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Abstract Background REBOA is a method used to manage bleeding during surgery involving sacropelvic tumors. Nevertheless, studies on the use of REBOA among elderly people are lacking. The aim of this research was to investigate the efficacy and safety of Zone III REBOA in patients aged more than 70 years. Methods A comparative study was conducted using case-control methods. A group of patients, referred to as Group A, who were younger than 70 years was identified and paired with a comparable group of patients, known as Group B, who were older than 70 years. Continuous monitoring of physiological parameters was conducted, and blood samples were collected at consistent intervals. Results Totally, 188 participants were enrolled and received REBOA. Among the 188 patients, seventeen were aged more than 70 years. By implementing REBOA, the average amount of blood loss was only 1427 ml. Experiments were also conducted to compare Group A and Group B. No notable differences were observed in terms of demographic variables, systolic blood pressure (SBP), arterial pH, lactate levels, blood creatinine levels, potassium levels, or calcium levels at baseline. Additionally, after the deflation of the REBOA, laboratory test results, which included arterial pH, lactate, potassium concentration, calcium concentration, and blood creatinine concentration, were not significantly different (P > 0.05). Conclusion This study indicated that in selected patients aged more than 70 years can achieve satisfactory hemodynamic and metabolic stability with Zone III REBOA. Level of evidence Therapeutic study, Level III.

Abstract Swine acute diarrhea syndrome coronavirus (SADS-CoV) is a novel porcine enteric coronavirus that causes acute watery diarrhea, vomiting, and dehydration in newborn piglets. The type III interferon (IFN-λ) response serves as the primary defense against viruses that replicate in intestinal epithelial cells. However, there is currently no information available on how SADS-CoV modulates the production of IFN-λ. In this study, we utilized IPI-FX cells (a cell line of porcine ileum epithelium) as an in vitro model to investigate the potential immune evasion strategies employed by SADS-CoV against the IFN-λ response. Our results showed that SADS-CoV infection suppressed the production of IFN-λ1 induced by poly(I:C). Through screening SADS-CoV-encoded proteins, nsp1, nsp5, nsp10, nsp12, nsp16, E, S1, and S2 were identified as antagonists of IFN-λ1 production. Specifically, SADS-CoV nsp1 impeded the activation of the IFN-λ1 promoter mediated by MAVS, TBK1, IKKε, and IRF1. Both SADS-CoV and nsp1 obstructed poly(I:C)-induced nuclear translocation of IRF1. Moreover, SADS-CoV nsp1 degraded IRF1 via the ubiquitin-mediated proteasome pathway without interacting with it. Overall, our study provides the first evidence that SADS-CoV inhibits the type III IFN response, shedding light on the molecular mechanisms employed by SADS-CoV to evade the host immune response.

Carbon fiber (CF) is one of the conductive fillers with the best electrical conductivity, but it is expensive and difficult to disperse in cement matrix, which limits the application and development of CF conductive cement-based composites. Therefore, this paper took the conductive cement slurry with CF content of 1.0 % as the control group, and proposed to use low-cost graphite (G) and nano-carbon black (NCB) instead of some CFs to prepare conductive cement-based composites. The synergistic enhancement effect between different conductive fillers was explored to reduce the cost of materials while maintaining electrical conductivity. The results showed that the resistivity decreased first, then increased, then decreased and then increased with the increase of the proportion of particle conductive filler instead of CF. The resistivity of conductive cement slurry was 125.65 Ω·cm when G replaced 20 % CF, the resistivity of conductive cement slurry was 140.66 Ω·cm when NCB replaced 30 % CF, and the resistivity of conductive cement slurry was 122.05 Ω·cm when G and NCB replaced 30 % CF, which were close to the resistivity of the control group (122.35 Ω·cm). The purpose of reducing the cost of materials without affecting the conductivity of conductive cement slurry was achieved.

BackgroundThe percutaneous screw reconstruction technique, known as the “Tripod Technique,” has demonstrated favorable clinical outcomes in the management of metastatic periacetabular lesions, as evidenced by our prior investigations and corroborated by independent studies. Nevertheless, there is a steep learning curve in handling this technique, with possible complications such as intraarticular screw placement.MethodsPreoperative pelvic CT scans were acquired before surgery and utilized for the guiding frame design. A convolutional neural network model was trained with annotated data to identify the starting point and trajectory of each potential screw. A model boundary intersection detection technology was used to determine the optimal diameter and length of each screw. A non-rigid registration technology was matched with a prefabricated model of the body surface to design personalized anchoring skin pads. Finally, a polylactic acid-based guiding frame for intraoperative was custom-made with a 3D printer.Results12 patients underwent a guiding frame-assisted Tripod procedure for treatment of periacetabular metastatic lesions. An intraoperative CT scan was performed in all cases to confirm screw trajectories. Among 36 screws that were implanted, 26 screws were implanted as designed. The remaining ten screws drifted, but all remained within the intra-osseous conduit without any complications. The mean surgical time was 1.22 h with the guiding frame compared with 2.3 h without the guiding frame. Following the surgical procedure, a noteworthy enhancement in pain management, as evidenced by a reduction in scores on the visual analog scale (p < 0.01), and an improvement in functional status, as assessed through the Eastern Cooperative Oncology Group score (p < 0.01), were observed when compared to the patient’s pre-operative condition.ConclusionThis proof-of-concept investigation demonstrates that the amalgamation of AI-assisted surgical planning and additive manufacturing can improve surgical accuracy and shorten surgical duration. While access to this technology is currently constrained during its early stages of development, it is anticipated that these limitations will diminish as the potential of AI and additive manufacturing in facilitating complex orthopedic procedures becomes more evident, leading to a surge in interest and adoption of this approach.

