Search

Wilson C Lai,1 Hunter L Bohlen,1 Nathan P Fackler,1,2 Dean Wang1,3 1Department of Orthopaedic Surgery, UCI Health, Orange, CA, USA; 2Georgetown University School of Medicine, Washington, DC, USA; 3Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USACorrespondence: Dean Wang, Department of Orthopaedic Surgery, UCI Health, 101 The City Drive S. Pavilion III, 2nd Floor, Orange, CA, 92868, USA, Tel +1 714-456-7012, Email deanwangmd@gmail.comAbstract: Knee articular cartilage defects can result in significant pain and loss of function in active patients. Osteochondral allograft (OCA) transplantation offers a single-stage solution to address large chondral and osteochondral defects by resurfacing focal cartilage defects with mature hyaline cartilage. To date, OCA transplantation of the knee has demonstrated excellent clinical outcomes and long-term survivorship. However, significant variability still exists among clinicians with regard to parameters for graft acceptance, surgical technique, and rehabilitation. Technologies to optimize graft viability during storage, improve osseous integration of the allograft, and shorten recovery timelines after surgery continue to evolve. The purpose of this review is to examine the latest evidence on treatment indications, graft storage and surgical technique, patient outcomes and survivorship, and rehabilitation after surgery.Keywords: cartilage, osteochondral allograft transplantation, survivorship, outcomes, rehabilitation

The Daya Bay experiment consists of functionally identical antineutrino detectors immersed in pools of ultrapure water in three well-separated underground experimental halls near two nuclear reactor complexes. These pools serve both as shields against natural, low-energy radiation, and as water Cherenkov detectors that efficiently detect cosmic muons using arrays of photomultiplier tubes. Each pool is covered by a plane of resistive plate chambers as an additional means of detecting muons. Design, construction, operation, and performance of these muon detectors are described.

A new measurement of the $\theta_{13}$ mixing angle has been obtained at theDaya Bay Reactor Neutrino Experiment via the detection of inverse beta decaystagged by neutron capture on hydrogen. The antineutrino events for hydrogencapture are distinct from those for gadolinium capture with largely differentsystematic uncertainties, allowing a determination independent of thegadolinium-capture result and an improvement on the precision of $\theta_{13}$measurement. With a 217-day antineutrino data set obtained with sixantineutrino detectors and from six 2.9 GW$_{th}$ reactors, the rate deficitobserved at the far hall is interpreted as $\sin^22\theta_{13}=0.083\pm0.018$in the three-flavor oscillation model. When combined with thegadolinium-capture result from Daya Bay, we obtain$\sin^22\theta_{13}=0.089\pm0.008$ as the final result for thesix-antineutrino-detector configuration of the Daya Bay experiment.

A new measurement of the $\theta_{13}$ mixing angle has been obtained at theDaya Bay Reactor Neutrino Experiment via the detection of inverse beta decaystagged by neutron capture on hydrogen. The antineutrino events for hydrogencapture are distinct from those for gadolinium capture with largely differentsystematic uncertainties, allowing a determination independent of thegadolinium-capture result and an improvement on the precision of $\theta_{13}$measurement. With a 217-day antineutrino data set obtained with sixantineutrino detectors and from six 2.9 GW$_{th}$ reactors, the rate deficitobserved at the far hall is interpreted as $\sin^22\theta_{13}=0.083\pm0.018$in the three-flavor oscillation model. When combined with thegadolinium-capture result from Daya Bay, we obtain$\sin^22\theta_{13}=0.089\pm0.008$ as the final result for thesix-antineutrino-detector configuration of the Daya Bay experiment.

A search for light sterile neutrino mixing was performed with the first 217 days of data from the Daya Bay Reactor Antineutrino Experiment. The experiment's unique configuration of multiple baselines from six 2.9 GW(th) nuclear reactors to six antineutrino detectors deployed in two near (effective baselines 512 m and 561 m) and one far (1579 m) underground experimental halls makes it possible to test for oscillations to a fourth (sterile) neutrino in the 10(-3) eV(2)

A measurement of the energy dependence of antineutrino disappearance at the Daya Bay reactor neutrino experiment is reported. Electron antineutrinos (ν¯(e)) from six 2.9  GW(th) reactors were detected with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls. Using 217 days of data, 41 589 (203 809 and 92 912) antineutrino candidates were detected in the far hall (near halls). An improved measurement of the oscillation amplitude sin(2)2θ(13)=0.090(-0.009)(+0.008) and the first direct measurement of the ν¯(e) mass-squared difference |Δm(ee)2|=(2.59(-0.20)(+0.19))×10(-3)  eV2 is obtained using the observed ν¯(e) rates and energy spectra in a three-neutrino framework. This value of |Δm(ee)2| is consistent with |Δm(μμ)2| measured by muon neutrino disappearance, supporting the three-flavor oscillation model.

The Daya Bay Reactor Neutrino Experiment was designed to achieve a sensitivity on the value of sin22θ13 to better than 0.01 at 90% CL. The experiment consists of eight antineutrino detectors installed underground at different baselines from six nuclear reactors. With data collected with six antineutrino detectors for 55 days, Daya Bay announced the discovery of a non-zero value for sin22θ13 with a significance of 5.2 standard deviations in March 2012. The most recent analysis with 139 days of data acquired in a six-detector configuration yields sin22θ13=0.089±0.010(stat.)±0.005(syst.), which is the most precise measurement of sin22θ13 to date. © 2013.

We report an improved measurement of the neutrino mixing angle θ13 from the Daya Bay Reactor Neutrino Experiment. We exclude a zero value for sin22θ13 with a significance of 7.7 standard deviations. Electron antineutrinos from six reactors of 2.9 GW th were detected in six antineutrino detectors deployed in two near (flux-weighted baselines of 470 m and 576 m) and one far (1648 m) underground experimental halls. Using 139 days of data, 28909 (205308) electron antineutrino candidates were detected at the far hall (near halls). The ratio of the observed to the expected number of antineutrinos assuming no oscillations at the far hall is 0.944±0.007(stat.)±0.003(syst.). An analysis of the relative rates in six detectors finds sin22θ13=0. 089±0.010(stat.)±0.005(syst.) in a three-neutrino framework. © 2013 Chinese Physical Society and the Institute of High Energy Physics of the Chinese Academy of Sciences and the Institute of Modern Physics of the Chinese Academy of Sciences and IOP Publishing Ltd.

