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Objective: To introduce a new method for intraoperative detection of rotational malreduction of the lateral malleolus using conventional fluoroscopy.Material and Methods: From January 2014 to December 2017, 56 Weber type C unstable lateral malleolar fractures with syndesmosis injury were identified. The fibular fracture patterns were simple oblique or transverse in 20, comminuted in 25, and Maisonneuve injury with fibular neck fractures in 11 cases. 47 cases were operated with ORIF, and 9 cases of Maisonneuve fractures were operated with CRIF. The mortise view of the contralateral uninjured ankle was used for intraoperative comparison. Two indexes were applied for fluoroscopic detection of distal fibula malrotation, i.e. the contour profile change in lateral malleolar shape, and the intrinsic structure appearance of lateral malleolar fossa cortex. Postoperative talofibular joint congruency was measured on axial CT scan to confirm the reduction quality.Results: Using the two radiographic parameters for intraoperative fluoroscopic evaluation, we finally achieved satisfying reduction and fixation of the lateral malleolus in all 56 cases. A more spoon-shaped fibula profile and disappearance of the lateral fossa cortex shadow indicates an internal rotation, while a more pointed blade-shaped fibula profile and disappearance of lateral fossa cortex shadow indicates an external rotation. Postoperative CT scanning identified distal fibular no rotation in 44 cases (78.6%), mild rotation less than 5° in 12 cases (21.4%), with 7 cases internal rotation (mean 3.1°) and 5 cases external rotation (mean 2.8°).Conclusion: Using conventional intraoperative fluoroscopy on mortise view, new radiographic parameters can provide reliable method to detect rotational malreduction of the lateral malleolus. [ABSTRACT FROM AUTHOR]

• A novel text classification model for FF events related webpages is introduced. • This model classifies webpage paragraphs into one or more of seven categories. • This model enables efficient review of heterogenous information on the web. • This model significantly improves prediction accuracy for minority labels. • The model can be used to enhance information on past events in existing databases. The web is a rich information repository that can be mined to uncover additional data about past flash flood (FF) events, currently missing from existing structured databases. However, this information originates from multiple sources (news articles, government records, and weather records among others) and may cover several topics. Furthermore, these topics may be disproportionately covered on the web. The large size and heterogenous nature of web information render manual review difficult. To address this challenge, we have developed a multi-label text classification model, FF-BERT. FF-BERT is designed to classify FF-related web paragraphs into one or more of seven categories: (1) Damage and Economic Impact (DI), (2) Fatalities, Injuries, and Rescue (FIR), (3) Hydrometeorology (HM), (4) Warning and Emergency (WE), (5) Response and Recovery (RR), (6) Public Health (PH), and (7) Mitigation (MG). To develop FF-BERT, we labeled 21,180 paragraphs from FF-related webpages and performed experiments with multiple model architectures based on the widely used language model Bidirectional Encoder Representation from Transformers (BERT). Our final model outperforms the baseline by 11.83%, as measured by the micro-F1 score. In addition, FF-BERT significantly improves the prediction of minority labels (RR-32.1%, PH-260.4%, and MG-138.6%). We demonstrate using real world examples that FF-BERT can be used to uncover new information about flash flood events. This information can be used to enhance existing databases, such as NOAA's Storm Events Database. [ABSTRACT FROM AUTHOR]

During the operation of proximal femoral nail antirotation (PFNA), surgeons may run across a rare problem that the helical blade fails to be tightened and locked by clockwise turning of the impactor handle. At this moment, three options can be taken: first, replace the unlocked helical blade and re-insert another new one; second, keep the unlocked helical blade in place, proceed and finish the operation as usual; and third, as we described, keep the first helical blade in situ and tighten and lock it by other instruments, such as the SW4.0 mm hexagonal screwdriver for the distal interlocking screw, which is already in the instrument box. The third option is the best, as it keeps the operation going and remains the fixation quality as usual. [ABSTRACT FROM AUTHOR]

