessed at 0° and 90° of flexion. Data related to FTA and HRM were compared between hips and between pitchers and position players., Results: No significant difference was observed in the FTAs between hips for any player (lead hip, 20.5° ± 9.2°; trail hip, 19.6° ± 9.8°; P = .276). No significant difference was observed in FTAs of both hips between pitchers and position players (lead hip, 20.1° ± 9.4° and 20.9° ± 9.0°, respectively, P = .957; trail hip, 19.5° ± 9.8° and 19.7° ± 9.8°, P = .999). In terms of HER in 90° of hip flexion in both hips, significant differences were observed in HRM variables between pitchers and position players (lead hip, 33.0° ± 8.9° and 37.5° ± 9.8°, respectively, P = .024; trail hip, 35.6° ± 9.6° and 40.4° ± 10.2°, P = .035). Linear regression analysis revealed a significant agreement between the FTA and HIR at both 0° ( R = 0.298, P < .001) and 90° of hip flexion ( R = 0.279, P < .001)., Conclusion: Our findings indicated that FTAs were not different between the hips of elite baseball players. Abnormalities of the HRM are not caused by differences in the FTA but rather involve soft tissue tightness around the hip area or other bony morphologic factors in the hip joint., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Background: The pivot-shift test is an important indicator of functional outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR). Preoperative instability as indicated by the pivot-shift test is associated with residual instability after ACLR. Few studies have used quantitative means to evaluate the pivot shift after ACLR., Purpose: To investigate the relationship between preoperative and residual instability and to identify the risk factors for residual instability by using quantitative measurements of the pivot shift., Study Design: Case-control study; Level of evidence, 3., Methods: A total of 91 patients undergoing primary double-bundle ACLR were retrospectively enrolled. Quantitative measurements of instability for ACL-deficient knees (ACLD) and uninjured contralateral knees (intact) preoperatively, as well as ACLR knees intraoperatively, were performed under general anesthesia using the pivot-shift test, with inertial sensors to measure acceleration and external rotational (ER) angular velocity. The ratios of intact to ACLD (ACLD/I) and intact to ACLR (ACLR/I) were measured. Patients who showed an ACLR/I of >1 were classified into the residual instability group, and those with an ACLR/I of ≤1 were classified into the noninstability group. Regarding demographic, surgical, and quantitative measurement factors, between-group comparisons and multivariate logistic regression were conducted for predictors of residual instability. Receiver operating characteristic curves were used to evaluate the correlations between ACLD/I and ACLR/I and the cutoff value of ACLD/I in predicting residual instability., Results: The predictive factors for intraoperative residual instability included female sex (odds ratio [OR], 0.3 [95% CI, 0.1-0.9]; P = .034) and ACLD/I for acceleration (OR, 1.6 [95% CI, 1.2-2.1]; P < .001), and ACLD/I for ER angular velocity (OR, 1.9 [95% CI, 1.2-3.1]; P = .013). Correlations between ACLD/I and ACLR/I were moderate with respect to both acceleration ( r = 0.435; P < .001) and ER angular velocity ( r = 0.533; P < .001). The cutoff points for ACLD/I were 4.9 for acceleration (sensitivity, 65.1%; specificity, 85.7%; area under the curve [AUC], 0.76) and 2.4 for ER angular velocity (sensitivity, 80.0%; specificity, 50.0%; AUC, 0.74)., Conclusion: Greater preoperative instability was a risk factor for residual instability as measured intraoperatively by a quantitatively evaluation in the pivot shift during ACL reconstruction. Quantitative measurements of instability during the pivot shift mechanism under general anesthesia may enable surgeons to predict postoperative residual instability., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Purpose: The purpose of this study was to investigate the biomechanical function of the anterolateral structures (ALS) of the knee regarding rotational stability, and to attempt to verify the effectiveness of anterolateral ligament (ALL) reconstruction concomitant with double-bundle anterior cruciate ligament (ACL) reconstruction by quantifying the pivot shift test (PST) using an inertial sensor., Methods: Six knees of the fresh-frozen cadavers were evaluated during the following phases: (1) [Intact]; (2) ACL-deficient [ACL-D]; (3) ACL-reconstructed [ACL-R]; (4) ACL-reconstructed + ALS-deficient [ACL-R + ALS-D]; and (5) combined ACL and ALL reconstructed [ACL-R + ALL-R]. We evaluated knee rotational instability during each phase using the PST. We used an inertial sensor to calculate tibial external rotational angular velocity (ERAV) and tibial acceleration. Data were analyzed using repeated-measures analysis of variance; statistical significance was accepted as P < 0.05., Results: Relative to [Intact], [ACL-D] caused a significant increase in ERAV and acceleration. However, there was no difference in these parameters between [ACL-R] and [Intact]. [ACL-R + ALS-D] increased ERAV significantly compared with [ACL-R], and there was a significant difference between ERAV during [ACL-R + ALS-D] and [Intact]. However, ERAV was significantly reduced during [ACL-R + ALL-R] compared with [ACL-R + ALS-D], and there was no significant difference in ERAV or acceleration between [ACL-R + ALL-R] and [Intact]., Conclusions: ALS controlled rotational instability in cooperation with the ACL in a cadaveric model. In cases of combined injury of ACL and ALS, concomitant ACL and ALL reconstruction may restore knee stability comparable with the intact state., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Many active individuals undergo multiple dislocations during the course of a season before surgical treatment without considering the implications of each successive injury. Therefore, the purpose of this study was to develop a multiple dislocation model for the glenohumeral joint and evaluate the resulting changes in joint function., Methods: Eight cadaveric shoulders were evaluated using a robotic testing system. A simulated clinical exam was performed by applying a 50 N anterior load to the humerus at 60° of glenohumeral abduction and external rotation. Each joint was then dislocated. The same loads were applied again and the resulting kinematics were recorded following each of 10 dislocations. The force required to achieve dislocation was recorded and capsulolabral status was assessed., Findings: A reproducible Bankart lesion was repeatedly created following the dislocation protocol. The force required for all dislocations significantly decreased following the 1st dislocation. In addition, even lower forces were required to achieve the 5th and subsequent dislocations (p < 0.05). Anterior translation in response to an anterior load during the simulated clinical exam increased between the intact and injured joints (p < 0.05). However, anterior translation reached a plateau following the 3rd to 10th dislocations and was increased compared with the 1st dislocation (p < 0.05)., Interpretation: A repeatable Bankart lesion was not surgically made, but created by our new dislocation model. Joint function appeared to reach a constant level after the 3rd to 5th dislocations. Thus, multiple dislocations result in a deleterious dose dependent effect suggesting additional damage is not sustained after the fifth dislocation., Level of Evidence: Controlled laboratory study., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Purpose: This study aims to investigate the superior clavicle cortex drilling points and fluoroscopic inclination angles for anatomic tunnel drilling in coracoclavicular ligament reconstruction., Methods: Twelve cadaveric shoulders with a mean age of 55.9 ± 6.2 years were investigated. Two 2.0 mm Kirschner wires were inserted penetrating the footprint centers of conoid and trapezoid both on the clavicle and coracoid. The location of the Kirschner wires on the superior clavicle cortex was measured. Fluoroscopy was used to obtain three views of shoulder: an anteroposterior, lateral, and cortical ring sign view. Reproducible angles were then recorded., Results: The Kirschner wire penetrating the conoid was located 40.0 ± 3.9 mm from the distal end and 18.1 ± 3.0 mm from the anterior edge of the clavicle. For the trapezoid, the Kirschner wire was located 19.1 ± 3.6 mm from the distal end and 9.9 ± 3.9 mm from the anterior edge. On the anteroposterior view, the conoid was 11.1° ± 10.1° medially and trapezoid was 26.8° ± 11.8° laterally tilted to the glenohumeral joint line. On the lateral view, the conoid was 42.8° ± 15.1° and trapezoid was 15.5° ± 12.0° superiorly tilted to the scapular spine. On the cortical ring sign view, the conoid was 50.8° ± 12.9° and trapezoid was 14.2 °± 11.0° superiorly tilted to the scapular spine., Conclusions: The superior clavicle cortex drilling points and fluoroscopic inclination angles for anatomic tunnel drilling in coracoclavicular ligament reconstruction were demonstrated. Arthroscopy-assisted anatomic coracoclavicular ligament reconstruction has increased in popularity, and these findings may facilitate a more anatomic approach to coracoclavicular ligament reconstruction.