Wilson C Lai,1 Brandon J Erickson,2 Ryan A Mlynarek,3 Dean Wang4 1David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Rothman Institute, New York, NY, USA; 3IHA Orthopaedic Specialists, Ann Arbor, MI, USA; 4Department of Orthopaedic Surgery, UC Irvine Health, Orange, CA, USA Abstract: Lateral epicondylitis (LE) is a significant source of pain and dysfunction resulting from repetitive gripping or wrist extension, radial deviation, and/or forearm supination. Although most cases are self-limiting over several years, controversy exists regarding the best treatment strategy for chronic LE. Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques. In this review, the current evidence behind these treatment strategies is presented. The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE. Biologics such as platelet-rich plasma and autologous whole-blood injections may be superior to steroid injections in the long-term management of LE. Although the initial results are promising, larger comparative studies on stem cell injections are needed. For refractory LE, open, arthroscopic, and percutaneous techniques are all highly effective, with no method seemingly superior over another. Arthroscopic and percutaneous approaches may result in faster recovery and earlier return to work. Keywords: lateral epicondylitis, tennis elbow, shockwave, injection, biologics, platelet-rich plasma, stem cells, surgery

Tetrabromobisphenol A (TBBPA), a brominated flame retardant (BFR), has been implicated as the neurotoxic effects in mammalian. However, the exact mechanisms underlying TBBPA-induced neurotoxicity remain unclear. In the present study, Neuro-2a cells, a mouse neural crest-derived cell line, were used to examine the mechanism of TBBPA-induced neuronal cytotoxicity. TBBPA exposure caused alterations in cell viability and mitochondrial membrane potential (MMP) and induction of apoptotic events, such as increased apoptotic cell population and cleaved caspase-3, -7, -9, and poly (ADP-ribose) polymerase (PARP) protein expression). TBBPA exposure triggered CCAAT/enhancer-binding protein (C/EBP) homologous protein (CHOP) activation. Transfection with CHOP-specific small interfering RNA (siRNA) obviously prevented the expression of CHOP protein and markedly attenuated MMP loss, and caspase-3 and -7 activation in TBBPA-exposed Neuro-2a cells. In addition, TBBPA exposure significantly evoked the phosphorylation of c-Jun N-terminal kinase (JNK), extracellular-signal regulated kinase1/2 (ERK1/2), p38-mitogen-activated protein kinase (p38-MAPK), and AMP-activated protein kinase (AMPK)α proteins. Pretreatment of cells with pharmacological inhibitors of p38-MAPK (SB203580) and AMPK (compound C), but not inhibitors of JNK (SP600125) or ERK1/2 (PD98059), effectively prevented the increase in caspase-3 activity, MMP loss, and activated CHOP and cleaved caspase-3 and -7 protein expression in TBBPA-treated cells. Notably, transfection with either p38α-MAPK- or AMPKα1/2-specific siRNAs markedly attenuated the expression of CHOP, and cleaved caspase-3 and -7. Interestingly, transfection with each siRNA significantly reduced the TBBPA-induced phosphorylation of p38-MAPK and AMPKα proteins. Collectively, these findings suggest that CHOP activation-mediated mitochondria-dependent apoptosis contributes to TBBPA-induced neurotoxicity. An interdependent p38-MAPK and AMPKα signaling-regulated apoptotic pathway may provide new insights into the mechanism understanding TBBPA-elicited neurotoxicity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Zinc (Zn)-based materials are cost-effective and promising single-metal catalysts for CO 2 electroreduction to CO but is still challenged by low selectivity and long-term stability. Undercoordinated Zn (Zn δ+ ) sites have been demonstrated to be powerful active centers with appropriate * COOH affinity for efficient CO production However, electrochemical reduction conditions generally cause the inevitable reduction of Zn δ+ , resulting in the decline of CO efficiency over prolonged operation. Herein, a Zn cyanamide (ZnNCN) catalyst is constructed for highly selective and durable CO 2 electroreduction, wherein the delocalized Zn d-electrons and resonant structure of cyanamide ligand prevent the self-reduction of ZnNCN and maintain Zn δ+ sites under cathodic conditions. The mechanism studies based on density functional theory and operando spectroscopies indicate that delocalized Zn δ+ site can stabilize the key * COOH intermediate through hard-soft acid-base theory, therefore thermodynamically promoting CO 2 -to-CO conversion. Consequently, ZnNCN delivers a CO Faradaic efficiency (FE) of up to 93.9% and further exhibits a remarkable stability lifespan of 96 h, representing a significant advancement in developing robust Zn-based electrocatalysts. Beyond expanding the variety of CO 2 reduction catalysts, this work also offers insights into understanding the structure-function sensitivity and controlling dynamic active sites., (© 2024 Wiley‐VCH GmbH.)

Background : Post-marketing surveillance is crucial for gathering data on vaccine reactogenicity, enhancing public trust in immunization, and promoting vaccine uptake. This study aims to characterize adverse events following immunization (AEFIs) and estimate the incidence rates of adverse reactions (ARs) associated with vaccines included in Taiwan's Expanded Program on Immunization (EPI). This study utilizes data from Taiwan's Vaccine Injury Compensation Program (VICP). Methods : Vaccine injury claims submitted to the VICP between 2014 and 2019 were analyzed. ARs were defined as AEFIs adjudicated as "related" or "indeterminate" by the VICP committee. Data on the annual number of vaccine doses administered were obtained from the Taiwan CDC, which helped calculate the AR incidence rates. Results : A total of 491 AEFI claims were reviewed, with 327 (66.6%) categorized as ARs. The AEFIs were mainly associated with the Bacillus Calmette-Guérin (BCG) vaccine (43.4%) and the seasonal influenza vaccine (22.0%). Most EPI vaccines demonstrated low AR incidence rates, ranging from 1.68 to 13.6 per million doses, with the exception of BCG, which exhibited 162.5 ARs per million doses. Shifting BCG immunization from below 5 months to at least 5 months reduced osteomyelitis incidence significantly, from 41.4 to 7.9 ( p = 0.0014), but increased abscess and lymphadenitis cases. Conclusions : EPI vaccines in Taiwan are highly safe, with minimal AR incidences in the general population. The BCG vaccine remains an exception, occasionally causing severe ARs like osteomyelitis. Adjusting the immunization schedule to an older age may mitigate some of these adverse effects.

Organic synaptic transistors are a promising technology for advanced electronic devices with simultaneous computing and memory functions and for the application of artificial neural networks. In this study, the neuromorphic electrical characteristics of organic synaptic electrolyte-gated transistors are correlated with the microstructural and interfacial properties of the active layers. This is accomplished by utilizing a semiconducting/insulating polyblend-based pseudobilayer with embedded source and drain electrodes, referred to as PB-ESD architecture. Three variations of poly(3-hexylthiophene) (P3HT)/poly(methyl methacrylate) (PMMA) PB-ESD-based organic synaptic transistors are fabricated, each exhibiting distinct microstructures and electrical characteristics, thus serving excellent samples for exploring the critical factors influencing neuro-electrical properties. Poor microstructures of P3HT within the active layer and a flat active layer/ion-gel interface correspond to typical neuromorphic behaviors such as potentiated excitatory postsynaptic current (EPSC), paired-pulse facilitation (PPF), and short-term potentiation (STP). Conversely, superior microstructures of P3HT and a rough active layer/ion-gel interface correspond to significantly higher channel conductance and enhanced EPSC and PPF characteristics as well as long-term potentiation behavior. Such devices were further applied to the simulation of neural networks, which produced a good recognition accuracy. However, excessive PMMA penetration into the P3HT conducting channel leads to features of a depressed EPSC and paired-pulse depression, which are uncommon in organic synaptic transistors. The inclusion of a second gate electrode enables the as-prepared organic synaptic transistors to function as two-input synaptic logic gates, performing various logical operations and effectively mimicking neural modulation functions. Microstructure and interface engineering is an effective method to modulate the neuromorphic behavior of organic synaptic transistors and advance the development of bionic artificial neural networks.

