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In a severely injured leg with acute limb ischemia, both immediate revascularization of an endangered part and coverage of soft tissue defect are crucial to limb salvage. In this article, we report a case of an anterolateral thigh free flap with interposition graft of descending branches of the lateral circumflex femoral vessels. A 18-cm-long graft was harvested and used to replace the injured anterior tibial vessels. One month later, a duplex sonogram revealed intact circulation to both the interposition graft and the flap. Despite anatomic inconstancy, the anterolateral thigh free flap is commonly utilized in reconstructive surgeries. When descending branches of the lateral femoral circumflex vessels were included sufficiently, its pedicle can be used to bridge a vascular defect in the extremity while covering soft tissue defect.

Background and purpose To analyze 18F-THK5351 positron emission tomography (PET) scans of patients with clinically diagnosed nonfluent/agrammatic variant primary progressive aphasia (navPPA). Methods Thirty-one participants, including those with Alzheimer's disease (AD, n=13), navPPA (n=3), and those with normal control (NC, n=15) who completed 3 Tesla magnetic resonance imaging, 18F-THK5351 PET scans, and detailed neuropsychological tests, were included. Voxel-based and region of interest (ROI)-based analyses were performed to evaluate retention of 18F-THK5351 in navPPA patients. Results In ROI-based analysis, patients with navPPA had higher levels of THK retention in the Broca's area, bilateral inferior frontal lobes, bilateral precentral gyri, and bilateral basal ganglia. Patients with navPPA showed higher levels of THK retention in bilateral frontal lobes (mainly left side) compared than NC in voxel-wise analysis. Conclusions In our study, THK retention in navPPA patients was mainly distributed at the frontal region which was well correlated with functional-radiological distribution of navPPA. Our results suggest that tau PET imaging could be a supportive tool for diagnosis of navPPA in combination with a clinical history.

The present study investigated the factors influencing the early clinical outcomes after ankle fracture surgery. We included 88 patients, who had undergone implant removal surgery at 1 year after ankle fracture surgery, with ankle computed tomographic (CT) scans obtained before ankle fracture surgery and at implant removal available. We collected demographic information, including age, sex, the presence of diabetes mellitus, level of trauma energy, and fracture classification from the medical records. We also recorded the fracture height using the radiographs and CT images. The medial joint space and articular incongruity were assessed on the follow-up radiographs and CT scans. Bone attenuation was measured by placing a circular region of interest around the ankle joint on the preoperative CT image. The postimplant removal outcomes were assessed using 2 functional questionnaires, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Foot and Ankle Outcome Score (FAOS). Significant factors related to the AOFAS ankle-hindfoot scale scores and FAOS were identified through univariate analysis using age, sex, radiographic measurements, and CT findings as explanatory variables, followed by multiple regression analysis. On multiple regression analysis, the total FAOS was independently related to the AO classification (p = .003) and Lauge-Hansen classification (p = .003). The total AOFAS ankle-hindfoot scale score was related to articular incongruity (p = .044). The early clinical outcomes after ankle fracture surgery were affected by involvement of the ankle joint fracture rather than the lateral malleolus fracture height. Female sex and the presence of postoperative articular incongruity correlated with inferior early clinical outcomes.

Background This study was performed to investigate leg length discrepancy (LLD), overgrowth, and associated risk factors after pediatric tibial shaft fractures. Materials and methods This study included 103 patients younger than 14 years of age (mean age 7.1 years; 75 boys, 28 girls) with unilateral tibial shaft fracture and a minimum follow-up of 24 months. LLD was calculated as the difference between the lengths of the injured and uninjured limbs. Overgrowth was calculated by adding the fracture site shortening from the LLD. Risk factors were assessed in patients with LLD Results Casting and titanium elastic nailing (TEN) were performed on 64 and 39 patients, respectively. The mean LLD and overgrowth were 5.6 and 6.4 mm, respectively. There were significant differences in sex (p = 0.018), age (p = 0.041), fibular involvement (p = 0.005), injury mechanism (p = 0.006), and treatment methods (p p = 0.029), fibular involvement (p = 0.002), injury mechanism (p = 0.008), and treatment methods (p Conclusions Patients undergoing TEN showed greater LLD and overgrowth than those undergoing casting, with boys showing greater LLD and overgrowth than girls. Surgeons should consider the possibility of LLD and overgrowth after pediatric tibial shaft fractures, especially when performing TEN for boys. Level of evidence Level III

Objectives Motion preserving surgeries could be unsuccessful because of underestimation of deformities of the foot and knee in ankle osteoarthritis. This study aimed to investigate the concomitant deformities in medial ankle osteoarthritis and the difference between the two types, varus angulation and medial translation. Methods A retrospective study was conducted using medical records and radiographic data. Patients with medial ankle osteoarthritis that underwent weight-bearing X ray imaging and radiographic measurements including tibial plafond inclination (TPI), tibiotalar tilt angle (TT), lateral talo-first metatarsal angle, naviculo-cuboid overlap, and mechanical tibiofemoral angle (mTFA) were studied. The patients were categorized into two groups, the varus angulation group (TT ≥4°) and medial translation group (TT Results A total of 102 patients (male = 44; female = 58) were included; the mean age was 64.9 years (SD 8.3 years). The varus rotation group (N = 66) showed a significantly smaller lateral talo-first metatarsal angle (p Conclusions Varus angulation of the ankle was correlated with knee alignment and foot deformity. Radiographic indices were different between the varus angulation and medial translation groups. The role of concomitant deformities needs to be further investigated in terms of a causal relationship. Surgeons need to pay attention to concomitant deformities in the treatment of medial ankle osteoarthritis.

Optical coherence tomography (OCT) uses the interference between the light waves reflected by the reference and sample arms to obtain spatial information on tissue microstructure, which is used to construct an in-vivo cross-sectional image. OCT has become an essential part of daily practice in the field of ophthalmology and glaucoma over the past 30 years. This success was possible by tremendous advances of its technology toward better sensitivity and faster scan speed from Time-domain to Spectral-domain and Swept-source OCT. This chapter was written to describe the basic principles of OCT and how they enable its various applications, which are crucial to understand how such advances of OCT have been possible in the past, and why OCT still has boundless potential for future growth.

