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To investigate the diagnostic performance and usefulness of texture analysis in differentiating angiomyolipoma (AML) without visible fat from clear cell renal cell carcinoma (ccRCC) on four-phase contrast-enhanced computed tomography (CECT).Seventeen patients with AML without visible fat and 50 patients with ccRCC of size ≤4.5 cm who had also undergone preoperative four-phase CECT were included in this study. The histogram, grey-level co-occurrence matrix (GLCM), and grey-level run length matrix (GLRLM) were evaluated. Sequential feature selection (SFS) and support vector machine (SVM) classifier with leave-one-out cross validation were used.Using the SFS and SVM classifiers, five texture features were selected; mean (unenhanced), standard deviation (unenhanced and excretory), cluster prominence (nephrographic), and long-run high grey-level emphasis (corticomedullary). Diagnostic performance of the five selected texture features for all CT phases was as follows: 82% sensitivity, 76% specificity, 85% accuracy, and 85 area under the receiver operating characteristic curve (AUC). In the subgroup analysis, the AUCs of each phase were significantly0.5 (p0.05). In the pairwise comparison of AUCs between four phases, there were no significant differences between the four phases except the unenhanced and corticomedullary phases (p=0.015), i.e., the unenhanced phase showed slightly higher AUC than the corticomedullary phase.Texture analysis of small renal masses (≤4.5 cm) on four-phase CECT can accurately differentiate AML without visible fat from ccRCC and showed good diagnostic performance for both the unenhanced and enhanced phases.

Purpose This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology (3DPT) versus typical strategy (thin-layer CT scan) for the treatment of complicated proximal humeral fractures (PHFs) in old people. Methods Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were randomly assigned to two groups as per the controlled randomization table (34 cases in the test group and 32 cases in the control group). In the test group, 3DPT was applied to build the 3D facture model of a patient, according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software. This helped to confirm the diagnosis, design the individual operation plan, simulate the surgical procedures and perform the surgery as plan. In the control group, only thin-layer CT scan was applied for the design of the operation plan prior to the surgery. Here, parameters including surgery duration, blood loss volume during surgery, the number of fluoroscopy, time to union were statistically analyzed for two groups after the operation. The screw lengths designed before the surgery and measured during the surgery were compared. Results The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation, which facilitated preoperative diagnosis, operation planning and design, data measurement, preselection of internal fixator and surgical outcome simulation. According to the follow-up ranging from 12∼28 months for the 66 patients, the results showed no significant difference in time to union between the two groups ( P > 0.05). Apart from that, less surgery duration, less blood loss during surgery, less number of fluoroscopy can be observed compared with the control group ( P Conclusions In this study, 3DPT showed great clinical feasibility of the treatment of complicated PHFs. The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury. It benefited surgeons to gain a better understanding of complicated PHFs, design a most suitable operation plan prior to surgery and facilitate the doctor-patient communication. This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes.

Cervical cancer is one of the most prevalent malignancies in women worldwide. Therefore, the investigation about the molecular pathogenesis and related therapy targets of cervical cancer is an emergency. The objective of the present study is to investigate the effects of valproic acid (VPA), a histone deacetylase inhibitor, on the angiogenesis of cervical cancer. The effects and mechanisms of VPA on in vitro angiogenesis and vascular endothelial growth factor (VEGF) expression of human cervical cancer HeLa and SiHa cells were investigated. Our present study reveals that 1 mM VPA can significantly inhibit the in vitro angiogenic potential and VEGF expression of human cervical cancer HeLa and SiHa cells. Further, the transcription and protein levels of hypoxia inducible factor-1α (HIF-1α), and not HIF-1β, are significantly inhibited in VPA-treated cervical cancer cells. Over expression of HIF-1α can obviously reverse VPA-induced VEGF down regulation. VPA-treatment decreases the activation of Akt and ERK1/2 in both HeLa and SiHa cells in a time-dependent manner. The inhibitor of Akt (LY 294002) or ERK1/2 (PD98059) can inhibit VEGF alone and cooperatively reinforce the suppression effects of VPA on HIF-1α and VEGF expression. Collectively, our data reveal that the inhibition of PI3K/Akt and ERK1/2 signals are involved in VPA-induced HIF-1α and VEGF suppression of cervical cancer cells.

