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Microglia-mediated neuroinflammation plays a vital role in the pathophysiological processes of multiple neurodegenerative diseases. Lipopolysaccharide (LPS) is an environmental poison that can induce inflammatory microglial activation. Matrix metalloproteinases (MMPs) are vital factors regulating microglial activation, and CD147 is a key MMP inducer, which can induce inflammation by inducing MMPs. However, whether it is involved in the regulation of microglial activation has not been reported. In this study, the role of CD147 in LPS-induced microglial inflammatory activation was investigated by establishing in vivo and in vitro models. The results suggested that LPS-induced microglial activation was accompanied by the induction of CD147 expression while the inhibition of CD147 expression could inhibit LPS-induced microglial inflammatory activation. In addition, the results also indicated that the role of CD147 in LPS-induced pro-inflammatory activation of microglia was related to its downstream MMP-3, MMP-8, and autophagy. Furthermore, the inhibition of MMP-3, MMP-8, and autophagy attenuated LPS-induced inflammatory activation of microglia. At the same time, there was a certain interaction between MMPs and autophagy, which is shown that inhibiting the expression of MMPs could inhibit autophagy, whereas inhibiting autophagy could inhibit the expression of MMPs. Taken together, we provided the first evidence that CD147/MMPs can be involved in LPS-induced inflammatory activation of microglia through an autophagy-dependent manner.

Changes in pelvic tilt angle (PTA) and cup orientation have been reported in patients after total hip arthroplasty, but the current literature generally has a brief follow-up period. This study will be the first to report PTA and cup orientation changes in the supine position for a minimum 18 years after total hip arthroplasty (THA) and investigate the factors associated with pelvic tilt and cup orientation changes.In this study, 101 patients (120 hips) who underwent THA were retrospectively analyzed. The aims of our study were to evaluate the PTA and cup orientation change over 18 years after THA to assess differential PTA, cup inclination, and anteversion. We also investigated whether factors such as gender, body mass index, and age have any influence on PTA and cup orientation after THA.Patients showed a significant incremental change in PTA pre-operatively, immediately post-operatively, and at final follow-up. Cup orientation increased significantly at the final follow-up compared to the immediate post-operative period. Gender subgroup analysis showed that PTA was significantly greater in females than in males at the final follow-up (p = 0.025). Age subgroup analysis showed that PTA was significantly greater in the over 60 years group than in the other groups.Our patients showed significant changes in PTA and cup orientation at a minimum 18 years after surgery, especially in females over 60 years. Female patients over 60 are a risk factor after THA.

Immune checkpoint blockade (ICB) therapy, represented by programmed cell death protein 1 (PD-1) and its ligand (PD-L1) monoclonal antibodies (mAbs), has shown an obvious benefit for melanoma immunotherapy, but the overall response rate is still low. To find an effective combination therapy strategy, we successfully produced small size silver nanoparticles coated with sucrose (S-AgNPs) as potent adjuvants. The antitumor effects of S-AgNPs were tested in vitro and comparatively investigated in immunodeficient and immunocompetent mice with melanoma. Fluorescence-activated cell sorting and immunofluorescent staining analysis were conducted to identify the tumor microenvironments. The expression of PD-L1 in tumors was tested by multiple methods. The combination therapy and potential toxicity of S-AgNPs and PD-1 mAbs were assessed in melanoma-bearing mice. In our findings, S-AgNPs presented potent antitumor effects, good druggability and low systemic toxicity. Functionally, we found that S-AgNPs exhibited better antitumor effects in immunocompetent mice. Mechanistically, we showed that S-AgNPs suppress tumor cell proliferation by inducing cellular apoptosis and promote cytotoxic CD8