Patients with unilateral open-angle glaucoma (OAG) have suffered glaucomatous optic neuropathy in one eye only despite shared systemic factors between two eyes. It suggests a locoregional susceptibility factor associated with glaucoma development. In this study, we measured the distance of the central retinal vascular trunk from the Bruch’s membrane opening (BMO) center relative to that of the BMO margin: the shift index, since it can be used as a surrogate of lamina cribrosa (LC) shift caused by different growth between retinal and scleral layers during eyeball expansion. The shift index was compared between OAG and fellow control eyes within individuals (129 OAG patients). Although OAG eyes also had higher baseline IOP, a larger β-zone parapapillary atrophy area, a larger shift index was the only risk factor of OAG diagnosis in a generalized linear mixed-effects model. Further, a generalized estimating equation regression model revealed that the shift index was larger in the OAG eyes than in the control eyes for all ranges of axial length, while it was the smallest for the axial length of 23.7 mm. Thus, a larger shift index and LC shift may act as a locoregional susceptibility factor for unilateral OAG eyes.

This study performed to investigate the incidence of growth arrest such as leg length discrepancy (LLD) and ankle joint angular deformity and its risk factors after physeal fracture of the distal tibia in children and adolescents.. Consecutive 78 patients (mean age 11.4 ± 2.0 years; mean follow-up period 2.0 ± 1.2 years) treated for the distal tibia physeal fracture were included. All patients underwent preoperative ankle radiographs, three-dimensional computed tomography (CT) scans, and postoperative follow-up teleradiogram. Patients were divided into two groups according to the LLD and the difference of lateral distal tibial angle (LDTA) with the contralateral limb as follows: Group 1 (growth arrest), patients with LLD ≥ 1cm or difference of LDTA ≥ 5°; Group 2 (normal growth), patients with LLD1cm and difference of LDTA5°.. The overall incidence of growth arrest was 12.8% (10 of 78). The mean displacement measured using CT scan was 4.4 ± 3.2 mm (range, 0.8-14.9). Of the total 78 fractures, 65 were treated surgically and 13 fractures were treated conservatively. The initial fracture displacement was significantly different between the two groups (p0.001). However, there were no statistically significant differences between the two groups with respect to other factors. Initial displacement was the only significant risk factor for growth arrest (p0.003). The cutoff values of initial displacement between the two groups were 5.2mm.. This study showed that degree of initial displacement was the only significant risk factor for growth arrest after physeal fracture of the distal tibia in children and adolescents. Therefore, physicians should consider the possibility of growth arrest for patients with severely displaced physeal fractures of the distal tibia.

Background and purpose Premanifest mutation carriers with spinocerebellar ataxia (SCA) can exhibit subtle abnormalities before developing ataxia. We summarized the preataxic manifestations of SCA1, -2, -3, and -6, and their associations with ataxia onset. Methods We included studies of the premanifest carriers of SCA published between January 1998 and December 2019 identified in Scopus and PubMed by searching for terms including 'spinocerebellar ataxia' and several synonyms of 'preataxic manifestation'. We systematically reviewed the results obtained in studies categorized based on clinical, imaging, and laboratory markers. Results We finally performed a qualitative analysis of 48 papers. Common preataxic manifestations appearing in multiple SCA subtypes were muscle cramps, abnormal muscle reflexes, instability in gait and posture, lower Composite Cerebellar Functional Severity scores, abnormalities in video-oculography and transcranial magnetic stimulation, and gray-matter loss and volume reduction in the brainstem and cerebellar structures. Also, decreased sensory amplitudes in nerve conduction studies were observed in SCA2. Eotaxin and neurofilament light-chain levels were revealed as sensitive blood biomarkers in SCA3. Concerning potential predictive markers, hyporeflexia and abnormalities of somatosensory evoked potentials showed correlations with the time to ataxia onset in SCA2 carriers. However, no longitudinal data were found for the other SCA gene carriers. Conclusions Our results suggest that preataxic manifestations vary among SCA1, -2, -3, and -6, with some subtypes sharing specific features. Combining various markers into a standardized index for premanifest carriers may be useful for early screening and assessing the risk of disease progression in SCA carriers.

Situs inversus of optic disc (SIOD) is thought to be a congenital optic disc abnormality that is caused by dysversion of optic nerve insertion. SIOD, however, has many additional features that cannot be explained by abnormal optic-nerve-insertion directionality. In this study, we measured the distance between the fovea and disc in 22 eyes of 15 SIOD patients. For comparison, two control eyes were matched with each SIOD eye by age and axial length. The vertical distance between the temporal vascular arcades also was measured. The foveo-disc distance was shorter in the SIOD eyes than in the control eyes, while the inter-arcade distance did not differ. Further, we measured the circumpapillary retinal nerve fiber layer thickness, which showed nasal crowding of two humps in the SIOD eyes. This nasal crowding disappeared when we shifted the circle scan by the mean difference (465 μm) of the foveal-disc distance between the two groups. Our findings suggest that the optic disc was located closer to the fovea than it would have been normally. Thus, SIOD might reflect incomplete expansion of the posterior pole in the direction of the fovea-disc axis.

Purpose To compare retinal nerve fiber layer (RNFL) defects' angle measurements determined from the center of the optic disc and Bruch's membrane opening (BMO), as a function of myopia and open-angle glaucoma (OAG) subtypes. Methods In total, 118 patients with OAG were grouped by axial length (AL; high myopia, AL >26 mm; mild to moderate myopia, 24 ≤ AL ≤26 mm; nonmyopia, AL

Background This study aimed to investigate the change in ankle varus incongruencies following total knee replacement (TKR) in patients with preoperative genu varum deformity of ≥10°. Methods The study cohort was composed of patients who underwent TKR in a single institution for knee osteoarthritis with preoperative genu varum deformity of ≥10° and concomitant varus ankle incongruencies. Eight radiographic measurements were evaluated preoperatively and postoperatively: mechanical tibiofemoral angle, mechanical lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle, tibial plafond inclination, talar inclination, tibiotalar tilt angle (TTTA), and tibia-mechanical axis angle. Of these, TTTA represented the quantitative degree of ankle joint incongruency. Results A total of 110 patients (male = 2; female = 108) were included in the analysis. The mean patient age was 68.9 (standard deviation [SD] 7.2) years at the time of TKR. All radiographic measurements showed significant changes postoperatively, representing the appropriate correction of genu varum deformity and restoration of the mechanical axis. Nineteen patients (17.3%) showed postoperative decrease in TTTA, 2 (1.8%) remained the same, and 89 (80.9%) showed increase. Overall, mean preoperative and postoperative TTTA were 3.3° (SD 2.2°) and 4.7° (SD 2.9°), respectively (P Conclusion Varus ankle incongruencies showed aggravation following TKR despite correction of genu varum deformity and restoration of the mechanical axis. This could be an important cause of postoperative increase or development of ankle pain following TKR. Therefore, patients with preoperative varus ankle incongruencies need to be warned of possible aggravation of ankle symptoms and be evaluated before TKR. Level of Evidence Prognostic level III.