The preparation of solid polymer electrolytes (SPEs) using poly(ethylene oxide) (PEO) typically involves incorporating fillers or undergoing chemical modifications to reduce crystallinity and enhance conductivity. PEO with a lower molecular weight, known as polyethylene glycol (PEG), exhibits higher conductivity, despite weaker mechanical strength. It is commonly employed as a plasticizer to improve the conductivity of SPEs or to fabricate PEG-based gel polymer electrolytes (GPEs). In this study, we use a straightforward approach to create innovative SPEs by blending liquid polymer electrolytes (LPEs), particularly low-molecular-weight polyethylene glycol (PEG), with a molecular weight of 400 g/mol, and sustainable poly(l-lactide) (PLLA). Solid PEG/PLLA forms are achieved by introducing 30 wt % of PLLA. Subsequently, the addition of lithium salts results in the development of novel PEG/PLLA SPEs. Another focal point of this study involves incorporating 1,3:2,4-dibenzylidene sorbitol (DBS) into these PEG/PLLA systems. DBS, an organic gelator derived from natural sugars, demonstrates self-assembly, leading to the formation of a nanofibrillar network structure. Leveraging DBS's ability to form organogels in liquid organic environments, we facilitate the transformation of low PLLA content LPEs into innovative solvent-free GPEs. Our prepared PEG/PLLA SPEs exhibited a maximum conductivity value of 4.39 × 10 -5 S/cm, approximately five times higher than that of neat PEG (10000 g/mol) SPEs. The ionic conductivity exhibited a declining trend as the content of PLLA and DBS increased. However, there was an improvement in electrochemical stability. Furthermore, the incorporation of PLLA and DBS into electrolytes contributed to enhanced mechanical support and stability within the electrolyte layer. This, in turn, mitigated capacity decay and improved the cycling performance of assembled lithium-ion cells.

Mammalian cell line stability is an important consideration when establishing a biologics manufacturing process in the biopharmaceutical and in vitro diagnostics (IVD) industries. Traditional Chinese hamster ovary (CHO) cell line development methods use a random integration approach that requires transfection, selection, optional amplification, screenings, and single-cell cloning to select clones with acceptable productivity, product quality, and genetic stability. Site-specific integration reduces these disadvantages, and new technologies have been developed to mitigate risks associated with genetic instability. In this study, we applied the Leap-In® transposase-mediated expression system from ATUM to generate stable CHOK1 pools for the production of four recombinant antibody reagents for IVD immunoassays. CHO cell line stability is defined by consistent antibody production over time. Three of the CHOK1 pools maintained productivity suitable for manufacturing, with high antibody yields. The productivity of the remaining CHOK1 pool decreased over time; however, derivative clones showed acceptable stability. l-glutamine had variable effects on CHOK1 cell line or stable pool stability and significantly affected antibody product titer. Compared with traditional random integration methods, the ATUM Leap-In system can reduce the time needed to develop new immunoassays by using semi site-specific integration to generate high-yield stable pools that meet manufacturing stability requirements.

Abstract: The implementation of the National Health Insurance has transformed the medical care landscape in Taiwan, rendering perceived medical service quality (PMSQ) and patient satisfaction significant focal points in medical care management. Past studies mostly focused on the technical aspects of medical care services, while overlooking the patients' perception of services and the delivery process of PMSQ in the medical care experience. This study integrated the theoretical framework of the Donabedian SPO model and the SERVQUAL questionnaire. The survey was conducted among the outpatients of three types of medical institutions in northern Taiwan: academic medical centers, metropolitan hospitals, and local community hospitals. A total of 400 questionnaires were collected, and 315 valid questionnaires remained after eliminating the incomplete ones. This study established a PMSQ delivery model to explore patients' perceptions of medical service quality. It was found that the variable, Assurance, could deliver the PMSQ and enhance the Medical outcome (MO), while improving the variable, Tangible, in medical institutions could not significantly enhance the MO. These findings emphasize the importance of healthcare institutions prioritizing the professional background, demeanor of their healthcare staff, treatment methods, and processes over tangible elements., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the National Association for Healthcare Quality.)

Magnetic Resonance Imaging (MRI) datasets from epidemiological studies often show a lower prevalence of motion artifacts than what is encountered in clinical practice. These artifacts can be unevenly distributed between subject groups and studies which introduces a bias that needs addressing when augmenting data for machine learning purposes. Since unreconstructed multi-channel k-space data is typically not available for population-based MRI datasets, motion simulations must be performed using signal magnitude data. There is thus a need to systematically evaluate how realistic such magnitude-based simulations are. We performed magnitude-based motion simulations on a dataset (MR-ART) from 148 subjects in which real motion-corrupted reference data was also available. The similarity of real and simulated motion was assessed by using image quality metrics (IQMs) including Coefficient of Joint Variation (CJV), Signal-to-Noise-Ratio (SNR), and Contrast-to-Noise-Ratio (CNR). An additional comparison was made by investigating the decrease in the Dice-Sørensen Coefficient (DSC) of automated segmentations with increasing motion severity. Segmentation of the cerebral cortex was performed with 6 freely available tools: FreeSurfer, BrainSuite, ANTs, SAMSEG, FastSurfer, and SynthSeg+. To better mimic the real subject motion, the original motion simulation within an existing data augmentation framework (TorchIO), was modified. This allowed a non-random motion paradigm and phase encoding direction. The mean difference in CJV/SNR/CNR between the real motion-corrupted images and our modified simulations (0.004±0.054/-0.7±1.8/-0.09±0.55) was lower than that of the original simulations (0.015±0.061/0.2±2.0/-0.29±0.62). Further, the mean difference in the DSC between the real motion-corrupted images was lower for our modified simulations (0.03±0.06) compared to the original simulations (-0.15±0.09). SynthSeg+ showed the highest robustness towards all forms of motion, real and simulated. In conclusion, reasonably realistic synthetic motion artifacts can be induced on a large-scale when only magnitude MR images are available to obtain unbiased data sets for the training of machine learning based models., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: HO is currently employed by Philips Healthcare. Remaining authors have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Olsson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Paraquat (PQ), a toxic and nonselective bipyridyl herbicide, is one of the most extensively used pesticides in agricultural countries. In addition to pneumotoxicity, the liver is an important target organ for PQ poisoning in humans. However, the mechanism of PQ in hepatotoxicity remains unclear. In this study, we found that exposure of rat hepatic H4IIE cells to PQ (0.1-2 mM) induced significant cytotoxicity and apoptosis, which was accompanied by mitochondria-dependent apoptotic signals, including loss of mitochondrial membrane potential (MMP), cytosolic cytochrome c release, and changes in the Bcl-2/Bax mRNA ratio. Moreover, PQ (0.5 mM) exposure markedly induced JNK and ERK1/2 activation, but not p38-MAPK. Blockade of JNK and ERK1/2 signaling by pretreatment with the specific pharmacological inhibitors SP600125 and PD98059, respectively, effectively prevented PQ-induced cytotoxicity, mitochondrial dysfunction, and apoptotic events. Additionally, PQ exposure stimulated significant oxidative stress-related signals, including reactive oxygen species (ROS) generation and intracellular glutathione (GSH) depletion, which could be reversed by the antioxidant N -Acetylcysteine (NAC). Buffering the oxidative stress response with NAC also effectively abrogated PQ-induced hepatotoxicity, MMP loss, apoptosis, and phosphorylation of JNK and ERK1/2 protein, however, the JNK or ERK inhibitors did not suppress ROS generation in PQ-treated cells. Collectively, these results demonstrate that PQ exposure induces hepatic cell toxicity and death via an oxidative stress-dependent JNK/ERK activation-mediated downstream mitochondria-regulated apoptotic pathway., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The complicated chemical reactions involved in the production of the newer drug delivery systems have mainly impeded efforts to build successful targeted drug delivery systems for a prolonged duration of time. Nanosponges, a recently created colloidal system, have the potential to overcome issues with medication toxicity, decreased bioavailability, and drug release over a wide area because they can be modified to work with both hydrophilic and hydrophobic types of drugs. Nanosponges are small sized with a three-dimensional network having a porous cavity. They can be prepared easily by crosslinking cyclodextrins with different compounds. Due to Cyclodextrin's outstanding biocompatibility, stability, and safety, a number of Cyclodextrin-based drug delivery systems have been developed promptly. The nanosponge drug delivery system possesses various applications in various ailments such as cancer, autoimmune diseases, theranostic applications, enhanced bioavailability, stability, etc. This review elaborates on benefits and drawbacks, preparation techniques, factors affecting their preparation, characterization techniques, applications, and most current developments in nanosponges., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Purpose: To evaluate the 30-day complication rates after arthroscopic meniscus repair and meniscectomy using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, with subgroup analysis of patients aged > 40 years., Methods: NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing arthroscopic meniscus repair (CPT 29882, 29883) and meniscectomy (29880, 29881). The following 30-day complications were assessed: pulmonary embolism (PE), venous thromboembolism (VTE), surgical site infection (SSI), reoperation, and readmission. Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and smoking/dyspnoea/COPD. A subgroup analysis was performed for patients aged > 40 years., Results: A total 6354 meniscus repairs and 99,372 meniscectomies were identified. Complication rates were < 1% for both meniscus repair and meniscectomy. Meniscus repair was associated with significantly higher rates of PE, VTE, and readmission compared to meniscectomy: PE (0.2% vs 0.1%, p < 0.001), VTE (0.8% vs 0.4%, p < 0.001), superficial SSI (0.1% vs 0.2%, n.s), deep SSI (0.07% vs 0.1%, n.s), reoperation (0.5% vs 0.4%, n.s), and readmission (0.9% vs 0.8%, p = 0.003). Among patients aged > 40 years, complication rates were < 1.3% for both meniscus repair and meniscectomy. Similar trends and rates were found in patients aged > 40 years undergoing meniscus repair versus meniscectomy: PE (0.38% vs 0.12%, p < 0.001), VTE (1.07% vs 0.46%, p < 0.001), superficial SSI (0.03% vs 0.19%, n.s), deep SSI (0.1% vs 0.06%, n.s), reoperation (0.48% vs 0.43%, n.s), and readmission (1.2% vs 0.85%, p = 0.01)., Conclusion: Arthroscopic meniscus repair and meniscectomy are both low-risk procedures with 30-day complication rates < 1% overall and < 1.3% among patients aged > 40 years. These findings support meniscus repair whenever feasible in the setting of preserved articular cartilage. Understanding of the short-term complication rates after arthroscopic meniscus repair and meniscectomy can aid surgeons in providing comprehensive preoperative counselling to patients considering such treatments, specifically when discussing the risks and benefits of meniscus repair., Level of Evidence: III., (© 2023. The Author(s).)