Purpose: A novel image feature set named histogram of triangular paths in graph (HoTPiG) is presented. The purpose of this study is to evaluate the feasibility of the proposed HoTPiG feature set through two clinical computer-aided detection tasks: nodule detection in lung CT images and aneurysm detection in head MR angiography images., Methods: The HoTPiG feature set is calculated from an undirected graph structure derived from a binarized volume. The features are derived from a 3-D histogram in which each bin represents a triplet of shortest path distances between the target node and all possible node pairs near the target node. First, the vessel structure is extracted from CT/MR volumes. Then, a graph structure is extracted using an 18-neighbor rule. Using this graph, a HoTPiG feature vector is calculated at every foreground voxel. After explicit feature mapping with an exponential-χ 2 kernel, each voxel is judged by a linear support vector machine classifier. The proposed method was evaluated using 300 CT and 300 MR datasets., Results: The proposed method successfully detected lung nodules and cerebral aneurysms. The sensitivity was about 80% when the number of false positives was three per case for both applications., Conclusions: The HoTPiG image feature set was presented, and its high general versatility was shown through two medical lesion detection applications.

Purpose: Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) tends to show higher diagnostic accuracy than other modalities. There is a demand for computer-assisted detection (CAD) software for Gd-EOB-DTPA-enhanced MRI. Segmentation with high accuracy is important for CAD software. We propose a liver segmentation method for Gd-EOB-DTPA-enhanced MRI that is based on a four-dimensional (4D) fully convolutional residual network (FC-ResNet). The aims of this study are to determine the best combination of an input image and output image in our proposed method and to compare our proposed method with the previous rule-based segmentation method., Methods: We prepared a five-phase image set and a hepatobiliary phase image set as the input image sets to determine the best input image set. We also prepared a labeled liver image and labeled liver and labeled body trunk images as the output image sets to determine the best output image set. In addition, we optimized the hyperparameters of our proposed model. We used 30 cases to train our model, 10 cases to determine the hyperparameters of our model, and 20 cases to evaluate our model., Results: Our network with the five-phase image set and the output image set of labeled liver and labeled body trunk images showed the highest accuracy. Our proposed method showed higher accuracy than the previous rule-based segmentation method. The Dice coefficient of the liver region was 0.944 ± 0.018., Conclusion: Our proposed 4D FC-ResNet showed satisfactory performance for liver segmentation as preprocessing in CAD software.