Aim To evaluate the outcome of arthroscopy treatment using high-strength line in the treatment of tibial avulsion fracture of posterior cruciate ligament. Methods Both the avulsed bone block and the tibia bone bed were refreshed. The procedure was completed with the assistance of PCL director drill guide. The reduction and fixation using high-strength line were used to fix the avulsed bone by from posterior middle portal. Rehabilitation began early postoperatively. Results From January 2010 to June 2012, a total of 18 arthroscopically treated cases of PCL tibial avulsion fracture were retrospectively evaluated. Reduction of the avulsion fragment was obtained in all cases. 16 cases were followed up for 7–30 months (average 13.6), and 2 cases were out of follow-up. In the 16 followed patients, flexion and extension were back to normal within 6 weeks, and return to normal walk in 12 weeks. The bone healing was good without any vascular or nerve complications. All the patients regained the preinjury activity level. The mean score (and standard deviation) increased from 38.9 ± 4.9 points to 95.2 ± 3.8 points with the system of Lysholm, from 57.1 ± 10.3 points to 94.3 ± 4.4 points with the system of IKDC. Post-test displacement of KT3000 declined from 3.6 ± 0.39 to 1.1 ± 0.27 mm. Conclusion Arthroscopic vertical fixation by high-strength line is a simple, safe, reliable, and micro-invasive treatment to PCL tibial avulsion fracture. It is a kind of real all arthroscopic technique, and good for early postoperative rehabilitation. The total stability of the knee could be gained, and the second operation to remove the internal fixation is avoided.

The SUS304 stainless steel is widely used in many industries, and the prediction and detection of fracture tendency in these stainless steel applications are very important for their safety and serviceability. The ductile fracture is caused by micro damage and its accumulation, whose mechanism can be described by the micro void nucleation, growth and final extension to failure. The nucleation, growth and extension of the micro voids are related with the movement of the dislocations. In this paper, the optic microscope, X-ray diffraction and scanning electron microscope were used to observe the changes of the sample during uniaxial tensile tests, and analyse the relationship between micro void and dislocation density, and finally establish a dislocation density-strain model. This model provides a new idea for non-destructive testing, which can be applied to the early identification of fracture tendency.

Background Tibiotalocalcaneal arthrodesis is most common and effective surgical treatment for severe hindfoot pathology, but the fusion rate is often lower than the ordinary tibiotalar arthrodesis because of the more serious joint disease associated with obvious deformity and osteoporosis. Recent literature describe tibiotalocalcaneal arthrodesis with reverse PHILOS plate with good clinical outcome result, though some patients non-union, due to eccentric force of the plate may be hidden. The purpose of this study was to evaluate clinical outcome of the lateral approach for tibiotalocalcaneal (TTC) arthrodesis with reverse PHILOS Plate and medial cannulated screw. Methods Between Jun, 2013 to April, 2015 12 patient with hindfoot pathology had TTC arthrodesis with a reverse PHILOS plate with medial cannulated screw through a lateral approach with resection of the distal fibula and bone graft. Perioperatively observe for wound and neurovascular status. Patients were follow-up from post-operative 1, 3, 6 and12 months, to observation of wound healing, ankle pain, subtalar Joint Fusion, internal fixation and ankle function. Ankle function were scored according to the American Orthopaedic Foot and Ankle Society(AOFAS) Ankle-Hindfoot Scale system. Results Twelve ankle fusion all patient follow-up, with mean time to surgery 18.6 months (12-36 month). No cases infection and issue necrosis; one patient complaint of lateral foot numbness we observe and follow-up was spontaneously recovery after 3 months. After 3 months of operation, no obvious pain of ankle joint and internal fixations loose were found. Almost fusion and good axial alignment of TTC joint also were found by X-ray and CT examination. After final fellow-up of each case, no case complain of pain of ankle joint, good fusion and axial alignment of TTC joint were also all found through Terminology. The mean American Orthopaedic Foot and Ankle society (AOFAS) score average was 77.5. Conclusion TTC arthrodesis with reverse PHILOS Plate and medial cannulated screw have advantages of clear incision, effective bone orthopaedic and graft fully secure, stable internal fixation, high fusion rate and less complications, can effectively correct deformities, alleviate hindfoot pain and improve function, and is an effective method of treatment of after severe hindfoot disease. Trial registration This trial is registered on ClinicalTrials.gov with reference number: ID: NCT02977910 . Registered 26 Nov 2016, retrospectively registered.