Campylobacter species are zoonotic pathogens, as well as the prevalent cause of foodborne bacterial gastroenteritis. The spread of antimicrobial-resistant strains poses a serious threat to global public health and attracts attention worldwide, but information about clinical Campylobacter is relatively limited compared to isolates from food and animals. The current study illustrated the prevalence and antimicrobial resistance profiles of Campylobacter jejuni and Campylobacter coli isolates collected from a consecutive surveillance program between 2012 and 2019 in Shanghai, China, using antimicrobial susceptibility testing and whole-genome sequencing. Among the 891 Campylobacter strains (761 C. jejuni and 130 C. coli) isolates collected, high portions above 90% of resistance to ciprofloxacin, nalidixic acid, and tetracycline were observed for both C. jejuni and C. coli. The most common MDR profiles represented by C. jejuni and C. coli were combination of ciprofloxacin, tetracycline, florfenicol and nalidixic acid (5.39%), and azithromycin, ciprofloxacin, erythromycin, gentamicin, tetracycline, clindamycin, nalidixic acid (28.46%), respectively. The erythromycin resistance of C. coli (59.23%) is higher than C. jejuni (2.50%). A total of 76 erythromycin resistant isolates (16 C. jejuni and 60 C. coli) were sequenced using Illumina platform for determining the genotypes, antimicrobial resistance patterns and phylogeny analysis. Multilocus sequence typing (MLST) analysis showed a high genetic diversity with 47 sequence types (STs), including 4 novel alleles and 12 new STs. The most abundant clonal complexes (CCs) were CC-403 (31.25%) and CC-828 (88.33%) for C. jejuni and C. coli, respectively. Among the 76 erythromycin-resistant isolates, mutation A2075G in 23S rRNA and erm(B) gene were detected in 53.95 and 39.47%, respectively. The erm(B) gene was identified exclusively in 30 C. coli isolates. All these erm(B) positive isolates were multi-drug resistant. Furthermore, comparison of the erm(B)-carrying isolates of multiple sources worldwide demonstrated the possibility of zoonotic transmission of erm(B) in Campylobacter. These findings highlight the importance of continuous surveillance of erythromycin resistance dissemination in Campylobacter which may compromise the effectiveness of antimicrobial therapy.

Background: Pruritus has been reported as an adverse drug reaction to arsenic trioxide, but the association of arsenic exposure with pruritus has not been systematically investigated. To investigate the association of arsenic exposure with pruritus, we performed observational, interventional, and Mendelian randomization studies. Methods: A cross-sectional study was conducted in Shimen, China. A Mendelian randomization study was conducted to confirm the causal relationship between susceptibility to arsenic toxicity, in terms of genetically predicted percentages of monomethylated arsenic (MMA%) and dimethylated arsenic (DMA%) in urine, and chronic pruritus in the UK Biobank participants. Then, a case-control study in Shimen participants was conducted to determine the biomarker for pruritus, and arsenite-treated mice were used to confirm the biomarker. Last, a randomized, double-blind, placebo-controlled trial was conducted to test the efficacy of naloxone, a μ-opioid receptor antagonist, in arsenic-exposed patients with pruritus in Shimen. Results: Hair arsenic showed a dose-response relationship with the intensity of itch in 1092 participants. The Mendelian randomization analysis confirmed the causal relationship in the UK Biobank participants, with odds ratios of 1.043 for MMA% and 0.904 for DMA% above versus under median. Serum β-endorphin was identified as a significant biomarker associated with the intensity of itch. Consistently, treatment with arsenite in mice upregulated the level of β-endorphin. The randomized controlled trial showed that treatment with sublingual naloxone significantly relieved the intensity of itch in arsenic-exposed participants. Conclusion: Arsenic exposure is associated with pruritus, and β-endorphin serves as a biomarker of pruritus. Naloxone relieves pruritus in patients with [arseniasis](javascript:;).

The existing static ABAC(Attribute-Based Access Control) model cannot fully meet the increasingly complex, dynamic and scalable demands of the power grid. At the same time, its versatility and flexibility bring high costs. Additionally, the increasing complexity of organizational systems and the need for federated access to their resources make implementing and managing access control more challenging. This paper proposes a fine-grained dynamic access control method based on Kformer to automate authorization management tasks. We use Kformer, which filters and integrates external knowledge through feed-forward layers in Transformer. Then, we use BERT(Bidirectional Encoder Representations from Transformer) to perform feature extraction on the input fused text, extract the implied attribute-authority relationship from the log records and external documents, and finally, perform sequence modeling on the extracted attribute features and input the obtained results. The final authorization result is obtained by classification through the softmax function in the final fully connected layer. The authorization management of the user’s request to the object is dynamically completed. Finally, using the access data of the grid information system to evaluate the method proposed by us, the experimental results show that the model can continuously monitor the access behavior of users inside the grid information system, change the access rights of entities and adjust the policy in real-time, and carry out dynamic access authorization. At the same time, the accuracy of the generated access control policy can reach 87.73%.