Background: Repetitive pitching in childhood was thought to restrict the physiological derotation process of the humeral head. Some studies reported that the side-to-side differences of humeral retroversion in baseball players occurred between the age of 9 and 11 years. The present study investigated the relationship between bilateral humeral retroversion angle and starting baseball age in skeletally mature baseball players., Methods: One hundred and seventeen male baseball players, who belonged to a college or amateur team, were investigated. Bilateral humeral retroversion was assessed using an ultrasound-assisted technique as described by previous studies. All players were divided into four groups: players who had started playing baseball before the age of 6 years, between 7 and 8 years, between 9 and 10 years and after 11 years. Bilateral humeral retroversion angle was compared among the four starting age groups., Results: All players started playing baseball between 5 and 12 years. Comparing the throwing arm, humeral retroversion in starting age group 11-12 (72°) was significantly smaller than the other 3 groups (81°, 82°, and 80° for groups 5-6, 7-8, and 9-10, respectively). Comparing the non-throwing arm revealed no significant differences among the 4 starting age groups (71°, 72°, 70°, and 66° for groups 5-6, 7-8, 9-10, and 11-12, respectively)., Conclusions: Skeletally mature baseball players who started playing baseball after 11 years had significantly smaller humeral retroversion in the throwing arm than those who started baseball before 11 years., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The differences between young right-handed and left-handed baseball players are not well known. This study compared the range of the shoulder motion and humeral torsion angle (HTA) between right-handed and left-handed young baseball pitchers., Methods: A total of 65 young baseball pitchers (age, 9-12 years; 46 right-handed throwers, R group; and 19 left-handed throwers, L group) were analyzed. The glenohumeral internal rotation (IR) angle and external rotation (ER) angle were measured at 90° shoulder abduction, and HTA was assessed using indirect ultrasonographic techniques. The side-to-side difference in HTA (d-HTA), glenohumeral ER difference (GERD), and glenohumeral IR deficit (GIRD) were calculated. The adjusted GIRD and adjusted GERD were defined as the angles obtained by subtracting d-HTA from GIRD and GERD, respectively, to exclude the influence of humeral retrotorsion difference., Results: HTA and ER of the throwing limb were significantly greater than those of the nonthrowing limb in the R group (HTA: 84° vs. 77°; P < .001, ER: 116° vs. 111°; P < .001), but no significant differences were observed in the L group (HTA: 79° vs. 77°, P = .103; ER: 113° vs. 114°, P = .380). Compared with the R group, the L group showed a significantly smaller d-HTA (2° vs. 8°, P < .001) and GERD (5° vs. -2°, P = .004), but no significant difference was observed in adjusted GERD between the groups (-3° vs. -4°, P = .690)., Conclusion: Compared with the right-handed pitchers, the side-to-side differences of glenohumeral external rotation angle and humeral torsion angle were significantly smaller in the left-handed pitchers at a young age., (Copyright © 2019. Published by Elsevier Inc.)

Purpose: For the development of computer-assisted detection (CAD) software using voxel-based classification, gold standards defined by pixel-by-pixel painting, called painted gold standards, are desirable. However, for radiologists who define gold standards, a simplified method of definition is desirable. One of the simplest methods of defining gold standards is a spherical region, called a spherical gold standard. In this study, we investigated whether spherical gold standards can be used as an alternative to painted gold standards for computerized detection using voxel-based classification., Materials and Methods: The spherical gold standards were determined by the center of gravity and the maximum diameter. We compared two types of gold standard, painted gold standards and spherical gold standards, by two types of CAD software using voxel-based classification., Results: The time required to paint the area of one lesion was 4.7-6.5 times longer than the time required to define a spherical gold standard. For the same performance of the CAD software, the number of training cases required for the spherical gold standard was 1.6-7.6 times that for the painted gold standards., Conclusion: Spherical gold standards can be used as an alternative to painted gold standards for the computerized detection of lesions with simple shapes.