We aimed to investigate the fluid–solid–ice coupling mechanism as structures break through ice into water. Using LS–DYNA finite element software, a numerical simulation method is established, based on the ALE flow–solid coupling method, and the penalty function contact algorithm, which describes the structure–ice–water coupling interaction. The Eulerian algorithm is used to describe the air and water domains, while the Lagrange method is applied to the wedge and ice structure. The mechanical properties of ice are characterized using the elastic–plastic failure strain model. The feasibility of simulating the entry of structures into water via the ALE method is demonstrated by comparing the experimental and simulation results of wedges entering into water. The applicability of the ice material model in simulating collision–induced breakup is verified by comparing a simulation of a rigid plate hitting a spherical head of ice, with results from the ISO standard. The effects of water during icebreaking are assessed by simulating a wedge breaking through ice into water, as well as through ice without water. Additionally, the ice breakup and motion response of the wedge under different working conditions are compared by varying the wedge mass and icebreaking speed.

BackgroundSurgical treatment of musculoskeletal tumors in the periacetabular region present extremely difficult due to the complex anatomy and need for reconstruction. Orthopedic surgeons face more difficulties in patients with neurological conditions, which can cause increased muscle tone, an elevated risk of fractures, and compromised bone quality. There is limited evidence regarding endoprosthetic reconstruction for periacetabular tumors in individuals with neurological disorders.MethodsWe conducted a single-center retrospective study to examine the outcomes of patients with preexisting neurological conditions who underwent surgery to remove periacetabular tumors and who underwent endoprosthesis reconstruction. Clinical presentation, detailed neurological conditions, complications, and functional outcomes were studied.ResultsSixteen out of the 838 patients were identified (1.91%), with a mean follow-up time of 33 months. The primary neurological conditions encompassed Parkinson's disease, Alzheimer's disease, dementia, and cerebral ischemic stroke. Every patient was diagnosed with periacetabular lesions that were either primary or oligometastatic. They underwent tumor resection and subsequently received endoprosthetic reconstruction of the hemipelvis. Three patients developed metastasis lesions later, and two patients experienced tumor recurrence. Five cases experienced hip dislocation—one with periprosthetic fracture and one with surgical site infection. The position of the prosthetic rotating center was not correlated with dislocation. The reoperation rate was 31.25%. The cohort of patients all presented with more extended hospital stays and rehabilitation. In 3 patients, the general functional score was good, while in 6 patients, it was fair; in 7 patients, it was regarded as poor. The average MSTS93 score was 49.71%.ConclusionEndoprosthetic reconstruction after periacetabular tumor resection is an effective way to eliminate tumors and salvage limbs. However, this group of patients has an increased likelihood of secondary surgery, complications, extended hospital stay, and no significant improvement in functional outcomes. Despite the diverse nature of the cohort, it is recommended to consider enhanced soft tissue reconstruction, supervised functional recovery and rehabilitation training.

Background: There is currently no consensus regarding the optimal perioperative antiplatelet strategy for carotid artery surgery. This multicentre study aimed to analyse the association between preoperative aspirin monotherapy following postoperative dual antiplatelet therapy (DAPT) and the risk for stroke and death after carotid endarterectomy (CEA). Methods: This cohort study included 821 patients with carotid artery stenosis who underwent CEA. Primary outcomes included any stroke or death up to the one-month postoperative follow-up. Multilevel multivariate regression analyses and descriptive statistics were performed. Results: Patients were predominantly male (53 %), with a mean age of 66.2 years. The primary outcome occurred in 1.6 % of patients. Univariate and multivariate analyses revealed that patients with chronic obstructive pulmonary disease (COPD) exhibited a high risk for stroke or death (P = 0.011). The occurrence of any local complications in the neck was accompanied by an increase in diastolic blood pressure (DBP) (P = 0.007). Patients with a high systolic blood pressure (SBP) (P = 0.002) experienced a longer operative duration. The length of hospital stay was longer in the patients with COPD (P = 0.020), minor stroke (P = 0.011), and major stroke (P = 0.001). A positive linear correlation was found between SBP and operative duration in the overall population (β 0.4 [95 % confidence interval (CI) 0.1–0.7]; P = 0.002). The resultant curve for DBP and any local complications in the neck exhibited a two-stage change and one breakpoint in the entire population (k = 68 mmHg,

ABSTRACTAtherosclerosis (AS) is a prevalent cardiovascular disease that greatly increases mortality in the aging population and imposes a heavy burden on global healthcare systems. The purpose of this study is to examine the research structure and current trends of monoclonal antibodies (mAbs) against AS from a bibliometric perspective, since the development of these drugs is currently booming. This study collected articles and reviews on mAbs against AS from the Web of Science Core Collection, spanning from 2003 to 2022. Biblioshiny was utilized to analyze and visualize the characteristics of countries, regions, authors, institutions, and journals included in this collection. We used VOS viewer to illustrate the frequency of country co-occurrence, and CiteSpace to visualize co-cited reference, keywords co-occurrence, keywords citation bursts, keywords clustering and timeline plots. The study included 1325 publications, with the United States emerging as a leading contributor to the field. ATHEROSCLEROSIS, CIRCULATION and ARTERIOSCLEROSISTHROMBOSIS AND VASCULAR BIOLOGY are core journals that publish high-quality literature on the latest advances in the field. Noteworthy authors with numerous high-quality publications include Witztum JL and Tsimikas S. Currently, lipid metabolism and inflammation are the main research areas of interest in this field. The mAbs against AS is an evolving field, and ongoing research continues to advance our understanding. This paper provides a comprehensive overview of the current state of knowledge in this area, highlighting two primary research directions: inflammation and lipid metabolism. Additionally, the paper identifies emerging research hotspots, which will provide researchers with useful insights to guide future investigations and anticipate research directions.