Membrane dialysis is one of the membrane contactors applied to wastewater treatment. The dialysis rate of a traditional dialyzer module is restricted because the solutes transport through the membrane only by diffusion, in which the mass-transfer driving force across the membrane is the concentration gradient between the retentate and dialysate phases. A two-dimensional mathematical model of the concentric tubular dialysis-and-ultrafiltration module was developed theoretically in this study. The simulated results show that the dialysis rate improvement was significantly improved through implementing the ultrafiltration effect by introducing a trans-membrane pressure during the membrane dialysis process. The velocity profiles of the retentate and dialysate phases in the dialysis-and-ultrafiltration system were derived and expressed in terms of the stream function, which was solved numerically by the Crank-Nicolson method. A maximum dialysis rate improvement of up to twice that of the pure dialysis system (Vw=0) was obtained by employing a dialysis system with an ultrafiltration rate of Vw=2 mL/min and a constant membrane sieving coefficient of θ=1. The influences of the concentric tubular radius, ultrafiltration fluxes and membrane sieve factor on the outlet retentate concentration and mass transfer rate are also illustrated.

Liver cancer ranks as the sixth most prevalent cancer among all cancers globally. Computed tomography (CT) scanning is a non-invasive analytic imaging sensory system that provides greater insight into human structures than traditional X-rays, which are typically used to make the diagnosis. Often, the final product of a CT scan is a three-dimensional image constructed from a series of interlaced two-dimensional slices. Remember that not all slices deliver useful information for tumor detection. Recently, CT scan images of the liver and its tumors have been segmented using deep learning techniques. The primary goal of this study is to develop a deep learning-based system for automatically segmenting the liver and its tumors from CT scan pictures, and also reduce the amount of time and labor required by speeding up the process of diagnosing liver cancer. At its core, an Encoder-Decoder Network (En-DeNet) uses a deep neural network built on UNet to serve as an encoder, and a pre-trained EfficientNet to serve as a decoder. In order to improve liver segmentation, we developed specialized preprocessing techniques, such as the production of multichannel pictures, de-noising, contrast enhancement, ensemble, and the union of model predictions. Then, we proposed the Gradational modular network (GraMNet), which is a unique and estimated efficient deep learning technique. In GraMNet, smaller networks called SubNets are used to construct larger and more robust networks using a variety of alternative configurations. Only one new SubNet modules is updated for learning at each level. This helps in the optimization of the network and minimizes the amount of computational resources needed for training. The segmentation and classification performance of this study is compared to the Liver Tumor Segmentation Benchmark (LiTS) and 3D Image Rebuilding for Comparison of Algorithms Database (3DIRCADb01). By breaking down the components of deep learning, a state-of-the-art level of performance can be attained in the scenarios used in the evaluation. In comparison to more conventional deep learning architectures, the GraMNets generated here have a low computational difficulty. When associated with the benchmark study methods, the straight forward GraMNet is trained faster, consumes less memory, and processes images more rapidly.

Upper extremity amputations represent a prime opportunity to restore function through replantation. There are a variety of options that treating surgeons use to protect neurovascular repairs and restore function including Kirschner wire fixation, external fixation, wrist arthrodesis, and proximal row carpectomy. Additionally, the dorsal spanning plate may be a valuable tool for protecting neurovascular repairs. Compared to temporary immobilization with Kirschner wire fixation, which has previously been described in conjunction with upper extremity replantation, dorsal spanning plates can be left in place for longer durations with a lower risk of loosening and loss of fixation and for preventing postoperative sabotage or repeat amputation of the replant by the patient. In this article, we describe a unique case of a patient with acute psychiatric illness that presented with a self-inflicted amputation through the radiocarpal joint and was initially treated with emergent replantation and application of a dorsal spanning plate to protect the neurovascular repair from patient sabotage and allow for early rehabilitation. We found the dorsal spanning plate to be an effective option in this complex clinical scenario. This case illustrates the utility of the dorsal spanning plate in protecting complex neurovascular repairs in the setting of severe skeletal and psychiatric instability., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Lai et al.)

