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Objective·To develope an auditory brainstem implant (ABI) vocoder based on cochlear implant (CI) vocoder characteristics and ABI electrode array topology, and to verify its reliability.Methods·An "n-of-m" coding strategy CI/ABI vocoder was constructed based on MATLAB. Within each frame, only the envelopes of the n channels with the highest energy were selected. The interaction coefficient (IC) (range: 1‒3), channel numbers (range: 5‒22), and electrode array topology (CI/ABI) were adjustable parameters, allowing for the synthesis of simulated speech. Psychoacoustic evaluation was employed, recruiting normal hearing subjects to perform closed-set simulated phoneme perception. The phoneme recognition accuracy (20 vowel questions/condition, 11 consonant questions/condition) was compared with the corresponding conditions of CI and ABI from reference literature to determine the IC value of the vocoder and verify its reliability.Results·The vocoder successfully synthesized all test stimuli. In the closed-set CI-simulated speech recognition, the simulated vowel and consonant recognition accuracy for IC2 and IC3 conditions showed no significant difference compared to the accuracy reported in the CI reference literature (P>0.05). The difference in vowel and consonant accuracy between IC2 and the literature was smaller than that between IC3 and the literature (vowel |d|=1.6% vs. 20%, consonant |d|=8.4% vs. 9.9%), thus determining the optimal interaction coefficient of this model as 2. Subsequently, when modifying the electrode array topology to ABI, it was found that the simulated phoneme recognition accuracy for a 16-channel ABI was significantly lower than that for the 16-channel CI group, consistent with the reported literature. The simulated vowel and consonant accuracy within the 5‒8 channel range for ABI showed no significant difference (P>0.05), also aligning with the trend reported in the literature.Conclusion·A CI/ABI vocoder based on "n-of-m" coding strategy is established and the optimal IC is determined. The established ABI encoder has been evaluated for high reliability through psychoacoustic experiments. It provides suitable technical means for validating ABI-specific coding strategies.

Objective To summarize the clinical characteristics and outcomes of corona virus disease 2019(COVID-19) in patients with adrenal insufficiency (AI), and analyze the risk factors of outcomes. Methods The clinical data of COVID-19 patients with AI in Peking Union Medical College Hospital in December 2022 were analyzed retrospectively and the patients were followed up to collect outcomes of their diseases. Results Among 28 COVID-19 patients with AI, 20 cases (71.4%) received basal corticosteroid replacement. Among the 18 patients with community-acquired COVID-19, 11 cases (61.1%) increased the corticosteroid dosage proactively at home. The most common symptoms of COVID-19 were fever (96.4%), gastrointestinal symptoms (82.1%) and consciousness disturbance (78.6%). Occurrence of severe consciousness disturbance was associated with older age and lower basal corticosteroid replacement dose(P＜0.05). Adrenal crisis(AC) occurred in 20 patients(71.4%), which was associated with lower basal corticosteroid replacement dose, hypochloremia, lower eosinophil, lower platelet, and longer activated partial thromboplastin time(APTT)(P＜0.05). 2 patients died during hospitalization.26.3 % (5/19) of surviving patient′s recovered consciousness longer than 48 hours. Delayed recovery of consciousness was associated with lower systolic pressure, higher blood creatinine, and higher fibrinogen(P＜0.05). Long COVID-19 symptoms such as fatigue and poor appetite occurred in 48.0 % (12/25) of patients. Among patients with increased corticosteroid dosage, 50.0 % (12/24) had their dose reduced to baseline within 3 weeks. Conclusions COVID-19 patients with AI have a high frequency of consciousness disturbance and AC. AI patients are lack of awareness of adjusting corticosteroid dosage proactively in case of infection stress, thus education of “sick day rules” for AI patients should be strengthened in clinical practice.

Objectives There is still controversy over the choice of treatment for end‐stage spinal metastases. With the continuous development of microwave technology in spinal tumors, related studies have reported that microwave combined with techniques such as pedicle screw fixation and percutaneous vertebroplasty can achieve the purpose of tumor ablation, relieving spinal cord compression, enhancing spinal stability, effectively relieving pain, and reducing recurrence rates. This study aimed to analyze the effectiveness of microwave ablation combined with decompression and pedicle screw fixation in the palliative management of spinal metastases with pathological fractures. Methods This retrospective study enrolled 82 patients with spinal metastases and pathological fractures treated between January 2016 and July 2020, with 44 patients undergoing pedicle screw fixation along with laminectomy (fixation group) and the remaining 38 receiving microwave ablation in addition to the treatment provided to group fixation (MWA group). Before surgery, all patients underwent pain assessment using the visual analogue scale (VAS) and evaluation of spinal cord injury using the Frankel classification. After surgery, the patients' prognoses were assessed using the Tomita score, modified Tokuhashi score system, and progression‐free survival. Additionally, we compared operative time and blood loss between the two groups. Survival analysis utilized the Kaplan–Meier method with a log‐rank test for group comparisons. Paired t‐tests and the Mann–Whitney U test were applied to metric and non‐normally distributed data, respectively. Neurological function improvement across groups was evaluated using the χ2 test. Results All patients were followed up for a median duration of 18 and 20 months in the fixation and MWA groups, respectively, with follow‐up periods ranging from 6 to 36 months. Statistically significant reductions in postoperative VAS scores were observed in all patients compared with their preoperative scores. The MWA group exhibited reduced blood loss (t = 2.74, p = 0.01), lower VAS scores at the 1‐ and 3‐month follow‐ups (t = 2.34, P = 0.02; t = 2.83, p = 0.006), and longer progression‐free survival than the fixation group (p = 0.03). Although the operation times in the MWA group were longer than those in the fixation group, this difference was not statistically significant (t = 6.06, p = 0.12). No statistically significant differences were found regarding improvements in spinal cord function between the two groups (p = 0.77). Conclusion Compared with decompression and pedicle screw fixation for treating spinal metastases with pathological fractures, microwave ablation combined with decompression and pedicle screw fixation showed better outcomes in terms of pain control, longer progression‐free survival, and lower blood loss without increasing operative time, which has favorable implications for clinical practice.

The electrocoagulation technology has advantages such as high efficiency, no need for adding chemicals, no secondary pollution, simple operation and equipment maintenance. However, there are issues such as unclear electrochemical performance patterns of the electrode plates. This article used polarization curve method to study the electrochemical performance of sacrificial anodes, and carried out experimental researches on the influences of different initial salt mass concentrations, pH, and oil mass concentrations on the electrochemical performance of sacrificial anodes. The results showed that the passivation current density increased, the potential range of the anode passivation zone narrowed, and the dissolution rate of the anode surface increased with the inceasing mass concentration of sodiur chloride solution; when the initial pH was too small or too large, the anodic dissolution rate increased, and the destruction of passivation film was enhanced; the increase in initial oil mass concentrations had little effect on the electrochemical properties of the aluminum anode and did not affect the dissolution rate of the anode. The research conclusion provides a theoretical basis and scientific basis for the application of electrocoagulation technology in emergency response to marine oil spills.