BackgroundPatients with neurological disorders often experience a high incidence of postoperative complications following proximal femur replacement (PFR) surgery. The orthopaedist faces a significant difficulty in treating Parkinson's disease (PD) because of the weakened bone condition, excessive muscle tension, and increased risk of fractures. The objective of this research is to assess the impact of PD on PFR following tumor removal.MethodsA retrospective study was conducted from 2010 to 2020, focusing on a solitary institution, analyzing 9 patients diagnosed with PD who underwent PFR with hemiarthroplasty as a result of tumor removal. The study consists of 2 men and 7 women, with an average age of 71 (SD, 12) years. We assessed the outcomes after surgery in terms of pain management, quality of life, functional ability, occurrence of complications, and survival durations.ResultsAll nine patients underwent planned surgeries. Intraoperative complications was not observed. The average length of the follow-up period was 24 (SD, 20) months, ranging from 8 to 72 months. Despite the fact that 8 patients passed away due to tumor progression, the endoprostheses were still well at that point. The preoperative VAS score of 7 (SD, 1.87) decreased to a postoperative score of 2 (SD, 1.32). The KPS was improved to73 (SD, 7) from 52 (SD, 14), postoperatively. Post-surgery, there were notable enhancements in both pain levels and the overall quality of life scores. Following the surgical procedure, individuals are able to ambulate steadily, resuming their regular daily routines. Living patients had an average MSTS score of 21 (SD, 2.5), ranging from 17 to 25. In total, there were four (44.4%) patients suffered complications after surgery, comprising of one wound dehiscence, one prosthetic fracture, one hip dislocation, and one local recurrence.ConclusionsSignificant improvements in function and pain relief can be achieved through PFR with hemiarthroplasty following tumor removal in patients with PD. The implementation of thorough preparation and carefull nursing results in reduced complications and improved outcomes in PD patients.

OBJECTIVE: The objective is to explore the correlation between carotid artery calcification score and cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS) in patients with carotid artery stenosis. METHODS: Consecutive patients treated for carotid artery stenosis from October 2016 to August 2021 from two centers were studied. Carotid artery calcification score was manually segmented on multi-detector row spiral computed tomography angiography scans before CAS. The associations between carotid artery calcification score and the occurrence of CHS during the in-hospital time were assessed. RESULTS: A total of 175 patients were enrolled in the study. The mean age was 72.12 ± 7.51 years. All patients were undergone CAS treatment successfully. There were 46 cases that occurred CHS (26.29%). Univariate logistic regression analyses showed that for every 1 unit (100-score) increase in carotid artery calcification score, the risk of CHS increased by 1937% (odds ratio [OR] = 20.37, 95% confidence interval [CI]: 7.54–55.03, P < 0.01). In addition, the increasing rate was significantly different between the open-cell group (OR = 261.7, P < 0.01) and the closed-cell group (OR = 11.4, P < 0.01). The area under curve of predictiong model of carotid artery calcification score to CHS was 0.84 (95% CI, 0.75–0.93). CONCLUSION: Carotid artery calcification score was an independent risk factor for CHS in patients who underwent CAS. The application of carotid artery calcification score as risk factor in clinical screening of carotid artery stenosis patients may have beneficial effects on the management of CAS.

In recent years, UAV industry is developing rapidly and vigorously. However, so far, there is no relevant research on the fatigue detection method for UAV remote pilot, which is the core technology to ensure the flight safety of UAV. Aiming at this problem, a fatigue detection method for UAV remote pilot is proposed in this paper. Specifically, we first build a UAV operator fatigue detection database (OFDD). By analyzing the fatigue features in the database, we find that multiple facial features are highly correlated to the fatigue state, especially the head posture, and the temporal information is essential for distinguish between yawn and speaking in the study of UAV remote pilot fatigue detection. Based on these findings, a fatigue detection method for UAV remote pilots was proposed by efficiently locating the related facial regions, a multiple features extraction module to extract the eye, mouth and head posture features, and an efficient temporal fatigue decision module based on SVM. The experimental results show that this method not only performs well on the traditional driver dataset, but also achieves an accuracy rate of 97.05%; and it achieves the highest detection accuracy rate of 97.32% on the UAV remote pilots fatigue detection dataset OFDD.

Abstract Background To assess the immediate effect and factors affecting the efficacy of rotational thrombectomy (RT) in patients with thrombus-containing lower-limb ischaemic lesions. Methods Patients were retrospectively divided into two groups: RT and RT+ CDT (Catheter-directed thrombolysis). The RT group included patients in whom intraoperative thrombus aspiration was successful, while the RT + CDT group included patients in whom intraoperative thrombus aspiration was less effective and remedial CDT treatment was used. The primary outcome was the immediate effect of RT on thrombus-containing lower-limb ischaemic lesions. Results From May 2015 to July 2021, 170 patients (113 men, 57 women; mean age, 74.0 years) with thrombus-containing lower-limb ischaemic lesions were treated in our centre. Of these patients, 113 received RT only, while 57 received RT + CDT. There were no significant intergroup differences in terms of age, disease duration, or comorbidities, but a higher proportion of male patients and higher preoperative plasma D-dimer levels (1.23 vs. 0.84; p = .017) was observed in the RT + CDT group. There were no significant intergroup differences in terms of diagnosis, lesion characteristics, lesion location, or lesion length. Multivariate logistic regression analysis revealed that male sex (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.098–6.410; p = .030) and poor distal runoff (OR, 2.94; 95% CI, 1.439–5.988; p = .003) were associated with higher rates of additional CDT. Male patients also had a significantly longer onset time, more thrombotic occlusions, and a greater frequency of in-stent restenosis. Conclusions RT alone or with CDT is a feasible primary treatment option for thrombus debulking. Sex significantly influences the effect of RT on thrombus-containing lower-limb ischaemic lesions.

For any cities, the optimal objective of development is to fully tap the value of land resources, while pursuing the progress of economy, society, and eco-environment. Currently, there is not yet a unified evaluation standard for sustainable development quality of urban environment; the land resource value has not been deeply evaluated from the three aspects of society, economy, and eco-environment. Therefore, this paper tries to measure urban land resource value based on sustainable environmental space governance. Firstly, the authors constructed a scientific evaluation index system for sustainable development quality of urban environment. Next, a comprehensive evaluation method was developed for sustainable land utilization in urban space governance system. After that, the urban space governance scheme was subject to multi-objective optimization. Finally, experiments were carried out to measure the urban land resource value, and estimate the urban ecological service functions and their values. On this basis, the benefits of the urban space governance scheme were analyzed in various aspects. The results confirm the effectiveness of our measurement algorithm.