Recent studies have shown that physiological signals such as heart beat and breathing can be remotely captured from human faces using a regular color camera under ambient light. This technology, referred to as remote photoplethysmography (rPPG), can be used to collect the physiological status of users who are in front of a camera, which may raise privacy concerns. To avoid the privacy abuse of the rPPG technology, this paper develops PulseEdit, a novel and efficient algorithm that can edit the physiological signals in facial videos without affecting visual appearance and thus protect the user's physiological signal from disclosure. PulseEdit can either remove the trace of the physiological signal in a video or transform the video to contain a target physiological signal chosen by a user. Experimental results show that PulseEdit can effectively edit physiological signals in facial videos and prevent heart rate measurement based on rPPG. It is possible to utilize PulseEdit in adversarial scenarios against rPPG-based visual security algorithms. We present analyses on the performance of PulseEdit against rPPG-based liveness detection and rPPG-based deepfake detection, and demonstrate its ability to circumvent these visual security algorithms and its important role in supporting the design of attack-resilient systems.

Recent studies have shown that subtle changes in human face color due to heartbeats can be captured by regular RGB digital video cameras. It is possible, though challenging, to track one's pulse rate when a video contains significant subject's body motions in a fitness setting. The robustness gain in the recently proposed systems is often achieved by adding or changing certain modules in the system's pipeline. Most existing works, however, only evaluate the performance of the pulse rate estimation at the system level of particular pipeline configurations, whereas the contribution from each module remains unclear. To gain a better understanding of the performance at the module level and facilitate future research in explainable learning and artificial intelligence (AI) in physiological monitoring, this paper conducts an in-depth comparative study at the module level for video-based pulse rate tracking algorithms; a special focus is placed on challenging fitness scenarios involving significant movement. The representative efforts over the past decade in the field are reviewed, upon which a reconfigurable rPPG framework/pipeline is constructed comprising of major processing modules. For performance attribution, different candidates for each module are evaluated while having the rest of modules fixed. The performance evaluation is based on a signal quality metric and four pulse-rate estimation metrics and uses the simultaneously recorded ECG-based heart rate measurement as a reference. Experimental results using a challenging fitness dataset reveals the synergy between pulse color mapping and adaptive motion filtering in obtaining accurate pulse rate estimates. The results also suggest the importance of robust frequency tracking for accurate PR estimation in low signal-to-noise ratio fitness scenarios.

Background Vestimentifera (Polychaeta, Siboglinidae) is a taxon of deep-sea worm-like animals living in deep-sea hydrothermal vents, cold seeps, and organic falls. The morphology and lifespan of Ridgeia piscesae, which is the only vestimentiferan tubeworm species found in the hydrothermal vents on the Juan de Fuca Ridge, vary greatly according to endemic environment. Recent analyses have revealed the genomic basis of adaptation in three vent- and seep-dwelling vestimentiferan tubeworms. However, the evolutionary history and mechanism of adaptation in R. piscesae, a unique species in the family Siboglinidae, remain to be investigated. Result We assembled a draft genome of R. piscesae collected at the Cathedral vent of the Juan de Fuca Ridge. Comparative genomic analysis showed that vent-dwelling tubeworms with a higher growth rate had smaller genome sizes than seep-dwelling tubeworms that grew much slower. A strong positive correlation between repeat content and genome size but not intron size and the number of protein-coding genes was identified in these deep-sea tubeworm species. Evolutionary analysis revealed that Ridgeia pachyptila and R. piscesae, the two tubeworm species that are endemic to hydrothermal vents of the eastern Pacific, started to diverge between 28.5 and 35 million years ago. Four genes involved in cell proliferation were found to be subject to positive selection in the genome of R. piscesae. Conclusion Ridgeia pachyptila and R. piscesae started to diverge after the formation of the Gorda/Juan de Fuca/Explorer ridge systems and the East Pacific Rise. The high growth rates of vent-dwelling tubeworms might be derived from their small genome sizes. Cell proliferation is important for regulating the growth rate in R. piscesae.