BACKGROUND Orthopedic physicians typically apply a cast to immobilize a body part that has been injured. There have been no significant structural changes or advances in synthetic casts since the development of the modern cast. The Opencast® is a recently developed type of cast that allows ventilation and direct visual inspection of the skin to avoid cast-related complications. Although this novel cast appears to have more benefits than the conventional synthetic cast, its clinical efficacy and advantages have not been established. AIM To investigate the clinical efficacy and advantages of the newly developed Opencast® based on patients’ perspectives in those with ankle inversion injury. METHODS A specifically designed questionnaire consisting of 19 items was used to compare patients’ opinions and concerns of the Opencast® and the conventional synthetic cast. The items were focused on subjective patient satisfaction, discomfort, and adverse effects while wearing the cast. Patients with an ankle inversion injury diagnosed as a high-grade ankle sprain were enrolled. The subjects were randomized and instructed to fill the questionnaire after wearing a synthetic cast or an Opencast® for 2 wk. They were then required to fill the questionnaire again, after switching to the alternative type of cast for 2 more weeks. RESULTS A total of 22 subjects participated in the study. The synthetic cast appeared to be more rigid and stable than the Opencast®, but there was no significant difference in the amount of pain relief. The likelihood of adverse effects when wearing the synthetic cast was significantly higher. Patient satisfaction tended to be rated higher after wearing the Opencast®. Opencast® showed more subjective vulnerability than the synthetic cast, but there was no significant difference in the redo rate. Patients were more anxious about removal of the synthetic cast than of the Opencast®. CONCLUSION The results indicate that the Opencast® could replace the conventional synthetic cast as it offers increased patient satisfaction, which would in turn increase compliance to treatment.

Stimuli-responsive hydrogels have attracted significant attention for their promising characteristics and have been used in diverse platforms developed for practical applications. When processed as films, these hydrogels show enhanced properties, including faster responses and higher loading capacities, and enhanced interfacial interactions. In this study, we prepared a functional polyacrylamide hydrogel film containing a rhodamine-based probe. The probe plays two fundamental roles: in the fabrication of the film via redox-initiated radical polymerization and in providing a fluorescence response to Al

Background In planovalgus deformity with triceps contracture, a midfoot break happens, and ankle dorsiflexion (ADF) occurs at the mid-tarsal joint during gait. Results of standard 3D gait analysis may misinterpret the true ankle dorsiflexion because it recognizes the entire foot as a single rigid segment. We performed this study to investigate whether the severity of planovalgus deformity is associated with the discrepancy between the value of ADF evaluated by physical examination and 3-dimensional (3D) gait analysis. In addition, we aimed to identify the radiographic parameters associated with this discrepancy and their relationships. Methods Consecutive 40 patients with 65 limbs (mean age, 11.7 ± 5.5 years) with planovalgus foot deformity and triceps surae contracture were included. All patients underwent 3D gait analysis, and weightbearing anteroposterior (AP) and lateral (LAT) foot radiographs. ADF with knee extension was measured using a goniometer with the patient’s foot in an inverted position. Results Twenty-one limbs underwent operation for planovalgus foot deformity, and 56 limbs underwent operation for equinus deformity. The difference between ADF on physical examination and ADF at initial contact on gait analysis was 17.5 ± 8.4°. Differences between ADF on physical examination and ADF at initial contact on gait analysis were significantly associated with the LAT talus-first metatarsal angle (p = 0.008) and calcaneal pitch angle (p = 0.006), but not associated with the AP talus-first metatarsal angle (p = 0.113), talonavicular coverage angle (p = 0.190), talocalcaneal angle (p = 0.946), and naviculocuboid overlap (p = 0.136). Conclusion The discrepancy between ADF on physical examination and 3D gait analysis was associated with the severity of planovalgus deformity, which was evaluated on weightbearing LAT foot radiographs. Therefore, physicians should be cautious about interpreting results from 3D gait analysis and perform a careful physical examination to assess the degree of equinus deformity in patients with planovalgus foot deformity.

Background Pathologic gait is common in patients with cerebral palsy (CP). Single-event multilevel surgery (SEMLS) is a combination of surgical procedures to improve pathologic gait in patients with CP. However, the effect of each procedure is difficult to predict. The gait deviation index (GDI) is useful in comparing pre- and postoperative improvement. Research question In this study, we evaluated the degree of GDI improvement in patients with CP and analyzed factors related to surgical outcomes. Methods We screened patients seen between May 2003 and December 2019 via a clinical data warehouse to identify those with CP who had been followed up for >1 year and who had undergone SEMLS. The inclusion criteria were (1) CP patients with GMFCS levels I, II and III, (2) patients who underwent SEMLS, (3) and patients who underwent 3D gait analyses preoperatively and at least 1 year postoperatively. A linear mixed model was used to model GDI improvement, assess effects of covariates, and examine factors that contributed to improvement. Results Overall, 544 patients were included. The average improvement in overall GDI was 8.9 ± 12.3, 9.6 ± 12.0, and 6.4 ± 8.6 in Gross Motor Function Classification System (GMFCS) levels I, II, and III, respectively. In GMFCS level II patients, GDI improvement decreased by 0.26 points with a 1-year delay in surgery (p = 0.0022). Within each group of GMFCS levels, femoral derotation osteotomy (FDO) was a significant factor in GDI improvement in GMFCS levels I and II. Rectus femoris transfer (RFT) and supracondylar extension osteotomy (SCO) were significant factors in GMFCS level II. No single procedure was shown to affect improvement in GMFCS level III. Significance Postoperative GDI improved in all levels of GMFCS. Particular procedures especially affected postoperative improvement in GDI in levels I and II. Our data do not mean to set an indication for particular procedures; however, in GMFCS levels I, II patients, particular procedures, such as FDO, yielded a greater GDI improvement in our data set.

This study evaluated the shielding effect of a newly developed dose-reduction fiber (DRF) made from barium sulfate, in terms of radiation doses delivered to patients’ radiosensitive organs and operator during C-arm fluoroscopy and its impact on the quality of images. A C-arm fluoroscopy unit was placed beside a whole-body phantom. Radiophotoluminescent glass dosimeters were attached to the back and front of the whole-body phantom at 20 cm intervals. Radiation doses were measured without DRF and with it applied to the back (position 1), front (position 2) or both sides (position 3) of the phantom. To investigate the impact of DRF on the quality of fluoroscopic images, step-wedge and modulation transfer function phantoms were used. The absorbed radiation doses to the back of the phantom significantly decreased by 25.3–88.8% after applying DRF to positions 1 and 3. The absorbed radiation doses to the front of the phantom significantly decreased by 55.3–93.6% after applying DRF to positions 2 and 3. The contrast resolution values for each adjacent step area fell in the range 0.0119–0.0209, 0.0128–0.0271, 0.0135–0.0339 and 0.0152–0.0339 without and with DRF applied to positions 1, 2 and 3, respectively. The investigated DRF effectively reduces absorbed radiation doses to patients and operators without decreasing the quality of C-arm fluoroscopic images. Therefore, routine clinical use of the DRF is recommended during the use of C-arm fluoroscopy.