The detection of broadband signal power spectrum based on spectral hole-burning (SHB) material has been investigated a lot, but the detection of phase is not reported yet. In this paper, a method of RF signal real-time phase detection is proposed by applying the SHB material. Phase measurement is performed through the in-phase and in-quadrature components of emitted field generated by the macro polarization at steady state. The time range of reaching steady state is determined by numerical solution of Bloch equation solved by Runge–Kutta method. Furthermore, the effect of phase change rate on the accuracy of real-time phase measurement is also given. The typical RF signals are performed in the simulation to demonstrate the feasibility of the method and agreeable results are obtained in the phase value. Through the analysis of the effect of noise on the phase accuracy, When SNR is greater than 24 dB, phase error is less than 0.83%, and the phase error does not accumulate with time. [ABSTRACT FROM AUTHOR]

Objective: Femoral intertrochanteric fractures are usually fixed with short, straight cephalomedullary nails. However, mismatches between the nail and the femur frequently occur, such as tip impingement and tail protrusion. The authors designed a new type of short femoral intertrochanteric nail (fitn) with an anterior curvature (length=19.5cm, r=120cm) and herein report the geometric match study for the first of 50 cases.Methods: A prospective case series of 50 geriatric patients suffering from unstable intertrochanteric fractures (AO/OTA 31 A2/3) were treated. There were 15 males and 35 females, with an average age of 82.3 years. Post-operatively, the nail entry point position in the sagittal greater trochanter (in three categories, anterior, central and posterior), the nail-tip position in the medullary canal (in 5-grade scale) and the nail-tail level to the greater trochanter (in 3-grade scale) were measured using X-ray films.Results: For the nail entry point measurement, 5 cases were anterior (10%), 38 cases were central (76%), and 7 cases were posterior (14%). For the distal nail-tip position, 32 cases (64%) were located along the central canal axis, 13 cases (26%) were located anteriorly but did not contact the anterior inner cortex, 2 cases (4%) showed less than one-third anterior cortex thickness contact, and 3 cases (6%) were located posteriorly with no contact. For the proximal nail-tail level, there were no protrusions over the greater trochanter in 15 cases (30%), protrusion of less than 5mm in 29 cases (58%), and protrusion of more than 5mm in 6 cases (12%). The fitness was very high, as 96% cases showed no tip-cortex contact, and 88% cases showed less than 5mm proximal tail protrusion.Conclusion: The newly designed femoral intertrochanteric nail has a good geometric match with the femur medullary canal and the proximal length in the Chinese population. [ABSTRACT FROM AUTHOR]

Background: As a predictor of the risk of lag screw cutout, it was recommended that keeping tip-apex distance (TAD)<25mm and placing the screw centrally or inferiorly, but positioning the lag screw too inferiorly in the head would produce TAD>25mm. We aim to simulate various positions of the lag screw in the femoral head and identify whether 25mm is a suitable cut-off value that favours all sizes of femoral heads with intertrochanteric fractures of the hip.Methods: Using a general mathematical software, the positions of the screw tip points were simulated. The virtual anterior-posterior and lateral views were then visualised, and the locus of the screw tips was projected into a Cartesian coordinate system according to the TAD and calcar-referenced tip-apex distance (CalTAD) formulas. Each original virtual anterior-posterior and lateral image was zoomed and compiled to match a calculated average image. The screw tip points were recorded, traced and compiled into volumes which could be used to visualise the screw's movements and positioning within the femoral head. The extracted volumes were calculated when 10mmResults: For the TAD calculation, the shape of the traced screw tip points had a pancake-like appearance, while the CalTAD plot produced a teardrop-shaped region. The volume ratios of TAD, CalTAD and overlapping region relative to the femoral head volume were respectively 3.51±1.30%, 5.19±1.62% and 2.64±1.32%. The volumes of the traced TAD, CalTAD and overlapping regions increased slower than the volume of an idealised sphere.Conclusion: Positioning the lag screw should address geometrical effects of both tip-apex distance and femoral head size, with an emphasis on measuring the position of the screw tip for the suitable zone by volume ratio. The previous 25mm TAD cut-off value should be adjusted according to the individual femoral head size. [ABSTRACT FROM AUTHOR]

