Search

PURPOSE: To evaluate the clinical outcomes for arthroscopic treatment of acute posterior cruciate ligament (PCL) avulsion fractures with adjustable-loop cortical button fixation device. METHODS: Patients with PCL tibial avulsion fractures treated with an adjustable-loop cortical button fixation device between October 2019 and October 2020 were retrospectively identified. Patients with type 1 were treated using plaster fixation as a conservative treatment, whereas patients with type 2 and 3 with displacement were treated using an arthroscopic adjustable-loop cortical button. Operating time, incision recovery, complications, and postoperative fracture healing time were monitored. All patient follow-up was done at 12 months’ postoperatively. Lysholm Knee Score and the International Knee Documentation Committee score were used to assess knee function. RESULTS: A total of 30 patients were included in the study (20 male/10 female; mean age 45.5 years, range 35-68 years). The mean operative time was 67.5 minutes (range: 50-90 minutes). The postoperative incision healed at stage A without complications, such as medically induced vascular nerve injury, intra-articular hematoma, or infection. All 30 patients were tracked postoperatively for 12 to 14 months, with a mean follow-up period of 12.6 months. The Lysholm knee function score was 45.93 ± 6.15 before surgery and 87.10 ± 3.71 at 12 months after surgery, and the International Knee Documentation Committee score was 19.27 ± 4.40 before surgery and 95.47 ± 1.87 at 12 months after surgery, with a statistically significant difference. CONCLUSIONS: The treatment of PCL avulsion fractures with arthroscopic adjustable-loop cortical button fixation is easy to perform and shows good clinical results in our study. LEVEL OF EVIDENCE: IV, therapeutic case series.

Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail.The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using "minimally invasive" and "hepatocellular carcinoma" or "liver cancer" as the keywords.Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC.A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.

Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear whether this has led to consolidation among elective surgeries. We examined trends in volumes per surgeon and hospital to assess whether the known volume-outcome relationship has led to consolidation in elective joint arthroplasty and to determine if there exist volume thresholds above which outcomes do not change.Among Medicare beneficiaries who underwent either total knee or total hip arthroplasty from 2009 through 2015, we described volume trends and used mixed-effect models to relate annual surgeon and hospital volumes with 30-day complications or mortality. We tested for optimal volume cut points at both the hospital and surgeon level.Adjusted annual complication rates were inversely associated with volume for both procedures at both the surgeon level and hospital level, but there was minimal consolidation between 2009 and 2015. Complications no longer declined after volumes of each case exceeded 260 per year. The vast majority of cases (around 93% of hip and 88% of knee arthroplasties) were performed by surgeons operating at suboptimal volumes.More than 2 decades after the volume-outcome relationship was established for joint arthroplasty, many cases continue to be performed by low-volume surgeons, with far more cases performed by surgeons operating at suboptimal volumes. Further improvement could be expected through consolidation at both the hospital and surgeon level, with a target of at least 260 cases per surgeon annually for each operation. Payers seem best-equipped to drive consolidation.

Although the treatment of hepatocellular carcinoma (HCC) has been revolutionized by the advent of effective systemic therapies, the prognosis of patients with HCC remains dismal. Herein, we examined the pathophysiological role of PARG and assessed the utility of targeting dePARylation for HCC therapy.The oncogenic function of PARG was evaluated in 2 orthotopic xenograft models and a PargHigh PARG expression was strongly associated with poor HCC prognosis. Hepatocyte-specific PARG deletion significantly impaired liver tumorigenesis. PARG promoted HCC growth and metastasis through DDB1-dependent modulation of c-Myc. Specifically, PARG dePARylated DDB1 and consequently promoted DDB1 autoubiquitination, thus stabilizing the c-Myc protein in HCC cells. PARG downregulation attenuated c-Myc-induced MMR expression and PARG deficiency was correlated with a favorable prognosis in patients with HCC treated with anti-PD-1-based immunotherapy. In addition, PARG inhibitors could act in synergy with anti-PD-1 antibodies in orthotopic mouse models.PARG can act as an oncogene in HCC by modulating PARG/DDB1/c-Myc signaling and could be used as a biomarker to identify patients with HCC who may benefit from anti-PD-1 treatment. Our findings suggest that co-inhibition of PARG and PD-1 is an effective novel combination strategy for patients with HCC.The increase in deaths due to hepatocellular carcinoma (HCC) is a growing concern, with the mechanisms responsible for HCC development still incompletely understood. Herein, we identify a novel mechanism by which the protein PARG contributes to HCC development. Inhibition of PARG increased the efficacy of anti-PD-1 therapy (a type of immunotherapy) in HCC. These findings support the future clinical development of PARG inhibitors, potentially in combination with anti-PD-1 inhibitors.