This paper describes the multifunctional effect of molybdenum disulfide (MoS

We present a novel retargeting algorithm that transfers the musculature of a reference anatomical model to new bodies with different sizes, body proportions, muscle capability, and joint range of motion while preserving the functionality of the original musculature as closely as possible. The geometric configuration and physiological parameters of musculotendon units are estimated and optimized to adapt to new bodies. The range of motion around joints is estimated from a motion capture dataset and edited further for individual models. The retargeted model is simulation-ready, so we can physically simulate muscle-actuated motor skills with the model. Our system is capable of generating a wide variety of anatomical bodies that can be simulated to walk, run, jump and dance while maintaining balance under gravity. We will also demonstrate the construction of individualized musculoskeletal models from bi-planar X-ray images and medical examinations., Comment: 15 pages, 20 figures

To build an appropriate strategy of pain management after ankle fracture surgery, surgeons need to know the characteristics of postoperative ankle pain and its contributing factors. The aim of the present study was to investigate the maximum pain period after ankle fracture surgery and the factors affecting postoperative pain using a linear mixed model when patient-controlled analgesia (PCA) was used as a basic modality. A total of 219 adult patients (108 males and 111 females; mean age 51.2 ± 15.9 years) who had undergone operative treatment for ankle fractures were included. Data on fracture severity, causes of injury, interval between injury and surgery, anesthesia method, American Society of Anesthesiologists classification, and operative time were collected. Pain intensity was measured using an 11-point pain intensity numerical rating scale preoperatively and postoperatively every 8 hours. Intravenous PCA was prescribed to all patients. The chronologic pattern of postoperative pain and factors affecting it were statistically analyzed using a linear mixed model. Maximum postoperative pain was observed at 8 hours postoperatively, and the maximum pain numerical rating scale score was 3.92, measured at 8-hour intervals. The severity of fracture ( p = .01) was the only significant factor contributing to postoperative pain after ankle fracture surgery on multivariate analysis. Clinicians should consider the chronologic pattern of postoperative pain after ankle fracture surgery during postoperative pain management. Interventions for pain control, in addition to PCA, might be needed at ~8 hours postoperatively, especially for those with severe ankle fractures.

Purpose To investigate the positional change of central retinal vasculature and vascular trunk to deduce the change in the lamina cribrosa (LC) during axial elongation. Design Prospective cohort study. Participants Twenty-three healthy myopic children (46 eyes). Methods Participants had undergone a full ophthalmologic examination and axial length measurement every 6 months for 2 years. Using spectral-domain OCT, circle scans centered around the optic disc in the glaucoma progression analysis mode, which enabled capturing of the same positions throughout the entire study period, and enhanced depth imaging of the deep optic nerve head complex were performed. Infrared imaging of the circle scans was used to measure the changes in the angles between the first and final visits. The angle between the major superior and inferior retinal arteries was measured along the circle scan twice: from the center of the circle scan and from the central retinal vascular trunk, respectively. The positional change of the retinal vascular trunk also was measured. Main Outcome Measures Change in vascular angle and position of vascular trunk with axial elongation and associated factors. Results The vascular angle measured from the center of the circle scan did not change ( P = 0.247), whereas the angle measured from the central retinal arterial trunk decreased with axial elongation ( P P = 0.004) and vascular trunk dragging ( P P P = 0.053), but the extent of dragging could not be explained fully by their combination. The major directionality of dragging was mostly to the nasal side of the optic disc, with large variations among participants. Conclusions During axial elongation, the retinal vasculature at the posterior pole was unchanged, whereas the position of the central vascular trunk was dragged nasally. Because the central retinal vascular trunk is embedded in the LC, its dragging indicates nasal shifting of the LC, which could explain the vulnerability of myopic eyes to glaucomatous optic neuropathy.

Purpose To delineate longitudinal changes in the optic nerve head (ONH) and peripapillary structure during myopia progression in childhood using spectral-domain (SD) OCT and to explore the factors associated with myopic ONH and peripapillary changes. Design Prospective cohort study. Participants Twenty-three healthy children with myopia (46 eyes). Methods The participants underwent fundus photography, SD OCT, and axial length (AXL) measurements every 6 months for 2 years. Based on the morphologic changes of the ONH and β-zone parapapillary atrophy (PPA), eyes were classified as group A (ONH unchanged without β-zone PPA; 11 eyes), group B (ONH changed without β-zone PPA at baseline; 10 eyes), group C (ONH changed with β-zone PPA at baseline; 15 eyes), and group D (ONH unchanged with β-zone PPA; 10 eyes). The configuration of the border tissue (BT) at the temporal margin of the ONH was assessed, and the ONH parameters, including Bruch's membrane opening distance (BMOD), border length (BL), and BT angle (BTA), were measured on horizontal SD OCT scans. Main Outcome Measures Changes in ONH parameters and associated factors. Results Group B showed the greatest AXL increase per year (group B > group C > group A = group D; P P P P = 0.100, respectively). In the multivariate analysis using the generalized linear mixed-effect model, the changes of BL and BTA were associated with axial elongation ( P = 0.028 and P = 0.010, respectively). Conclusions Development of myopic optic disc and γ-zone PPA during myopia progression was delineated using SD OCT images. During the ONH and peripapillary changes, the BL was increased nasally and the BTA was decreased, whereas the BMOD remained relatively stable. The association of axial elongation with ONH and peripapillary tissue changes may facilitate understanding of the relationship between myopia and glaucoma.