Growth substrates are essential for aquaponic systems and play an important role in vegetable growth and water quality. In this study, we explored an innovative combination of coconut bran and coconut shell biochar (CSB) as a composite growth substrate for lettuce cultivation in aquaponic systems. The study included the control (100 % coconut bran as the growth substrate) and treatment groups (T1–T5; containing 10 %, 20 %, 30 %, 40 %, and 50 % CSB as the growth substrate, respectively). The substrate properties; lettuce growth performance; and soil enzyme activity, nitrogen content, and abundance of microbial communities in the substrate were analyzed to determine the optimal substrate. Our findings indicated that CSB incorporation significantly altered the properties of the substrate, resulting in increased dry and bulk densities, pH, and water-holding capacity, and decreased electrical conductivity, water-absorption capacity, and porosity. Furthermore, the fresh weight of lettuce was notably increased in the treatment groups. The activities of fluorescein diacetate hydrolase, urease, nitrate reductase, and hydroxylamine reductase initially increased and further decreased, reaching the maximum in the T3 group. Conversely, the activity of nitrite reductase and contents of available nitrogen, nitrate-nitrogen, and ammonium-nitrogen in the substrates initially decreased and further increased, with the minimum values observed in the T3 group. The microbial sequencing results indicated that CSB incorporation significantly increased the microbial diversity and relative abundance of microorganisms associated with nitrogen transformation. Moreover, 30 % CSB incorporation exhibited the greatest effect on lettuce growth, with a 34.5 % and 31.6 % increase in fresh weight compared to the control during the growth and harvest periods, respectively. This study indicated the enormous potential of biochar in the research and development of green technologies for substrate amendment in aquaponic systems.

Amidst the rapid advancements in materials science, the exploration of aerogel-based biomaterials has garnered extensive attention across diverse sectors, including biomedicine, energy, architecture, and sensing. Comprehensive studies have unveiled the utilization of organic, inorganic, and hybridized materials for aerogel preparation, catapulting aerogel-based biomaterials to global prominence. Endowed with distinctive properties, including low density, a hierarchical porous network, high porosity, and nanoscale micropores, aerogels have exhibited a broad spectrum of applications, particularly in the realm of tissue engineering. The deployment of aerogel-based biomaterials in tissue engineering is in a dynamic phase of development, with available reports indicating varying degrees of exploration in fields such as blood vessels, soft tissues, nerves, skin, muscles, heart, bronchial tubes, bone, and cartilage—an evolutionary process. This paper offers a comprehensive review of the evolution of aerogel properties and preparation processes, encapsulating strategic insights for the application of aerogel-based biomaterials in tissue engineering. It succinctly summarizes recent developments in tissue engineering research, emphasizing their significance. Additionally, the review outlines future prospects for the application of aerogels in tissue engineering and envisions challenges arising from current studies. Through this thorough exploration of aerogel-based biomaterials in tissue engineering, the paper aspires to make a profound impact on regenerative medicine, offering innovative and effective application strategies for biomedicine.

BackgroundIn elderly individuals suffering from hip fractures, a prolonged hospital length of stay (PLOS) not only heightens the probability of patient complications but also amplifies mortality risks. Yet, most elderly hip fracture patients present compromised baseline health conditions. Additionally, PLOS leads to increased expenses for patient treatment and care, while also diminishing hospital turnover rates. This, in turn, jeopardizes the prompt allocation of beds for urgent cases.MethodsA retrospective study was carried out from October 2021 to November 2023 on 360 elderly hip fracture patients who underwent surgical treatment at West China Hospital. The 75th percentile of the total patient cohort’s hospital stay duration, which was 12 days, was used to define prolonged hospital length of stay (PLOS). The cohort was divided into training and testing datasets with a 70:30 split. A predictive model was developed using the random forest algorithm, and its performance was validated and compared with the Lasso regression model.ResultsOut of 360 patients, 103 (28.61%) experienced PLOS. A Random Forest classification model was developed using the training dataset, identifying 10 essential variables. The Random Forest model achieved perfect performance in the training set, with an area under the curve (AUC), balanced accuracy, Kappa value, and F1 score of 1.000. In the testing set, the model’s performance was assessed with an AUC of 0.846, balanced accuracy of 0.7294, Kappa value of 0.4325, and F1 score of 0.6061.ConclusionThis study aims to develop a prognostic model for predicting delayed discharge in elderly patients with hip fractures, thereby improving the accuracy of predicting PLOS in this population. By utilizing machine learning models, clinicians can optimize the allocation of medical resources and devise effective rehabilitation strategies for geriatric hip fracture patients. Additionally, this method can potentially improve hospital bed turnover rates, providing latent benefits for the healthcare system.

The aim of this study is to compare external fixation versus intramedullary (IM) nailing to determine which strategy was more suitable for patients with open tibial shaft fractures. Eleven RCTs that compared the therapeutic outcomes between external fixation and IM nailing in patients suffering from open tibial shaft fractures were screened out from the PubMed, Embase, and Cochrane Library in this analysis. For open tibia fractures of Gustilo-Anderson I-IIIA, significantly lower incidence of malunion and superficial infection was revealed for the IM nailing group when compared with the external fixation group. Further subgroup analyses within I-IIIA fractures showed comparable results between fractures managed with IM nails and ring external fixators. In conclusion, IM nailing is recommended over external fixation for open tibia fractures of I-IIIA. In addition, the use of ring external fixators may be more suitable than the ordinary external fixators for the treatment of I-IIIA fractures.

In this paper, we report an elderly patient who had been experiencing poor appetite for one month and yellowing of the skin and sclera for two months before visiting the Department of Geriatrics at Peking Union Medical College Hospital. The patient's blood tests revealed significantly elevated levels of serum total bilirubin, direct bilirubin, and blood sugar. The serum IgG4 level nearly tripled. Abdominal imaging examinations revealed diffuse pancreatic lesions, narrowing of the intrapancreatic segment of the common bile duct, and thickening and marked enhancement of the common hepatic duct, left and right hepatic ducts, and branches. Blood glucose was also significantly elevated during the course of the disease. Moreover, nutritional assessment found that the patient was malnourished. After multidisciplinary discussion, a medium dose of oral methylprednisolone was prescribed to the patient due to his advanced age and multiple chronic conditions. The dose was then quickly reduced while the patient simultaneously received low-dose mycophenolate mofetil (MMF) treatment. As a result, the patient's bilirubin level significantly decreased, jaundice subsided, and his body weight returned to normal with improved physical function. Throughout the diagnosis and treatment process, a multidisciplinary team actively participated in discussions and gradually identified the underlying cause. This exemplifies the crucial role of interdisciplinary collaboration in effectively diagnosing and treating complex illnesses in elderly patients.