Driving safely is crucial to avoid death, injuries, or financial losses that can be sustained in an accident. Thus, a driver's physical state should be monitored to prevent accidents, rather than vehicle-based or behavioral measurements, and provide reliable information in this regard. Electrocardiography (ECG), electroencephalography (EEG), electrooculography (EOG), and surface electromyography (sEMG) signals are used to monitor a driver's physical state during a drive. The purpose of this study was to detect driver hypovigilance (drowsiness, fatigue, as well as visual and cognitive inattention) using signals collected from 10 drivers while they were driving. EOG signals from the driver were preprocessed to remove noise, and 17 features were extracted. ANOVA (analysis of variance) was used to select statistically significant features that were then loaded into a machine learning algorithm. We then reduced the features by using principal component analysis (PCA) and trained three classifiers: support vector machine (SVM), k-nearest neighbor (KNN), and ensemble. A maximum accuracy of 98.7% was obtained for the classification of normal and cognitive classes under the category of two-class detection. Upon considering hypovigilance states as five-class, a maximum accuracy of 90.9% was achieved. In this case, the number of detection classes increased, resulting in a reduction in the accuracy of detecting more driver states. However, with the possibility of incorrect identification and the presence of issues, the ensemble classifier's performance produced an enhanced accuracy when compared to others.

Systems for medical analytics and decision making that make use of multimodal intelligence are of critical importance in the field of healthcare. Liver cancer is one of the most frequent types of cancer and early identification of it is crucial for effective therapy. Liver tumours share the same brightness and contrast characteristics as their surrounding tissues. Likewise, irregular tumour shapes are a serious concern that varies with cancer stage and tumour kind. There are two main phases of tumour segmentation in the liver: identifying the liver, and then segmenting the tumour itself. Conventional interactive segmentation approaches, however, necessitate a high number of intensity levels, whereas recently projected CNN-based interactive segmentation approaches are constrained by low presentation on liver tumour images. This research provides a unique deep Learning based Segmentation with Coot Extreme Learning Model approach that shows high efficiency in results and also detects tumours from the publicly available data of liver images. Specifically, the study processes the initial segmentation with a small number of additional users clicks to generate an improved segmentation by incorporating inner boundary points through the proposed geodesic distance encoding method. Finally, classification is carried out using an Extreme Learning Model, with the classifier's parameters having been ideally chosen by means of the Coot Optimization algorithm (COA). On the 3D-IRCADb1 dataset, the research evaluates the segmentation quality metrics DICE and accuracy, finding improvements over approaches in together liver-coloured and tumour separation.

In recent years, lung cancer prediction is an essential topic for reducing the death rate of humans. In the literature section, some papers are reviewed that reduce the accuracy level during the prediction stage. Hence, in this paper, we develop a Multi-Process Remora Optimized Hyperparameters of Convolutional Neural Network (MPROH-CNN) aimed at lung cancer prediction. The proposed technique can be utilized to detect the CT images of the human lung. The proposed technique proceeds with four phases, including pre-processing, feature extraction and classification. Initially, the databases are collected from the open-source system. After that, the collected CT images contain unwanted noise, which affects classification efficiency. So, the pre-processing techniques can be considered to remove unwanted noise from the input images, such as filtering and contrast enhancement. Following that, the essential features are extracted with the assistance of feature extraction techniques such as histogram, texture and wavelet. The extracted features are utilized to classification stage. The proposed classifier is a combination of the Remora Optimization Algorithm (ROA) and Convolutional Neural Network (CNN). In the CNN, the ROA is utilized for multi process optimization such as structure optimization and hyperparameter optimization. The proposed methodology is implemented in MATLAB and performances are evaluated by utilized performance matrices such as accuracy, precision, recall, specificity, sensitivity and F&#95;Measure. To validate the projected approach, it is compared with the traditional techniques CNN, CNN-Particle Swarm Optimization (PSO) and CNN-Firefly Algorithm (FA), respectively. From the analysis, the proposed method achieved a 0.98 accuracy level in the lung cancer prediction.

InSe layered semiconductors with high mobility have advantages over transition-metal dichalcogenides in certain device applications. Understanding the dynamics of carriers, especially around the major bandgaps, is not only of fundamental interest but also important for improving the performance of devices. We investigated ultrafast carrier dynamics in exfoliated InSe near the bandgap and found that the presence of photocarriers led to shrinkage in the optical bandgap. In addition, we observed that the carrier recombination rate increased when the thickness of the InSe nanoflakes was reduced and the process was dominated by surface recombination. For the same flakes, the recombination rate became lower after the freshly exfoliated InSe was exposed to air and oxidized. Using a free carrier diffusion model, layer-dependent surface recombination velocities were obtained. Our investigation reveals that the surface condition and the thickness of few-layer InSe play important roles in carrier lifetimes.

The growth conditions of the AlGaN barrier in AlGaN/AlGaN deep ultra-violet (DUV) multiple quantum wells (MQWs) have crucial influences on the light output power of DUV light-emitting diodes (LEDs). The reduction of the AlGaN barrier growth rate improved the qualities of AlGaN/AlGaN MQWs, such as surface roughness and defects. The light output power enhancement could reach 83% when the AlGaN barrier growth rate was reduced from 900 nm h -1 to 200 nm h -1 . In addition to the light output power enhancement, lowering the AlGaN barrier growth rate altered the far-field emission patterns of the DUV LEDs and increased the degree of polarization in the DUV LEDs. The enhanced transverse electric polarized emission indicates that the strain in AlGaN/AlGaN MQWs was modified by lowering the AlGaN barrier growth rate., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Different oxygen partial-pressure MgGa 2 O 4 -resistive RAMs (RRAMs) are fabricated to investigate the resistive switching behaviors. The X-ray photoelectron spectroscopy results, set voltage, reset voltage, cycling endurance, and retention time are drawn for comparison. With the increasing oxygen ratio gas flow, the resistive switching characteristics of MgGa 2 O 4 RRAM are drastically elevated by changing the fabrication conditions of the RS layer. Moreover, we portray a filament model to explain the most likely mechanism associated with the generation and rupture of conductive filaments composed of oxygen vacancies. The formation of the interfacial layer (AlO x ) and the participation of the Joule heating effect are included to explain the highly distributed high-resistance state (HRS). The high randomness among switching cycles for memory application should be prevented, but it is suitable for the physical unclonable function. The relationship between HRS and the next time set voltage shows a strong correlation, and the conduction mechanisms of the low-resistance state (LRS) and HRS correspond to ohmic conduction and space charge-limited conduction, respectively. Meanwhile, the RRAM undergoes 10,000 s retention tests, and the two resistance states can be distinguished without obvious alternation or degradation. A favorable cycling endurance and retention time achieved by optimizing the fabrication parameters of Al/MgGa 2 O 4 /Pt RRAM have the potential for nonvolatile memristors and information security applications., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Diagnosis and treatment of hepatocellular carcinoma or metastases rely heavily on accurate segmentation and classification of liver tumours. However, due to the liver tumor's hazy borders and wide range of possible shapes, sizes, and positions, accurate and automatic tumour segmentation and classification remains a difficult challenge. With the advancement of computing, new models in artificial intelligence have evolved. Following its success in Natural language processing (NLP), the transformer paradigm has been adopted by the computer vision (CV) community of the NLP. While there are already accepted approaches to classifying the liver, especially in clinical settings, there is room for advancement in terms of their precision. This paper makes an effort to apply a novel model for segmenting and classifying liver tumours built on deep learning. In order to accomplish this, the created model follows a three-stage procedure consisting of (a) pre-processing, (b) liver segmentation, and (c) classification. In the first phase, the collected Computed Tomography (CT) images undergo three stages of pre-processing, including contrast improvement via histogram equalization and noise reduction via the median filter. Next, an enhanced mask region-based convolutional neural networks (Mask R-CNN) model is used to separate the liver from the CT abdominal image. To prevent overfitting, the segmented picture is fed onto an Enhanced Swin Transformer Network with Adversarial Propagation (APESTNet). The experimental results prove the superior performance of the proposed perfect on a wide variety of CT images, as well as its efficiency and low sensitivity to noise.