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in sacral and pelvic tumor resection that provides hemorrhage control. However, few studies have been performed to capture the effects of REBOA in a nonshock condition and provide a detailed description of the changes occurring with prolonged occlusion time. This study aimed to examine the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections following different periods of REBOA. Methods In total, 121 patients who underwent surgical tumor resections of the pelvis and/or the sacrum with the use of aortic balloon occlusion were prospectively enrolled from October 2020 to December 2021. All cases were divided into Group A (occlusion time ≤ 60 min, n = 57) and Group B (occlusion time ≥ 90 min, n = 64). Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Results Balloon inflation resulted in a significant increase in SBP from 106 to 120 mmHg and decreased to 96 mmHg immediately following balloon deflation. With the application of REBOA, the median blood loss was only 1200 ml (range, 400–7900). When deflating the REBOA, the arterial pH was lower than baseline (7.36 vs. 7.41, p

BackgroundCarotid body tumor (CBT) is the most common head and neck paraganglioma. Whether preoperative embolization benefits CBT patients who will receive surgical resection is still controversial.MethodsIn this multi-center retrospective study, we collected data from patients with CBT who received surgical treatment without (group A) or with preoperative embolization (group B) from 2011 to 2019. The primary outcome was the rate of death or stroke after 3 years of follow-up. The secondary outcomes of the study were length of operation (LOO), intraoperative blood loss (IBL), length of stay (LOS), rate of recurrence, and rate of cranial nerve (CN) injuries. Descriptive statistics were used to analyze the demographics, clinical characteristics, complications, and follow-up results of the patients.ResultsBetween January 2011 and October 2019, 261 consecutive patients (107 male and 154 female) entered analysis. After 3 years of follow-up, no patient died in both groups. Only three patients with stroke were detected: 2/226 (0.9%) in group A vs. 1/35 (2.9%) in group B (p = .308). The LOO in group A was 132.6 ± 64.6 min compared with 152.9 ± 40.4 min in group B (p = .072). IBL in group A was 375.4 ± 497.8 ml compared with 448.0 ± 270.8 ml in group B (p = .400). LOS in group A was 8.3 ± 2.0 days compared with 7.4 ± 1.7 days in group B (p = .016). Seventy-two CN injuries were detected: 65/226 (28.8%) in group A vs. 7/35 (20.0%) in group B (p = .281). There were 65 temporary CN injuries (59 in group A vs. 6 in group B) (p = .254) and seven permanent CN injuries (6 in group A vs. 1 in group B) (p = .945). Three most frequently injured cranial nerves were the pharyngeal branch and superior laryngeal nerve (12.3%), recurrent laryngeal nerve (7.7%) and vagus nerve (7.3%).ConclusionThere was insufficient evidence to support the efficacy of preoperative embolization. CBT resection alone had a similar rate of stoke, recurrence, and CN injuries when compared with CBT resection with preoperative arterial embolization. Meanwhile, CBT resection alone did not increase LOO and IBL.

Abstract Background Aortic dissection is one of the most common emergency condition leading to internal organs or lower limb ischemia and aortic rupture. Herein, we described a reverse “cheese wire” endovascular fenestration repair (CWFER) in a patient with complicated abdominal aortic dissection which had never been reported. Case presentation A 62-year-old male presented abdominal tear-like pain and acute ischemia of the right lower extremity during the endovascular treatment of celiac trunk aneurysms. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed abdominal aortic type B dissection with acute ischemia of the right lower extremity preoperatively. After a detailed preoperative examination, the patient then was performed a reverse CWFER. So far, the patient has been followed-up for 6 months, postoperative CTA demonstrated good stent-graft expansion and perfusion of bilateral common iliac arteries; also, no endoleak was detected. Conclusions The right iliac artery in this patient supplied by false lumen, which lead to acute ischemia of the right lower extremity, needed to be treated as an emergency and dealt with promptly. CWFER is a very high-risk treatment that requires the rich experience of vascular surgeon and accurate assessment of aortic dissection. After interventional treatment, the patient recovered uneventfully after 6 months’ follow-up.

Background Eosinophil count (EOS) has been proposed to provide prognostic information in multiple cardiovascular disorders. However, few researchers have investigated the predictive value of EOS for patients with type B aortic dissection who had thoracic endovascular repair. Methods and Results The authors reviewed the records of 912 patients with type B aortic dissection who were treated with thoracic endovascular repair in Changhai Hospital, Shanghai. By using receiver operating characteristic curve analysis, patients were divided into 2 groups based on the admission EOS cutoff value (0.05). Kaplan–Meier analysis revealed that patients with an EOS

This paper focuses on how to solve the demand of how to quickly explore more urban space design and layout in terms of the conservation and reuse of historical blocks under computer-aided design technology. Referring to urban inductive patterns, the author establishes an urban space design grammar of historical districts based on shape grammar and pattern language. It forms a complete generative urban space design method involving morphological analysis, rule-making, and scheme generation. Furthermore, taking the typical Russian-style historical block along the Chinese Eastern Railway—the historical district in front of Anda Station as an application example—this paper completed the generative urban space design process of block redevelopment and environmental reconstruction, which, using computer-aided technology, was under the premise of protecting the original historic block fabric. The final two group results of the experimental plot and the other plots of the historical district show that this method can quickly and accurately generate lots of urban space design schemes that meet the designers’ pre-thinking, and these schemes can be modified by real-time calculation and interactive operation.