Abstract Background Femoral head fractures are rare injuries often associated with poor functional outcomes and complications. The purpose of this study was to evaluate the incidence, treatment methods and approaches, complications, and functional outcomes of femoral head fractures. Methods We retrospectively reviewed 50 patients who sustained femoral head fractures between January 2011 and December 2018. There were thirty-seven (74%) males and thirteen (26%) females with a median age of 40 years. According to Pipkin’s classification, there were eighteen (36%) Pipkin I, ten (20%) Pipkin II, eight (16%) Pipkin III, and fourteen (28%) Pipkin IV patients. Treatment methods were categorized into non-operative, operative by open reduction and internal fixation (ORIF), and immediate total hip replacement (THR). The recorded surgical approach consists of an anterior(S-P) approach, posterior(K-L) approach, lateral stab, and combined anterior + lateral stab approach for fixation. The patients were also stratified by the Injury Severity Score (ISS), associated injuries, and, mechanism of injuries. The modified harris hip score (MHHS) was used to evaluate the ongoing complications with the clinical outcome of patients with two years or greater follow-up. Results Eight (16%) patients were managed successfully with closed reduction without surgery and thirty-seven (74%) patients required operative reduction and internal fixation (ORIF) of the femoral head and acetabulum, and 5 (10%) patients required immediate THR. Six (12%) patients developed AVN, and four (8%) required a secondary THR. Sixteen patients (33%) developed post-traumatic osteoarthritis (PTOA), eight (16%) developed heterotopic ossification (HO) and six patients (12%) had sciatic nerve injury, none requiring operative treatment. Overall functional results according to MHHS were, excellent in two (4%) patients, good in sixteen (32%) patients, fair in twenty-two (44%) patients, and poor in ten (20%) patients. A statistically significant difference in outcome was observed among four pipkin subtypes. Conclusion Femoral head fractures are rare injuries often associated with poor outcomes. In this study, we report the functional outcomes and complications of all treatment approaches for femoral head fracture based on the Pipkin classification. The treatment aim should always be the anatomical reduction of the fragments. This study, adds to the growing literature on femoral head fracture and provides a reference for the clinical treatment to guide patient management. Trial registration Our study was approved by the Clinical Research and Biomedical Ethical Committee of West China Hospital, Sichuan University, and was performed in accordance with the Declaration of Helsinki. All participants provided written informed consent to participate in this study.

Abstract Background Recently, some studies on the efficacy of the femoral neck system (FNS) in treating femoral neck fractures (FNFs) have been published. Therefore, a systematic review was performed to clarify the efficacy and safety of FNS versus cannulated screws (CS) for the treatment of FNFs. Method The PubMed, EMBASE, and Cochrane databases were systematically searched for studies comparing FNS and CS fixations in FNFs. Intraoperative indicators, postoperative clinical indicators, postoperative complications, and postoperative scores were compared between the implants. Results A total of eight studies were included in the study, involving 448 FNFs patients. The results showed that patients in FNS group were significantly lower than the CS group in the number of X-ray exposures (WMD = -10.16; 95% CI, -11.44 to -8.88; P

ObjectiveThe study aimed to investigate the relationship between Life’s Simple 7 (LS7) and the risk of rheumatoid arthritis (RA) in adult Americans.MethodsA total of 17,532 participants were included in this study. The association between LS7 and the risk of RA was assessed using a weighted logistic regression model, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Moreover, the nonlinear relationship was further characterized through smooth curve fitting (SCF) and weighted generalized additive model (GAM) analysis.ResultsAfter adjusting for all covariates, the weighted logistic regression model demonstrated that the LS7 was negatively correlated with the risk of RA. Compared to quintile 1 of LS7, the OR between the risk of RA and quartile 4 of LS7 (LS7.Q4) was 0.261 (95% CI, 0.203, 0.337) in males under 50 years old, while in females of the same age group, the OR was 0.183 (95% CI, 0.142, 0.234). For females aged between 50 and 70 years old, the OR between the risk of RA and LS7.Q4 was 0.313 (95% CI, 0.264, 0.371). In females aged 70 years or older, the OR between the risk of RA and LS7.Q4 was 0.632 (95% CI, 0.486, 0.822).ConclusionThis finding suggested the healthy lifestyle behaviors represented by LS7 have a negative association with RA. However, further prospective studies are needed to verify the causal relationship in the results.

Grape seed extracts, due to its strong antioxidant activity, is commonly used as a nutritional supplement or dietary supplement. It can be used to prevent metabolic diseases such as inflammation, tumors, and atherosclerosis. This article provides an overview of the nutritional composition and biological functions of grape seed extracts, summarizes the latest research findings on the bioactive ingredients in grape seed extracts in terms of antioxidant, anti-inflammatory, anti-tumor, antimicrobial, and anti-atherosclerosis effects, and discusses the shortcomings and future research directions in grape seed extracts research.

IntroductionCalf muscular vein thrombosis (CMVT) is a common complication in geriatric hip fracture patients. Despite its high incidence, prior research on the topic is limited. The occurrence of CMVT in patients will prolong the preoperative waiting time and even lead to serious thromboembolic events, which can be detrimental to the patient’s prognosis. Therefore, this study aimed to identify the risk factors for preoperative CMVT in geriatric hip fracture patients and construct a nomogram model to predict the risk of preoperative CMVT in patients.Materials and methodsGeriatric hip fracture patients who underwent surgery between January 2019 and January 2022 were included. The patients were categorized into two groups depending on whether they had preoperative CMVT, confirmed through Color Doppler ultrasound or venography examination. Univariate and multivariate logistic regression analyses were used to analyze demographic characteristics, medical history, comorbidities, and laboratory tests. A nomogram was constructed to predict preoperative CMVT in geriatric hip fracture patients based on the results of the multivariate logistic regression.ResultsThree hundred and eighty-eight geriatric hip fracture patients, including one hundred and thirty-four patients with CMVT and two hundred and fifty-four patients without CMVT, were ultimately included in our study. After multivariable logistic regression analysis, the time from injury to admission, smoking history, serum albumin levels, and D-dimer levels was identified as independent risk factors and was entered into a nomogram model. The nomogram showed robust discrimination, with an area under the receiver operating characteristic curve of 0.805. The calibration curve showed strong agreement between the CMVT probabilities predicted by the nomogram and the actual probabilities. The decision curve analysis illustrates the excellent clinical utility of the model.ConclusionWe have constructed a new nomogram prediction model that can effectively predict the risk of preoperative CMVT in geriatric hip fracture patients based on their medical history and blood test results. This model can help clinicians make individualized predictions of CMVT that are tailored to each patient’s unique circumstances.

Various wounds caused by burns, trauma, surgery, and genetic irregularities, including acute and chronic wounds, pose a huge burden on global healthcare. Many therapeutic strategies, such as nanomedicine and regenerative medicine, have been applied to wound repair and skin regeneration. As a promising and exciting nanomaterial, metal–organic frameworks (MOFs) encompass many desirable properties, including crystalline porous structure, tunable size, good mechanical stability, large specific surface area, and exceptional chemical stability. Most importantly, the performance of MOFs can be modulated by changing synthesis steps and conditions. MOFs can release metal ions to modulate cellular behaviors and kill various microorganisms, which meets this dual agent release therapeutic strategy for wound healing and skin regeneration. Additionally, MOFs can act as carriers for delivering bioactive agents in a desired manner. Recently, an increasing number of researchers have conducted many studies on applying various MOFs in wound healing and skin regeneration. Based on this, we perform this study to report the current status and further perspective of MOFs-based therapeutic strategy. Furthermore, the molecular process of wound healing and the fabrication of MOFs were also discussed.