Objective: The posterolateral (PL) tibial plateau quadrant is laterally covered by the fibular head and posteriorly covered by a mass of muscle ligament and important neurovascular structures. There are several limitations in exposing and fixing the PL tibial plateau fractures using a posterior approach. The aim of this study is to present a novel anterolateral supra-fibular-head approach for plating PL tibial plateau fractures.Methods: Five fresh and ten preserved knee specimens were dissected to measure the following parameters:1) the vertical distance from the apex of the fibular head to the lateral plateau surface, 2) the transverse distance between the PL platform and fibula collateral ligament (FCL), and 3) the tension of the FCL in different knee flexion positions. Clinically, isolated PL quadrant tibial plateau fractures were treated via an anterolateral supra-fibular-head approach and lateral rafting plate fixation. The outcome of the patients was assessed after a short to medium follow-up period.Results: The distance from the apex of the fibular head to the lateral condylar surface was 12.2 ± 1.6 mm on average. With the knee extended and the FCL tensioned, the transverse distance between the PL platform and the FCL was 6.7 ± 1.1 mm. With the knee flexed to 60° and the FCL was in the most relaxed position, the distance increased to 21.1 ± 3.0 mm. Clinically, a series of 7 cases of PL tibial plateau fractures were treated via this anterolateral supra-fibular-head approach. The patient was placed in a lateral decubitus position with the knee flexed to approximately 60 degrees. After the posterior retraction of the FCL, the plate was placed more posteriorly to provide a raft or horizontal belt fixation of the PL tibial plateau fragment. After an average of 14.3 months of follow up, the knee range of motion(ROM) was 121.4° ± 8.8° (range: 105°-135°), the HSS score was 96.7 ± 2.6 (range: 90-100), and the SMFA dysfunction score was 22.4 ± 3.8 (range: 16-28) points.Conclusion: The anterolateral supra-fibular-head approach can provide direct visualization of the posterolateral tibial plateau quadrant and put the plate more posteriorly to provide a raft for the fragments such that good clinical outcomes can be anticipated. [ABSTRACT FROM AUTHOR]

Background Serial histological sections are suffering from mechanical distortions that disturb the reconstruction of 3-D objects. We have corrected such artifacts with a non-rigid landmark-based method that respects the original geometry in the tissue block. The method is exemplified on a large scale in the registration of semi-thin serial sections of the mouse and rat kidneys, and has been tested on FFPE-sections. Aim In this study of mouse and rat kidneys, we have measured and characterized the deformations introduced in the preparation of 2.5-μm-thick Epon sections and then eliminated them by a landmark-based non-rigid transformation (NRT). Methods We obtained 2.5-μm-thick serial Epon sections from three mouse kidneys and three rat kidneys for 3-D reconstruction of the nephron tubules. First, the images from 3000 serial mouse and 13,000 serial rat sections underwent a classic rigid registration (CRR), and the distortions were measured and indexed. The section images underwent a further NRT in order to compensate for the deformations. The NRT used is a classic interactive landmark-based approach. The quality of the NRT was verified by comparing the geometry of the transformed images with corresponding block images. Results After CRR, the 2.5-μm-thick sections had a linear deformation of up to 2%, the tubular lengths were overestimated with up to 1.5×, and it was most difficult to trace the tubules from section to section. After the additional NRT, the geometry of the images reflected the original geometry in the block, the tubular lengths were no longer overestimated, and the NRT highly facilitated the tracing of the tubular system. Conclusions NRT has facilitated the tracing of the tubular system in kidneys, a tracing, which would otherwise have been most difficult to perform. NRT has yielded substantial new knowledge to segmental and spatial nephron organization in the mouse and rat kidneys. [ABSTRACT FROM AUTHOR]