BACKGROUND: In mouse skin cancer models, high-dose oral vitamin D3 (VD3; cholecalciferol) combined with photodynamic therapy (PDT) can improve the clearance of squamous precancers (actinic keratoses, AK). OBJECTIVE: To determine whether oral VD3 can improve clinical efficacy of a painless PDT regimen in humans with AK. METHODS: Baseline lesion counts and serum 25OH-D3 levels were obtained. In one cohort (Group 1), 29 patients received gentle debridement and 15-min ALA preincubation followed by blue light (30 min; 20 J/cm(2)). In Group 2, 29 patients took oral VD3 (10,000 IU daily, 5 or 14 days) prior to the debridement/PDT. Lesion clearance was assessed at 3–6 months. RESULTS: In Group 1, mean clearance rates (CR) of facial AK were lower in patients with VD3 deficiency (25OH-D3

The 3D visualization of the porosity in high-pressure die casting (HPDC) Mg alloys AZ91D and Mg4Ce2Al0.5Mn (EA42) was investigated by X-ray computed tomography. It was demonstrated that the volumetric porosity at the near-gate location for alloy EA42 was significantly higher than that far from the gate location. This difference resulted from the low valid time during intensified casting pressure conditions. Specimens of alloy EA42 exhibited a narrow pore distribution in the side view (∼0.5 mm) compared to the wide distribution (∼1.8 mm) of alloy AZ91D, which was mainly attributed to the formation mechanism of the defect band. The formation of microporosity in the defect band of alloy EA42 was inhibited because of the significant latent heat released by a large amount of the Al11Ce3 phase segregated in the defect band during solidification. Additionally, an effective estimator (Z-Propagation) was introduced, which is proposed to predict the projected area fraction of the porosity (f) involved during tensile failure with better effectiveness compared with traditional methods based on the actual fractured surface. By coupling the Z-Propagation method with the critical local strain model, the logarithmic fracture strain and true fracture stress of the specimens were predicted within 3.03% and 1.65% of the absolute value of the average relative error (AARE), respectively.

Five new polycyclic polyprenylated acylphloroglucinols (1-5), ascyrones A-E, and four known compounds (6-9) were isolated from the aerial parts of Hypericum ascyron. All of the isolates containing a bicyclo[3.3.1]nonane-2,4,9-trione core and a benzoyl group, belonged to type B bicyclic polyprenylated acylphloroglucinols (BPAPs). Their structures and absolute configurations were established based on spectroscopic analyses and calculated electronic circular dichroism (ECD) data. The anti-inflammatory, neuroprotective and cytotoxicity activities of compounds 1-4 and 6-9 were evaluated. Compound 6 exhibited obvious anti-inflammatory activity in lipopolysaccharide (LPS)-induced RAW264.7 cells. Compounds 1 and 9 exhibited slight cytotoxicity against Hep3B cells. Meanwhile, compound 1 showed mild neuroprotective activity against corticosterone (CORT)-induced PC12 cell damage at 10 μmol·L