Bacterial infection continues to be one of the biggest threats to human health. The therapeutic effect is significantly reduced as a result of the development of super-bacteria-resistant bacteria due to the overuse of antibiotics for conventional antimicrobial treatment. The emergence of drug-resistant bacteria makes it necessary to develop new antimicrobial treatments. Following the successful application of photothermal therapy in the field of oncology treatment, more and more researchers are applying it to antimicrobial treatments and achieving important results, especially in the treatment of drug-resistant bacterial infections. As a non-invasive anti-infection method, photothermal therapy has the advantages of broad-spectrum antimicrobial properties, a short treatment period, and low systemic impact. In the PTT, the antimicrobial efficacy strongly depends on the different laser properties and the choice of photothermal agents (PTAs). The purpose of this review is to discuss the most recent developments in photothermal nanomaterials that are antibacterial. We will delve into the antimicrobial principles and antimicrobial spectrum of different PTAs and provide a summary of current developments in synthesis, classification, structural features, physicochemical properties, and antibacterial performance research. The challenges and future prospects of enhanced antimicrobial performance and reduced cytotoxicity of PTAs are investigated.

Objective: This study aimed to find the best clarifying method of fermented wine by using L. lucidus Turcz and improve its quality and stability. Methods: The gelatin clarification method, bentonite clarification method, chitosan clarification method, heat treatment method, membrane filtration method and static clarification at different temperatures were used to treat the wine fermented with L. lucidus Turcz. As an evaluation index for the clarification effect, the best clarification method and related parameters were selected by combining turbidity, color, light transmittance, the content of alcohol, total acid, total sugar, caffeic acid and rosmarinic acid, and sensory scores. Results: The results showed that, after 70 ℃ water bath heat treatment for 20 min, the wine fermented with L. lucidus had the best clarity, with a turbidity of only 1.19 EBC and a light transmittance of 95.8%. The highest sensory score was 88.9 points, and the soluble solid content was 8.02%. The content of alcohol, total acid, total sugar, caffeic acid and rosmarinic acid had little change after the clarification. Moreover, the fermented wine in the present study had no turbidity during storage and showed good stability after heat treatment. Conclusion: After heat treatment, the fermented wine of L. lucidus Turcz is orange-red, transparent, odorless, good taste, and stable quality.

The maximum electromagnetic field formed in the electrically large enclosures for a given input power has always been the focus of electromagnetic compatibility issues such as radiation sensitivity and shielding effectiveness. To model the maximums in a simple manner, the electrically large enclosure can be regarded as a reverberation chamber (RC), thus the generalized extreme value (GEV) theory based framework is used for both undermoded and overmoded frequencies. Since the mechanical stirrer is not easy to be installed like that for RC, frequency stirring and mechanical stirring related configurations are discussed, and the corresponding results have confirmed the validity of frequency stirring with the estimate of the parameters in GEV distribution. As for the maximum field, a comparison has been made between GEV distribution and IEC 61000-4-21, and the corresponding results have also highlighted that the maximum field can be assessed by frequency stirring configuration, and by GEV distribution with a desired confidence.

Slot resources are limited and not properly allocated, and the wave-system structures of airlines can organize slot time effectively. The article identifies and evaluates the wave-system structure of Beijing Daxing International Airport and Beijing Capital International Airport. It is found that: the wave-system of Beijing Capital International Airport is more obvious than that of Beijing Daxing International Airport, and the density and amplitude of waves are higher in summer and autumn than in winter and spring; the system waveforms of both Daxing Airport and Capital Airport are in the shape of morning and evening peaks; the indirect connection quality of flights from different departure airports via Capital Airport is higher than that of Daxing Airport; the indirect connections to destination airports via the two airports in Beijing are uneven in spatial distribution. The spatial distribution of indirect connections to destination airports via the two airports is uneven, but the wave-system plays a significant role in connecting small and medium-sized regional airports.

This article, through the method of questionnaire survey and based on the technical analysis of SPSS, investigates the current application of commercial AI in labor education during the transition phase from kindergarten to elementary school. On the basis of analyzing the reasons, corresponding solutions are proposed.

Currently, biomineralization is widely used as a surface modification approach to obtain ideal material surfaces with complex hierarchical nanostructures, morphologies, unique biological functions, and categorized organizations. The fabrication of biomineralized coating for the surfaces of scaffolds, especially synthetic polymer scaffolds, can alter surface characteristics, provide a favorable microenvironment, release various bioactive substances, regulate the cellular behaviors of osteoblasts, and promote bone regeneration after implantation. However, the biomineralized coating fabricated by immersion in a simulated body fluid has the disadvantages of non-uniformity, instability, and limited capacity to act as an effective reservoir of bioactive ions for bone regeneration. In this study, in order to promote the osteoinductivity of 3D-printed PCL scaffolds, we optimized the surface biomineralization procedure by nano-topographical guidance. Compared with biomineralized coating constructed by the conventional method, the nano-topographically guided biomineralized coating possessed more mineral substances and firmly existed on the surface of scaffolds. Additionally, nano-topographically guided biomineralized coating possessed better protein adsorption and ion release capacities. To this end, the present work also demonstrated that nano-topographically guided biomineralized coating on the surface of 3D-printed PCL scaffolds can regulate the cellular behaviors of USCs, guide the osteogenic differentiation of USCs, and provide a biomimetic microenvironment for bone regeneration.

Vascularization plays a crucial role in transporting and exchanging nutrients and oxygen between implanted grafts with the host tissue. In the biofabrication of the implanted grafts, remodeling the vascular networks can accelerate vascularized tissue repair and regeneration. Given the heterogeneity of vascular networks in vascularized tissues, traditional scaffold manufacturing techniques cannot effectively achieve vascular with various scales in vitro and in vivo biomimetic. In recent years, 3D bioprinting technologies have been widely used in fabricating various 3D grafts for tissue repair and regeneration due to their shape customizability, simple manufacturing procedure, reproducibility, and precise multi-dimensional control. With the rapid development of 3D bioprinting technologies, bioprinting-based biofabrication strategies have been gradually applied in the construction of various vascularized tissues. Based on this background, our study aimed to review recent advances, challenges, and future perspectives in biofabrication strategies based on bioprinting for vascularized tissue repair and regeneration. The bioprinting techniques, bioinks, seed cells, and growth factors used for vascularized tissue construction were also enrolled in this review. In addition, the bioprinting history, vessel formation mechanism, and histology of vascular networks in vascularized tissue were also discussed.

The non-repeated support advanced support equipment in environments with small space, large vibration, and severe electromagnetic interference has problems of low sensing technology level, imprecise motion control, and complex operation process. In order to solve the above problems, a non-repeated support advanced support intelligent control system is proposed. According to the controlled requirements of the non-repeated support advanced support technology, it has the capability to detect surrounding environmental information such as posture, obstacles, and positions. It has control methods of adaptive, self- adjusting, and self -decision-making. It has fast, stable, and precise execution components. It is pointed out that this intelligent control system proposes three key technologies: intelligent perception, logical control and execution. Based on the control functions and task flow of the intelligent control system for non-repeated support advanced support, the overall architecture of the system is proposed. The multi-sensor fusion technology based on attitude, obstacle recognition, pressure, position, and velocity information is proposed to control and execute multi working condition motion control strategies. The integrated prototype of 'turn-transport-support' for advanced support in transportation roadways is developed. And ground tests are conducted. The test results show that the intelligent control system for non-repeated support advanced support can achieve visual recognition of the center point and obstacles of the support, automatic walking and stroke judgment of the support handling trolley, automatic offset and rotation of the support, and automatic grasping and lifting functions of the support. The visual recognition sensor can achieve support frame number coding recognition, support posture, and support area decision-making functions. The automated operation process of 'walk-grasp-lower-turn-walk-turn-lift-loose-lower' is implemented. It can meet the application requirements.