Purpose: Previous studies reported sonography was inferior to MRI to predict hamstring tendon graft diameter for ACL reconstruction. This study aimed to investigate the correlation between intraoperative hamstring tendon graft diameter and its preoperative measurement using different sonographic scanning protocol from previous studies., Methods: Two cadaveric knees were utilized for validation. Sonographically guided gracilis tendon (G) and semitendinosus tendon (ST) injections were performed at myotendinous junction of sartorius using colored latex and then dissection was performed. In the clinical studies, 28 patients underwent primary ACL reconstruction were enrolled. Cross-sectional area (CSA) of G and ST were measured at myotendinous junction of Sartorius. The diameter of doubled G (2G), doubled ST (2ST) and quadrupled ST + G (4STG) were intraoperatively measured using graft sizing devices with 0.5-mm increments., Results: Cadaveric dissection showed the presence of latex on the surface of G and ST at myotendinous junction of Sartorius in all specimens. In the clinical studies, CSA of G, ST, and ST + G significantly correlated with diameter of 2G (r = 0.464, p = 0.039), 2ST (r = 0.712, p < 0.001), and 4STG (r = 0.792, p < 0.001), respectively. As a result of the simple linear regression analysis, 4STG diameter could be predicted by the following formula: 4.345 + 0.210 × CSA. The differences between calculated diameter by this formula and intraoperative 4STG diameter were within ± 0.5 mm in 89.3% (25/28) of subjects., Conclusions: The diameter of 2ST and 4STG can be reliably predicted based on sonographic CSA measurement preoperatively. Sonography is a cost-effective alternate to repeat MRI to predict hamstring graft diameter preoperatively., Level of Evidence: Diagnostic study; Level II.

Objective: Although arthroscopic Bankart repair is widely performed, little is known concerning the healing process of the Bankart lesion. This study aimed to describe the sonographic sequential change of the anteroinferior labrum following arthroscopic Bankart repair, both quantitatively and qualitatively., Materials and Methods: Twenty-five subjects who had undergone arthroscopic Bankart repair were investigated using a sonographic diagnostic device equipped with shear-wave elastographic technology. In addition to measuring the elasticity of the anteroinferior labrum, the B-mode echogram of the anteroinferior labrum was classified into three grades based on the relative echogenicity. Assessment was performed in the affected shoulder 1, 2, 3, 4, 5, 6, and 12 months postoperatively and in the contralateral shoulder 1 month postoperatively for the control., Results: The mean elasticity of the anteroinferior labrum in the affected shoulder 1 and 2 months postoperatively was significantly lower than in the contralateral shoulder (p < 0.001 for both). However, no significant difference was found after 3 months postoperatively. B-mode echograms of the anteroinferior labrum in the contralateral shoulder were classified as grade 0 in all subjects (100%), whereas the percentage of grade 0s in the affected shoulder was 0, 4, 96, and 100% at 1, 2, 3, and 4 months postoperatively., Conclusion: Both quantitative and qualitative assessment of repaired anteroinferior labrum using ultrasound became comparable with the contralateral shoulder 3-4 months postoperatively. Ultrasound is a useful decision-supporting tool to prescribe postoperative rehabilitation protocol following arthroscopic Bankart repair, although functional recovery should also be evaluated on an individual basis.

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease. It is characterized by the accumulation of triglyceride within hepatocytes. Taurine is a sulfur-containing-β-amino acid that is widely distributed in mammalian tissues. The objective of this study was to examine the effects of taurine on the development of hepatic steatosis in a model of NAFLD in vivo and in vitro. Male C57BL/6J mice were fed a high-fat diet (HFD) supplemented with 2% (w/v) or 5% (w/v) taurine for 12 weeks. An in vitro study was performed in HepG2 cells loaded with fatty acids. Twelve weeks of supplementation with an HFD increased the hepatic lipid levels and oxidative stress as well as the body weight and liver weight. Taurine significantly suppressed these changes, which was accompanied by a decrease in the hepatic level of thiobarbituric acid-reactive substances (TBARS). In addition, taurine treatment suppressed the HFD-induced reduction of the enzyme activity of hepatic superoxide dismutase and catalase and the reduction of the hepatic level of reduced glutathione and ATP. In HepG2 cells, taurine suppressed the fatty acid-induced lipid accumulation, production of reactive oxygen species and TBARS level, and amelioration of the fatty acid-induced disruption of the mitochondrial membrane potential. These results showed that taurine was effective in alleviating hepatic steatosis by reducing oxidative stress. Taurine may, therefore, be of therapeutic value in reducing the risks associated with NAFLD.

Influenza B virus has been known to infect humans and other animals, including seals. Vaccination efficacy varies across seasons. Human monoclonal antibodies (mAbs) can be useful for developing novel vaccines, guided by epitope analysis, and can be used therapeutically. Hybridoma technology has been used to make mAbs. Here we evaluated SPYMEG as a fusion partner cell line for human mAb generation specific to influenza B hemagglutinin (HA). SPYMEG is a human/murine myeloma partner cell line that has previously been used to generate human mAbs that recognize the HA of influenza A and B viruses. Peripheral blood mononuclear cells were obtained from 16 volunteers, previously vaccinated with the 2014-2015 trivalent seasonal influenza vaccine, and were fused with SPYMEG to yield hybridomas. The resulting hybridomas were screened for antigen-specific antibody secretion and cloned by limiting dilution. We obtained 32 stable clones secreting anti-influenza B HA human IgG, although most of these clones were obtained from one volunteer (SeaV-29) who had a robust immune response. We conclude that SPYMEG is a good fusion partner cell line, although cloning by limiting dilution may lead to significant loss of hybridomas.