Luoyang is a typical heavy industrial city in China, with a coal-dominated energy structure and serious air pollution. Following the implementation of the clean air actions, the physicochemical characteristics and sources of PM2.5 have changed. A comprehensive study of PM2.5 was conducted from October 16, 2019 to January 23, 2020 to evaluate the effectiveness of previous control measures and further to provide theory basis for more effective policies in the future. Results showed that the aerosol pollution in Luoyang in autumn and winter is still serious with the average concentration of 91.1 μg/m3, although a large reduction (46.9%) since 2014. With the contribution of nitrate increased from 12.5% to 25.1% and sulfate decreased from 16.7% to 11.2%, aerosol pollution has changed from sulfate-dominate to nitrate-dominate. High NO3−/SO42− ratio and the increasing of NO3−/SO42− ratio with the aggravation of pollution indicating vehicle exhaust playing an increasingly important role in PM2.5 pollution in Luoyang, especially in the haze processes. Secondary inorganic ions contributed significantly to the enhancement of PM2.5 during the pollution period. The high value of Cl−/Na+ and EC concentration indicate coal combustion in Luoyang is still serious. The top three contributor sources were secondary inorganic aerosols (33.3%), coal combustion (13.6%), and industrial emissions (13.4%). Close-range transport from the western and northeastern directions were more important factors in air pollution in Luoyang during the sampling period. It is necessary to strengthen the control of coal combustion and reduce vehicle emissions in future policies.

A criterion based on solidification microstructure was proposed to precisely predict the hot tearing behavior of cast alloys, which takes into account the effects of both mechanical and nonmechanical factors. This criterion focuses on the events occurring at the grain boundary, which are determined by the thermal contraction, solidification shrinkage, grain growing and liquid feeding. This criterion responds to a series of factors that affect hot tearing, such as alloy composition, mold design, casting process and microstructure. Its credibility has been validated by studying the hot tearing behavior of Mg-Ce alloys. In conformity with the experimental results, this criterion predicted decrease in the number of rods occurring hot tearing with increasing cerium content. A simplified criterion was derived and validated by Mg-Ce (equiaxed grain) and Mg-Al (columnar grain) alloy systems, which is suitable for the case where the eutectic liquid fraction is low and the liquid feeding can be ignored. In addition, a hot tearing index for equiaxed grains was proposed, that is, | d T / d ( f s 1 / 3 ) | near ( f s ) 1 / 3 = 1 , and its prediction results were consistent with the hot tearing susceptibility calculated from the experimental results.

Background The coronavirus disease 2019 (COVID-19) is an ongoing pandemic since December 2019. Invasive mechanical ventilation (IMV) is essential for the management of COVID-19 with acute respiratory distress syndrome (ARDS). We aimed to assess the impact of compliance with a respiratory decision support system on the outcomes of patients with COVID-19-associated ARDS who required IMV. Methods In this retrospective, single-center, case series, 46 patients with COVID-19-associated ARDS who required IMV at Zhongnan Hospital of Wuhan University, China, from January 8, 2020, to March 24, 2020, with the final follow-up date of April 20, 2020, were included. Demographic, clinical, laboratory, imaging, and management information were collected and analyzed. Compliance with the respiratory support decision system was documented, and its relationship with 28-day mortality was evaluated. Results The median age of the 46 patients with COVID-19-associated ARDS requiring IMV was 68.5 years, and 31 were men. The partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio at intensive care unit (ICU) admission was 104 mmHg. The median total length of IMV was 12.0 (interquartile range [IQR], 6.0–27.3) days, and the median respiratory support decision score was 11.0 (IQR, 7.8–16.0). To 28 days after ICU admission, 18 (39.1%) patients died. Survivors had a significantly higher respiratory support decision score than non-survivors (15.0 [10.3–17.0] vs. 8.5 (6.0–10.3), P = 0.001). Using receiver operating characteristic (ROC) curve to assess the discrimination of respiratory support decision score to 28-day mortality, the area under the curve (AUC) was 0.796 (95% confidence interval [CI]: 0.657–0.934, P = 0.001) and the cut-off was 11.5 (sensitivity = 0.679, specificity = 0.889). Patients with a higher score (>11.5) were more likely to survive at 28 days after ICU admission (log-rank test, P 11.5, the mortality at 28 days after ICU admission showed an obvious decrease.

