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Accuracy of computational hemodynamics in complex arterial geometries reconstructed from magnetic resonance imaging.

PURPOSE: Combining computational blood flow modeling with three-dimensional medical imaging provides a new approach for studying links between hemodynamic factors and arterial disease. Although this provides patient-specific hemodynamic information, it is subject to several potential errors. This study quantifies some of these errors and identifies optimal reconstruction methodologies. METHODS: A carotid artery bifurcation phantom of known geometry was imaged using a commercial magnetic resonance (MR) imager. Three-dimensional models were reconstructed from the images using several reconstruction techniques, and steady and unsteady blood flow simulations were performed. The carotid bifurcation from a healthy, human volunteer was then imaged in vivo, and geometric models were reconstructed. RESULTS: Reconstructed models of the phantom showed good agreement with the gold standard geometry, with a mean error of approximately 15% between the computed wall shear stress fields. Reconstructed models of the in vivo carotid bifurcation were unacceptably noisy, unless lumenal profile smoothing and approximating surface splines were used. CONCLUSIONS: All reconstruction methods gave acceptable results for the phantom model, but in vivo models appear to require smoothing. If proper attention is paid to smoothing and geometric fidelity issues, models reconstructed from MR images appear to be suitable for use in computational studies of in vivo hemodynamics.

Carotid Arteries↗

Automated detection of lung nodules in CT scans: effect of image reconstruction algorithm.

We have investigated the effect of computed tomography (CT) image reconstruction algorithm on the performance of our automated lung nodule detection method. Commercial CT scanners offer a choice of several algorithms for the reconstruction of projection data into transaxial images. Different algorithms produce images with substantially different properties that are apparent not only quantitatively, but also through visual assessment. During some clinical thoracic CT examinations, patient scans are reconstructed with multiple reconstruction algorithms. Thirty-eight such cases were collected to form two databases: one with patient projection data reconstructed with the "standard" reconstruction algorithm and the other with the same patient projection data reconstructed with the "lung" reconstruction algorithm. The automated nodule detection method was applied to both databases. This method is based on gray-level-thresholding techniques to segment the lung regions from each CT section to create a segmented lung volume. Further gray-level-thresholding techniques are applied within the segmented lung volume to identify a set of lung nodule candidates. Rule-based and linear discriminant classifiers are used to differentiate between lung nodule candidates that correspond to actual nodules and those that correspond to non-nodules. The automated method that was applied to both databases was exactly the same, except that the classifiers were calibrated separately for each database. For comparison, the classifier then was trained on one database and tested independently on the other database. When applied to the databases in this manner, the automated method demonstrated overall a similar level of performance, indicating an encouraging degree of robustness.

Adult↗

A reconstruction algorithm for coherent scatter computed tomography based on filtered back-projection.

Coherent scatter computed tomography (CSCT) is a reconstructive x-ray imaging technique that yields the spatially resolved coherent-scatter form factor of the investigated object. Reconstruction from coherently scattered x-rays is commonly done using algebraic reconstruction techniques (ART). In this paper, we propose an alternative approach based on filtered back-projection. For the first time, a three-dimensional (3D) filtered back-projection technique using curved 3D back-projection lines is applied to two-dimensional coherent scatter projection data. The proposed algorithm is tested with simulated projection data as well as with projection data acquired with a demonstrator setup similar to a multi-line CT scanner geometry. While yielding comparable image quality as ART reconstruction, the modified 3D filtered back-projection algorithm is about two orders of magnitude faster. In contrast to iterative reconstruction schemes, it has the advantage that subfield-of-view reconstruction becomes feasible. This allows a selective reconstruction of the coherent-scatter form factor for a region of interest. The proposed modified 3D filtered back-projection algorithm is a powerful reconstruction technique to be implemented in a CSCT scanning system. This method gives coherent scatter CT the potential of becoming a competitive modality for medical imaging or nondestructive testing.

Algorithms↗

Suppression of intensity transition artifacts in statistical x-ray computer tomography reconstruction through radon inversion initialization.