ObjectivesThe objective of this study was to quantify the relative movement between the articular surfaces in the tibiotalar and subtalar joints during normal walking in asymptomatic individuals.Methods3D movement data of the ankle joint complex were acquired from 18 subjects using a biplanar fluoroscopic system and 3D-to-2D registration of bone models obtained from CT images. Surface relative velocity vectors (SRVVs) of the articular surfaces of the tibiotalar and subtalar joints were calculated. The relative movement of the articulating surfaces was quantified as the mean relative speed (RS) and synchronization index (SIENT) of the SRVVs.ResultsSIENTand mean RS data showed that the tibiotalar joint exhibited translational movement throughout the stance, with a mean SIENTof 0.54 (sd 0.21). The mean RS of the tibiotalar joint during the 0% to 20% post heel-strike phase was 36.0 mm/s (sd 14.2), which was higher than for the rest of the stance period. The subtalar joint had a mean SIENTvalue of 0.43 (sd 0.21) during the stance phase and exhibited a greater degree of rotational movement than the tibiotalar joint. The mean relative speeds of the subtalar joint in early (0% to 10%) and late (80% to 90%) stance were 23.9 mm/s (sd 11.3) and 25.1 mm/s (sd 9.5), respectively, which were significantly higher than the mean RS during mid-stance (10% to 80%).ConclusionThe tibiotalar and subtalar joints exhibited significant translational and rotational movement in the initial stance, whereas only the subtalar joint exhibited significant rotational movement during the late stance. The relative movement on the articular surfaces provided deeper insight into the interactions between articular surfaces, which are unobtainable using the joint coordinate system. Cite this article: C-B. Phan, D-P. Nguyen, K. M. Lee, S. Koo. Relative movement on the articular surfaces of the tibiotalar and subtalar joints during walking. Bone Joint Res 2018;7:501–507. DOI: 10.1302/2046-3758.78.BJR-2018-0014.R1.

In this research, we compared three tactile conditions (No vs. Soft vs. Spiky) in both positive and negative scenes to explore whether tactile perception could influence emotional responses and immersive experience in a virtual environment (VE). The results showed that, when viewing positive scenes with soft stimuli, participants experienced an increase in both positive emotions and their level of immersion compared to those in the No and Spiky tactile conditions. We also found that participants in the No and Spiky tactile conditions reported no significant differences in either emotion or immersion when viewing positive scenes. During the viewing of negative scenes, spiky stimuli did not intensify negative feelings, while soft stimuli decreased negative emotions. In terms of immersion, there was no meaningful difference between the three tactile conditions for negative scenes. Overall, this study has demonstrated the important association between tactile perception, emotion, and immersion in a VE.

Femoral derotation osteotomy (FDO) is generally reported to be excellent for correcting the hip rotation and foot progression angles in children with cerebral palsy (CP). However, it is unclear how long the favorable outcomes are maintained.This study was performed to evaluate the long-term outcomes at more than 10 years after FDO in children with CP.FDO, as part of single event multilevel surgery to improve gait function, was performed at the intertrochanteric level with the patient in the prone position. The goal of the index surgery was femoral anteversion of 15°, measured using a modified trochanteric prominence angle test intraoperatively. All patients underwent three-dimensional gait analysis preoperatively and at 1 year and over 10 years postoperatively.Thirty-four ambulatory patients (53 hips) with CP undergoing FDO were included. The mean age at surgery was 7.8 years (SD = 3.0 years) and mean follow-up duration was 12.9 years (SD = 2.7 years). The mean hip rotation decreased significantly from 9.6° preoperatively to 3.1° at 1 year postoperatively (p = 0.004), and decreased significantly to -5.9° at the final follow-up (p 0.001). The mean foot progression in stance decreased from 7.9° preoperatively to -7.4° at 1 year postoperatively (p 0.001), and was maintained at -10.9° at the final follow-up. The GDI significantly improved from 68.2 preoperatively to 83.4 1 year postoperatively (p 0.001), and was maintained at 82.3 at the final follow-up. No patients underwent revision surgery due to recurrence of rotation deformity.Proximal FDO performed in the prone position provides favorable long-term outcomes at more than 10 years postoperatively, without recurrence of rotation deformity. To avoid under-correction or recurrence due to insufficient derotation, surgeons should consider not only dynamic gait analysis findings but also the measurement of anatomic femoral anteversion during intraoperative derotation.

Background Myopic tilted disc, observed as an oval disc, has been alleged to be a funduscopic en-face manifestation of excessive optic nerve head (ONH) sloping or tilting. Here, we report the case of a myopic child showing a developing oval disc in fundus photos during axial elongation, but without progressive tilting in spectral-domain optical coherence tomography (SD-OCT) images. Case presentation By merging B-scan SD-OCT images of the ONH and macula, the curvature of the posterior pole, including both the fovea and ONH, was reconstructed and compared before and after 2 years of axial elongation. Despite the marked increase of disc ovality, the posterior polar curvature was rarely changed. The preponderance of optic disc change was induced by the shift of the temporal disc margin in the nasal direction. This shifting alone imitated an increase of tilt angle but one that was still far smaller than the required degree of tilt for ONH-tilt-based disc ovality. To clarify, we calculated the required extent of axial elongation to obtain a substantial degree of ONH tilt when considering the adjacency of the fovea and the ONH. Without a focal increase of posterior polar curvature, which is to say posterior staphyloma, such change is not possible until the axial length increases extraordinarily. Conclusion The most prominent change in the development of myopic tilted disc, which change gives it an oval appearance and imitates a tilt when measured, is actually not a tilt but rather a shift of the temporal disc margin.

Category: Ankle Introduction/Purpose: Insufficient bony coverage surrounding the talus could cause considerable mechanical ankle instability, whereas excessive bony coverage could cause bone contusion at the time of injury and subsequent osteochondral lesions of the talus (OLT). This study aimed to investigate the relationship between radiographic lateral ankle instability and OLT in patients that sustained ankle inversion injuries. Methods: One-hundred-ninety-five patients (113 men and 83 women; mean age, 38.7 years; standard deviation, 8.8 years) with a history of ankle inversion injuries were included. All patients underwent ankle magnetic resonance imaging (MRI) and stress X-ray (varus stress and anterior drawer) examination. The tibiotalar tilt angle on varus stress X-ray, anterior translation of the talus on anterior-drawer lateral X-rays, bimalleolar tilt angle, and fibular position were radiographically determined. The anatomical grade of the lateral ankle ligament injury and the presence of OLTs were determined from MRI findings. Results: A greater lateral ankle ligament grade tends to increase the tibiotalar tilt angle (p=0.074), significantly affecting the anterior translation of the talus (p=0.036). The presence of radiographic lateral ankle instability (tibiotalar tilt angle =10°) showed opposite associations with the presence of OLT in the chi-square test (p=0.003). OLT was a negative significant factor (p=0.011) affecting the tibiotalar tilt angle in the multiple regression analysis (Table 1) and was negatively affected by the tibiotalar tilt angle (p=0.016) in the binary logistic regression analysis. Conclusion: This study showed an opposite association between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony predisposition in the development of sports injuries in the ankle should be considered and investigated further.