The 5' cap and 3' poly(A) tail of mRNA are known to synergistically stimulate translation initiation via the formation of the cap•eIF4E•eIF4G•PABP•poly(A) complex. Most mRNA sequences have an intrinsic propensity to fold into extensive intramolecular secondary structures that result in short end-to-end distances. The inherent compactness of mRNAs might stabilize the cap•eIF4E•eIF4G•PABP•poly(A) complex and enhance cap-poly(A) translational synergy. Here, we test this hypothesis by introducing intrinsically unstructured sequences into the 5' or 3' UTRs of model mRNAs. We found that the introduction of unstructured sequences into the 3' UTR, but not the 5' UTR, decreases mRNA translation in cell-free wheat germ and yeast extracts without affecting mRNA stability. The observed reduction in protein synthesis results from the diminished ability of the poly(A) tail to stimulate translation. These results suggest that base pair formation by the 3' UTR enhances the cap-poly(A) synergy in translation initiation., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

An outbreak of respiratory syncytial virus (RSV) has been observed in Taiwan since August 2020. We reviewed a central laboratory-based surveillance network established over 20 years by Taiwan Centres for Disease Control for respiratory viral pathogens between 2010 and 2020.A retrospective study of children <5 years old hospitalized with RSV infection at Chang Gung Memorial Hospital between 2018 and 2020 was conducted, and samples positive for RSV-A were sequenced. Clinical data were obtained and stratified by genotype and year.Data from 2020 showed an approximately 4-fold surge in RSV cases compared to 2010 in Taiwan, surpassing previous years during which ON1 was prevalent. Phylogenetic analysis of G protein showed that novel ON1 variants were clustered separately from those of 2018 and 2019 seasons and ON1 reference strains. The variant G protein carried six amino acid changes that emerged gradually in 2019; high consistency was observed in 2020. A unique substitution, E257K, was observed in 2020 exclusively. The F protein of the variant carried T12I and H514N substitutions, which weren't at antigenic sites. In terms of multivariate analysis, age (OR: 0.97; 95% CI: 0.94-0.99; p  = 0.02) and 2020 ON1 variant (OR:2.52; 95% CI:1.13-5.63; p  = 0.025) were independently associated with oxygen saturation <94% during hospitalization.The 2020 ON1 variant didn't show higher replication or virulence compared with those in 2018 in our study. The unprecedented 2020 RSV epidemic may attribute to antigenic changes and lack of interferon-stimulated immunity induced by seasonal circulating virus under non-pharmaceutical intervention.

Biogenic CoFe 2 O 4 nanoparticles were prepared by co-precipitation and Hibiscus rosa sinensis plant leaf was used as a bio-reductant of the nanoparticle productions. The biosynthesized CoFe 2 O 4 nanoparticles were characterized by XRD, FTIR, UV, VSM, and SEM via EDX analysis. The cubic phase of biosynthesized CoFe 2 O 4 nanoparticles and their crystallite size was determined by XRD. The Co-Fe-O bonding and cation displacement was confirmed by FTIR spectroscopy. The presence of spherically-shaped biosynthesized CoFe 2 O 4 nanoparticles and their material were confirmed by SEM and TEM via EDX. The super-paramagnetic behaviour of the biosynthesized CoFe 2 O 4 nanoparticles and magnetic pulse was established by VSM analysis. Organic and bacterial pollutants were eradicated using the biosynthesized CoFe 2 O 4 nanoparticles. The spinel ferrite biosynthesized CoFe 2 O 4 nanoparticles generate radical and superoxide ions, which degrade toxic organic and bacterial pollutants in the environment.

Background: The statistical significance of randomized controlled trials (RCTs) and comparative studies is often conveyed utilizing the P value. However, P values are an imperfect measure and may be vulnerable to a small number of outcome reversals to alter statistical significance. The interpretation of the statistical strength of these studies may be aided by the inclusion of a Fragility Index (FI) and Fragility Quotient (FQ). This study examines the statistical stability of studies comparing operative vs nonoperative management for Achilles tendon rupture., Methods: A systematic search was performed of 10 orthopaedic journals between 2000 and 2021 for comparative studies focusing on management of Achilles tendon rupture reporting dichotomous outcome measures. FI for each outcome was determined by the number of event reversals necessary to alter significance ( P < .05). FQ was calculated by dividing the FI by the respective sample size. Additional subgroup analyses were performed., Results: Of 8020 studies screened, 1062 met initial search criteria with 17 comparative studies ultimately included for analysis, 10 of which were RCTs. A total of 40 outcomes were examined. Overall, the median FI was 2.5 (interquartile range [IQR] 2-4), the mean FI was 2.90 (±1.58), the median FQ was 0.032 (IQR 0.012-0.069), and the mean FQ was 0.049 (±0.062). The FI was less than the number of patients lost to follow-up for 78% of outcomes., Conclusion: Studies examining the efficacy of operative vs nonoperative management of Achilles tendon rupture may not be as statistically stable as previously thought. The average number of outcome reversals needed to alter the significance of a given study was 2.90. Future analyses may benefit from the inclusion of a fragility index and a fragility quotient in their statistical analyses.

Medical records generated in hospitals are treasures for academic research and future references. Medical Image Retrieval (MIR) Systems contribute significantly to locating the relevant records required for a particular diagnosis, analysis, and treatment. An efficient classifier and effective indexing technique are required for the storage and retrieval of medical images. In this paper, a retrieval framework is formulated by adopting a modified Local Binary Pattern feature (AvN-LBP) for indexing and an optimized Fuzzy Art Map (FAM) for classifying and searching medical images. The proposed indexing method extracts LBP considering information from neighborhood pixels and is robust to background noise. The FAM network is optimized using the Differential Evaluation (DE) algorithm (DEFAMNet) with a modified mutation operation to minimize the size of the network without compromising the classification accuracy. The performance of the proposed DEFAMNet is compared with that of other classifiers and descriptors; the classification accuracy of the proposed AvN-LBP operator with DEFAMNet is higher. The experimental results on three benchmark medical image datasets provide evidence that the proposed framework classifies the medical images faster and more efficiently with lesser computational cost.

In this study, Fe 2 O 3 powder was synthesized using the co-precipitation method from scrap iron, which was then treated with varying concentrations of copper. Afterwards, the modified Fe 2 O 3 was reinforced in the PVC matrix by using the solution-casting method to synthesize PVC composite films, which were subjected to a UV-visible spectrophotometer, a Fourier transform infrared spectrophotometer, an X-ray diffractometer, and a thermal gravimetric analyzer to evaluate the optical, chemical, structural, and thermal properties. FTIR analysis reveals the formation of the composite through vibrational bands pertaining to both components present, whereas no significant changes in the XRD patterns of PVC were observed after the doping of modified iron oxide, which reveals the compatibility of fillers with the PVC matrix. The optical properties of the copper-doped iron oxide-PVC composites, including absorbance, refractive index, urbach energy, and optical as well as electrical conductivity are measured, and show an increase in optical activity when compared to the pure PVC compound. Moreover, the increased thermal stability of the synthesized composite was also observed and compared with conventional compounds, which, in accordance with all the other mentioned properties, makes the copper-dopped iron oxide-PVC composite an effective material for electronic, photonic, and optical device applications.