BackgroundBilateral posterior hip dislocation and femoral head fracture are rare injuries, which may be the earliest case report that focuses on treatment with open reduction via the direct anterior approach (DAA) for bilateral symmetrical Pipkin type II fracture within 5 years of the follow-up period.Case reportWe present a case of bilateral posterior dislocation with a femoral head fracture (Pipkin II) of the hip in 47-year-old woman caused by a high-velocity accident. The dislocation was successfully reduced under general anesthesia at a local hospital and transferred to a tertiary center for surgical management. She was surgically treated with internal fixation using three Herbert screws on the bilateral hips. The DAA was used during surgery. Follow-up for 5 years was performed, and functional outcomes were evaluated using the D'Aubigné range of motion and modified Harris hip score. The range of motion in the bilateral hip was satisfactory, with no signs of post-traumatic arthritis, heterotopic ossification, or avascular necrosis of the femoral head.ConclusionSurgical management of bilateral Pipkin type II fractures was performed successfully with open reduction and internal fixation using a safe and reliable direct anterior approach, with good functional outcomes at 5-year follow-up.

For the problem that the accuracy of personnel positioning in coal mines is susceptible to the calculation errors of the hardware system and complex roadway conditions, which leads to the problem of inconsistency between the calculation results and the actual position coordinates of the personnel, a real-time positioning correction algorithm based on topological structure of lanes and positioning equipment for precise personnel positioning system in underground mine was proposed. Firstly, the topological relationship between lanes and positioning equipment was constructed; then, the deviation of personnel ranging signal was calculated; finally, the real-time position correction of personnel positioning was realized based on the topology network and deviation of ranging signal. Test results show that in the complex condition of lanes, the average time-consuming of correction calculation was about 0.002 5 s, and the accuracy of lanes positioning was higher than 90%, the error between coordinate correction and actual measurement is small. Experimental results show that proposed method can get high correction accuracy, real-time effects and robustness.

Abstract Background Few studies focus on the trauma-specific functional outcomes after surgical revascularization and risk factors contributing to poor outcomes in patients with acute blunt popliteal artery injury (PAI). The objective of this study was to investigate the long-term trauma-specific functional outcomes in patients with acute blunt PAI and identify the associated risk factors. Methods There were 36 patients with acute blunt PAI who require surgical revascularization at a national trauma center of West China Hospital of Sichuan University between March 2010 and April 2019. After propensity matching, each patient was matched to one patient who did not have a concomitant vascular injury in control cohort. Functional outcomes were assessed with trauma-specific functional scores, physical examination of range of motion, nerve functional status and knee stability. A logistics regression model was established to determine the independent risk factors. Results The 5-year (range 2–10 years) follow-up showed that 22 patients (22/36, 61.1%) had functional deficit due to limited activity or chronic neurological symptoms. Patients in vascular cohort had significantly decreased FIM score and AHFS score compared with matched patients without vascular involvement (P = 0.003 and P

Background Femoral neck fractures in young patients are mostly caused by high‐energy trauma and demonstrate more displacement and vertical fracture surfaces, which increase nonunion and osteonecrosis risks. Free vascularized fibula graft (FVFG) is effective in treating old femoral neck fractures and nonunion; however, available data are limited to patients within 2 years after injury or revision surgery. We present the case of a patient who was diagnosed with femoral neck fracture at the age 9 and treated with FVFG 13 years later. Case presentation A 9‐year‐old Asian girl who experienced left hip pain after an injury was diagnosed with Garden IV left femoral neck fracture, which was treated through manipulation reduction and fixed with splints. At age 16, the pain worsened after another injury and was considered to be in the physical development stage. She refused surgical treatment; hence, the fracture was fixed externally with splints. At age 22, she was hospitalized owing to a 12‐day left hip pain with restricted movement caused by a fall. She was diagnosed with old Garden IV femoral neck fracture nonunion and treated with FVFG. Seven years postoperatively, imaging showed that the left femoral neck was internally fixed, the fracture had healed, and the Harris score was 90 points. The 36‐Item Short Form Health Survey responses revealed that the patient's physiological functioning, emotional well‐being, energy, and mental health were normal. She achieved satisfactory functional results and resumed her normal daily life. Conclusion FVFG could provide satisfactory outcomes for long‐term old femoral neck fractures.

Abstract Background To systematically review the literature and provide a comprehensive understanding of the preemptive effects of oral pregabalin on perioperative pain management in lower limb orthopedic surgery. Method We searched three electronic databases for randomized controlled trials comparing the results of preoperative pregabalin and placebo in patients undergoing lower limb orthopedic surgery. Data analyses were conducted using RevMan 5.4. Results Twenty-one randomized controlled trials met our inclusion criteria. The cumulative opioid consumption within 24 and 48 h postoperatively in the pregabalin group was significantly less than that in the placebo group. The pooled static pain intensity at all time points within the first day was significantly lower in the pregabalin group than in the placebo group. Lower dynamic pain intensity at 48 h was detected in the pregabalin group than in the placebo group. Meanwhile, pregabalin led to a lower incidence of nausea but appeared to be associated with a higher incidence of dizziness and sedation. Subgroup analyses showed that no difference was detected between subgroups stratified by dosing regimen or pregabalin dose in the results of opioid consumption, pain intensity and incidence of complications. Conclusion This meta-analysis supports the use of pregabalin preoperatively in patients undergoing lower limb orthopedic surgery. However, it was wary of the resulting increase in dizziness and sedation. There is no evidence to support the continued use of pregabalin postoperatively or using more than 150 mg of pregabalin per day. Trial registration: This study was registered on 09 November 2021 with INPLASY (registration number: INPLASY2021110031).