Abstract Background The incidence rate of adenocarcinoma of the oesophagogastric junction (AEG) has significantly increased over the past decades, with a steady increase in morbidity. The aim of this study was to explore a variety of clinical factors to judge the survival outcomes of AEG patients. Methods We first obtained the clinical data of AEG patients from the Surveillance, Epidemiology, and End Results Program (SEER) database. Univariate and least absolute shrinkage and selection operator (LASSO) regression models were used to build a risk score system. Patient survival was analysed using the Kaplan-Meier method and the log-rank test. The specificity and sensitivity of the risk score were determined by receiver operating characteristic (ROC) curves. Finally, the internal validation set from the SEER database and external validation sets from our center were used to validate the prognostic power of this model. Results We identified a risk score system consisting of six clinical features that can be a good predictor of AEG patient survival. Patients with high risk scores had a significantly worse prognosis than those with low risk scores (log-rank test, P-value

Abstract Background and objectives Treatment of benign osteolytic lesions in the femoral head and neck can be extremely challenging, particularly in children with open physis or for aggressive tumors with pathological fracture. There remains the difficult management decision as to whether to perform complete excision of the involved area or only curettage. Moreover, there is no agreed consensus on the optimal approach to lesion access when performing curettage, which included the transcervical, open and direct approach. The current systematic review aims to provide guidance for selection of surgical methods in clinical practice by comparing the advantages and drawbacks of different procedures. Methods A comprehensive literature search of PubMed, Embase and Web of Science databases were executed for human studies restricted to the English language. The search was filtered to include studies published from January 1980 to January 2020. Results A total of 33 articles including 274 patients were enrolled in the final analysis. The most common diagnosis was chondroblastoma (CBT) (104, 38.0%), followed by giant cell tumor (GCT) (56, 20.4%). There were 57 (20.8%) patients with pathological fracture. Intralesional curettage was performed in 257 (93.8%) patients with the local recurrence of 12.5% at the mean follow-up of 51.5 months. The patients who were presented with open physis or curetted via transcervical approach developed higher local recurrence in patients with CBT (P

BackgroundCarotid body tumor (CBT) is a rare paraganglioma located at the carotid bifurcation. The red blood cell count, hemoglobin, and hematocrit are indexes to be evaluated in blood routine tests. The purpose of this study was to clarify their predictive value for temporary postoperative complications in patients that had undergone CBT surgery.MethodsThis retrospective trial included data from 169 patients received surgical treatment for CBT from October 2008 to September 2018 in this retrospective study. Postoperative follow-up was conducted under the guidance of both vascular surgeon and neurologist. The symptoms existed less than 2 years postoperatively were regarded as temporary injuries. The red blood cell count, hemoglobin, and hematocrit were obtained from the complete blood count results of the participants. Analyses of multilevel multivariable regression and descriptive statistics were conducted.ResultsThe baseline data showed no significant difference. Patients were predominantly women (53.8%), with a mean age of 42.6 years. The total incidence of temporary postoperative complications was 22 (13.0%), including transient ischemic attack (8, 4.7%), tongue bias (7, 4.1%), dysphagia (2, 1.2%), hoarseness (4, 1.8%), and eyelid ptosis (1, 2.4%). The univariate and multivariate regression analysis results revealed that the occurrence of temporary postoperative complications was increased with age [odd ratio (OR, 0.09; 95% CI (CI), 0.9–1.0; P = 0.014], length of operation time (OR, 1.0; 95% CI, 1.0–1.0; P = 0.005), Shamblin type II vs. I (OR, 0.1; 95% CI, 0.0–0.5; P = 0.008), red blood cell count postoperative (OR, 0.2; 95% CI, 0.1–0.8; P = 0.026), hemoglobin (OR, 0.9; 95% CI, 0.9–1.0; P = 0.011), and hematocrit (OR, 0.8; 95% CI, 0.7–1.0; P = 0.025). The smooth curve fitting showed that the trend of complications occurrence rate was reduced with the increase of patients’ postoperative red blood cell count, hemoglobin, and hematocrit. Gender, weight, length of operation, Shamblin type, postoperative red blood cell count, hemoglobin, and hematocrit were included in the risk model with AUC = 0.86.ConclusionThese patients with CBT who received surgical resection with low postoperative red blood cell, hemoglobin, or hematocrit had a high risk of temporary postoperative complications. The risk prediction model established for predicting temporary postoperative complications showed satisfactory prediction effects.

Abstract Background Treatments for metastatic fracture of the humeral shaft continue to evolve as advances are made in both oncological and operative management. The purposes of this study were to critically evaluate the effectiveness of intercalary endoprostheses in treating metastatic humeral shaft fractures and to clarify the surgical indications for this technique. Methods Sixty-three patients treated surgically for 66 metastatic fractures of the humerus shaft were retrospectively reviewed. Intramedullary nailing (IMN) was performed in 16 lesions, plate fixation (PF) in 33 lesions, and prosthetic replacement in 17 lesions. The operative time, intraoperative blood loss, and postoperative complications were noted. The function of the upper extremities was assessed by the Musculoskeletal Tumor Society (MSTS) score and American Shoulder and Elbow Surgeons (ASES) score. All included patients were followed until reconstructive failure or death. Results The operative time was relatively shorter in the prosthesis group than in either the IMN group (p = 0.169) or PF group (p = 0.002). Notably, intraoperative blood loss was significantly less in the prosthesis group than in either the IMN group (p = 0.03) or PF group (p = 0.012). The average follow-up time was 20.3 (range, 3–75) months, and the overall survival rate was 59.7% at 12 months and 46.7% at 24 months. One rotator cuff injury, 3 cases of iatrogenic radial nerve palsy, 5 cases of local tumor progression, and 1 mechanical failure occurred in the osteosynthesis group, whereas one case of aseptic loosening of the distal stem and one case of local relapse were observed in the prosthesis group. There were no significant differences in functional scores among the three groups. Conclusions Intercalary prosthetic replacement of the humeral shaft may be a reliable solution for pathologic fractures patients; it is indicated for lesions with substantial bone loss, or accompanied soft tissue mass, or for those patients with better prognosis.