Abstract: Background: Although there is an inverse relationship between bone mass and marrow adiposity, the reversal function of zoledronic acid (ZOL) on increased marrow fat has not been studied. The aim of our study is to use the 3T magnetic resonance spectroscopy (MRS) to characterize the dynamical change process of the marrow fat responding to early ZOL treatment in the rabbit model with glucocorticoid-induced bone loss. Methods: Fifteen 20-week-old female New Zealand White rabbits were randomized to control group, methylprednisolone (MPS) group, and MPS+ZOL group equally. Bone mineral density (BMD) and marrow fat fraction (FF) at L3–L4 vertebrae and left proximal femur were measured by Dual-energy X-ray absorptiometry and MRS at week 0, 4, 8, and 12. The animals were euthanized at the end of our experiment and their left femurs were dissected out for the histopathological examination. Results: The MPS group demonstrated a remarkable increase in FF but a reduction in BMD compared with the controls at week 4 and 8, respectively (P <0.05 for all). Early treatment of ZOL can inhibit bone degeneration, although the bone mass would not recover to its original level. FF in MPS group exhibited a dramatic increase over time, with an increased FF variation (+31.6%, P =0.009) at week 4 from baseline and it was maintained until week 12 (+75.2%, P <0.001). In MPS+ZOL group, the FF returned to baseline value after the ZOL treatment. Comparing with the controls, larger marrow adipocyte density, the mean of the adipocyte diameter, and the percentage area of the adipocyte were observed in the MPS group (P <0.05 for all), whereas there were no significant differences in quantitative parameters of marrow adipocytes between the ZOL-treated group and the normal rabbits. Conclusion: An increase of the marrow adiposity is synchronized with the deterioration of the MPS-induced bone mass. A single dose of early ZOL can reverse the marrow adiposity to its original level completely. [Copyright &y& Elsevier]

Abstract: The vehicle routing problem with uncertain demand at nodes is considered. The approximate reasoning algorithm is developed to determine the preference strength to send the vehicle to next node, and the improved sweeping algorithm with vehicle coordinated strategy is originally proposed to determine a set of vehicle routes that minimizes costs. Finally the computational results are presented to show the high effectiveness and performance of the solution approaches. [Copyright &y& Elsevier]

Background: Thoracic esophageal squamous cell carcinoma (TESCC) is an aggressive malignancy with a poor prognosis. The current American Joint Committee on Cancer (AJCC) TNM cancer staging system focusing on the effect of regional (N1) and nonregional lymph node (M1a and M1b) metastasis may need reappraisal. We investigated the role of the number of dissected and positive nodes in TESCC patients. Methods: A total of 109 TESCC patients (97 men; mean age of 62.3 years) who underwent surgical resection were retrospectively analyzed. The current AJCC TNM system and other lymph node classifications were used to subgroup these patients and analyze survival differences. Previously reported prognostic factors were evaluated. Results: Patients with positive lymph node metastasis had a poor prognosis ( p < 0.001). There was a significant difference in survival among the 67 node-positive patients subdivided into subgroups with 1 to 3 and 4 or more positive nodes ( p = 0.004). Multivariable Cox proportional hazard regression analysis identified four independent prognostic factors: difficulty in swallowing ( p = 0.024), cigarette smoking ( p = 0.003), number of positive lymph nodes (0, 1 to 3, and ≥4; p < 0.001), and gastric cardia invasion ( p = 0.012). Total dissection of at least 20 lymph nodes was the minimal requirement to achieve accurate nodal staging. Conclusions: Dissection of more than 20 lymph nodes is mandatory in TESCC patients to achieve accurate staging. Positive lymph node metastasis of 4 or higher is a significant independent prognostic factor. [Copyright &y& Elsevier]

Abstract: Aims: To evaluate potential agents of therapeutic value in tissue inflammation, we studied norcantharidin (NCTD) and its derivatives for their effects on immune responses of human peripheral blood mononuclear cells (PBMC) in vitro. Main methods: PBMC proliferation was evaluated by tritiated thymidine uptake method. The production and gene expression of cytokines were determined with enzyme immunoassays (EIA) and reverse transcription-polymerase chain reaction (RT-PCR), respectively. Key findings: Five derivatives from NCTD had no significant effect on cell proliferation in PBMC. NCTD inhibited PBMC proliferation induced by phytohemagglutinin (PHA) with a 50% inhibitory concentration (IC50) 42.1±2.3 μM. The inhibitory action of NCTD did not involve direct cytotoxicity. To localize the point in the PBMC proliferation where arrest occurred, a set of key regulatory events leading to the cell proliferation, including cell cycle progression, production and gene expression of interleukin-2 (IL-2), IL-4, IL-10, and interferon-γ (IFN-γ) and cyclins was examined. Data demonstrated NCTD arrested the cell cycle progression of activated PBMC from the G1 transition to the S phase. The cyclin D3, E, A, and B transcripts and protein production in PHA-treated PBMC was reduced by NCTD. Whereas NCTD exerted no effect on IL-4 and IFN-γ production, it significantly alleviated the production and mRNA expression of IL-2 and IL-10 in activated PBMC. Significance: The suppressant effects of NCTD on proliferation of PBMC activated by PHA therefore appear to be mediated, at least in part, through inhibition of cyclins and IL-2 production and arrest of cell cycle progression in the cells. [Copyright &y& Elsevier]

