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Abstract Periprosthetic joint infection (PJI) is a severe complication after joint replacement surgery that demands precise diagnosis for effective treatment. We enhanced PJI diagnostic accuracy through three steps: (1) developing a self-supervised PJI model with DINO v2 to create a large dataset; (2) comparing multiple intelligent models to identify the best one; and (3) using the optimal model for visual analysis to refine diagnostic practices. The self-supervised model generated 27,724 training samples and achieved a perfect AUC of 1, indicating flawless case differentiation. EfficientNet v2-S outperformed CAMEL2 at the image level, while CAMEL2 was superior at the patient level. By using the weakly supervised PJI model to adjust diagnostic criteria, we reduced the required high-power field diagnoses per slide from five to three. These findings demonstrate AI’s potential to improve the accuracy and standardization of PJI pathology and have significant implications for infectious disease diagnostics.

Abstract Background Good wound healing is critical to infection prophylaxis and satisfactory rehabilitation in Total Knee Arthroplasty (TKA). Currently, two techniques, i.e., barbed continuous subcuticular suture without skin adhesive or combined use skin adhesive (n-butyl-2) are being used for superficial wound closure of TKA. While a new skin adhesive (2-octyl) with self-adhesive mesh has been employed as an alternative to conventional surgical skin closure in TKA, its superiority, especially in reducing wound complications and improving wound cosmetic outcomes has not been investigated. This study aimed to compare 2-octyl, n-butyl-2, and no skin adhesive in terms of safety and efficacy in TKA superficial wound closure. Methods We conducted a multicenter, prospective, randomized controlled study in 105 patients undergoing primary TKA between May 2022 and October 2023. Each patient’s knee was randomized to receive 2-octyl, n-butyl-2, or no skin adhesive skin closure with all using barbed continuous sutures in deep tissue. Wounds were followed 1, 3, 5 days, 2, 6 weeks, and 3 months after surgery. Wound discharge, complications, cosmetic outcomes, patient satisfaction, and wound-related costs were compared among these three methods. Results Wound discharge was less in 2-octyl group and n-butyl-2 group than in non-adhesive group at 1 day, with the discharge only being less in 2-octyl group than in the non-adhesive group at day 3 and day 5 days (P 0.05). The 2-octyl group achieved better cosmetic effects than the other two groups in 6 weeks and 3 months (P

Abstract Land use and cover change (LUCC) significantly impacts global carbon cycles and land surface properties, accounting for 25% of the historical atmospheric CO2 increase. We explore a previously overlooked role of LUCC in driving the land carbon cycle by using a three-level meta-analysis and Land Use Harmonization data to drive an ecosystem model. Our findings reveal that a loss of 39.2% of soil organic carbon (SOC) change in China due to LUCC, mitigated by afforestation, doubles gross primary productivity at 0.02 Pg C yr−1, countering central China’s urbanization decline. Indirect climate effects, especially soil bulk density, significantly impact SOC compared to direct climate effects. LUCC has significantly increased the Chinese terrestrial carbon sink, with net ecosystem productivity reaching 0.02 ± 0.12 Pg C yr−1. Our study underscores the importance of reforestation and afforestation in addressing climate change and enhancing carbon sinks in future carbon management.

Abstract Cyber–physical distribution systems with renewable energy should have high resilience under extreme conditions. However, in a distribution system with deep cyber–physical coupling, the propagation of information risk impairs the resilience of the system. This paper proposes a strategy to improve the resilience of cyber–physical distribution systems that considers cross‐space propagation of information risk. First, the mechanism for interaction between the cyber space and physical space is analyzed, and an information risk cross‐space propagation model is proposed. Second, the risk status of key device nodes is quantified according to the risk propagation model, and an optimization strategy for information risk control is obtained, whose objective function is the minimum risk of the coupling network. Third, a fault restoration strategy that considers cyber space risk is proposed. Finally, the paper reports experiments using the modified IEEE 33‐node and 123‐node distribution networks to simulate the proposed strategy and verify its effectiveness.