Abstract Background There are different surgical methods for primary malignant tumor located at distal tibia. Previous studies have reported that double-strut fibula ankle arthrodesis is an alternative option. The purpose of this study was to investigate the biomechanical effect of double-strut fibula ankle arthrodesis by finite element analysis (FEA). Methods Computer-aided design software was used to establish three-dimension models. Three different models were constructed: normal tibia-fibula-talus complex (model A), double-strut fibula ankle arthrodesis (model B), and reconstruction by ipsilateral fibula (model C). We used FEA to evaluate and compare the biomechanical characteristics of these constructs. Simulated load of 600 N was applied to the tibial plateau to simulate balanced single-foot standing. Output results representing the model von Mises stress and displacement of the components were analyzed. Results Construct stiffness was increased when the internal plate fixation was used. For axial load, model B (1460.5 N/mm) was stiffer than the construct of model A (524.8 N/mm), and model C (636.6 N/mm), indicating model B was more stable. Maximum stress on the fibular graft occurred on the proximal end. The von Mises stress and stress distribution of fibular graft in model B (71.4 MPa) and model C (67.8 MPa) were similar. In model B, the ipsilateral fibula in model B has a higher value of stress (16.1 MPa) than that in model A (0.5 MPa), indicating the ipsilateral fibula shared load after fusion with talus. Conclusions Our computational findings suggest that double-strut fibula ankle arthrodesis is an acceptable construct for distal tibia defect and the ipsilateral fibula shares load after fusion with talus.

In ancient Chinese architecture, Feng Shui was a prevalent practice used to enhance the built environment. This study utilized computer simulation techniques to assess the effectiveness of Long–Hu Sand layout Feng Shui in the Bailudong Academy complex in Jiangxi, China, compared to a layout without Feng Shui principles. Computational fluid dynamics (CFD) were employed to simulate the winter courtyard wind environment, and the resulting simulations were used to analyze the winter courtyard ventilation of both layouts. The findings indicate that the Feng Shui layout provided better wind speed and pressure ratios in the winter courtyard, which were more conducive to human comfort and helped prevent the infiltration of cold winter air. The area of ideal wind pressure difference between the front and back of the main house for indoor ventilation in winter was also larger in the Feng Shui layout compared to the non-Feng Shui layout, meeting the standard for wind environment evaluation. The study highlights the ecological wisdom of ancient Chinese people and confirms that optimizing Feng Shui improves the wind environment of the courtyard in winter. The practical implications of these results include improving comfort and sustainability in contemporary architecture and urban planning.

MicroRNA 22 (miR-22) was found in diverse cardiovascular diseases to have a role in regulating multiple cellular processes. However, the regulatory role of miR-22 in aortic dissection (AD) was still unclear. The miR-22 expression in human aorta was explored. A series of mimic, inhibitor, or small interfering RNA (siRNA) plasmids were delivered into vascular smooth muscle cells (VSMCs) to explore the effects of miR-22 and p38 mitogen-activated protein kinase α (p38MAPKα) in controlling VSMC apoptosis in vitro. In addition, a mouse AD model was established, and histopathologic analyses were performed to evaluate the regulatory effects of miR-22. Reduced miR-22 and increased apoptosis of VSMCs was seen in human AD aorta. Downregulation of miR-22 increased the apoptosis of VSMCs in vitro. Bioinformatics analyses revealed that p38MAPKα was a target of miR-22. Inhibiting p38MAPKα expression could reverse the apoptosis of VSMCs induced by miR-22 downregulation. Knockdown of miR-22 in the AD mouse model significantly promoted the development of AD. Our data underscore the importance of vascular remodeling and VSMC function in AD. miR-22 may represent a new therapeutic approach for AD by regulating the apoptosis of VSMCs through the MAPK signaling pathway.

Abstract Background Multiple primary tumors, especially quadruple primary neoplasms is extremely rare. Fibrous dysplasia (FD), osteosarcoma (OS), and giant cell tumor of bone (GCTB) are three bone tumors with low incidence while primary pulmonary meningioma is a rare disease. In this case report, we present a unique synchronous occurrence of these four separate pathological conditions. Case presentation A 53-year-old male previously underwent resection of OS of fifth rib and FD of eighth rib 1 year ago. Recently, a discontinuous pain at right knee developed. Serial X-ray films showed a progressively pure osteolytic lesion of proximal tibia which extended gradually. The incisional biopsy revealed that this tumor was confirmed as GCTB, and the tumor was successfully managed by extensive curettage and bone cement filling. The diagnosis of GCTB was re-confirmed by the postoperative histopathologic examinations. High-throughput sequencing from the GCTB exhibited a somatic mutation of H3.3A (G35W exon2). Germline testing revealed a germ-cell variant in gene of BRCA2 (exon 8 V220Ifs*4). Conclusions This is a unique case with quadruple primary tumors. Germline mutation in gene of BRCA2 may be associated with the occurrence of multiple primary tumors in this patient.

Biaxial compression-compression, biaxial tension-compression and compression-shear tests were carried out on self-compacting concrete (SCC) using the rock true triaxial machine and compression-shear hydraulic servo machine to explore the biaxial mechanical properties of SCC. The failure modes and stress-strain curves of SCC under different loading conditions were obtained through experiment. Based on the comparison with the biaxial loading test data of ordinary concrete, the following conclusions are drawn: the failure modes and failure mechanisms under biaxial compression-compression and biaxial tension-compression are similar between SCC and ordinary concrete. Under compression-shear loading, the oblique cracks formed on the lateral surface of the specimen parallel to the shear direction gradually increased and the friction marks on the shear failure section were gradually deepened with the increase of axial compression ratio. The development trend of the stress-strain curve in the principal stress direction was not related to the lateral stress. Under the influence of lateral compressive stress, the principal compressive stress of SCC was increased by 55.78% on average; under biaxial tension-compression, the principal tensile stress of SCC had a maximum reduction of 62.79%; and under the compression-shear action, the shear stress of SCC had a maximum increase of 3.35 times. Compared with the biaxial stress test data of ordinary concrete, it can be seen that the lateral compressive stress had a more significant effect on the principal stress of SCC under biaxial loading. Subsequently, the strength criterion equations of SCC under biaxial loading were proposed based on the principal stress space and octahedral space stress respectively, which have shown good applicability in practice.