Abstract: The mechanical resonance behavior of a ZnO nanowire/nanorod at ambient condition has been studied under optical microscope by cutting its length using focused ion beam microscopy. Nanobalance using a ZnO nanowire as the cantilever has been demonstrated for measuring the mass in the order of pico-grams in working atmosphere (see optical microscopy images). The measurement limit of the balance is estimated to be ∼1 pg. The technique demonstrated here has potential for commercial applications in general laboratories, especially for measuring the mass of wet biological cells or species. [Copyright &y& Elsevier]

Despite advances in understanding the role of histone deacetylases (HDACs) in tumorigenesis, the mechanism by which HDAC inhibitors mediate antineoplastic effects remains elusive. Modifications of the histone code alone are not sufficient to account for the antitumor effect of HDAC inhibitors. The present study demonstrates a novel histone acetylation-independent mechanism by which HDAC inhibitors cause Akt dephosphorylation in U87MG glioblastoma and PC-3 prostate cancer cells by disrupting HDAC-protein phosphatase 1 (PP1) complexes. Of four HDAC inhibitors examined, trichostatin A (TSA) and HDAC42 exhibit the highest activity in down-regulating phospho-Akt, followed by suberoylanilide hydroxamic acid, whereas MS-275 shows only a marginal effect at 5 μM. This differential potency parallels the respective activities in inducing tubulin acetylation, a non-histone substrate for HDAC6. Evidence indicates that this Akt dephosphorylation is not mediated through deactivation of upstream kinases or activation of downstream phosphatases. However, the effect of TSA on phospho-Akt can be rescued by PP1 inhibition but not that of protein phosphatase 2A. Immunochemical analyses reveal that TSA blocks specific interactions of PP1 with HDACs 1 and 6, resulting in increased PP1-Akt association. Moreover, we used isozyme-specific small interfering RNAs to confirm the role of HDACs 1 and 6 as key mediators in facilitating Akt dephosphorylation. The selective action of HDAC inhibitors on HDAC-PP1 complexes represents the first example of modulating specific PP1 interactions by small molecule agents. From a clinical perspective, identification of this PP1-facilitated dephosphorylation mechanism underscores the potential use of HDAC inhibitors in lowering the apoptosis threshold for other therapeutic agents through Akt down-regulation. [ABSTRACT FROM AUTHOR]

To evaluate the feasibility and clinical outcomes of tension-band wiring through a single cannulated screw combined with two suture anchors in treating inferior pole fracture of the patella. Between September 2018 and September 2021, a total of 22 patients with a mean age of 55 years who sustained inferior pole fracture of the patella and were treated by tension-band wiring through a single cannulated screw combined with two suture anchors were enrolled. X-ray radiographs were performed to observe the bone union time. The duration of each operation was recorded to reflect the complexity of surgical treatment. Functional measurements, comprising range of motion (ROM), the Böstman scale, and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were taken. Postoperative complications including fixation failure, incision infection, loss of reduction, and malunion were evaluated. All patients were followed up for an average of 17 months (range: 12–25 months). The average clinical bone union time was 8 weeks (range: 6–12 weeks), and the radiographic bone union time was 11 weeks (range: 8–12 weeks). At the final follow-up, the mean ROM was 136° (range: 115°-140°), the KOOS was 85 (range: 68–100) and the Böstman score was 28 (range: 20–30); these outcomes were classified as excellent in 17 cases and good in 5 cases, with no instances of poor results. Loss of reduction occurred in one case, while no cases of incision infection, fixation failure or malunion were observed. For inferior pole fracture of the patella, tension-band wiring through a single cannulated screw combined with suture anchors can offer sufficient fixation stability to achieve a satisfactory clinical outcome with reduced operational complexity; this procedure should be recommended in clinical practice. [ABSTRACT FROM AUTHOR]