Objective To evaluate the radiological and clinical outcomes of the surgical treatment for transverse and posterior wall fractures using single‐column posterior fixation. Methods From January 2009 to January 2018, a total of 24 patients with transverse and posterior wall acetabular fractures in our center were included in this retrospective study, including 17 males and seven females with a mean age of 47 years and a minimum follow‐up of 1 year. All cases were closed fractures. All fractures were fixed with single‐column fixation via the Kocher–Langenbeck approach. Primary outcome measures, including quality of reduction and clinical outcomes, were recorded by an independent observer, who also noted secondary outcome measures, including time to surgery, surgical time, intraoperative blood loss, and postoperative complications. Results Twenty‐four patients (range, 26–74 years) included 17 males and seven females. There were 14 cases on the left side and 10 cases on the right side. The mean time from injury to surgery was 7.1 days. Mean intraoperative blood loss and surgical time were 405.4 mL and 135.8 min, respectively. The mean follow‐up time was 29.5 months (range 12–96 months). All the acetabular fractures united within 5 months after surgery. The quality of reduction was graded as anatomical in 17 cases (70.8%), imperfect in three cases (12.5%), and poor in four cases (16.7%). According to grading system of Merle d’ Aubigne and Postel, clinical outcomes at the final follow‐up were excellent in 10 cases (41.7%), good in six cases (25.0%), fair in five cases (20.5%), and poor in three cases (12.5%). The excellent and good rate was 66.7%. There was a significant relation between the quality of reduction and clinical outcomes (P

PurposeThe objective of this study was to evaluate the association between thyroid hormone and bone mineral density (BMD) among euthyroid adults.MethodsThis cross-sectional study researched the information from the National Health and Nutrition Examination Survey 2007–2010. We included 3,759 euthyroid participants finally. We used multivariate linear regression models to evaluate the linear relationship between the thyroid hormone profile and BMD. Subgroup analyses stratified by gender and age were further performed. Moreover, the nonlinear relationship was characterized by fitted smoothing curves and generalized additive models, and logistic regression models were used to determine the association of thyroid-stimulating hormone (TSH) and thyroxine (T4) with previous fractures.ResultsThe weighted multivariable linear regression models showed no association between TSH and BMD. Free thyroxine (FT4), T4, free triiodothyronine (FT3), and total triiodothyronine (T3) were negatively associated with the total femur BMD and the total spine BMD after adjusting for all covariates. Subgroup analyses demonstrated that all groups had a negative association between T4 and BMD, even in patients with osteopenia/osteoporosis. The nonlinear relationship characterized by smooth curve fittings and generalized additive models suggested that an obvious U-shaped, an inverted U -shaped, and an L - shaped curve was exhibited between thyroid hormone and BMD in the different subgroups. In addition, normal high-level T4 was associated with an increased prevalence of previous fractures than normal low-level T4.ConclusionsIn this sample of euthyroid adults, T4 exhibits a negative correlation with BMD, regardless of age and gender, in subjects with either normal or lowered BMD. Moreover, high-normal FT4 was associated with an increased prevalence of previous fractures. TSH was not associated with variations of BMD and the fracture risk.

ObjectiveThe burden of both general and drug-resistant tuberculosis in rural areas is higher than that in urban areas in China. To characterize the genetic structure and transmission risk of Mycobacterium tuberculosis in rural China, we used whole genome sequencing to analyze clinical strains collected from patients in two counties of Yichang for three consecutive years.MethodsFrom 2018 to 2020, sputum samples were collected for cultures from patients with suspected tuberculosis in Yidu and Zigui county, and DNA was extracted from the positive strains for genome sequencing. The online SAM-TB platform was used to identify the genotypes and drug resistance-related mutations of each strain, establish a phylogenetic tree, and calculated the genetic distances between pairwise strains. Twelve single nucleotide polymorphisms (SNPs) were used as thresholds to identify transmission clusters. The risk of related factors was estimated by univariable and multivariable logistic regression.ResultsA total of 161 out of the collected 231 positive strains were enrolled for analysis, excluding non-tuberculous mycobacterium and duplicate strains from the same patient. These strains belonged to Lineage 2 (92, 57.1%) and Lineage 4 (69, 42.9%), respectively. A total of 49 (30.4%) strains were detected with known drug resistance-related mutations, including 6 (3.7%) multidrug-resistant-TB (MDR-TB) strains and 11 (6.8%) RIF-resistant INH-susceptible TB (Rr-TB) strains. Six of the MDR/Rr-TB (35.3%) were also resistant to fluoroquinolones, which made them pre-extensively drug-resistant TB (pre-XDR-TB). There were another seven strains with mono-resistance to fluoroquinolones and one strain with resistance to both INH and fluoroquinolones, making the overall rate of fluoroquinolones resistance 8.7% (14/161). A total of 50 strains (31.1%) were identified as transmission clusters. Patients under 45 years old (adjusted odds ratio 3.46 [95% confidential intervals 1.28–9.35]), treatment-naive patients (6.14 [1.39–27.07]) and patients infected by lineage 4 strains (2.22 [1.00–4.91]) had a higher risk of transmission.ConclusionThe drug resistance of tuberculosis in rural China, especially to the second-line drug fluoroquinolones, is relatively serious. The standardized treatment for patients and the clinical use of fluoroquinolones warrant attention. At the same time, the recent transmission risk of tuberculosis is high, and rapid diagnosis and treatment management at the primary care needs to be strengthened.

The number of skeletal muscle injuries derived from myopathies, exercise, and trauma, is growing due to increasing sports activities in normal life of people. Skeletal muscle has a robust capacity for regeneration following injury. However, few if any effective therapeutic options for volumetric muscle loss are available. Poor repair of muscle injury will lead to skeletal muscle dysfunction, resulting in physical pain and even seriously compromising daily life. As a new technology of biomedicine, 3D bioprinting is widely used in the field of tissue engineering and regenerative medicine due to its enormous advantages. 3D bioprinting creates biological structures similar to that of protists by precisely constructing a specified geometric shape at micro/nano levels, thus addressing the unmet needs in tissue replacement and organ transplantation. With the further application of bioprinting in various tissue repairs, more and more researchers utilized 3D bioprinting in skeletal muscle regeneration. Various bioinks, such as alginate, gelatin, fibrin hydrogels, and extracellular matrix (ECM), loaded with functional seed cells or growth factors have been applied to fabricating 3D bioprinted constructs with complicated inner structures for skeletal muscle regeneration. Therefore, we conducted this review to report the skeletal muscle regeneration process, the development status of bioprinting technology, and the mechanism of promoting skeletal muscle repair. In addition, the current challenges and further perspectives of skeletal muscle regeneration by bioprinting are also discussed in this study.

Abstract Background The invasive and complicated procedures involving the use of traditional stem cells limit their application in bone tissue engineering. Cell-free, tissue-engineered bones often have complex scaffold structures and are usually engineered using several growth factors (GFs), thus leading to costly and difficult preparations. Urine-derived stem cells (USCs), a type of autologous stem cell isolated noninvasively and with minimum cost, are expected to solve the typical problems of using traditional stem cells to engineer bones. In this study, a graphene oxide (GO)-modified silk fibroin (SF)/nanohydroxyapatite (nHA) scaffold loaded with USCs was developed for immunomodulation and bone regeneration. Methods The SF/nHA scaffolds were prepared via lyophilization and cross-linked with GO using 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC) and N-hydroxy succinimide (NHS). Scaffolds containing various concentrations of GO were characterized using scanning electron microscopy (SEM), the elastic modulus test, Fourier transform infrared spectroscopy (FTIR), and X-ray photoelectron spectrometer (XPS). Examinations of cell adhesion, proliferation, viability, morphology, alkaline phosphatase activity, and osteogenesis-related gene expression were performed to compare the osteogenesis-related biological behaviors of USCs cultured on the scaffolds. The effect of USC-laden scaffolds on the differentiation of macrophages was tested using ELISA, qRT-PCR, and immunofluorescence staining. Subcutaneous implantations in rats were performed to evaluate the inflammatory response of the USC-laden scaffolds after implantation. The scaffolds loaded with USCs were implanted into a cranial defect model in rats to repair bone defects. Micro-computed tomography (μCT) analyses and histological evaluation were performed to evaluate the bone repair effects. Results GO modification enhanced the mechanical properties of the scaffolds. Scaffolds containing less than 0.5% GO had good biocompatibility and promoted USC proliferation and osteogenesis. The scaffolds loaded with USCs induced the M2-type differentiation and inhibited the M1-type differentiation of macrophages. The USC-laden scaffolds containing 0.1% GO exhibited the best capacity for promoting the M2-type differentiation of macrophages and accelerating bone regeneration and almost bridged the site of the rat cranial defects at 12 weeks after surgery. Conclusions This composite system has the capacity for immunomodulation and the promotion of bone regeneration and shows promising potential for clinical applications of USC-based, tissue-engineered bones.