Abstract Background Reconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial. This study presents a novel “double-strut” fibula ankle arthrodesis for this issue. Methods Nine patients with malignant or aggressive tumors of distal tibia underwent novel “double-strut” fibula ankle arthrodesis after wide tumor resection were retrospectively reviewed. We assessed the bone union time, complications and oncology outcome clinically and radiographically. The Musculoskeletal Tumor Society (MSTS) score and the Foot and Ankle Outcome Score (FAOS) were used to evaluate the functional outcome. Results The average followup period was 53 ± 46 months. There was no deep infection or graft fracture observed in this series. Internal fixation loosening was found in one case. In these patients, eight achieved union at both proximal and distal junctions, while one achieved union only distally. The mean union time of the proximal junctions and distal junctions was 10.5 ± 1.6 months and 8.7 ± 2.3 months, respectively. The mean postoperative MSTS score was 83% ± 8%. The subscales of FAOS indicating the most problem was Sport and Recreation Function with a mean score of 18 ± 11. At the final follow-up, one of them (1/9, 11%) experienced local recurrence in soft tissue and received another resection surgery, and four (4/9, 44%) patients developed lung metastases. Conclusions For large bone defect of distal tibia, this novel “double-strut” fibula reconstruction can be a viable alternative, which is capable of achieving durable ankle fusion and functional salvaged limb with low rate of complications.

Abstract Background The aim of this study was to investigate the relationship between Talin-1 and stability of carotid atherosclerosis plaque and also find out the role of miRNA, as an upstream regulator, in regulating the expression level of Talin-1. Methods Human carotid plaques were obtained from 20 symptomatic carotid stenosis patients who underwent carotid endarterectomy (CEA) in our hospital between October 2014 and August 2017. Western blot analysis and immunohistochemistry was carried out to detect the distribution and expression level of Talin-1 in each plaque sample. The content of miRNAs in carotid plaque was decected by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and the relative expression levels were calculated by 2-△△Ct method after the (cycle threshold) Ct value (power amplification knee point) was obtained. Dual-luciferase reporter assays were applied to verify the successful transfections. Finally, we compared all the groups with independent-samples t-test and one-way analysis of variance (ANOVA). Results Talin-1 was significantly downregulated in human unstable carotid plaque samples compared with stable carotid plaques (P

For the purpose of studying the dynamic properties of lightweight aggregate concrete, dynamic performance tests under uniaxial compression were conducted by considering 10 different strain rates ranging from 10−5/s to 10−1/s, from which the stress-strain curves under various compressive loads were obtained. From the stress-strain curves, parameters including peak stress, peak strain, and elastic modulus of lightweight aggregate concrete, as well as the concrete failure mode, were determined and examined. By reviewing the relevant literature on ordinary concrete, the dynamic properties of lightweight aggregate concrete were analyzed accordingly. Meanwhile, by applying the dynamic elastoplastic damage constitutive model, the effect of dynamic rate on lightweight aggregate concrete was calculated. The experimental results showed that the damage mode of lightweight aggregate concrete under the static and dynamic strain rates belonged to shear failure, which is different from that of ordinary concrete (binding material failure). On the other hand, it was also found that the peak stress and elastic modulus of lightweight aggregate concrete could be increased by 54.48% and 28.75%, respectively, with the increase of strain rate, suggesting that the loading strain rate has a stronger influence on lightweight aggregate concrete than on ordinary concrete. Based on the experimental data, both the peak stress and nondimensionalized elastic modulus are in linear relationship with the logarithm of the nondimensionalized strain rate. Moreover, the established constitutive model had been verified as an effective and reliable tool for simulating the dynamic rate effect of lightweight aggregate concrete.

When a tunnel is excavated in the water-rich soft rock stratum, the strength of the soft rock is greatly reduced due to the seepage of groundwater. The condition may result in engineering accidents, such as large deformation, limit invasion, and even local collapse of the tunnel. Therefore, it is very important to research the stability of the surrounding rock in the water-rich soft rock tunnel. The water-rich disturbance factor considering the seepage influence of groundwater and blasting disturbance is proposed, and the generalized Hoek–Brown strength criterion is modified on the basis of the immersion softening test of soft rock. In accordance with the classical elastic–plastic mechanics theory, the stress, strain, and displacement calculation formulas of the tunnel surrounding rock are derived. The displacement of tunnel surrounding rock is analyzed using the derived formula and the modified Hoek–Brown strength criterion and then compared with the measured value. Results show that the displacement of surrounding rock, which is calculated by modified Hoek–Brown strength criterion considering water-rich disturbance factor and the displacement calculation formula, is close to the measured deformation of surrounding rock in water-rich soft rock tunnel, and the error is small. Therefore, the modified Hoek–Brown strength criterion can be applied to the water-rich soft rock tunnel, and the derived displacement calculation formula can accurately calculate the deformation of tunnel surrounding rock. It is of great significance to the study of surrounding rock stability of water-rich soft rock tunnel.

Osteosarcoma is one of the most aggressive malignant bone tumors worldwide. Although great advancements have been made in its treatment owing to the advent of neoadjuvant chemotherapy, the problem of lung metastasis is a major obstacle in the improvement of survival outcomes. Thus, the aim of the present study is to screen novel and key biomarkers, which may act as potential prognostic markers and therapeutic targets in osteosarcoma. We utilized the robust rank aggregation (RRA) method to integrate three osteosarcoma microarray datasets downloaded from the Gene Expression Omnibus (GEO) database, and we identified the robust differentially expressed genes (DEGs) between primary and metastatic osteosarcoma tissues. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the functions of robust DEGs. The results of enrichment analysis showed that the robust DEGs were closely associated with osteosarcoma development and progression. Immune cell infiltration analysis was also conducted by CIBERSORT algorithm, and we found that macrophages are the most principal infiltrating immune cells in osteosarcoma, especially macrophages M0 and M2. Then, the protein–protein interaction network and key modules were constructed by Cytoscape, and 10 hub genes were selected by plugin cytoHubba from the whole network. The survival analysis of hub genes was also carried out based on the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database. The integrated bioinformatics analysis was utilized to provide new insight into osteosarcoma development and metastasis and identified EGR1, CXCL10, MYC, and CXCR4 as potential biomarkers for prognosis of osteosarcoma.