Statistical reconstruction (SR) methods provide a general and flexible framework for obtaining tomographic images from projections. For several applications SR has been shown to outperform analytical algorithms in terms of resolution-noise trade-off achieved in the reconstructions. A disadvantage of SR is the long computational time required to obtain the reconstructions, in particular when large data sets characteristic for x-ray computer tomography (CT) are involved. As was shown recently, by combining statistical methods with block iterative acceleration schemes [e.g., like in the ordered subsets convex (OSC) algorithm], the reconstruction time for x-ray CT applications can be reduced by about two orders of magnitude. There are, however, some factors lengthening the reconstruction process that hamper both accelerated and standard statistical algorithms to similar degree. In this simulation study based on monoenergetic and scatter-free projection data, we demonstrate that one of these factors is the extremely high number of iterations needed to remove artifacts that can appear around high-contrast structures. We also show (using the OSC method) that these artifacts can be adequately suppressed if statistical reconstruction is initialized with images generated by means of Radon inversion algorithms like filtered back projection (FBP). This allows the reconstruction time to be shortened by even as much as one order of magnitude. Although the initialization of the statistical algorithm with FBP image introduces some additional noise into the first iteration of OSC reconstruction, the resolution-noise trade-off and the contrast-to-noise ratio of final images are not markedly compromised.

Algorithms↗

A Monte Carlo based three-dimensional dose reconstruction method derived from portal dose images.

The verification of intensity-modulated radiation therapy (IMRT) is necessary for adequate quality control of the treatment. Pretreatment verification may trace the possible differences between the planned dose and the actual dose delivered to the patient. To estimate the impact of differences between planned and delivered photon beams, a three-dimensional (3-D) dose verification method has been developed that reconstructs the dose inside a phantom. The pretreatment procedure is based on portal dose images measured with an electronic portal imaging device (EPID) of the separate beams, without the phantom in the beam and a 3-D dose calculation engine based on the Monte Carlo calculation. Measured gray scale portal images are converted into portal dose images. From these images the lateral scattered dose in the EPID is subtracted and the image is converted into energy fluence. Subsequently, a phase-space distribution is sampled from the energy fluence and a 3-D dose calculation in a phantom is started based on a Monte Carlo dose engine. The reconstruction model is compared to film and ionization chamber measurements for various field sizes. The reconstruction algorithm is also tested for an IMRT plan using 10 MV photons delivered to a phantom and measured using films at several depths in the phantom. Depth dose curves for both 6 and 10 MV photons are reconstructed with a maximum error generally smaller than 1% at depths larger than the buildup region, and smaller than 2% for the off-axis profiles, excluding the penumbra region. The absolute dose values are reconstructed to within 1.5% for square field sizes ranging from 5 to 20 cm width. For the IMRT plan, the dose was reconstructed and compared to the dose distribution with film using the gamma evaluation, with a 3% and 3 mm criterion. 99% of the pixels inside the irradiated field had a gamma value smaller than one. The absolute dose at the isocenter agreed to within 1% with the dose measured with an ionization chamber. It can be concluded that our new dose reconstruction algorithm is able to reconstruct the 3-D dose distribution in phantoms with a high accuracy. This result is obtained by combining portal dose images measured prior to treatment with an accurate dose calculation engine.

Algorithms↗

Evaluation of digitally reconstructed radiographs (DRRs) used for clinical radiotherapy: a phantom study.