Nitrogen mustard (NM) can alkylate nucleophilic proteins and DNA, causing severe cell damage. However, there are no reports on NM-induced proteomics dynamic changes. In this study, nuclear and cytoplasmic proteins of 16HBE cell were separated and the components and amounts were detected and analyzed. The amount of DNA protein cross-linking (DPC) and the function of p97 were also explored. One-hour-NM-exposure caused a tremendous number of proteins entered into the nucleus and DPC formation. As repair progressed, proteins exited. Although the protein influx at 1 h was delayed by si-p97 intervention, it continued to 24 h after NM withdrawal. In the early damage, the affected pathways mainly included spliceosome, ribosome biogenesis in eukaryotes, and mRNA surveillance, which switched to protein processing in endoplasmic reticulum and energy production in presumed repair stage. Si-p97 aggravated ferroptosis, cysteine and methionine metabolism at beginning of the damage, followed by downward ranking the transcription related pathways at 24 h. NM caused DPC and H2AX increases at 1 h. Si-p97 suppressed them at 1 h and extended the increase time to 24 h. MG132 effected similar to si-p97. Si-p97 and si-DVC1 increased the cytoplasmic level of proteasome (PSMD2). Si-DVC1 also increased the DPC content. These results suggest that NM caused a severe and rapid protein influx and crosslink in the nucleus in the early stage of injury, followed by the formation of secondary double-strand breaks. P97 was involved in the clearance of proteins in nucleus and DPC for repair, which required the participation of DVC1 and proteasome.

Underwater ghost imaging is an effective means of underwater detection. In this paper, a theoretical and experimental study of underwater ghost imaging is carried out by combining the description of underwater optical field transmission with the inherent optical parameters of the water body. This paper utilizes the Wells model and the approximate S-S scattering phase function to create a model for optical transmission underwater. The second-order Glauber function of the optical field is then employed to analyze the scattering field's degradation during the transmission process. This analysis is used to evaluate the impact of the water body on ghost imaging. The simulation and experimental results verify that the proposed underwater ghost imaging model can better describe the degradation effect of water bodies on ghost imaging. A series of experiments comparing underwater ghost imaging at different detection distances are also carried out in this paper. In the experiments, cooperative targets can be imaged up to 65.2m (9.3AL, at attenuation coefficient c=0.1426m-1 and the scattering coefficient b=0.052m-1) and non-cooperative targets up to 41.2m (6.4AL, at c=0.1569m-1 and b=0.081m-1) . By equating the experimental maximum imaged attenuation length for cooperative targets to Jerlov-I water (b=0.002m-1 and a=0.046m-1), the system will have a maximum imaging distance of 193m. Underwater ghost imaging is expected to achieve longer-range imaging by optimizing the system emission energy and detection sensitivity., Comment: 16 pages, 9 figures

BACKGROUND Psoriasis is one of the most frequent inflammatory skin conditions and could be treated via tele-dermatology, provided that the current lack of reliable tools for objective severity assessments is overcome. Psoriasis Area and Severity Index (PASI) has a prominent level of subjectivity and is rarely used in real practice, although it is the most widely accepted metric for measuring psoriasis severity currently. OBJECTIVE This study aimed to develop an image–artificial intelligence (AI)–based validated system for severity assessment with the explicit intention of facilitating long-term management of patients with psoriasis. METHODS A deep learning system was trained to estimate the PASI score by using 14,096 images from 2367 patients with psoriasis. We used 1962 patients from January 2015 to April 2021 to train the model and the other 405 patients from May 2021 to July 2021 to validate it. A multiview feature enhancement block was designed to combine vision features from different perspectives to better simulate the visual diagnostic method in clinical practice. A classification header along with a regression header was simultaneously applied to generate PASI scores, and an extra cross-teacher header after these 2 headers was designed to revise their output. The mean average error (MAE) was used as the metric to evaluate the accuracy of the predicted PASI score. By making the model minimize the MAE value, the model becomes closer to the target value. Then, the proposed model was compared with 43 experienced dermatologists. Finally, the proposed model was deployed into an app named SkinTeller on the WeChat platform. RESULTS The proposed image-AI–based PASI-estimating model outperformed the average performance of 43 experienced dermatologists with a 33.2% performance gain in the overall PASI score. The model achieved the smallest MAE of 2.05 at 3 input images by the ablation experiment. In other words, for the task of psoriasis severity assessment, the severity score predicted by our model was close to the PASI score diagnosed by experienced dermatologists. The SkinTeller app has been used 3369 times for PASI scoring in 1497 patients from 18 hospitals, and its excellent performance was confirmed by a feedback survey of 43 dermatologist users. CONCLUSIONS An image-AI–based psoriasis severity assessment model has been proposed to automatically calculate PASI scores in an efficient, objective, and accurate manner. The SkinTeller app may be a promising alternative for dermatologists’ accurate assessment in the real world and chronic disease self-management in patients with psoriasis.