Background: Mycoplasma pneumoniae is a major pathogen for community-acquired pneumonia and frequently causes outbreaks in children. M. pneumoniae-specific antibody response is detected upon acute infection and the serology is widely used in the clinical setting. Nevertheless, the cellular basis for antigen-specific antibody response to acute M. pneumoniae infection is largely undetermined in children., Methods: Hospitalized children with community-acquired pneumonia were enrolled and the infection with M. pneumoniae was confirmed with positive PCR result and negative findings for other pathogens. The M. pneumoniae P1-specific antibody-secreting B cell (ASC) response was examined with the ex vivo enzyme-linked immunosorbent spot assay and the relationships between the ASC frequency and serological level and clinical parameters within M. pneumoniae patients were studied., Results: A robust M. pneumoniae P1-specific ASC response was detected in the peripheral blood among M. pneumoniae-positive patients. By contrast, no M. pneumoniae-specific ASCs were detected among M. pneumoniae-negative patients. The IgM-secreting B cells are the predominant class and account for over 60% of total circulating M. pneumoniae-specific ASCs in the acute phase of illness. The M. pneumoniae P1-specific ASC frequency significantly correlated with the fever duration, and the IgG ASC frequency significantly correlated with serological titer among patients., Conclusion: A rapid and potent elicitation of peripheral M. pneumoniae-specific ASC response to acute infection provides the cellular basis of antigen-specific humoral response and indicates the potential of cell-based diagnostic tool for acute M. pneumoniae infection. Our findings warrant further investigations into functional and molecular aspects of antibody immunity to M. pneumoniae., Competing Interests: Declaration of competing interest All authors declared no conflicts of interest., (Copyright © 2021. Published by Elsevier B.V.)

Purpose: To report a case of a 42-year-old male with proliferative diabetic retinopathy (PDR) complicated by tractional retinal detachments (TRD) bilaterally with a rare finding on B-scan ultrasonography., Observations: On B-scan ultrasound, a total combined rhegmatogenous-TRD was observed, accompanied by extensive retinal macrocysts that appeared nearly confluent for 360°., Conclusions and Importance: Retinal macrocysts are rare but important clinical entities that help drive management, as their presence typically suggests a chronic retinal detachment., Competing Interests: The following authors have no financial disclosures: WL, SC.

AlGaN and GaN sidewalls were turned into Al x Ga 2- x O 3 and Ga 2 O 3 , respectively, by thermal oxidation to improve the optoelectrical characteristics of deep ultraviolet (DUV) light-emitting diodes (LEDs). The thermally oxidized Ga 2 O 3 is a single crystal with nanosized voids homogenously distributed inside the layer. Two oxidized Al x Ga 2- x O 3 layers were observed on the sidewall of the AlGaN layer in transmission electron microscopy images. The first oxidized Al x Ga 2- x O 3 layer is a single crystal, while the second oxidized Al x Ga 2-x O 3 layer is a single crystal with numerous nanosized voids inside. The composition of Al in the first oxidized Al x Ga 2- x O 3 layer is higher than that in the second one. The thermal oxidation at high temperature degrades the quality of the p-GaN layer and increases the forward voltage from 8.18 to 11.36 V. The thermally oxidized Al x Ga 2- x O 3 sidewall greatly enhances the light extraction efficiency of the lateral light of the DUV LEDs by combined mechanisms of holey structure, graded refractive index, high transparency, and tensile stress. Consequently, the light output power of the DUV LEDs increases from 0.69 to 0.88 mW by introducing a 420 nm thick Al x Ga 2- x O 3 sidewall oxidized at 900 °C, in which the enhancement of light output power can reach 27.5%., Competing Interests: The authors declare no competing financial interest., (© 2022 The Authors. Published by American Chemical Society.)

5.2-GHz all-digital frequency synthesizer implemented proposed reference spur reducing with the tsmc 0.18 µm CMOS technology is proposed. It can be used for radar equipped applications and radar-communication control. It provides one ration frequency ranged from 4.68 GHz to 5.36 GHz for the local oscillator in RF frontend circuits. Adopting a phase detector that only delivers phase error raw data when phase error is investigated and reduces the updating frequency for DCO handling code achieves a decreased reference spur. Since an all-digital phase-locked loop is designed, the prototype not only optimized the chip dimensions, but also precludes the influence of process shrinks and has the advantage of noise immunity. The elements of novelties of this article are low phase noise and low power consumption. With 1.8 V supply voltage and locking at 5.22 GHz, measured results find that the output signal power is -8.03 dBm, the phase noise is -110.74 dBc/Hz at 1 MHz offset frequency and the power dissipation is 16.2 mW, while the die dimensions are 0.901 × 0.935 mm 2 .

Small bowel obstruction is a common surgical condition that needs surgical intervention if conservative measures fail. Bezoar is a rare aetiology of small bowel obstruction with incidence of 4.5%. The bezoars can be grouped, according to the content, into four common types: phytobezoars, trichobezoars, pharmacobezoars, and lactobezoars. However, unusual bezoars like plastic bezoars and metal bezoars have been reported too. Herein, we report a case of an elderly lady who was treated for small bowel obstruction due to crab shell bezoar. This is the first case reported in literature. Ingestion of large intact pieces of crab shell should be avoided due to the potential of causing small bowel obstruction.

We have previously identified Candida albicans GPH1 (orf19.7021) whose protein product was associated with C. albicans Cdc4. The GPH1 gene is a putative glycogen phosphorylase because its Saccharomyces cerevisiae homolog participates in glycogen catabolism, which involves the synthesis of β-glucan of the fungal cell wall. We made a strain whose CaCDC4 expression is repressed, and GPH1 is constitutively expressed. We established a GPH1 null mutant strain and used it to conduct the in vitro virulence assays that detect cell wall function. The in vitro virulence assay is centered on biofilm formation in which analytic procedures are implemented to evaluate cell surface hydrophobicity; competence, either in stress resistance, germ tube formation, or fibronection association; and the XTT-based adhesion and biofilm formation. We showed that the constitutively expressed GPH1 partially suppresses filamentation when the CaCDC4 expression is repressed. The C. albicans Gph1 protein is reduced in the presence of Ca Cdc4 in comparison with the absence of Ca Cdc4. Compared with the wild-type strain, the gph1 Δ/ gph1 Δ mutant displayed a reduction in the capability to form germ tubes and the cell surface hydrophobicity but an increase in binding with fibronectin. Compared with the wild-type strain, the gph1 Δ/ gph1 Δ mutant showed a rise in adhesion, the initial stage of biofilm formation, but displayed a similar capacity to form a mature biofilm. There was no major impact on the gph1 Δ/ gph1 Δ mutant regarding the conditions of cell wall damaging and TOR pathway-associated nutrient depletion. We conclude that GPH1 , adversely regulated by the filament suppressor CDC4 , contributes to cell wall function in C. albicans .