Abstract Objective Osteonecrosis of the femoral head (ONFH) is a severe disease that primarily affects the middle-aged population, imposing a significant economic and social burden. Recent research has linked the progression of non-traumatic osteonecrosis of the femoral head (NONFH) to the composition of the gut microbiota. Steroids and alcohol are considered major contributing factors. However, the relationship between NONFH caused by two etiologies and the microbiota remains unclear. In this study, we examined the gut microbiota and fecal metabolic phenotypes of two groups of patients, and analyzed potential differences in the pathogenic mechanisms from both the microbial and metabolic perspectives. Methods Utilizing fecal samples from 68 NONFH patients (32 steroid-induced, 36 alcohol-induced), high-throughput 16 S rDNA sequencing and liquid chromatography with tandem mass spectrometry (LC-MS/MS) metabolomics analyses were conducted. Univariate and multivariate analyses were applied to the omics data, employing linear discriminant analysis effect size to identify potential biomarkers. Additionally, functional annotation of differential metabolites and associated pathways was performed using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Subsequently, Spearman correlation analysis was employed to assess the potential correlations between differential gut microbiota and metabolites. Results High-throughput 16 S rDNA sequencing revealed significant gut microbial differences. At the genus level, the alcohol group had higher Lactobacillus and Roseburia, while the steroid group had more Megasphaera and Akkermansia. LC-MS/MS metabolomic analysis indicates significant differences in fecal metabolites between steroid- and alcohol-induced ONFH patients. Alcohol-induced ONFH (AONFH) showed elevated levels of L-Lysine and Oxoglutaric acid, while steroid-induced ONFH(SONFH) had increased Gluconic acid and Phosphoric acid. KEGG annotation revealed 10 pathways with metabolite differences between AONFH and SONFH patients. Correlation analysis revealed the association between differential gut flora and differential metabolites. Conclusions Our results suggest that hormones and alcohol can induce changes in the gut microbiota, leading to alterations in fecal metabolites. These changes, driven by different pathways, contribute to the progression of the disease. The study opens new research directions for understanding the pathogenic mechanisms of hormone- or alcohol-induced NONFH, suggesting that differentiated preventive and therapeutic approaches may be needed for NONFH caused by different triggers.

IntroductionGranulocytic myeloid-derived suppressor cells (G-MDSCs) show fast recovery following allogeneic hematopoietic stem cell transplantation (allo-HSCT) constituting the major part of peripheral blood in the early phase. Although G-MDSCs mediate immune suppression through multiple mechanisms, they may also promote inflammation under specific conditions. MethodsG-MDSCs were isolated from 82 patients following allo-HSCT within 90 days after allo-HSCT, and their interactions with autologous CD3+ T-cells were examined. T-cell proliferation was assessed by flow cytometry following CFSE staining, while differentiation and interferon-γ secretion were characterized using chemokine receptor profiling and ELISpot assays, respectively. NK cell cytotoxicity was evaluated through co-culture with K562 cells. An aGVHD xenogeneic model in humanized mice was employed to study the in vivo effects of human leukocytes. Furthermore, transcriptional alterations in G-MDSCs were analyzed via RNA sequencing to investigate functional transitions.ResultsG-MDSCs promoted inflammation in the early-stage, by facilitating cytokine secretion and proliferation of T cells, as well as their differentiation into pro-inflammatory T helper subsets. At day 28, patients with a higher number of G-MDSCs exhibited an increased risk of developing grades II-IV aGvHD. Besides, adoptive transfer of G-MDSCs from patients at day 28 into humanized mice exacerbated aGvHD. However, at day 90, G-MDSCs led to immunosuppression, characterized by upregulated expression of indoleamine 2,3-dioxygenase gene and interleukin-10 secretion, coupled with the inhibition of T cell proliferation. Furthermore, transcriptional analysis of G-MDSCs at day 28 and day 90 revealed that 1445 genes were differentially expressed. These genes were associated with various pathways, revealing the molecular signatures of early post-transplant differentiation in G-MDSCs. In addition, genes linked to the endoplasmic reticulum stress were upregulated in patients without aGvHD. The acquisition of immunosuppressive function by G-MDSCs may depend on the activation of CXCL2 and DERL1 genes. ConclusionOur findings revealed the alteration in the immune characteristics of G-MDSCs within the first 90 days post-allo-HSCT. Moreover, the quantity of G-MDSCs at day 28 may serve as a predictive indicator for the development of aGvHD.