Digitally reconstructed radiographs produced from a commercial CT simulator have been evaluated using an in-house test phantom. The phantom consists of a polystyrene cubic block of dimension 15 cm. It contains four test patterns to measure contrast detail, modulation transfer function, ray line divergence accuracy, and spatial distortion. A total of six CT data sets, which vary by CT slice thickness and separation between slices, as well as CT slice reconstruction area have been used to analyze digitally reconstructed radiographs produced by the system. Results show that contrast detail is independent of slice thickness and separation but dependent upon slice reconstruction area for small object diameters (< or = 1.5 mm). Half field (24-cm diameter) reconstruction images provide lower threshold contrasts than full field (48-cm diameter) scans. The modulation transfer function for each data set was calculated and the spatial frequency at which the modulation transfer function is 50% (f50) of the maximum indicates that high contrast resolution depends on slice thickness for both the full and half field reconstructions. For full field scans, f50 values were 0.19, 0.10, and 0.10 line pairs/mm for the 2 mm/2 mm (slice thickness/separation), 5 mm/3 mm, and 5 mm/5 mm data sets, respectively. Similarly, half field f50 values were 0.19, 0.10, and 0.10 line pairs/mm for these same three thickness/separation data sets, respectively. The error in the ray tracing component of the digitally reconstructed radiograph algorithm for source to skin distances between 60 and 200 cm was 1.0 mm while the spatial linearity error was < or = 2.5 mm. Errors in CT simulator collimator and table rotations were calculated by measuring the angle between a grid pattern inlayed onto two orthogonal faces of the phantom and a graphical grid superimposed onto the digitally reconstructed radiograph by the CT simulator software. Measured angular differences were < or = 1.0 degree. The largest error in shifting the CT simulator field isocenter was 2.2 mm and occurred on the 5-mm slice thickness and separation CT data sets.

Biophysical Phenomena↗

Three-dimensional reconstruction of curves from pairs of projection views in the presence of error. I. Algorithms.

We have previously described an approach to 3D intracerebral vascular reconstruction that uses an MRA as a reconstruction base. Additional vessels seen only by angiography are added by segmenting 2D curves from projection angiograms and reconstructing these curves into 3D, building upon the MRA. Intracerebral vascular reconstruction is difficult for at least two reasons. First, 2D curves must be associated on projection images even when the human eye cannot do so. Second, 3D curves must be reconstructed in the presence of errors such as misregistration, image distortion, and misdefinition of 2D curves. This paper is the first of two that address the specific issue of reconstruction of a 3D curve from a given pair of 2D curves in the presence of error. The method explicitly separates what can and cannot be determined from a pair of projection views. It is also capable of recognizing interruptions produced by viewplane errors, of continuing reconstruction beyond such interruptions, and of localizing and estimating the magnitude of the interruptions. These measurements can also be used to estimate the lengths of regional disparities between a pair of 2D curves, leading to a quantitative estimate of the capacity of a pair of 2D curves to combine to create a 3D object (match value). Match values can be used, in turn, as part of the strategy for automatically associating pairs of 2D curves. This paper provides methods for reconstructing a given pair of 2D curves into 3D in the presence of error and for calculating match values. Error analysis is given in the companion report.

Algorithms↗

3D reconstruction of the cerebral arterial network from stereotactic DSA.

The authors present an automatic algorithm for 3D reconstruction of cerebral blood vessels by digital subtracted angiography. The patient is localized by a stereotactic method. The reconstruction algorithm includes two steps: first vessel extraction then 2D matching and reconstruction. Accurate vessel skeletons are generated by a combination of mathematical morphological algorithms and adaptive filters. The 3D reconstruction algorithm is based on the reconstruction of vessels center lines. For that purpose, three different projections of the vascular network are used. Reconstruction is computed segment by segment (a curved line between two nodes). For each segment point, the algorithm defines all epipolar solutions on the other views. These epipolar solutions are sorted and pooled by 2D continuity and 3D proximity criteria resulting in a 3D graph. Optimal 3D segment is defined by a recursive algorithm that looks up the better path in the 3D graph. The algorithms have been implemented on a Compatible-PC computer in C language. More than 95% of static copper phantom was reconstructed in 5 min and with 1 mm 3D accuracy. 70% of arteries (from carotid to the seventh node) of a true patient arterial network were reconstructed is less than 30 min.

Algorithms↗

Multi-detector row CT coronary angiography: influence of reconstruction technique and heart rate on image quality.