With the feedback rotor speed outer-loop PI control, the mechanism analysis of SMES-based power oscillation damping is derived by the small signal and classical electric torque method in this research. Theoretical analysis shows that adjusting the proportional and integral can equivalently dominate the damping ability and synchronization level. However, the conventional PI may cause the deep charging-discharging so that the power oscillation damping failure. To this end, the proportional integral controller with integral alleviation (PI-IA) controller is designed to address this issue, which not only ensures energy deviation-free of SMES, but also holds the advantage of PI controller. Moreover, the effectiveness of the proposed controller and the validity of the mechanism analysis are performed by the time-domain simulation.

The dual mobility cup (DMC) is designed to extend the longevity of the prosthesis by improving stability, enhancing the range of motion, and decreasing impingement without increasing wear. We hypothesized that DMC would reduce the risk of dislocation in elderly patients. This study aimed to investigate the clinical and radiographic outcomes of DMC-total hip arthroplasty (THA) in elderly patients at high risk of dislocation.From June 2016 to March 2020, 94 patients with a mean age of 77.7 years (97 hips) who underwent a posterolateral approach for DMC-THA in our department were followed up for at least one year. Preoperative and postoperative pelvic tilt angles (PTA) and DMC orientation were prospectively collected for all patients. Intraoperative and postoperative complications were recorded. A parametric test was used for normal distribution, and a non-parametric test was used for non-normal distribution.Abduction and anteversion angles of the cup were 42.4 and 18.0° in the supine position immediately postoperative. The average PTA for patients in the supine and standing positions were 26.5 and 34.5°, respectively. When moving from the supine to the standing position, patients experienced a mean posterior pelvic tilt of 9°. No intraoperative acetabular-related complications were recorded. Postoperative complications included early infection in one patient (1.0%) and dislocation in one patient (1.0%).Our study demonstrates that DMC-THA provides satisfactory short-term outcomes in elderly patients at a high risk of dislocation, regardless of the change in PTA resulting from postural transition.

Using sulfur mustard analog 2-chloroethyl ethyl sulfide (CEES), we established an

Sulfur mustard (a type of vesicant) can directly damage lung bronchial epithelium via aerosol inhalation, and prevalent cell death is an early event that obstructs the respiratory tract. JNK/c-Jun is a stress response pathway, but its role in cell death of the injured cells is not clear. Here, we report that JNK/c-Jun was activated in immortalized human bronchial epithelial (HBE) cells exposed to a lethal dose (20 μM) of nitrogen mustard (NM, a sulfur mustard analog). c-Jun silencing using small-interfering RNA (siRNA) rendered the cells resistant to NM-mediated cell death by blocking poly(ADP-ribose) polymerase 1 (PARP1) cleavage and DNA fragmentation. In addition, the transduction of upstream extrinsic (Fasl-Fas-caspase-8) and intrinsic (loss of Bcl-2 and mitochondrial membrane potential, ΔΨm) apoptosis pathways, as well as phosphorylated (p)-H2AX (Ser139), an epigenetic marker contributing to DNA fragmentation and PARP1 activity, was partially suppressed. To mimic the detachment of cells by NM, HBE cells were trypsinized and seeded on culture plates that were pre-coated with poly-HEMA to prevent cell adhesion. The JNK/c-Jun pathway was found to be activated in the detached cells. In conclusion, our results indicate that JNK/c-Jun pathway activation is necessary for NM-caused HBE cell death and further suggest that c-Jun silencing may be a potential approach to protect HBE cells from vesicant damage.