Since the 2017 Southern Hemisphere influenza season, the A(H1N1)pdm09-like virus recommended for use in the vaccine was changed because human, but not ferret, sera distinguish A(H1N1)pdm09 viruses isolated after 2013 from the previously circulating strains. An amino acid substitution, lysine to glutamine, at position 166 (H3 numbering) in the major antigenic site of HA was reported to be responsible for the antigenic drift. Here, we obtained two anti-A(H1N1)pdm09 HA monoclonal antibodies that failed to neutralize viruses isolated after 2013 from a vaccinated volunteer. Escape mutations were identified at position 129, 165, or 166 in the major antigenic site of HA. Competitive growth of the escape mutant viruses with the wild-type virus revealed that some escape mutants possessing an amino acid substitution other than K166Q showed superior growth to that of the wild-type virus. These results suggest that in addition to the K166Q mutation that occurred in epidemic strains, other HA mutations can confer resistance to antibodies that recognize the K166 area, leading to emergence of epidemic strains with such mutations.

Background: It is known that the humeral retroversion of baseball players is greater in the throwing arm than in the nonthrowing arm. An investigation measuring dry bone specimens also showed that the right humerus had greater retroversion than the left. Considering these facts, it was hypothesized that humeral retroversion would differ between right- and left-handed players. This study aimed to compare the bilateral humeral retroversion between right- and left-handed skeletally mature baseball players., Methods: We investigated 260 (196 right-handed and 64 left-handed) male baseball players who belonged to a college or amateur team. Bilateral humeral retroversion was assessed using an ultrasound-assisted technique (humeral torsion angle [HTA]) as described by previous studies. Analysis of covariance, adjusted for handedness and baseball position, assessed the effect of throwing arm dominance on HTA., Results: In comparison of the throwing arm, HTA was significantly smaller in left-handed (left humerus) than in right-handed (right humerus) players (77° vs. 81°; P < .001). In comparison of the nonthrowing arm, HTA was significantly greater in left-handed (right humerus) than in right-handed (left humerus) players (73° vs. 69°; P < .001). The mean side-to-side difference of HTA was significantly smaller in left-handed than in right-handed players (3° vs. 12°; P < .001)., Conclusions: Humeral retroversion of left-handed skeletally mature baseball players was significantly smaller in the throwing arm, greater in the nonthrowing arm, and smaller in side-to-side differences than that of right-handed players. These findings may be key to understanding some of the biomechanical differences between right- and left-handed baseball players., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: The anterior oblique bundle (AOL) of the ulnar collateral ligament (UCL) is composed of anterior and posterior bands. This study evaluated the anatomy of the anterior and posterior bands in the AOL of the UCL for their separate visualization with ultrasound (US)., Methods: We dissected 18 cadaveric elbow joints and recorded the direction of each band from the lateral view to determine the proper position for the US transducer. To determine the proper inclination of the transducer, we measured the inclinations of each band at the proximal and distal insertions from the transverse view. A paired t test was used for comparisons between both bands. Values of P < .05 were considered statistically significant., Results: The mean angles of the directions in the anterior and posterior bands were 10° ± 4° and 24° ± 9°, respectively. At the medial epicondyle, the mean inclination angles of both bands were 61° ± 5° and 67° ± 5°, respectively. At the sublime tubercle, the mean inclination angles of both bands were 14° ± 7° and 44° ± 9°, respectively. The inclination angles at the proximal ulna and the directions in both bands were significantly different (P < .001)., Conclusions: This study shows that the directions of both bands and inclination angles of the bony attachments in both bands can assist with correct placement of the US transducer and allow for separate visualization of each band., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Recently several authors have reported on the quantitative evaluation of the pivot-shift test using cutaneous fixation of inertial sensors. Before utilizing this sensor for clinical studies, it is necessary to evaluate the accuracy of cutaneous sensor in assessing rotational knee instability. To evaluate the accuracy of inertial sensors, we compared cutaneous and transosseous sensors in the quantitative assessment of rotational knee instability in a cadaveric setting, in order to demonstrate their clinical applicability., Methods: Eight freshly frozen human cadaveric knees were used in this study. Inertial sensors were fixed on the tibial tuberosity and directly fixed to the distal tibia bone. A single examiner performed the pivot shift test from flexion to extension on the intact knees and ACL deficient knees. The peak overall magnitude of acceleration and the maximum rotational angular velocity in the tibial superoinferior axis was repeatedly measured with the inertial sensor during the pivot shift test. Correlations between cutaneous and transosseous inertial sensors were evaluated, as well as statistical analysis for differences between ACL intact and ACL deficient knees., Results: Acceleration and angular velocity measured with the cutaneous sensor demonstrated a strong positive correlation with the transosseous sensor (r = 0.86 and r = 0.83). Comparison between cutaneous and transosseous sensor indicated significant difference for the peak overall magnitude of acceleration (cutaneous: 10.3 ± 5.2 m/s 2 , transosseous: 14.3 ± 7.6 m/s 2 , P < 0.01) and for the maximum internal rotation angular velocity (cutaneous: 189.5 ± 99.6 deg/s, transosseous: 225.1 ± 103.3 deg/s, P < 0.05), but no significant difference for the maximum external rotation angular velocity (cutaneous: 176.1 ± 87.3 deg/s, transosseous: 195.9 ± 106.2 deg/s, N.S)., Conclusions: There is a positive correlation between cutaneous and transosseous inertial sensors. Therefore, this study indicated that the cutaneous inertial sensors could be used clinically for quantifying rotational knee instability, irrespective of the location of utilization., (Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Purpose: The anatomical anomaly of the number of vertebral bones is one of the major anomalies in the human body, which can cause confusion of the spinal level in, for example, surgery. The aim of this study is to develop an automatic detection system for this type of anomaly., Methods: We utilized our previously reported anatomical landmark detection system for this anomaly detection problem. This system uses a landmark point distribution model (L-PDM) to find multiple landmark positions. The L-PDM is a statistical probabilistic model of all landmark positions in the human body, including five landmarks for each vertebra. Given a new volume, the proposed algorithm applies five hypotheses (normal, 11 or 13 thoracic vertebrae, 4 or 6 lumbar vertebrae) to the given spine and attempts to detect all the landmarks. Then, the most plausible hypothesis with the largest posterior likelihood is selected as the anatomy detection result., Results: The proposed method was evaluated using 300 neck-to-pelvis CT datasets. For normal subjects, the vertebrae of 211/217 (97.2%) of the subjects were successfully determined as normal. For subjects with 23 or 25 vertebrae without a transitional vertebra (TV), the vertebrae of 9/10 (90%) of the subjects were successfully determined. For subjects with TV, the vertebrae of 71/73 (97.3%) of subjects were judged as partially successfully determined., Conclusion: Our algorithm successfully determined the number of vertebrae, and the feasibility of our proposed system was validated.