PURPOSE: To prospectively evaluate to what extent image quality in 16-detector row computed tomographic (CT) coronary angiography is a function of the heart rate and the image reconstruction technique used. MATERIALS AND METHODS: A total of 70 patients (49 men, 21 women; mean age, 59.1 years +/- 5.8 [standard deviation]) consecutively underwent multi-detector row CT coronary angiography; 49 patients additionally underwent coronary angiography. Image reconstruction was based on both relative and absolute timing. A total of 20 equidistant relative and absolute image reconstructed intervals were assessed by applying a four-step grading scale. Cluster and discrimination analysis, Spearman correlation analysis, and Wilcoxon and chi2 tests were used for statistical analysis. Institutional review board approval and written informed consent were obtained. RESULTS: Though significantly (P < .001) better image quality was observed for image reconstruction based on absolute timing and in patients with lower heart rates, influence on diagnostic accuracy was not significant. Irrespective of the reconstruction technique used, best image quality was observed in patients with a low heart rate for middiastolic reconstruction intervals (starting points: 61% of R-R interval [range, 40%-75%] and 599.3 msec after R [range, 450-840 msec]) and in patients with a high heart rate for end-systolic or early-diastolic intervals (starting points: 27.3% of R-R interval [range, 10%-45%] and 202.3 msec after R [range, 82-336 msec]). With regard to the vessel section and reconstruction technique, cutoff heart rates of the intervals were 64.0-68.5 beats per minute. Patients with stenoses of more than 50% were identified with 86% sensitivity and specificity, and there was no significant difference between relative and absolute timing (P = .99). CONCLUSION: In multi-detector row CT coronary angiography, image quality depends on the choice of a suited reconstruction interval. In patients with high heart rates, the best image quality can be obtained with end-systolic and early-diastolic intervals; in patients with low heart rates, the best results are achieved with middiastolic intervals.

Adult↗

Pylorus-preserving pancreatoduodenectomy: influence of a Billroth I versus a Billroth II type of reconstruction on gastric emptying.

BACKGROUND/AIM: Delayed gastric emptying (DGE) is a frequent problem after pylorus-preserving pancreatoduodenectomy. Important risk factors are the presence of intra-abdominal complications. Searching for other causes, this study evaluates the influence of the type of reconstruction after a pancreatoduodenectomy (Billroth I vs. Billroth II; B I vs. B II on DGE. METHODS: A retrospective study was performed evaluating consecutive patients from two surgical institutes. 174 patients were included (B II type of reconstruction n = 123, period 1992-1996; B I type of reconstruction n = 51, period 1988-1998). DGE was defined by gastric stasis requiring nasogastric intubation for 10 days or more or the inability to tolerate a regular diet on or before the 14th postoperative day. RESULTS: After a B I type of reconstruction, there was significantly longer nasogastric intubation period as compared with a B II type of reconstruction (B I median 13 days, range 4-47, B II median 6 days, range 1-40; p < 0.05). There was no difference in postoperative commencement of a normal diet. Also significantly more patients had DGE after a B I (76%) as compared with a B II type of reconstruction (32%; p < 0.05). CONCLUSIONS: The results of this study indicate a significantly higher incidence of DGE after a B I type of reconstruction as compared with a B II type reconstruction. The etiology remains speculative.

Adult↗

The effect of posterior cruciate ligament reconstruction on patellofemoral contact pressures in the knee joint under simulated muscle loads.

BACKGROUND: The mechanism of cartilage degeneration in the patellofemoral joint (PFJ) and medial compartment of the knee following posterior cruciate ligament (PCL) injury remains unclear. PCL reconstruction has been recommended to restore kinematics and prevent long-term degeneration. The effect of current reconstruction techniques on PFJ contact pressures is unknown. PURPOSE: To measure PFJ contact pressures after PCL deficiency and reconstruction. METHOD: Eight cadaveric knees were tested with the PCL intact, deficient, and reconstructed. Contact pressures were measured at 30 degrees, 60 degrees, 90 degrees, and 120 degrees of flexion under simulated muscle loads. Knee kinematics were measured by a robotic testing system, and the PFJ contact pressures were measured using a thin film transducer. A single bundle achilles tendon allograft was used in the reconstruction. RESULTS: PCL deficiency significantly increased the peak contact pressures measured in the PFJ relative to the intact knee under both an isolated quadriceps load of 400 N and a combined quadriceps/hamstrings load of 400 N/200 N. Reconstruction did not significantly reduce the increased contact pressures observed in the PCL-deficient knee. CONCLUSION: The elevated contact pressures observed in the PCL-deficient knee and reconstructed knee might contribute to the long-term degeneration observed in both the non-operatively treated and PCL-reconstructed knees.