Category: Trauma Introduction/Purpose: Long-term usage of bisphosphonate can severely suppress bone turnover and alter bone mechanical properties, thereby resulting in atypical fractures that mainly occur at the femur.We present a rare case of suspicious atypical fracture of the metatarsal bone. Methods: A 63-year-old woman presented to our clinic with a primary complain of a one-week history of pain in her right foot. The patient had no history of trauma to the right foot and denied any strenuous activity. She experienced lateral foot pain while walking within her home. She was on alendronate therapy for osteoporosis for a decade. X ray and CT examination revealed a fifth metatarsal fracture whose features were compatible with those of atypical femoral fractures (Figure 1). Results: The patient was advised to discontinue alendronate and underwent percutaneous surgical fixation of the fracture via a proximal approach using a 4.0-mm half-threaded cannulated screw. Postoperatively, a short leg cast was created and the patients performed non-weight bearing ambulation until the cast was removed at the sixth postoperative week. Radiography in the sixth postoperative week revealed callus formation. Conclusion: Our findings suggest that physicians must keep in mind that atypical fractures could possibly occur at bones other than the femur.

The net force and moment of a joint have been widely used to understand joint disease in the foot. Meanwhile, it does not reflect the physiological forces on muscles and contact surfaces. The objective of the study is to estimate active moments by muscles, passive moments by connective tissues and joint contact forces in the foot joints during walking. Joint kinematics and external forces of ten healthy subjects (all males, 24.7 ± 1.2 years) were acquired during walking. The data were entered into the five-segment musculoskeletal foot model to calculate muscle forces and joint contact forces of the foot joints using an inverse dynamics-based optimization. Joint reaction forces and active, passive and net moments of each joint were calculated from muscle and ligament forces. The maximum joint reaction forces were 8.72, 4.31, 2.65, and 3.41 body weight (BW) for the ankle, Chopart's, Lisfranc and metatarsophalangeal joints, respectively. Active and passive moments along with net moments were also obtained. The maximum net moments were 8.6, 8.4, 5.4 and 0.8%BW∙HT, respectively. While the trend of net moment was very similar between the four joints, the magnitudes and directions of the active and passive moments varied between joints. The active and passive moments during walking could reveal the roles of muscles and ligaments in each of the foot joints, which was not obvious in the net moment. This method may help narrow down the source of joint problems if applied to clinical studies.

Seasonal changes in precipitation characteristics over India were projected using a high-resolution (40-km) atmospheric general circulation model (AGCM) during the near- (2010–2039), mid- (2040–2069), and far- (2070–2099) futures. For the model evaluation, we simulated an Atmospheric Model Intercomparison Project-type present-day climate using AGCM with observed sea-surface temperature and sea-ice concentration. Based on this simulation, we have simulated the current climate from 1979 to 2009 and subsequently the future climate projection until 2100 using a CMCC-CM model from Coupled Model Intercomparison Project phase 5 models based on RCP4.5 and RCP8.5 scenarios. Using various observed precipitation data, the validation of the simulated precipitation indicates that the AGCM well-captured the high and low rain belts and also onset and withdrawal of monsoon in the present-day climate simulation. Future projections were performed for the above-mentioned time slices (near-, mid-, and far futures). The model projected an increase in summer precipitation from 7 to 18% under RCP4.5 and from 14 to 18% under RCP8.5 from the mid- to far futures. Projected summer precipitation from different time slices depicts an increase over northwest (NWI) and west-south peninsular India (SPI) and a reduction over northeast and north-central India. The model projected an eastward shift of monsoon trough around 2° longitude and expansion and intensification of Mascarene High and Tibetan High seems to be associated with projected precipitation. The model projected extreme precipitation events show an increase (20–50%) in rainy days over NWI and SPI. While a significant increase of about 20–50% is noticed in heavy rain events over SPI during the far future.

Calcaneal lengthening (CL) is one of the treatment options for planovalgus deformity in patients with cerebral palsy (CP). However, its indication still needs to be clarified according to the functional status of CP. The aim of this study was to investigate the radiographic outcome after CL in patients with CP and to evaluate the risk factors causing undercorrection of planovalgus deformities. We included consecutive patients with CP who underwent CL for planovalgus deformity, were followed for more than 2 years, and had preoperative and postoperative weight-bearing anteroposterior (AP) and lateral foot radiographs. Six radiographic indices were used to assess the radiographic outcome. The patient age, sex, and Gross Motor Function Classification System (GMFCS) level were evaluated as possible risk factors, and we controlled for the interaction of potentially confounding variables using multivariate analysis. A total of 44 (77 feet) patients were included in this study. The mean age of the patients at the time of surgery was 10.5±4.0 years and the mean follow-up was 5.1±2.2 years. Patients with GMFCS III/IV achieved less correction than those with GMFCS I/II in the AP talus-first metatarsal angle (P=0.001), lateral talocalcaneal angle (P=0.028), and the lateral talus-first metatarsal angle (P

Proximal femoral osteotomy has been used in cerebral palsy, Perthes disease, hip dysplasia, idiopathic femoral anteversion, and various hip diseases in children and adolescents. Conventionally, a blade plate (BP) has been used. However, the pediatric locking compression plate (LCP) has recently been applied widely. We compared the hardware-related complications of the BP and the LCP as well as the factors influencing these complications in patients who have undergone a proximal femoral osteotomy in children and adolescents. We enrolled consecutive patients aged less than or equal to 20 years who had undergone proximal femoral osteotomy with BP or LCP between May 2003 and December 2014, and who were followed up until 6 months after hardware removal. Following consensus building, hardware-related complications were identified from the patients' medical records and hip radiographs. Patient age, sex, type of plate, and Gross Motor Function Classification System (GMFCS) level in cerebral palsy patients were evaluated as possible risk factors, and a generalized estimating equation was used to assess the risk factors for hardware-related complications. A total of 417 hips from 251 patients were finally included in this study. Seven losses of fixation around the plate (five patients, 3.0%) occurred in the BP, three implant-related fractures (three patients, 3.6%) occurred in the LCP, and there was no significant difference (P=0.74). All hardware-related complications occurred in cerebral palsy patients, and the implant-related fractures occurred in patients with GMFCS IV/V. The risk of complications increased with age (P=0.002). The risk of loss of fixation around the BP is a well-known complication. However, LCP is not without hardware-related complications. The LCP provides strong stability of fixation. However, it is speculated that the LCP is related to implant-related fractures because of the stress shielding effect. Therefore, care should be exercised when using a locking plate in patients with osteoporosis, such as cerebral palsy with GMFCS IV/V. LEVEL OF EVIDENCE Therapeutic Level III.