Abstract Tuberous sclerosis complex 1 (TSC1) plays important roles in regulating innate immunity. However, the precise role of TSC1 in macrophages in the regulation of oxidative stress response and hepatic inflammation in liver ischemia/reperfusion injury (I/R) remains unknown. In a mouse model of liver I/R injury, deletion of myeloid-specific TSC1 inhibited AKT and MST1 phosphorylation, and decreased NRF2 accumulation, whereas activated TLR4/NF-κB pathway, leading to increased hepatic inflammation. Adoptive transfer of AKT- or MST1-overexpressing macrophages, or Keap1 disruption in myeloid-specific TSC1-knockout mice promoted NRF2 activation but reduced TLR4 activity and mitigated I/R-induced liver inflammation. Mechanistically, TSC1 in macrophages promoted AKT and MST1 phosphorylation, and protected NRF2 from Keap1-mediated ubiquitination. Furthermore, overexpression AKT or MST1 in TSC1-knockout macrophages upregulated NRF2 expression, downregulated TLR4/NF-κB, resulting in reduced inflammatory factors, ROS and inflammatory cytokine-mediated hepatocyte apoptosis. Strikingly, TSC1 induction in NRF2-deficient macrophages failed to reverse the TLR4/NF-κB activity and production of pro-inflammatory factors. Conclusions: Macrophage TSC1 promoted the activation of the AKT/MST1 signaling pathway, increased NRF2 levels via reducing Keap1-mediated ubiquitination, and modulated oxidative stress-driven inflammatory responses in liver I/R injury. Our findings underscore the critical role of macrophage TSC1 as a novel regulator of innate immunity and imply the therapeutic potential for the treatment of sterile liver inflammation in transplant recipients. Schematic illustration of macrophage TSC1-mediated AKT/MST1/NRF2 signaling pathway in I/R-triggered liver inflammation. Macrophage TSC1 can be activated in I/R-stressed livers. TSC1 activation promotes phosphorylation of AKT and MST1, which in turn increases NRF2 expression and inhibits ROS production and TLR4/NF-κB activation, resulting in reduced hepatocellular apoptosis in I/R-triggered liver injury.

Deep learning models have demonstrated promising results in the early and accurate diagnosis of osteonecrosis of the femoral head (ONFH), enabling early detection and informed surgical decision-making. The objective of this review is to summarize the applications of deep learning models on the medical images of ONFH. English papers were searched from CINAHL via EBSCOhost, Embase, IEEE Xplore® Digital Library, PubMed, Scopus, and Web of Science. Sixteen studies (n =16) were eligible for data synthesis. Among these, five studies (n =5) focusing on radiographs, ten studies (n =10) focusing on magnetic resonance imaging, and one study (n =1) focusing on computed tomographic images. The applications of these studies included identifying ONFH from normal or other hip pathologies, classifying severity, segmenting, and detecting femoral head and necrotic regions, predicting signs and symptoms of ONFH, and predicting potential ONFH after fracture fixation. Generally, the models demonstrated good to excellent classification performance and excellent discriminatory power; and generally comparable to that of experienced physicians and superior to that of less experienced physicians. However, the external validity of these studies demonstrated only moderate, as evidenced by the performance on the external testing set and might be attributed to the relatively small data size used during model training. we observed a shift from CNN-based models to U-Net-based models (i.e., with encoder-decoder architecture). In addition to streamlining the segmentation, detection, and classification procedures, future studies will explore multimodal attention, self-supervised learning, explainable models, and data augmentation through generative models.

Abstract Background Early cervical spondylotic myelopathy (CSM) is challenging to diagnose and easily missed. Diffusion MRI (dMRI) has the potential to identify early CSM. Methods Using diffusion tensor imaging (DTI), diffusion kurtosis imaging (DKI), and neurite orientation dispersion and density imaging (NODDI), a 1:1 matched case-control study was conducted to evaluate the potential of dMRI in identifying early CSM and assessing uncompressed segments of CSM patients. CSM patients and volunteers were matched by age and spinal location. The differences in dMRI parameters between groups were assessed by the paired t-test, the multicollinearity of the dMRI parameters was evaluated by the variance inflation factor (VIF), and the value of dMRI parameters in distinguishing controls from CSM patients was determined by logistic regression. The univariate t-test was used to analyse differences between CSM patients and volunteers in adjacent uncompressed areas. Results In total, 56 CSM patients and 56 control volunteers were included. Paired t-tests revealed significant differences in nine dMRI parameters between groups. Multicollinearity calculated through VIF and combined with logistic regression showed that the orientation division index (ODI) was significantly positively correlated (r = 2.12, p = 0.035), and the anisotropic water fraction (AWF) was significantly negatively correlated (r = −0.98, p = 0.015). The fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), isotropic volume fraction (ISOVF), ODI, and AWF were significantly different in the upper and lower uncompressed areas at all ages. Conclusion dMRI can noninvasively identify early CSM patients and potentially identify the extent of CSM lesions involving the cervical spinal cord. Critical relevance statement Diffusion MRI (dMRI) can identify early cervical spondylotic myelopathy (CSM) and has the potential to help determine the extent of CSM involvement. The application of dMRI can help screen for early CSM and develop clinical surgical and rehabilitation treatment plans. Key points • Diffusion MRI can differentiate between normal and early-stage cervical spondylotic myelopathy patients. • Diffusion MRI has the ability to identify the extent of spinal cord involvement in cervical spondylotic myelopathy. • Diffusion MRI enables the early screening of cervical spondylotic myelopathy and helps guide clinical treatment. Graphical Abstract