Japanese and South Koreans have a dietary habit of eating seaweed. Although it is known that some seaweed contains taurine, there have been few detailed analyses on the taurine content of seaweed other than the major types of edible seaweed. In the present study, we determined the content of free amino acids, including taurine, in seaweed obtained along the Sea of Japan coast. The taurine content in the seaweed varied according to the species. Among the 29 different types of seaweed that were studied, red algae contained relatively high concentrations of taurine. In contrast, the taurine content was low or undetectable in brown and green algae. The algal alanine level was relatively higher in brown sea algae, which was in sharp contrast to its taurine level. No clear trends were observed with regards to the distribution of the other free amino acids, including aspartic acid, glutamic acid, and phenylalanine. Considering the physiological role of taurine in cellular homeostasis, the algal taurine content may be associated with the growing environment. Taurine-rich red edible algae such as mafunori (Gloiopeltis tenax)/fukurofunori (Gloiopeltis furcata), kabanori (Gracilaria textorii), and ogonori (Gracilaria vermiculophylla) may be used to create functional foods that are rich in naturally occurring taurine.

Practical simulations of low-dose CT images have a possibility of being helpful means for optimization of the CT exposure dose. Because current methods reported by several researchers are limited to specific vendor platforms and generally rely on raw sinogram data that are difficult to access, we have developed a new computerized scheme for producing simulated low-dose CT images from real high-dose images without use of raw sinogram data or of a particular phantom. Our computerized scheme for low-dose CT simulation was based on the addition of a simulated noise image to a real high-dose CT image reconstructed by the filtered back-projection algorithm. First, a sinogram was generated from the forward projection of a high-dose CT image. Then, an additional noise sinogram resulting from use of a reduced exposure dose was estimated from a predetermined noise model. Finally, a noise CT image was reconstructed with a predetermined filter and was added to the real high-dose CT image to create a simulated low-dose CT image. The noise power spectrum and modulation transfer function of the simulated low-dose images were very close to those of the real low-dose images. In order to confirm the feasibility of our method, we applied this method to clinical cases which were examined with the high dose initially and then followed with a low-dose CT. In conclusion, our proposed method could simulate the low-dose CT images from their real high-dose images with sufficient accuracy and could be used for determining the optimal dose setting for various clinical CT examinations.

Background: Posterior and posteroinferior capsules in the shoulder joints of throwing athletes have been reported to be thicker in throwing than nonthrowing shoulders, and this has a relationship to glenohumeral internal rotation deficit (GIRD). However, the stiffness of these thickened capsules has not been reported. Shear-wave ultrasound elastography is a new technology that can measure tissue elasticity quantitatively., Hypothesis: The posterior and posteroinferior capsules are stiffer as well as thicker in the throwing shoulders of baseball players than in their nonthrowing shoulders. The thickness and elasticity of these capsules are inversely correlated with glenohumeral internal rotation., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Forty-five male college baseball players were examined. The thickness and elasticity of the posterior capsule beneath the infraspinatus and the posteroinferior capsule beneath the teres minor were measured using an ultrasonic device equipped with shear-wave elastographic technology. Glenohumeral internal rotation at 90° of shoulder abduction and humeral retrotorsion were also measured., Results: The mean thickness and elasticity of the posterior capsule were significantly greater for the throwing compared with the nonthrowing shoulder (thickness: 1.34 vs 1.04 mm, respectively; elasticity: 40.0 vs 32.2 kPa, respectively; P < .001 for both). The mean thickness and elasticity of the posteroinferior capsule were also significantly greater in the throwing compared with the nonthrowing shoulder (thickness: 1.40 vs 1.04 mm, respectively; elasticity: 39.4 vs 31.6 kPa, respectively; P < .001 for both). After correcting the range of motion for bilateral differences in retrotorsion, correlation coefficients showed that posterior capsule thickness and elasticity (Pearson r = -0.43 and -0.56, respectively; P < .001 for both) and posteroinferior capsule thickness and elasticity (Pearson r = -0.51 and -0.52, respectively; P < .001 for both) were negatively correlated with the corrected glenohumeral internal rotation. Bilateral differences in posterior and posteroinferior capsule elasticity correlated with bilateral differences in the corrected glenohumeral internal rotation (Pearson r = 0.46 [P = .0015] and 0.48 [P < .001], respectively), whereas bilateral differences in posterior and posteroinferior capsule thickness did not (Pearson r = -0.13 [P = .38] and 0.17 [P = .28], respectively)., Conclusion: The posterior and posteroinferior capsules were stiffer as well as thicker in the throwing shoulder of college baseball players compared with the nonthrowing shoulder. Posterior capsule elasticity appeared to have a greater effect on GIRD than did posterior capsule thickness. This technology could be used as a noninvasive screening method for throwing athletes to identify players at potential risk of shoulder injuries., (© 2015 The Author(s).)