Non-melanoma skin cancer (NMSC) is the most common malignancy. Photodynamic therapy (PDT) is effective for the treatment of certain NMSCs. However, the clinical response rates of some NMSCs to single PDT are still far from ideal. The reason may be that PDT has shown limited efficacy in managing thicker NMSCs. To explore the efficacy and safety of dermabrasion combined with PDT (D-PDT) for the treatment of NMSCs. This was a retrospective, single-arm, multi-centre study. In total, 172 tumours from 40 patients were treated with D-PDT during the study period. The mean follow-up period was 40 months (range 15–110 months). D-PDT was performed with 633-nm red light at 80 m W/cm2 after lesion dermabrasion and 4 h of photosensitizer exposure. Six nodular basal cell carcinomas (nBCCs) from 6 patients, 9 squamous cell carcinomas (SCCs) from 9 patients, 17 Bowen diseases (BDs) from 10 patients and 140 actinic keratoses (AKs) from 15 patients treated with D-PDT were examined in this study. Only two patients with three AKs experienced recurrence over 12 months. The mean final follow-up periods of patients with AKs, BDs, nBCCs and SCCs were 30, 33, 45 and 60 months, respectively. Thirty-four of the 40 patients treated with D-PDT reported excellent or good cosmetic results. The mean Dermatology Life Quality Index (DLQI) scores of the patients improved significantly after treatment (estimated MD 9.72 [95% CI 8.69 to 10.75]; p

Camera-based remote photoplethysmography (rPPG) technology has shown a promising future in contact-free cardiac and other smart health applications. The rPPG technology typically requires facial videos as a source input, which may lead to identity-privacy concerns. Facial videos are sensitive and contain subjects' identifiable appearance features. Coupled with the health information potentially revealed by rPPG techniques, the compounding sensitivity has been a major obstacle to encouraging the sharing of facial rPPG video datasets in the research community to foster the advancement of the field. This paper investigates a suite of anonymization transforms that remove the identifiable appearance features in facial videos and retain the physiological signals for rPPG analysis. After the transformation, the facial videos are de-identified and may be shared in public with little risk of identity-privacy leakage. The proposed algorithm offers tunable options to balance the physiological fidelity and the identity-protecting strength to meet different levels of privacy requirements. A human subject study has been carried out to understand -- both qualitatively and quantitatively -- the perceived strength and efficacy of privacy protection by these anonymization techniques in de-identifying the facial videos and maintaining the physiological signals.

The recurrence of cutaneous squamous cell carcinoma (cSCC) after surgery remains a key factor affecting cSCC outcomes, which is related to the reprogramming of the tumour microenvironment (TME). Herein, we utilized single-cell RNA sequencing (scRNA-seq) to examine the dynamic changes in epithelial cells, T cells, myeloid cells and fibroblasts between primary and recurrent cSCC. We uncovered the immunosuppressed microenvironment in recurrent cSCC, which exhibited a T-cell- excluded and SPP1+ TAM-enriched status. In recurrent cSCC, CD8+ T cells showed high exhaustion and low inflammatory features, while SPP1+ TAMs displayed global protumour characteristics, including decreased phagocytosis and inflammation as well as increased angiogenesis. Furthermore, we found that the subgroups of SPP1+ tumour- associated macrophages (TAMs) harboured distinct functions. SPP1+ CD209high TAMs showed obvious features of phagocytosis, while SPP1+ CD209low TAMs tended to have a high angiogenic ability. A subpopulation of tumour-specific keratinocytes (TSKs) showed significant epithelial–mesenchymal transition (EMT) features in recurrent cSCC, which might be due to their active communication with IL7R+ cancer-associated fibroblasts (CAFs). In addition, we found that MDK could provoke different cell–cell interactions in cSCCs with distinctive staging. In primary cSCC, MDK was highly expressed in fibroblasts and could promote their proliferation and block the migration of tumour cells, while in recurrent cSCC, the high expression of MDK in TSKs promotes their proliferation and metastasis. Overall, our study provides insights into the critical mechanisms of cSCC progression, which might facilitate the development of a powerful system for the prevention and treatment of cSCC recurrence.