Poly-dopamine (PDA) as an anode electrode of the potassium ion battery (PIB) has received a lot of attention due to its convenient preparation, environmental protection and low cost. However, due...

The volume of fluid (VOF) method combined with the adaptive grid method is used to study the influence of shear-thinning liquid viscosity ratio (e=μ0/μ∞) for various values of rheological index (n) and characteristic time (λ) on bubble shape, rise velocity, and apparent viscosity around a bubble; where 1/λ represents the shear rate at which the change in the viscosity curve occurs from the low shear rate to the power-law region. The present results show that, depending on the magnitudes of n and λ, the bubble shape and deformation parameter are strongly related to e, and the bubble shape can exhibit both stable and unstable states. There are two types of deformation phenomena for the unsteady deformation of bubbles. First, the aspect ratio changes with time, whereas the shape remains similar throughout. Second, the shape changes periodically with time. For the given values of n and λ, the bubble rise velocity at large time shows a nonlinear increase as e increases from 10 to ∞. Under the conditions of n≤0.3, λ*≥68.6, and e≥100 (λ*is the dimensionless characteristic time), a viscosity blind region (a region of high viscosity, where e is close to 1) appears behind the bubble. It is found that the tendency for the viscosity blind region is to reduce the bubble rise velocity at large time.

Digital, Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p, Funding Full funding sources are listed at the end of the paper (see Acknowledgments)., Ciencias Médicas y de la Salud

Submicron aerosol is of extensive concern not only due to its significant impact on air quality but also because it is detrimental to human health. In this study, we investigated the characteristics, sources and chemical processes of submicron aerosol based on real-time online measurements of submicron aerosols (NR-PM1) during December 2015 at an urban site in Beijing. The average mass concentration of NR-PM1 was 92.5±84.9 µg/m3, the hourly maximum was 459.1 µg/m3 during the entire observation. The organic aerosol (OA) (55%) was the largest contributor to NR-PM1. The average mass concentration of PAHs was 0.217±0.247 µg/m3, exhibiting the highest concentration at night and the lowest levels in the daytime. The average mass concentration of organic nitrate was 2.52±2.36 µg/m3 and that of inorganic nitrate was 7.62±8.22 µg/m3, accounting for 36% and 64%, respectively, of the total nitrate mass. Positive matrix factorization (PMF) differentiated the OA into five chemical components including LV-OOA, SV-OOA, COA, HOA and CCOA, accounting for 22%, 16%, 13%, 25% and 24% respectively, of the total OA. The average NR-PM1 mass concentration on the heavy polluted days (HPD) was 182.8±70.2 µg/m3, which was approximately 9 times that on clean days (CD). The enhanced secondary formation of SNA was evident on HPD, especially the rapid increase of sulfate (23%) and nitrate (19%).

The traditional Hassler-Brunner (HB) interpretation method of centrifuge capillary pressure is widely used in materials, soil, biotechnology, and especially in the petroleum industry. However, the assumptions of the traditional method cannot be simultaneously satisfied, the traditional method has been known to lead significant errors in some cases. In this paper, a new double integral method is proposed to evaluate the centrifuge capillary pressure of long tight sandstone samples. Both the changes of capillary length and interface of wetting phase and non-wetting phase fluids are considered by the new integral method, thus the average pressure and saturation derived from the proposed double integral method is more sufficient in theoretic foundation and clearer on physical meaning. By comparing with the measured capillary pressure of long tight sandstone core samples from porous plate, the capillary pressure calculated from traditional HB method is obviously smaller than the measured value, and the discrepancy increases with the decreasing core porosity. However, the average capillary pressure obtained by the proposed double integral method is remarkably consistent with the measured value. The findings of this study can help for better understanding of distribution of wetting phase fluid and average centrifuge capillary pressure in the core during centrifugal process.