Coastal settlements in urban areas show certain degrees of spatial complexity. Understanding the evolution law of fractal settlements is practically important for marine engineering and urban planning. In this paper, we investigate the fractal evolution of coastal settlement land use based on fractal theory. The fractal dimensions of the land uses for three typically coastal settlements in Xiamen city, China, are obtained to quantify their spatial complexity. The results reveal the fractal characteristics and regional differences of the coastal settlements. Furthermore, nonlinear modeling is applied to describe the fractal dimension evolution of the coastal settlement land uses from 2000 to 2018. Three settlements in rapid urbanization show different nonlinear evolution equations of the fractal dimension due to their different land uses. This study might provide a theoretical basis for understanding the fractal characteristic evolution of coastal settlements in urban areas and show its potential application in urban geography.

Abstract Background This study aimed to assessed whether Talin-1 is involved in the pathogenesis of aortic dissection via regulating vascular smooth muscle cell (VSMC) biological function. Methods Human aortic samples were obtained from organ donors who died from nonvascular diseases as normal controls and from patients undergoing surgical repair of thoracic aortic dissection. The expression level and distribution of Talin-1 were detected using westernblot analysis and immunohistochemistry in each sample. We inhibited the expression of Talin-1 via RNA interference in VSMCs. VSMC proliferation was detected by Cell-counting Kit-8 analyses. Scratch test and flow cytometry were used to identify the migration and apoptosis ability. Antibody microarray analysis and qRT-PCR were used to detect some protein and mRNA changes which were induced by Talin-1 downregulation. Results Talin-1 was significantly downregulated in the media of aortic dissection samples compared with controls (P

Osteosarcoma is an aggressive bone cancer that frequently metastasizes to the lungs. The cytotoxicity of most chemotherapeutics and targeted drugs in the treatment of osteosarcoma is partially lessened. Furthermore, there is a poor response to current chemo- and radiotherapy for both primary lesions and pulmonary metastases of osteosarcoma. There is a clear need to explore promising drug candidates that could improve the efficacy of osteosarcoma treatment. Autophagy, a dynamic and highly conserved catabolic process, has dual roles in promoting cell survival as well as cell death. The role of autophagy has been investigated extensively in different tumor types, and a growing body of research has highlighted the potential value of using autophagy in clinical therapy. Here, we address significant aspects of autophagy in osteosarcoma, including its functions, modulation, and possible therapeutic applications.

Background: Primary malignant or aggressive benign bone tumors rarely occur in distal tibia, and limb salvage remains the mainstay of surgical options. However, reconstruction methods for large bone defect after wide tumor resection in this location are debatable. The purpose of this systematical review is to critically evaluate each reconstruction method regarding the postoperative complications and functional outcome. Methods: A systematic review of the 33 studies including 337 cases with tumors affecting distal tibia was performed after searching the PubMed and EMBASE databases. Pooled descriptive statistics with separate analyses for postoperative complications and functional outcome of different reconstruction options were performed. Results: 290 (86.1%) patients received limb salvage procedures. Reconstruction strategies including biological reconstruction, such as autograft, allograft, distraction osteogenesis and non-biological prosthetic replacement. The patients received limb salvage procedures tended to have a higher MSTS score (77.1% vs 70.9%, P = .055) and a higher incidence of local relapse (28/290 vs 0/47, P = .052) than those amputated. Biological reconstruction methods provided better functional outcome (78.4% vs 72.2%, P = .017) compared with non-biological prosthetic reconstruction, although similarity of incidence of major complications (51/253 vs 12/37, P = .091). With respect to the comparison between autograft and allograft reconstruction, the autograft seemed to have less major postoperative complications occurrence (27/165 vs 22/78, P = .032), and consequently better functional outcome (MSTS score, 80.2% vs 74.3%, P = .025) than allograft reconstruction. Conclusions: Limb salvage results in better functional outcome compared with amputation. Biological reconstruction is more advocated than prosthetics replacement, and furthermore, autograft might be suggested to be the optimal reconstructive method with regard to better postoperative functional outcome and less major complications. Keywords: Distal tibia, Bone tumor, Complications, Function, Systematic review

β3-Adrenoceptors (β3-ARs) mediate a negative inotropic effect in human ventricular cardiomyocytes, which is opposite to that of β1- and β2-ARs. It has been previously demonstrated that autoantibodies against the β1/β2-AR exist in the sera of some patients with heart failure (HF) and these autoantibodies display agonist-like effects. Our aim in this study was to observe whether autoantibodies against the β3-AR (β3-AR Abs) exist in the sera of patients with HF and to assess the effects of β3-AR Abs on rat model of pressure overload cardiomyopthy. In the present study, the level of β3-AR Abs in the sera of HF patients was screened by ELISA. β3-AR Abs from HF patients were administrated to male adult rats with abdominal aortic banding (AAB), and the cardiac function was measured by echocardiographic examination and hemodynamic studies. The biological effects of this autoantibody on cardiomyocytes were evaluated using a motion-edge detection system, intracellular calcium transient assay, and patch clamp techniques. Compared to healthy subjects, the frequency of occurrence and titer of β3-AR Abs in the sera of HF patients were greatly increased, and β3-AR Abs could prevent LV dilation and improve the cardiac function of rats with AAB. β3-AR Abs exhibited negative chronotropic and inotropic effects and were accompanied by a decreased intracellular Ca(2+) transient and membrane L-type Ca(2+) current in cardiomyocytes. Our results demonstrated the existence of β3-AR Abs in the sera of patients with HF and found that this autoantibody could alleviate the cardiac dysfunction induced by pressure-overload in AAB rats.