Background: Tranexamic acid (TXA) has been widely applied to reduce perioperative bleeding. Recently, several studies focused on the administration of TXA in the treatment for with intertrochanteric fracture patients treated with intramedullary fixation. However, the efficacy and safety of TXA in these studies remain controversial. Therefore, we performed this systematic review and meta-analysis to investigate the efficacy and safety of TXA in intertrochanteric fracture patients treated with intramedullary fixation.Methods: We systematically searched electronic databases, including Cochrane, PubMed, and EMBASE, up to 16 May 2022. The efficacy and safety of TXA was evaluated in four aspects, which were bleeding-related outcomes, non-bleeding-related outcomes, thromboembolic events, and other complications. The outcomes of these studies were extracted and analyzed by RevMan Manager 5.4.Results: Finally, nine randomized controlled trials, involving nine hundred and seventy-two intertrochanteric fracture patients treated with TXA, were enrolled in this study. In the bleeding-related outcomes, TXA group was significantly lower than the control group in terms of total blood loss (MD = −219.42; 95% CI, −299.80 to −139.03; p < 0.001), intraoperative blood loss (MD = −36.81; 95% CI, −54.21 to −19.41; p < 0.001), hidden blood loss (MD = −189.23; 95% CI, −274.92 to −103.54; p < 0.001), and transfusion rate (RR = 0.64; 95% CI, 0.49 to 0.85; p = 0.002). Moreover, the postoperative hemoglobin on day 3 of the TXA group was significantly higher than that of the control group (MD = 5.75; 95% CI, 1.26 to 10.23; p = 0.01). In the non-bleeding-related outcomes, the length of hospital stays was significantly shorter in the TXA group (MD = −0.67; 95% CI, −1.12 to −0.23; p = 0.003). In terms of thromboembolic events, there was no significant differences between the TXA group and control group in deep vein thrombosis, pulmonary embolism, myocardial infarction, and ischemic stroke. As for complications and mortality, there was no significant differences between the TXA group and control group in respiratory infection, renal failure, and postoperative mortality within 1 year.Conclusion: TXA is an effective and safe drug for perioperative bleeding control in intertrochanteric fracture patients treated with intramedullary fixation. However, the long-term efficacy of TXA still needs to be investigated by large-scale multicenter randomized controlled trials.Level of evidence: II, Systematic review and Meta-analysis.Systematic Review Registration:https://inplasy.com/, identifier [INPLASY202280027]

Objective To investigate the factors, surgical treatment methods and clinical effect of internal fixation failure of intertrochanteric and subtrochanteric fractures. Methods From June 2015 to May 2019, arthroplasty and internal fixation revision were used to treat 18 cases of internal fixation failure of intertrochanteric and subtrochanteric fractures. There were 10 males and eight females, with an average age of 67.3 years (38–92 years). The 16 cases of initial intertrochanteric fractures were classified according to AO/OTA:13 cases of A2 and 3 cases of A3, the other 2 cases were subtrochanteric fractures (Seinsheimer type IV). The internal fixation failure was treated with total hip arthroplasty (6 cases), bipolar hemiarthroplasty (4 cases), revision with proximal femoral lockingplate (4 cases) and extend intramedullary nail (4 cases). Results All patients were followed up for an average of 24.7 months (range, 12 to 36 months). The average operative time was 111.4 min (range, 72 to 146 min) and the average intraoperative blood loss was 403.6 mL (range, 200 to 650 mL). The average time of fracture union was 6.9 months (range, 5 to 9 months) for cases of internal fixation revision. The operative time of the arthroplasty group was shorter than the revision group (P

Abstract Background Stem cells are the main choice for seed cells in tissue engineering, but using most traditional stem cells requires invasive and complicated procedures. Human urine-derived stem cells (hUSCs) are an alternative stem cell source with the advantages of being isolated noninvasively and repetitively from the same individual. The aim of this study was to compare chondrogenesis-related biological behaviors between hUSCs and human bone marrow mesenchymal stem cells (hBMSCs) from the same individual. Methods hUSCs and hBMSCs were isolated from six patients who underwent iliac bone grafting. Cell morphology, proliferation, colony-forming, migration, and multidifferentiation analyses were performed in vitro. Then, acellular cartilage extracellular matrix (ACM) scaffolds were fabricated for in vivo implantation. The comparisons of cell viability, morphology, proliferation, and chondrogenesis between hUSCs and hBMSCs cultured on scaffolds were performed before implantation. The scaffolds loaded with hUSCs or hBMSCs were implanted into a rabbit knee model to repair cartilage defects. Magnetic resonance imaging (MRI) and micro-computed tomography (μCT) Analyses, inflammation and toxicity assays, gross observation, and histological evaluation were performed to evaluate the cartilage repair effects. Results In in vitro experiments, hUSCs had better capacity for proliferation, colony-forming, and migration compared to hBMSCs in the same passage, while hBMSCs had greater osteogenic, adipogenic, and chondrogenic abilities compared to hUSCs in the same passage. Both hUSCs and hBMSCs at passage 3 had the strongest potential for proliferation, colony-forming, and multilineage differentiation compared to cells in other passages. The ACM scaffolds loaded with hUSCs or hBMSCs both significantly promoted the repair of cartilage defects in the rabbit knee model at 12 weeks’ postimplantation, and the new tissue was mainly hyaline cartilage. However, there was no significant difference in cartilage repair effects between hUSCs and hBMSCs. Conclusions In in vitro experiments, hUSCs presented better capacity for proliferation, while hBMSCs had greater chondrogenic ability. However, hUSCs and hBMSCs had similar cartilage repair effects in vivo. Results indicated that hUSCs can be a stem cell alternative for cartilage regeneration and provide a powerful platform for cartilage tissue engineering and clinical transformation. Graphical abstract

In recent years, three-dimensional (3D) bioprinting has been widely utilized as a novel manufacturing technique by more and more researchers to construct various tissue substitutes with complex architectures and geometries. Different biomaterials, including natural and synthetic materials, have been manufactured into bioinks for tissue regeneration using 3D bioprinting. Among the natural biomaterials derived from various natural tissues or organs, the decellularized extracellular matrix (dECM) has a complex internal structure and a variety of bioactive factors that provide mechanistic, biophysical, and biochemical signals for tissue regeneration and remodeling. In recent years, more and more researchers have been developing the dECM as a novel bioink for the construction of tissue substitutes. Compared with other bioinks, the various ECM components in dECM-based bioink can regulate cellular functions, modulate the tissue regeneration process, and adjust tissue remodeling. Therefore, we conducted this review to discuss the current status of and perspectives on dECM-based bioinks for bioprinting in tissue engineering. In addition, the various bioprinting techniques and decellularization methods were also discussed in this study.