Purpose: This study investigated the direct and continuous attachment of the labrum to the glenoid fossa, including the fibrocartilaginous tissue, using image-analysis software and histology., Methods: Twenty-six cadaveric shoulders (11 male, 15 female; mean age 80.1 years; age range 36-103 years) were used. The glenoid of each specimen was divided into six pie-slice-shaped pieces from the center perpendicular to the articular surface by radial incisions at the 2, 4, 6, 8, 10, and 12 o'clock positions. The general distribution of the labrum, including the fibrocartilage, was assessed in hematoxylin and eosin-, Safranin O- and Azan-Mallory-stained sections. The continuous length of attachment of the labrum to the glenoid was measured using image-analysis software. The width of attachment to the articular surface of the glenoid was assessed in each position., Results: The labrum attached to both the articular surface and the neck of the glenoid in all shoulders (100 %) in the 4 and 6 o'clock positions. The mean length of the entire attachment to the glenoid was 4.6 mm (range 3.2-6.1 mm). The width of attachment from the bony edge of the glenoid to the edge of the labrum on the articular surface ranged from 0 to 4.3 mm. The length of the entire attachment of the labrum was shortest in the 2 o'clock position (p = 0.229). Additionally, the length of the entire attachment of the labrum was longest in the 4 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01)., Conclusion: In the 4 and 6 o'clock positions, the labrum attached to both the articular surface and neck of the glenoid in all of the shoulders (100 %). The length of the entire attachment to the labrum, including the fibrocartilage, was shortest in the 2 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01).

Background: Here we investigated the angle and placement of bone holes for suture anchors using postoperative computed-tomography scapula scans., Methods: The study group comprised 20 shoulders from 20 consecutive patients (13 males and seven females; mean age 23.4 years) who underwent arthroscopic Bankart repair. All anchors were inserted through the anterior portal after establishing a bone hole at the edge of the glenoid articular surface using a drill. Computed tomography images of the scapula were taken 1 month postoperatively and used to create three-dimensional scapula models with Mimics and Magics software. Bone holes in the anterior-inferior (3:00-6:00) position were assigned either to the non-perforated group if they were positioned entirely inside the glenoid bone or to the perforated group if the far cortex of the glenoid was penetrated by the drill. The angle between the glenoid articular surface and the bone hole was measured in the oblique coronal and transverse plane views. The length of the bone hole was also assessed., Results: Of the 85 bone holes investigated, 42 were in the 3:00-6:00 position. Perforation was detected in 16 of these 42 holes (38.2%). The angle in the oblique coronal plane view and the length of the bone hole were significantly larger in the non-perforated group than in the perforated group; however, the angle in the transverse plane view did not significantly differ between the two groups., Conclusions: Before inserting an implant in the anterior-inferior area, the angle between the drill guide and the glenoid surface in the oblique coronal plane view should be carefully checked to ensure that the length of the hole inside the glenoid bone is adequate.

We propose a method for measuring the modulation transfer function (MTF) of a computed tomography (CT) system by use of a circular edge method with a logistic curve-fitting technique. An American College of Radiology (ACR) phantom was scanned by a Philips Brilliance system, and axial images were reconstructed by the filtered back projection algorithm with a standard reconstruction filter. The radial MTF was measured from a disk image of a rod or cylinder in the ACR phantom by use of the circular edge method. In this study, we applied a logistic curve-fitting technique to an edge-spread function (ESF) to eliminate noise because the edge method is very susceptible to noise in the ESF in a CT image. The circular edge method with the logistic curve-fitting technique provided the MTF without fluctuations due to noise for the entire spatial frequency range. The MTF was not affected by the tube current, the slice thickness, or the disk contrast, which were factors related to the amount of noise in the CT image. However, the MTF was affected by the location of the disk and by the disk size, depending on the average distance from the isocenter to the disk edge. Our results indicated that the MTF measured by the circular edge method with the logistic curve-fitting technique was not susceptible to noise in CT images. Therefore, this method is useful for MTF measurement for not only high-contrast objects, but also low-contrast objects with a large amount of noise.