Background The arthroscopic Broström–Gould procedure (ABG) gained particular attention among clinicians and researchers due to its high rate of satisfactory results. There is a lack of evidence regarding the differences in clinical outcomes for the various suture techniques. The purpose of this study was to compare the differences in clinical effect in patients treated with one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture for chronic ankle instability (CAI). Methods This retrospective cohort study examined CAI patients who underwent either one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture ABG between January 2018 and January 2020. Patients were divided into two groups based on the suture knot type used and the associated number of anchors. The operative time, surgical cost, Visual Analog Scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) Score, Karlsson Ankle Functional Score (KAFS), the rate of return to sports, complications, and measured biomechanical strength using standardized equipment were compared between groups. Results Sixty-four CAI patients were included (one-anchor modified Mason–Allen suture group n = 30, two-anchor horizontal mattress suture group n = 34). Compared to the two-anchor horizontal mattress suture group, the one-anchor modified Mason–Allen suture group had significantly shorter operative time (p p p > .05) between the one-anchor modified Mason–Allen suture and two-anchor horizontal mattress suture at 2 years after surgery. Conclusion ABG using a one-anchor modified Mason–Allen suture showed comparable clinical results to a two-anchor horizontal mattress suture in the treatment of CAI at intermediate-term follow-up time. However, one-anchor modified Mason–Allen suture may be a faster, simpler, cost-effective substitute technology. Level of evidence Level III, comparative study.

Invasive meningococcal disease (IMD) due to serogroup Y Neisseria meningitidis (NmY) is rare in China; recently, an invasive NmY isolate, Nm512, was discovered in Shanghai with decreased susceptibility to penicillin (Pen(NS)). Here, we investigated the epidemiology of NmY isolates in Shanghai and explored the potential commensal Neisseria lactamica donor of the Pen(NS) NmY isolate. A total of 491 N. meningitidis and 724 commensal Neisseria spp. isolates were collected. Eleven NmY isolates were discovered from IMD (n = 1) and carriers (n = 10), including two Pen(NS) isolates with five-key-mutation-harboring (F504L-A510V-I515V-H541N-I566V) penA genes. Five of the eight ST-175 complex (CC175) isolates had a genotype [Y:P1.5-1,2-2:F5-8:ST-175(CC175)] identical to that of the predominant invasive clone found in South Africa. Only one invasive NmY CC23 isolate (Nm512) was discovered; this isolate carried a novel Pen(NS) penA832 allele, which was identified in commensal N. lactamica isolates locally. Recombination analysis and transformation of the penA allele highlighted that N. meningitidis Nm512 may acquire resistance from its commensal donor; this was supported by the similar distribution of transformation-required DNA uptake sequence variants and the highly cognate receptor ComP between N. meningitidis and N. lactamica. In 2,309 NmY CC23 genomes from the PubMLST database, isolates with key-mutation-harboring penA genes comprised 12% and have been increasing since the 1990s, accompanied by recruitment of the bla(ROB-1) and/or quinolone resistance allele. Moreover, penA22 was predominant among genomes without key mutations in penA. These results strongly suggest that Nm512 is a descendant of the penA22-harboring CC23 isolate from Europe and acquired its penicillin resistance locally from commensal N. lactamica species by natural transformation.

Cemented polished tapered femoral stems (PTS) made of cobalt–chrome alloy (CoCr) are a known risk factor for periprosthetic fracture (PPF). The mechanical differences between CoCr-PTS and stainless-steel (SUS) PTS were investigated. CoCr stems having the same shape and surface roughness as the SUS Exeter® stem were manufactured and dynamic loading tests were performed on three each. Stem subsidence and the compressive force at the bone–cement interface were recorded. Tantalum balls were injected into the cement, and their movement was tracked to indicate cement movement. Stem motions in the cement were greater for the CoCr stems than for the SUS stems. In addition, although we found a significant positive correlation between stem subsidence and compressive force in all stems, CoCr stems generated a compressive force over three times higher than SUS stems at the bone–cement interface with the same stem subsidence (p < 0.01). The final stem subsidence amount and final force were greater in the CoCr group (p < 0.01), and the ratio of tantalum ball vertical distance to stem subsidence was significantly smaller for CoCr than for SUS (p < 0.01). CoCr stems appear to move more easily in cement than SUS stems, which might contribute to the increased occurrence of PPF with the use of CoCr-PTS.