Ultrasound Computer Tomography (USCT) is a promising new imaging system for breast cancer diagnosis. An essential step before further processing is to remove the water background from the reconstructed images. In this paper we present a fully-automated image segmentation method based on three-dimensional active contours. The active contour method is extended by applying gradient vector flow and encoding the USCT aperture characteristics as additional weighting terms. A surface detection algorithm based on a ray model is developed to initialize the active contour, which is iteratively deformed to capture the breast outline in USCT reflection images. The evaluation with synthetic data showed that the method is able to cope with noisy images, and is not influenced by the position of the breast and the presence of scattering objects within the breast. The proposed method was applied to 14 in-vivo images resulting in an average surface deviation from a manual segmentation of 2.7 mm. We conclude that automated segmentation of USCT reflection images is feasible and produces results comparable to a manual segmentation. By applying the proposed method, reproducible segmentation results can be obtained without manual interaction by an expert.

Aim To identify magnetic resonance imaging (MRI) features for differentiating hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (IHCC) and summarise their diagnostic accuracy. Materials and methods PubMed and EMBASE were searched for studies that employed MRI features to differentiate HCC from IHCC. Overlapping descriptors used to denote the same imaging finding in different studies were subsumed under a single feature. The pooled diagnostic accuracies, including the diagnostic odds ratios (DORs) and 95% confidence intervals (CIs) of the identified features, were calculated using a bivariate random-effects model. Results In total, 1,370 patients with HCC and 687 patients with IHCC in 14 studies were included. Fifty-two descriptors were subsumed under 15 MRI features. Of these, 11 features were informative for differentiating HCC from IHCC. The five MRI features favouring HCC were capsule, arterial diffuse enhancement, portal venous washout, conventional washout, and intralesional fat; the six MRI features favouring IHCC were surface retraction, arterial rim enhancement, progressive enhancement, target appearance on diffusion-weighted and hepatobiliary phase (HBP) images, and bile duct dilatation. These features tended to show high specificity, but low sensitivity. Useful MRI features with high DORs (>20) were capsule (34; 95% CI, 5–215) and intralesional fat (23; 4–85) for HCC and arterial rim enhancement (31; 6–160), progressive enhancement (24; 8–73), and target appearance on HBP images (29; 3–261) for IHCC. Conclusion Eleven informative MRI features for differentiating HCC from IHCC were identified. These features will assist in the accurate diagnosis of these diseases and in disease outcome prediction.

In this study, a miniature bandpass power divider based on capacitive-loaded multicoupled line is proposed, which features equal-ripple insertion loss, return loss and isolation responses. Owing to the employment of capacitive-loaded transmission line resonators, it can achieve very compact size and wide upper stopband. The proposed bandpass power divider can be designed according to the conventional filter synthesis techniques, and is suitable for on-chip implementation. Specifically, a bandpass power divider with a centre frequency f0 of 5.5 GHz, 18.2% fractional bandwidth, and third-order equal-ripple response is designed and implemented using the commercial GaAs pseudomorphic high electron mobility transistor (pHEMT) process. The circuit size without pads is 0.87 mm×0.95 mm, and the electrical size is only 0.057 λg×0.062 λg at f0. The in-band insertion loss is less than 6 dB with a minimum insertion loss of 5.12 dB. The in-band return loss is better than 10 dB, and the isolation is better than 15 dB. In addition, a wide 30-dB upper stopband up to 57 GHz is achieved.

In this paper, the exponentially weighted moving average (EWMA) chart when the process parameters are unknown is studied. Under such circumstances, the process parameters are estimated from an in-control Phase-I dataset. Since the run length distribution of EWMA chart is skewed to the right, interpretation based on average run length (ARL) does not provide meaningful information about the chart's performance. On the contrary, the median run length (MRL) provides more useful interpretation. Thus, MRL will be used to assess the performance of the EWMA chart when process parameters are known and estimated. In this study, it is found that the out-of-control and in-control performances are severely affected by parameter estimation, especially when the sample size and process mean shifts are small. Moreover, a large number of in-control Phase-I samples is required so that the EWMA chart with estimated process parameters attains satisfactory performances as its known process parameters counterpart.