Aged↗

Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation.

BACKGROUND: Techniques for ulnar collateral ligament reconstruction have evolved. HYPOTHESIS: Ulnar collateral ligament reconstruction with interference screw fixation restores elbow kinematics and failure strength to that of the native ligament. STUDY DESIGN: Controlled laboratory study. METHODS: Of 10 matched pairs of cadaveric elbows, one underwent kinematic testing under conditions of an intact, released, and reconstructed ligament. Single 5-mm diameter bone tunnels were created at the isometric anatomic insertion sites on the medial epicondyle and sublime tubercle. Graft fixation was achieved with 5 x 15 mm soft tissue interference screws. The reconstructed and contralateral intact elbows were then tested to failure. RESULTS: Average stiffness for intact elbows (42.81 +/- 11.6 N/mm) was significantly greater than for reconstructed elbows (20.28 +/- 12.5 N/mm). Ultimate moment for intact elbows (34.0 +/- 6.9 N.m) was not significantly different from reconstructed elbows (30.6 +/- 19.2 N.m). Release of the ulnar collateral ligament caused a significant increase in valgus instability. Reconstruction restored valgus stability to near that of the intact elbow. CONCLUSIONS: With this reconstruction method, failure strength was comparable with that of the native ligament and physiologic elbow kinematics were reliably restored. CLINICAL RELEVANCE: This technique returns elbow kinematics to near normal, with less soft tissue dissection and risk of ulnar nerve injury and ease of graft insertion, tensioning, and fixation.

Adult↗

Measurement of posterior tibial translation in the posterior cruciate ligament-reconstructed knee: significance of the shift in the reference position.

BACKGROUND: The measurement of anterior or posterior tibial translation depends on the existence of a repeatable and accurate reference position of the knee from which the corresponding translation is measured. HYPOTHESIS: Clinical measurements of posterior tibial translation alone do not accurately reflect the laxity of posterior cruciate ligament-reconstructed knees. STUDY DESIGN: Controlled laboratory study. METHODS: Ten human cadaveric knees were tested by using a robotic/universal force-moment sensor testing system. The reference positions and the resulting kinematics in response to a 134-N anterior-posterior tibial load were determined for the intact and reconstructed knees. Posterior cruciate ligament reconstruction was performed with the graft tensioned and fixed at two different positions: 1) 90 degrees of knee flexion with a 134-N anterior tibial load and 2) full extension with no load. RESULTS: Posterior cruciate ligament reconstruction with graft fixation at full extension with no load resulted in anterior shift of the reference position by 1.5 to 3.2 mm. The reconstruction resulted in an overconstrained knee with significantly decreased total anterior-posterior translation of 2.6 to 3.2 mm. However, the posterior tibial translation measured was not significantly different from that of the intact knee. Posterior cruciate ligament reconstruction with graft fixation performed at 90 degrees of flexion with a 134-N anterior tibial load resulted in kinematics similar to those of the intact knee. CONCLUSION: Posterior tibial translations that are measured clinically can be misleading because the reference position of the knee can be shifted significantly after posterior cruciate ligament reconstruction. CLINICAL RELEVANCE: The measurement of total anterior-posterior translation may be a more accurate way to assess kinematics of the reconstructed knee.

Adult↗

Tibiofemoral kinematics following successful anterior cruciate ligament reconstruction using dynamic multiple resonance imaging.