BackgroundPost-operative mortality risk assessment for geriatric patients with hip fractures (HF) is a challenge for clinicians. Early identification of geriatric HF patients with a high risk of post-operative death is helpful for early intervention and improving clinical prognosis. However, a single significant risk factor of post-operative death cannot accurately predict the prognosis of geriatric HF patients. Therefore, our study aims to utilize a machine learning approach, random forest algorithm, to fabricate a prediction model for post-operative death of geriatric HF patients.MethodsThis retrospective study enrolled consecutive geriatric HF patients who underwent treatment for surgery. The study cohort was divided into training and testing datasets at a 70:30 ratio. The random forest algorithm selected or excluded variables according to the feature importance. Least absolute shrinkage and selection operator (Lasso) was utilized to compare feature selection results of random forest. The confirmed variables were used to create a simplified model instead of a full model with all variables. The prediction model was then verified in the training dataset and testing dataset. Additionally, a prediction model constructed by logistic regression was used as a control to evaluate the efficiency of the new prediction model.ResultsFeature selection by random forest algorithm and Lasso regression demonstrated that seven variables, including age, time from injury to surgery, chronic obstructive pulmonary disease (COPD), albumin, hemoglobin, history of malignancy, and perioperative blood transfusion, could be used to predict the 1-year post-operative mortality. The area under the curve (AUC) of the random forest algorithm-based prediction model in training and testing datasets were 1.000, and 0.813, respectively. While the prediction tool constructed by logistic regression in training and testing datasets were 0.895, and 0.797, respectively.ConclusionsCompared with logistic regression, the random forest algorithm-based prediction model exhibits better predictive ability for geriatric HF patients with a high risk of death within post-operative 1 year.

BackgroundThe geriatric nutritional risk index (GNRI) has been used as a significant tool to access the nutritional status of the elderly. However, the relationship between the GNRI and femur bone mineral density (BMD) and the risk of osteoporosis remains unclear in American postmenopausal women.ObjectivesWe aimed to explore associations between the GNRI with femur BMD and the risk of osteoporosis in American postmenopausal women.MethodsWe merged the continuous National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 to ensure a large and representative sample, including 3,152 participants. The linear relationship between the GNRI and femur BMD was assessed via a weighted multivariate linear regression model. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between the GNRI and the risk of osteoporosis were assessed by a weighted logistic regression model. Moreover, the nonlinear relationship was also characterized by smooth curve fitting (SCF) and a weighted generalized additive model (GAM).ResultsAfter adjusting for all covariates, the weighted multivariable linear regression models demonstrated that the GNRI was positively correlated with femur BMD. The weighted logistic regression models demonstrated that each unit of increased GNRI value was associated with a decreased risk of osteoporosis of 4.13%. When categorizing GNRI based on quartiles, ORs between the risk of osteoporosis and the GNRI across quintiles 2, 3, and 4 compared with quintile 1 were 0.5565 (95% CI: 0.4791, 0.6463; P < 0.000001), 0.5580 (95% CI: 0.4600, 0.6769; P < 0.000001), and 0.3475 (95% CI: 0.2681, 0.4505; P < 0.000001). The trends similar to the above were also observed in SCF and GAM.ConclusionThis study indicated that nutritional status, represented by the GNRI, was positively associated with femur BMD and negatively associated with the risk of osteoporosis in American postmenopausal women. The GNRI may be a good tool to identify American postmenopausal women who need further bone health nutritional support.

ObjectivesThe study aimed to explore the associations between dietary magnesium (Mg) intake and magnesium depletion score (MDS) among American adults with osteoporosis.MethodsThe continuous data from the National Health and Nutrition Examination Survey 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018 were merged to ensure a large and representative sample and a total of 14,566 participants were enrolled for the analysis. The weighted multivariate linear regression model was performed to assess the linear relationship between dietary Mg intake and osteoporosis. Further, the non-linear relationship was also characterized by smooth curve fitting (SCF) and weighted generalized additive model (GAM). In addition, the odds ratios (ORs) and 95% confidence intervals (95% CIs) for associations between the MDS and osteoporosis were assessed by weighted logistic regression models.ResultsAfter adjusting all covariates, the weighted multivariable linear regression models demonstrated that the dietary Mg intake negatively correlated with osteoporosis, especially in participants aged 55 years or older. In addition, the non-linear relationship characterized by SCF and weighted GAM showed that the dietary Mg intake presented an L-shaped association with osteoporosis among females aged 55 years or older. Moreover, the weighted logistic regression model demonstrated that compared with MDS 0, the OR between MDS ≥3 and osteoporosis was 2.987 (95% CI 1.904, 4.686) in the male-middle intake group. Moreover, compared with MDS 0, the ORs between MDS ≥3 and osteoporosis was 5.666 (95% CI 3.188, 10.069) in the female-low intake group and 1.691 (95% CI 1.394, 2.051) in the female-middle intake group.ConclusionThe present study indicated that in people with a daily intake of Mg level below the recommended daily intake (RDI), the dietary Mg intake and Mg bioavailability represented by MDS have a negative correlation with osteoporosis. According to the results, the combination of MDS and dietary Mg intake may be more comprehensive and rigorous in screening the population with osteoporosis. Therefore, early monitoring and interventions for osteoporosis may be necessary for those with insufficient dietary Mg intake or high MDS scores.

Purpose Hook plate fixation is one of the most frequently used methods for unstable distal clavicular fractures, but it is still unknown if there is a need for coracoclavicular (CC) reconstruction. This study aimed to compare the efficacy of hook plate fixation with versus without CC reconstruction for distal clavicular fractures. Methods Eighty-one patients who underwent hook plate fixation (HP group, n = 45) or hook plate fixation plus suture anchor reconstruction (HPA group, n = 36) for Neer type II or V clavicular fractures were enrolled. Demographics, fracture characteristics, and surgical data were recorded. Union time, coracoclavicular distance (CCD), post-operative complications, Constant score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score were compared between HPA and HP groups. Results Constant score in the HPA group was higher than that in the HP group (91.8 ± 3.6 vs 88.8 ± 6.0, P = 0.007). However, there were no significant differences in union time, DASH score, CCD, and post-operative complications between the two groups (P > 0.05). Hook plate fixation combined with CC reconstruction costed more (3023.7 ± 202.6 vs 2416.2 ± 167.6 EUR, P < 0.001) and prolonged operative duration (78.2 ± 9.2 vs 73.7 ± 8.3 min, P = 0.023) compared with hook plate fixation alone. Conclusion Hook plate fixation with or without suture anchor reconstruction achieved satisfactory outcomes for Neer type II or V clavicular fractures. However, hook plate fixation plus CC reconstruction showed better functional outcomes compared with hook plate fixation alone.