Background: Ultrasound is suitable for routine examinations of capitellar osteochondritis dissecans because it can visualize both the subchondral bone and the overlying articular cartilage non-invasively. The radial head interferes with the sonographically visible area of the articular surface of the humeral capitellum, although the precise extent of this is currently unknown. This study aimed to investigate the visible area of the humeral capitellum using both anterior and posterior ultrasonographic scans., Methods: Twelve elbows were used from cadavers with a mean age of 85.6 years. After marking a 45° angle in the anterior capitellum in a caudal direction using a drill, anterior and posterior, long-axis ultrasonographic scans were performed with the cadaveric elbows bent. The elbow-flexion angle at which the 45° point was obscured by the radial head was measured and these ultrasonic measurements were then verified by macroscopic observation., Results: The elbow-flexion angle at which the 45° point was obscured by the radial head was 24° in anterior scans and 102° in posterior scans. These ultrasonic measurements corresponded to the macroscopic measurements. The results showed that anterior, long-axis ultrasound scans could visualize the capitellum from 45° through the rest of the anterior area at 24° flexion of the elbow: the radial head obscured the area of the capitellum that is 21° anterior to the elbow flexion angle. Similarly, posterior long-axis scans could visualize the capitellum from 45° through the rest of the posterior area at 102° flexion of the elbow: the radial head obscured the area of the capitellum that is 57° posterior to the elbow flexion angle. The radial head obscured a 78° (21° + 57°) arc of the capitellum in ultrasonography., Conclusions: This study thus clarified the area of the humeral capitellum visible in both anterior and posterior ultrasound scans in the sagittal plane.

The fact that accurate detection of metastatic brain tumors is important for making decisions on the treatment course of patients prompted us to develop a computer-aided diagnostic scheme for detecting metastatic brain tumors. In this paper, we first describe how we extracted the cerebral parenchyma region using a standard deviation filter. Second, initial candidates for tumors were decided by sphericity and cross-correlation value with a simulated ring template. Third, we made true positive and false positive templates obtained from actual clinical images and applied the template matching technique to them. Finally, we detected metastatic tumors using these two characteristics. Our improved method was applied to 13 cases with 97 brain metastases. Sensitivity of detection of metastatic brain tumors was 80.4%, with 5.6 false positives per patient. Our proposed method has potential for detection of metastatic brain tumors in brain magnetic resonance (MR) images.

Previously we first noted that taurine (TR) has anti-osteopenic effect on low Ca diet-induced osteopenia in rats (1). Employing osteoblastic MC3T3-E1 cells, the mechanism of the anti-osteopenic effect was explored in vitro. TR (1 mM) was found to promote mineralization of extracellular matrices, without affecting alkaline phosphataase activity. Gel shift assay using 32P-labeled OSE2 (osteoblast-specific cis-element 2: the consensus sequence for Cbfa1, refer to 2) indicated that TR (1 mM) increased the nuclear localization of Cbfa1, just as TPH (1-34) (3,4) and bisphosphonates did (5). In addition, TR was found to stimulate ERK phosphorylation. PD98059, a MEK inhibitor, suppressed effects of TR on both Cbfa1 transactivation and ERK activation. The results strongly suggest that TR first activates intracellular MEK-ERK-Cbfa1 signaling system thereby promoting mineralization and finally leading to its bone anabolic action.

To investigate the effects on renal hemodynamics of specific antagonists of arginine vasopressin (AVP), CGP 29325 (d(CH2)5-D-Tyr(Et)VAVP), which has both anti-vasopressor and anti-antidiuretic activities against AVP, and CGP 25838E (d(CH2)5-Tyr(Me)AVP), which has only anti-vasopressor activity, were administered to normally hydrated anesthetized dogs, and the effects on renal function were examined. The pressor response and constriction of renal and mesenteric arteries induced by AVP were dose-dependently blocked by intravenous CGP 25838E. Following intrarenal arterial administration (i.r.a.) of CGP 29325 at 3 micrograms/min, water diuresis occurred and urine osmolality (UOsm) decreased to less than 250 mOsm/kg. Renal blood flow (RBF), glomerular filtration rate (GFR), and urinary sodium excretion (UNaV) remained unchanged. A higher dose (10 micrograms/min, i.r.a.) of CGP 29325 further decreased UOsm to about 110 mOsm/kg. Although arterial blood pressure (BP), GFR and UNaV remained unchanged, RBF decreased from the control value 3.7 +/- 0.35 to 2.4 +/- 0.40 ml/g.min. CGP 25838E (10 micrograms/min, i.r.a.) had no effect on renal hemodynamics and urine formation. When administered into the mesenteric artery, CGP 25838E (10 micrograms/min) increased mesenteric blood flow (MBF) from 199 +/- 34 to 240 +/- 40 ml/min without any alteration in blood pressure. We tentatively conclude that CGP 29325, at a lower dose, exerted anti-antidiuretic effects through a specific inhibition of V2 receptors, while the higher dose of CGP 29325 altered RBF, through yet to be determined mechanisms. The vasoconstrictive activity of AVP may contribute to the regulation of mesenteric circulation, but not to renal hemodynamics, in anesthetized dogs.