BACKGROUND: The aim of anterior cruciate ligament reconstruction is to reduce excess joint laxity, hoping to restore normal tibiofemoral kinematics and therefore improve joint stability. It remains unclear if successful ACL reconstruction restores normal tibiofemoral kinematics and whether it is this that is associated with a good result. STUDY: Case series. PURPOSE: To assess the kinematics of the anterior cruciate ligament-reconstructed knee using open-access MRI. METHODS: Tibiofemoral motion was assessed using open-access MRI, weightbearing through the arc of flexion from 0 degrees to 90 degrees in 10 patients with isolated reconstruction of the anterior cruciate ligament (hamstring autograft) in one knee and a normal contralateral knee. Midmedial and midlateral sagittal images were analyzed in all positions of flexion in both knees to assess the tibiofemoral relationship. Sagittal laxity was also assessed by performing the Lachman test while the knees were scanned dynamically using open-access MRI. RESULTS: The amount of excursion between the tibial and femoral joint surfaces was similar between the normal and reconstructed knees, but the relationship of tibia to femur was always different for each position of knee flexion assessed-the lateral tibia being about 5 mm more anterior in the anterior cruciate ligament-reconstructed knees. This anterior tibial position is statistically significantly different at 0 degrees (P <.0006), 20 degrees (P =.0004), 45 degrees (P =.002), and 90 degrees of flexion (P <.006). Anteroposterior laxity was similar between normal and anterior cruciate ligament-reconstructed knees. CONCLUSION: Anterior cruciate ligament reconstruction reduces sagittal laxity to within normal limits but does not restore normal tibiofemoral kinematics despite a successful outcome.

Adult↗

Revision anterior cruciate ligament reconstruction with hamstring tendon autograft: 5- to 9-year follow-up.

BACKGROUND: The results of revision anterior cruciate ligament reconstruction are limited in the current literature, and no studies have previously documented the outcome of revision anterior cruciate ligament reconstruction using solely hamstring tendon grafts. HYPOTHESIS: Revision anterior cruciate ligament reconstruction with 4-strand hamstring tendon graft affords acceptable results and is comparable to reported outcomes with the bone-patellar tendon-bone graft. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-seven consecutive revision anterior cruciate ligament reconstructions with the hamstring tendon graft and interference screw fixation were assessed a mean time of 89 months (range, 60-109 months) after surgery. Assessment included the International Knee Documentation Committee knee ligament evaluation, instrumented laxity testing, and radiologic examination. RESULTS: Of the 50 knees reviewed, 5 (10%) had objective failure of the revision anterior cruciate ligament reconstruction. Of the 45 patients with functional grafts, knee function was normal or nearly normal in 33 patients (73%). An overall grade of normal or nearly normal was found in 56% of patients. The mean side-to-side difference on manual maximum testing was 2.5 mm (range, -1 to 4 mm). Degenerative changes on radiographs were identified in 23% of patients at the time of surgery, increasing to 56% of patients at review. The status of the articular cartilage at the time of revision surgery was the most significant contributor to successful outcome. CONCLUSION: Revision anterior cruciate ligament reconstruction with hamstring tendon graft and interference screw fixation affords acceptable results at a minimum of 5 years' follow-up. Good objective results can be obtained, but subjectively, the results appear inferior to those of primary anterior cruciate ligament reconstruction in the literature, which may be related to the high incidence of articular surface damage in this patient population. We recommend that, when available, hamstring tendon autografts should be considered for revision anterior cruciate ligament reconstruction.

Adolescent↗

Anatomical reconstruction of knee posterolateral complex with the tendon of the long head of biceps femoris.