Given the lack of information about catastrophic antiphospholipid syndrome (APS) in pediatric patients, the objective of the current study was to describe the clinical characteristics, laboratory features, treatment, and outcome of pediatric patients with catastrophic APS and compare them with the adult patients with catastrophic APS. We identified patients who were under 18years of age at time of catastrophic APS diagnosis included in the international registry of patients with catastrophic APS (CAPS Registry). Their main demographic and clinical characteristics, laboratory features, treatment, and outcome were described and compared with those of adult patients with catastrophic APS. From the 446 patients included in the CAPS Registry as of May 2013, 45 (10.3%) patients developed 46 catastrophic events before 18years of age (one patient presented two episodes). Overall, 32 (71.1%) patients were female and the mean age was 11.5±4.6years (range, 3months-18years). A total of 31 (68.9%) patients suffered from primary APS and 13 (28.9%) from systemic lupus erythematosus (SLE). The main differences between the two groups of patients were the higher prevalence of infections as precipitating factor for catastrophic event in the pediatric population (60.9% versus 26.8% in the adult population, p0.001) and of peripheral vessel thrombosis (52.2% versus 34.3%, p=0.017). In addition, catastrophic APS was the first manifestation of APS more frequently in pediatric patients (86.6% versus 45.2%, p0.001). Interestingly, pediatric patients showed a trend of lower mortality, although the difference was not statistically significant (26.1% versus 40.2%; odds ratio, 1.9; 95% confidence interval, 0.96-3.79; p=0.063). No differences were found neither in the laboratory features nor in the isolated or combination treatments between groups. Catastrophic APS in pediatric patients is a rare disease. There are minimal differences in the clinical and laboratory features, treatment, and outcome of pediatric and adult catastrophic APS patients.

Purpose This study was conducted to investigate the feasibility and clinical potential of using the 3D printing technology (3DPT) versus typical strategy (thin-layer CT scan) for the treatment of complicated proximal humeral fractures (PHFs) in old people. Methods Sixty-six old patients age ranging from 61 to 76 years with persistent complicated PHFs were randomly assigned to two groups as per the controlled randomization table (34 cases in the test group and 32 cases in the control group). In the test group 3DPT was applied to build the 3D facture model of a patient, according to the data acquired from the thin-layer CT scan and subsequently processed with Mimics software. This helped to confirm the diagnosis, design the individual operation plan, simulate the surgical procedures and perform the surgery as plan. In the control group, only thin-layer CT scan was applied for the design of the operation plan prior to the surgery. Here parameters including surgery duration, blood loss volume during surgery, the number of fluoroscopy, time to union were statistically analyzed for two groups after the operation. The screw lengths designed before the surgery and measured during the surgery were compared. Results The 3D PHF model generated using 3DPT was able to provide the visual display and omni-directional observation of the direction and severity of the fracture dislocation, which facilitated preoperative diagnosis, operation planning and design, data measurement, pre-selection of internal fixator and surgical outcome simulation. According to the follow-up ranging from 12∼28 months for the 66 patients, the results showed no significant difference in time to union between the two groups ( P > 0.05). Apart from that, less surgery duration, less blood loss during surgery, less number of fluoroscopy can be observed compared with the control group ( P Conclusions In this study 3DPT showed great clinical feasibility of the treatment of complicated PHFs. The 3D-print PHF model had the ability to clearly display the fracture and thus was useful to determine the fracture classification and the magnitude of fracture injury. It benefited surgeons to gain better understanding of complicated PHFs, design a most suitable operation plan prior to surgery and facilitate the doctor–patient communication. This therefore enabled the reduction of intraoperative injury and the optimization of surgical outcomes.

The aim of the present study was to determine the effect of purified high-dose anthocyanoside oligomer administration on nocturnal visual function and clinical symptoms in low-to-moderate myopia subjects. The study was a randomized, double-blind, placebo-controlled trial and involved sixty subjects with asthenopia and refractive errors between −1·00 and −8·00 diopters in both eyes. Thirty subjects were administered a purified high-dose anthocyanoside oligomer (100 mg tablet comprising 85 % anthocyanoside oligomer), and thirty were given a placebo in tablet form twice daily for 4 weeks. Prior to the treatment, the placebo and anthocyanoside groups were similar in terms of age and contrast sensitivity. Before and after treatment, subjects completed a questionnaire to determine their clinical symptoms and were also assessed for nocturnal visual function using contrast sensitivity testing. Questionnaire data analysis showed that, following treatment, twenty-two (73·3 %) anthocyanoside subjects showed improved symptoms, whereas only one placebo subject showed an improvement (Fisher's exact test,Pttest,Pttest,P

The authors have proposed an H2-optimal control method of random loading for a fatigue test. The optimal prefilter or optimal controller has been realized, and its system function or frequency response function was derived. The control method was verified by a test, and its use was presented.