Recurrent falls are a common cause of morbidity in the elderly population, as more than one-third of individuals aged 65 years or older experience falls each year. Falls remain a multifactorial phenomenon that can potentially result in devastating debilitation and hence require proper medical attention and management. In an elderly patient presenting with recurrent falls, the workup for differential diagnoses remains wide with various causes such as postural hypotension, syncope, seizures, arrhythmia, medication-induced, and cognitive impairment. In this report, we discuss an interesting case of recurrent falls in an elderly woman with hyperthyroidism who was repeatedly found to have unremarkable lab results and negative imaging studies. She was later diagnosed with divergence insufficiency with intermittent esotropia secondary to thyroid ophthalmopathy, which was the cause of her underlying horizontal diplopia contributing to her falls. This can cause blurry vision at further distances, which is observed especially in individuals older than 50 years. Treatment typically involves prism therapy, surgery in refractory patients, and, currently, novel therapy using teprotumumab infusion. The patient was referred to see a strabismus specialist for prism prescription and possible surgical intervention. In elderly patients with a history of recurrent falls, a comprehensive visual exam should be strongly considered, especially for individuals with repeated negative workups, to prevent further testing or procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Lai et al.)

Multi-stakeholder and organizational involvement is an integral part of the medicine supply chain. Keeping track of the activities associated with medical products is difficult when the system is complex. Their complexity limits transparency and data provenance. Deficiencies within existing supply chains result in the counterfeiting of drugs, illegal imports, and inefficient operations. Due to these limitations, product integrity is compromised, resulting in product wastage. Visibility of the entire product supply chain is crucial for the pharmaceutical industry in terms of product safety and reduction of manufacturing costs. The Cloud-based Blockchain-powered architecture of the system provides a platform for addressing the need of pharma-material traceability, data storage, privacy of data, and quality assurance. This framework comprises of the identification of activities through tagging, information sharing in a secure environment; cloud-based storage using an off-chain Interplanetary File System (IPFS) and an on-chain couch DB; and access to this information that is controlled by the system's regulator. Electronic drug records will be accessed via a smart contract in Hyperledger Blockchain. The system assists in identifying false and cross-border products through the manufacturer and country of origin. A scan will identify counterfeit medications, showing that they are unauthorized products which may pose a risk to patients. Our experiments demonstrated the efficiency and usability of the design platform. Finally, we benchmarked the system using Hyperledger Caliper., Competing Interests: Competing interestsNo conflict of Interest., (© The Author(s) 2022.)

Post Endoscopic Retrograde Cholangiopancreatography (ERCP) pneumoperitoneum is commonly associated with perforated viscus but is rarely associated with benign causes. We present a case of 29 years old lady who underwent ERCP, who was found to have benign pneumoperitoneum subsequently. She was treated conservatively and recovered without complication. Although rare, post ERCP pneumoperitoneum of benign causes should be investigated as the course of treatment and outcome differ largely.

Purpose: To appraise the available animal and human studies investigating low-intensity pulsed ultrasound stimulation (LIPUS) on tendon, ligament, and bone-soft tissue (B-ST) junction healing., Methods: A systematic review of PUBMED, EMBASE, and the Cochrane Library was performed for animal and human studies investigating the effects of LIPUS on tendon, ligament, and B-ST junction healing. The systematic search was performed using the key term "low intensity pulsed ultrasound" and any of the following: "tendon," "ligament," "tendon-bone," and "bone-tendon." Inclusion criteria consisted of (1) randomized controlled trials assessing the effect of LIPUS on bone, tendon, and soft tissue in animals or humans and (2) English-language articles., Results: A total of 28 animal and 2 human studies met inclusion criteria. Animal studies utilized various models, including Achilles and patellar tendon transections, medial collateral ligament transections, and surgical repair of patellar tendon, rotator cuff tendon, and anterior cruciate ligament, to evaluate the effects of LIPUS. Animal studies demonstrated significantly improved collagen content and organization, bone formation, fibrocartilage remodeling, and mechanical strength with LIPUS treatment compared with controls. In human trials, LIPUS treatment of chronic tendinopathies did not improve clinical outcomes., Conclusions: In acute injury animal models, LIPUS augmented healing of acute tendon, ligament, and B-ST junction injuries through increased collagen content and organization; increased anti-inflammatory cellular signaling; and increased angiogenesis. However, in 2 human studies investigating chronic tendinopathy, LIPUS did not lead to superior outcomes compared with controls., Clinical Relevance: Animal models suggest that LIPUS may be a promising noninvasive treatment modality for accelerating patient recovery after acute tendon and ligament injuries, as well as after surgical repair of B-ST junction injuries, but this has not been demonstrated in human studies. Randomized clinical trials evaluating LIPUS for acute tendon and ligament injuries are warranted., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

The stability of a resistive random-access memory (RRAM) device over long-term use has been widely acknowledged as a pertinent concern. For investigating the stability of RRAM devices, a stacked In x Ga 1- x O structure is designed as its switching layer in this study. Each stacked structure in the switching layer, formed via sputtering, consists of varying contents of gallium, which is a suppressor of oxygen vacancies; thus, the oxygen vacancies are well controlled in each layer. When a stacked structure with layers of different contents is formed, the original gradients of concentration of oxygen vacancies and mobility influence the set and reset processes. With the stacked structure, an average set voltage of 0.76 V, an average reset voltage of -0.66 V, a coefficient of variation of set voltage of 0.34, and a coefficient of variation of reset voltage of 0.18 are obtained. Additionally, under DC sweeps, the stacked RRAM demonstrates a high operating life of more than 4000 cycles. In conclusion, the performance and stability of the RRAM are enhanced herein by adjusting the concentration of oxygen vacancies via different compositions of elements., Competing Interests: The authors declare no competing financial interest., (© 2021 The Authors. Published by American Chemical Society.)

Background: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery., Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ratios (OR) of associated perioperative risk factors and sequelae of postoperative transfusion., Results: In total, 8416 geriatric hip fracture patients were identified of whom 28.3% had documented postoperative transfusion. In multivariate analysis, age (OR 1.03 [1.02-1.04], p  < 0.001), preoperative anaemia (OR 4.69 [3.99-5.52], p  = 0.001), female sex (OR 1.61 [1.39-1.87], p  < 0.001), lower BMI (OR 0.97 [0.96-0.98], p  < 0.001), American Society of Anesthesiologists (ASA) classification (OR 1.14 [1.01-1.27], p  = 0.031), COPD (OR 1.30 [1.06-1.59], p  = 0.011), hypertension (OR 1.17 [1.01-1.35], p  = 0.038), increased OR time (OR 1.02 [1.01-1.03], p  < 0.001), and intertrochanteric (OR 2.99 [2.57-3.49], p  < 0.001) and subtrochanteric femur fractures (OR 5.07 [3.84-6.69], p  < 0.001) were independent risk factors for receiving postoperative blood transfusion. Patients with postoperative transfusion had a significantly higher risk-adjusted 30-day mortality (8.4% vs. 6.4%, OR 1.29 [1.02-1.64], p  = 0.035), hospital readmission rate (9.4% vs. 7.7%, OR 1.27 [1.04-1.55], p  = 0.018), and total hospital LOS (7.3 vs. 6.3 days, p  < 0.001)., Conclusions: Postoperative transfusion is a common occurrence in geriatric fragility hip fractures with multiple risk factors. Careful preoperative planning and multidisciplinary management efforts are warranted to reduce use of postoperative transfusions.