BACKGROUND: There is no consensus about the best way to reconstruct the knee posterolateral complex. HYPOTHESIS: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris can restore knee posterolateral stability. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Anatomical reconstruction of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon was performed consecutively in 28 patients with chronic posterolateral knee injuries. Two distally pedicled tendon slips more than 16 cm long were created from the tendon of the long head of the biceps femoris. The posterior tendon slip was used to reconstruct the popliteofibular ligament and popliteus tendon, and the anterior slip were doubled to reconstruct the lateral collateral ligament. The patients were followed up for 2 to 4 years. RESULTS: At the latest follow-up, examinations showed that 96.4% (27/28) of the patients had a normal or nearly normal reconstructed fibular collateral ligament as judged by manual examination. All patients had a normal or nearly normal reconstructed popliteofibular ligament and popliteus tendon as judged by manual examination. CONCLUSION: Anatomical reconstruction of the knee posterolateral complex with the tendon of the long head of biceps femoris is effective in restoring knee posterolateral stability.

Adult↗

Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study.

BACKGROUND: The role of knee bracing in anterior cruciate ligament reconstructions is controversial. HYPOTHESIS: Functional bracing will have an effect on subsequent knee injury in skiers with anterior cruciate ligament reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From 1991 to 1997, 11606 skiers at a major destination ski resort underwent preseason knee screening. The anterior cruciate ligament-reconstructed group consisted of 820 skiers who had had an anterior cruciate ligament reconstruction 2 years or more earlier. Of these, 257 skiers selected the use of functional knee brace during skiing. The dependent variable was subsequent knee injury, identified via workers' compensation records. Covariates included age, gender, ski occupation, Lachman grade, pivot-shift grade, KT-1000 arthrometer manual maximum displacement, and use of a functional brace. Univariate and multivariate risk factors for subsequent knee injury were determined. RESULTS: In this study, 257 skier-employees with anterior cruciate ligament reconstruction wore braces and 563 skier-employees with anterior cruciate ligament reconstruction did not. Braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot-shift tests (braced, 29% and 22%, respectively; nonbraced, 11% and 10%, respectively; P < .05). Sixty-one subsequent knee injuries were identified, 51 (8.9 injuries/100 knees/ski season) in the nonbraced group and 10 (4.0 injuries/100 knees/ski season) in the braced group (P = .009). Nonbraced skiers were 2.74 times more likely to suffer subsequent injury than were braced skiers (odds ratio, 2.74 [confidence interval, 1.2-4.9]). Logistic regression modeling identified nonbracing as a significant independent multivariate risk factor for subsequent knee injury in the high-demand skiers with anterior cruciate ligament reconstruction. CONCLUSION: Because of the increased risk of subsequent knee injury in nonbraced skiers, the authors recommend functional bracing for skiers with anterior cruciate ligament reconstruction. Whether the protective effect of functional bracing can be extrapolated to other high-demand patients is yet to be determined.

Adolescent↗

Reconstruction of ancestral protein sequences and its applications.

BACKGROUND: Modern-day proteins were selected during long evolutionary history as descendants of ancient life forms. In silico reconstruction of such ancestral protein sequences facilitates our understanding of evolutionary processes, protein classification and biological function. Additionally, reconstructed ancestral protein sequences could serve to fill in sequence space thus aiding remote homology inference. RESULTS: We developed ANCESCON, a package for distance-based phylogenetic inference and reconstruction of ancestral protein sequences that takes into account the observed variation of evolutionary rates between positions that more precisely describes the evolution of protein families. To improve the accuracy of evolutionary distance estimation and ancestral sequence reconstruction, two approaches are proposed to estimate position-specific evolutionary rates. Comparisons show that at large evolutionary distances our method gives more accurate ancestral sequence reconstruction than PAML, PHYLIP and PAUP*. We apply the reconstructed ancestral sequences to homology inference and functional site prediction. We show that the usage of hypothetical ancestors together with the present day sequences improves profile-based sequence similarity searches; and that ancestral sequence reconstruction methods can be used to predict positions with functional specificity. CONCLUSIONS: As a computational tool to reconstruct ancestral protein sequences from a given multiple sequence alignment, ANCESCON shows high accuracy in tests and helps detection of remote homologs and prediction of functional sites. ANCESCON is freely available for non-commercial use. Pre-compiled versions for several platforms can be downloaded from ftp://iole.swmed.edu/pub/ANCESCON/.

Amino Acid Sequence↗