The aim of this study was to find the optimal table height to facilitate insertion of the spinal needle at a 90° angle and to reduce the anesthesiologist's discomfort. Sixty patients were randomly allocated according to landmarks on the anesthesiologist's body: umbilicus (group U), lowest rib margin (R), xiphoid process (X), and nipple (N). The coronal insertion angle between the patient's skin and the spinal needle was obtuse in groups U and R, and 90° in group X. We demonstrated that high operating tables at the xiphoid and nipple level facilitate more optimal needle entry angles while reducing the discomfort and joint flexion of anesthesiologists during spinal anesthesia.

Superabsorbent hydrogels are significant not only in materials science but also in industries and daily life, being used in diapers or soil conditioners as typical examples. The main feature of these materials is their capacity to hold considerable amount of water, which is strongly dependent on the cross-linking density. This study focuses on the preparation of hydrogels by reweighing the effect of cross-linking density on physical properties, which provides green fabrication of bilayered hydrogels that consist of homogeneous structural motifs but show programmed responses via sequential radical polymerization. In particular, when two hydrogel layers containing different cross-linking densities are joined together, an integrated linear bilayer shows heterogeneous deformation triggered by water. We monitor the linear hydrogel bilayer bending into a circle and engineer it by incorporating disperse dyes, changing colors as well as physical properties. In addition, we demonstrate an electric circuit switch using a patterned hydrogel. Anisotropic shape change of the polyelectrolyte switch closes an open circuit and lights a light-emitting diode in red. This proposed fabrication and engineering can be expanded to other superabsorbent systems and create smart responses in cross-linked systems for biomedical or environmental applications.

Background:This study aimed to investigate the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up.Methods:Seventy adult patients with hallux valgus who were followed for at least 2 years and underwent weightbearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo–first metatarsal angle, and lateral talo–first metatarsal angle. Patients were divided into progressive and nonprogressive groups. Binary logistic regression analysis was performed to identify factors that significantly affected the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed.Results:The DMAA ( P = .027) and AP talo–first metatarsal angle ( P = .034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA ( r = 0.423; P = .001) and DMAA ( r = 0.541; P < .001).Conclusion:The change in the HVA was found to be significantly correlated with changes in the IMA and DMAA. A future study is required to elucidate whether this correlation can be explained by the progressive instability of the first tarsometatarsal joint. We believe special attention needs to be paid to patients with pes planus and increased DMAA.Level of Evidence:Level III, comparative study.

The present paper examined the teleconnections between two huge Asian summer monsoon components (South and East Asia) during three time slices in future: near-(2010–2039), mid-(2040–2069) and far-(2070–2100) futures under the RCP4.5 and RCP8.5 scenarios. For this purpose, a high-resolution atmospheric general circulation model is used and integrated at 40 km horizontal resolution. To get more insight into the relationships between the two Asian monsoon components, we have studied the spatial displaying correlation coefficients (CCs) pattern of precipitation over the entire Asian monsoon region with that of South Asia and three regions of East Asia (North China, Korea–Japan and Southern China) separately during the same three time slices. The possible factors responsible for these teleconnections are explored by using mean sea level pressure (MSLP) and wind fields at 850 hPa. The CC pattern of precipitation over South Asia shows an in-phase relationship with North China and an out-of-phase relationship with Korea–Japan, while precipitation variations over Korea–Japan and Southern China exhibit an out-of-phase relationship with South Asia. The CCs analysis between the two Asian blocks during different time slices shows the strongest CCs during the near and far future with the RCP8.5 scenario. The CC pattern of precipitation over Korea–Japan and Southern China with the wind (at 850 hPa) and MSLP fields indicate that the major parts of the moisture over Korea–Japan gets transported from the west Pacific along the western limb of NPSH, while the moisture over Southern China comes from the Bay of Bengal and South China Seas for good monsoon activity.

Stimuli-responsive hydrogels have attracted significant attention for their promising characteristics and have been used in diverse platforms developed for practical applications. When processed as films, these hydrogels show enhanced properties, including faster responses and higher loading capacities, and enhanced interfacial interactions. In this study, we prepared a functional polyacrylamide hydrogel film containing a rhodamine-based probe. The probe plays two fundamental roles: in the fabrication of the film via redox-initiated radical polymerization and in providing a fluorescence response to Al3+. The amine-containing probe initiated the polymerization reaction at room temperature; the resulting film synthesized through the one-step reaction was transparent and stretchable, elongating by more than five times under tensile tension. The fluorogenic probe in the film showed a sensitive, selective response to Al3+ with a detection limit of 1.5 μM. Furthermore, after detection, the addition of ethylenediaminetetraacetic acid (EDTA) to the film turned off the fluorescence from the probe; this facilitated reversible fluorescence sensing when the film was repeatedly exposed to Al3+, as expected. The facile preparation method can be expanded to incorporate other multi-functional amine probes that can impart hydrogel films with autonomous, responsive systems.

BACKGROUND Semantic variant primary progressive aphasia (svPPA) has been associated with a variety of proteinopathies, mainly transactive response DNA-binding protein, but also with tau and β-amyloid. Recently selective tau tracers for positron emission tomography (PET) have been developed to determine the presence of cerebral tau deposits in vivo. Here, we investigated the topographical distribution of THK5351 in svPPA patients. MATERIALS AND METHODS Five svPPA patients, 14 Alzheimer's disease patients, and 15 age-matched normal controls underwent [F]-THK5351 PET scans, magnetic resonance imaging, and detailed neuropsychological tests. [F]-fluorodeoxyglucose PET was obtained in 3 svPPA patients, whereas the remaining 2 underwent amyloid PET using [F]-flutemetamol. Tau distribution among the 3 groups was compared using regions of interest-based and voxel-based statistical analyses. RESULTS In svPPA patients, [F]-THK5351 retention was elevated in the anteroinferior and lateral temporal cortices compared with the normal controls group (left>right), and in the left inferior and temporal polar region compared with Alzheimer's disease patients. [F]-THK5351 retention inversely correlated with glucose metabolism, whereas regional THK retention correlated with clinical severity. [F]-flutemetamol scans were negative for β-amyloid. CONCLUSIONS These findings show that [F]-THK5351 retention may be detected in cortical regions correlating with svPPA pathology.