Background Psoriasis is one of the most frequent inflammatory skin conditions and could be treated via tele-dermatology, provided that the current lack of reliable tools for objective severity assessments is overcome. Psoriasis Area and Severity Index (PASI) has a prominent level of subjectivity and is rarely used in real practice, although it is the most widely accepted metric for measuring psoriasis severity currently. Objective This study aimed to develop an image–artificial intelligence (AI)–based validated system for severity assessment with the explicit intention of facilitating long-term management of patients with psoriasis. Methods A deep learning system was trained to estimate the PASI score by using 14,096 images from 2367 patients with psoriasis. We used 1962 patients from January 2015 to April 2021 to train the model and the other 405 patients from May 2021 to July 2021 to validate it. A multiview feature enhancement block was designed to combine vision features from different perspectives to better simulate the visual diagnostic method in clinical practice. A classification header along with a regression header was simultaneously applied to generate PASI scores, and an extra cross-teacher header after these 2 headers was designed to revise their output. The mean average error (MAE) was used as the metric to evaluate the accuracy of the predicted PASI score. By making the model minimize the MAE value, the model becomes closer to the target value. Then, the proposed model was compared with 43 experienced dermatologists. Finally, the proposed model was deployed into an app named SkinTeller on the WeChat platform. Results The proposed image-AI–based PASI-estimating model outperformed the average performance of 43 experienced dermatologists with a 33.2% performance gain in the overall PASI score. The model achieved the smallest MAE of 2.05 at 3 input images by the ablation experiment. In other words, for the task of psoriasis severity assessment, the severity score predicted by our model was close to the PASI score diagnosed by experienced dermatologists. The SkinTeller app has been used 3369 times for PASI scoring in 1497 patients from 18 hospitals, and its excellent performance was confirmed by a feedback survey of 43 dermatologist users. Conclusions An image-AI–based psoriasis severity assessment model has been proposed to automatically calculate PASI scores in an efficient, objective, and accurate manner. The SkinTeller app may be a promising alternative for dermatologists’ accurate assessment in the real world and chronic disease self-management in patients with psoriasis.

Photodynamic therapy (PDT) is widely used in skin diseases; the response rate of PDT treatment varies widely. The limited penetration in the tissue of photosensitizers influenced the penetration depth of PDT, which obviously impacts the therapeutic effect. The studies have improved the efficacy of PDT through various pretreatment applications; especially, the physical pretreatment had achieved significant outcomes. We will review the physical pretreatment to optimize the efficacy of PDT in skin diseases by searching the literature on this topic. The types of physical pretreatment commonly used in the clinical practice are discussed: curettage, superficial shaving, laser, surgical resection, plum-blossom needles, and microneedles. Compared with PDT alone, the physical pretreatment before PDT application was generally improved the efficacy and reduced the recurrence, especially in actinic keratoses (AK), Bowen disease (BD), basal cell carcinoma (BCC), and viral warts. The application of the physical pretreatments before PDT may improve the efficacy of PDT in various skin diseases. However, each kind of physical pretreatment has the benefit and shortcoming, and the applicable situation is different.

ObjectiveThis study aimed to describe the economic burden of Chinese patients with melanoma in Hunan province of China, and to investigate the factors for hospitalization spending and length of stay (LOS) in patients undergoing melanoma surgery.MethodsData was extracted from the Chinese National Health Statistics Network Reporting System database in Hunan province during 2017–2019. Population and individual statistics were presented, and nonparametric tests and quantile regression were used to analyze the factors for spending and LOS.ResultA total of 2,644 hospitalized patients with melanoma in Hunan were identified. During 2017–2019, the total hospitalization spending was $5,247,972, and out-of-pocket payment (OOP) was $1,817,869, accounting for 34.6% of the total expenditure. The median spending was $1,123 [interquartile range (IQR): $555–2,411] per capita, and the median LOS was 10 days (IQR: 5–18). A total of 1,104 patients who underwent surgery were further analyzed. The non-parametric tests and quantile regression showed that women were associated with less spending and LOS than men. In general, patients aged 46–65 and those with lesions on the limbs had higher hospitalization costs and LOS than other subgroups.ConclusionMelanoma causes heavy economic burdens on patients in Hunan, such that the median spending is close to 60% of the averagely annual disposable income. Middle-aged men patients with melanoma on the limbs present the highest financial burden of melanoma.