Objective. With the development in the field of neural networks, explainable AI (XAI), is being studied to ensure that artificial intelligence models can be explained. There are some attempts to apply neural networks to neuroscientific studies to explain neurophysiological information with high machine learning performances. However, most of those studies have simply visualized features extracted from XAI and seem to lack an active neuroscientific interpretation of those features. In this study, we have tried to actively explain the high-dimensional learning features contained in the neurophysiological information extracted from XAI, compared with the previously reported neuroscientific results. Approach. We designed a deep neural network classifier using 3D information (3D DNN) and a 3D class activation map (3D CAM) to visualize high-dimensional classification features. We used those tools to classify monkey electrocorticogram (ECoG) data obtained from the unimanual and bimanual movement experiment. Main results. The 3D DNN showed better classification accuracy than other machine learning techniques, such as 2D DNN. Unexpectedly, the activation weight in the 3D CAM analysis was high in the ipsilateral motor and somatosensory cortex regions, whereas the gamma-band power was activated in the contralateral areas during unimanual movement, which suggests that the brain signal acquired from the motor cortex contains information about both contralateral movement and ipsilateral movement. Moreover, the hand-movement classification system used critical temporal information at movement onset and offset when classifying bimanual movements. Significance. As far as we know, this is the first study to use high-dimensional neurophysiological information (spatial, spectral, and temporal) with the deep learning method, reconstruct those features, and explain how the neural network works. We expect that our methods can be widely applied and used in neuroscience and electrophysiology research from the point of view of the explainability of XAI as well as its performance.

Abnormal foot kinematics is observed in flatfoot subjects with postural foot deformity. We aimed to investigate joint instability in flatfoot subjects by analyzing the abnormal rotational position and speed of their joints while walking. Five flatfoot subjects participated in our study. Three-dimensional motions of the tibia, talus, calcaneus, navicular, and cuboid were obtained during walking using the biplanar fluoroscopic motion analyses. An anatomical coordinate system was established for each bone. The rotations and ranges of motion (ROMs) of the joints from heel-strike to toe-off were quantified. The relative movements on the articular surfaces were quantified by surface relative velocity vector analysis. The data from flat foot subjects were compared with the data from normal foot subjects in previous studies. The average relative speed on the articular surface of the tibiotalar, subtalar, and calcaneocuboid joints for the flatfoot subjects was significantly higher (p 0.05) than that for the normal foot subjects. The flatfoot subjects exhibited increased movements toward plantar flexion in the tibiotalar joint, and eversion and external rotations in the talonavicular joint during the stance phase, compared to the normal subjects (p 0.01). Furthermore, the flatfoot subjects had a significantly larger ROM along with the inversion/eversion rotations (5.6 ± 1.8° vs. 10.7 ± 4.0°) and internal/external rotations (7.1 ± 1.5° vs. 10.5 ± 3.5°) in the tibiotalar joint. The flatfoot subjects demonstrated abnormal kinematics and larger joint movements in multiple joints during the mid-stance and terminal stance phases of walking. This demonstrates their high instability levels.

Studies on iconic memory demonstrate that rich information from a visual scene quickly becomes unavailable with the passage of time. The decay rate of iconic memory refers to the dynamics of memory...

This study aims to evaluate the clinical validity of [18F]THK5351 positron emission tomography (PET) for the assessment of disease progression and symptoms in Alzheimer's disease (AD). Fifty-one patients with AD dementia, 30 patients with amnestic mild cognitive impairment (aMCI), and 43 controls with normal cognition (NC) were included. All subjects underwent [18F]THK5351 PET, 3.0-T magnetic resonance imaging, and detailed neuropsychological tests. Regions of interest and voxel-based statistical analyses were performed. In patients with AD dementia, [18F]THK5351 retention was greater in most association cortices as well as the limbic area compared to NC or aMCI participants. Patients with aMCI also showed higher THK5351 retention in those areas compared to NC. [18F]THK5351 retention significantly correlated with neuropsychological test results. Negative correlations between [18F]THK5351 and [18F] fluorodeoxyglucose were observed in AD dementia and aMCI groups. Mirror images of [18F]THK5351 retention and glucose hypometabolism in [18F] fluorodeoxyglucose were noticeable in the focal variants of AD. [18F]THK5351 PET reflects disease severity and symptoms in AD. Our results suggest [18F]THK5351 is reflective of tau-related AD pathology.

Idiopathic flatfoot is common in infants and children, and patients with this condition are frequently referred to pediatric orthopedic clinics. Flatfoot is a physiologic process, and that the arch of the foot elevates spontaneously in most children during the first decade of life. To achieve a consensus as the rate of spontaneous improvement of flatfoot, the present study aimed to estimate the rate of spontaneous improvement of flatfoot and to analyze correlating factors. We reviewed the records of patients examined between May 2013 and May 2019 so as to identify those factors associated with idiopathic flatfoot below 12 years of age. We included patients with who had been followed for >6 months, and those for whom ≥2 (anteroposterior and lateral) weight-bearing bilateral radiographs of the foot had been obtained. The progression rates of the anteroposterior (AP) talo-first metatarsal angle, talonavicular coverage angle, lateral talo-first metatarsal angle, and calcaneal pitch angle were adjusted by multiple factors using a linear mixed model, with sex, body mass index, and Achilles tendon contracture as the fixed effects and age and each subject as the random effects. We found that 4 of the radiographic measurements improved as patients grew older. The AP talo-first metatarsal angle, talonavicular coverage angle, and the lateral talo-first metatarsal angle decreased, while the calcaneal pitch angle increased. The AP talo-first metatarsal angle (P

Background Generally, the analysis of functional magnetic resonance imaging (fMRI) using echo-planar imaging (EPI) data is based on independent component analysis (ICA) and the general linear model (GLM). The application of these two approaches is highly independent, like GLM is for task-related activation mapping, and ICA is for resting-state imaging. Herein, we propose white noise-removed T2*-variation mapping as a new analysis method for fMRI that integrates the two conventional mapping approaches. New Method We derived the standard deviation to the mean-square ratio of the true T2* signal from the multi-echo EPI (ME-EPI) dataset. For the true T2*-variation-based value, we removed the S0 (initial signal intensity) and white noise component from the variation in the EPI signal using signal-coherence analysis of the echo time (TE) dataset and slope analysis of the TE-variated coefficient of variation of the ME-EPI dataset. Results The activation mapping for a visual task and resting-state imaging by the proposed method showed the reliable activation map in the visual cortex area and area for the typical default mode network, with white noise and the S0 component removed. Comparison with existing methods Conventional analyses for fMRI cannot be applied to both activation mapping and resting-state imaging, with white noise removed, while the proposed method can be applied. Conclusions We demonstrated white noise-removed true T2*-variation-based mapping as a new functional brain analysis approach. We expect the method allows studying in which that the association between task timing and brain activity is somewhat uncertain, such as studies of emotion and awareness.