Hydrogels have emerged as promising biomaterials for nerve regeneration due to their adjustable properties, structural resemblance to the extracellular matrix, and ability to promote cell adhesion and proliferation. This comprehensive review discusses the advantages, challenges, and future directions of various functional hydrogels. Advanced technologies for fabricating Multistructured hydrogel, including injectable hydrogels, hydrogel microspheres, fibrous hydrogels, 3D printing hydrogels, nanogels, stem cell-loaded hydrogels, electrical hydrogels, ultrasound hydrogels, and magnetic hydrogels, have been developed and studied for nerve regeneration. These technologies demonstrate the versatility of hydrogels in neural tissue repair. However, challenges such as biocompatibility, degradation rates, and scaffold design need to be addressed. Interdisciplinary research is necessary to develop innovative hydrogel systems that overcome these challenges and realize the potential of hydrogels for nerve regeneration. This review provides valuable insights into advanced hydrogel technologies and highlights their potential in regenerative medicine, particularly in neural regeneration. Researchers can use this knowledge to refine therapeutic approaches involving hydrogels for enhancing nerve regeneration.

Abstract Purposes To develop a deep learning (DL) model to measure the sagittal Cobb angle of the cervical spine on computed tomography (CT). Materials and methods Two VB-Net-based DL models for cervical vertebra segmentation and key-point detection were developed. Four-points and line-fitting methods were used to calculate the sagittal Cobb angle automatically. The average value of the sagittal Cobb angle was manually measured by two doctors as the reference standard. The percentage of correct key points (PCK), matched samples t test, intraclass correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), and Bland‒Altman plots were used to evaluate the performance of the DL model and the robustness and generalization of the model on the external test set. Results A total of 991 patients were included in the internal data set, and 112 patients were included in the external data set. The PCK of the DL model ranged from 78 to 100% in the test set. The four-points method, line-fitting method, and reference standard measured sagittal Cobb angles were − 1.10 ± 18.29°, 0.30 ± 13.36°, and 0.50 ± 12.83° in the internal test set and 4.55 ± 20.01°, 3.66 ± 18.55°, and 1.83 ± 12.02° in the external test set, respectively. The sagittal Cobb angle calculated by the four-points method and the line-fitting method maintained high consistency with the reference standard (internal test set: ICC = 0.75 and 0.97; r = 0.64 and 0.94; MAE = 5.42° and 3.23°, respectively; external test set: ICC = 0.74 and 0.80, r = 0.66 and 0.974, MAE = 5.25° and 4.68°, respectively). Conclusions The DL model can accurately measure the sagittal Cobb angle of the cervical spine on CT. The line-fitting method shows a higher consistency with the doctors and a minor average absolute error.

Abstract Pulmonary polymorphic carcinoma (PPC) is a rare and poorly differentiated form of non‐small cell lung cancer (NSCLC), accounting for just approximately 0.1% to 0.4% of all NSCLC cases. Historically, the conventional treatments for PPC have been linked to a grim prognosis. However, with the advent of immune checkpoint inhibitors (ICIs), including PD‐1 inhibitors, for the management of NSCLC, our center has witnessed encouraging outcomes in two PPC patients who underwent PD‐1 inhibitor therapy. The first patient was a 70‐year‐old male who initially came to our attention after the discovery of a lung mass during a routine physical examination. A lung biopsy confirmed the diagnosis of PPC, and further complications included brain metastasis. Surgical intervention was conducted for the brain metastases, while PD‐1 inhibitor therapy was employed for the lung tumors. The second patient was a 60‐year‐old male who was admitted with a history of persistent coughing and hemoptysis, which led to the diagnosis of a left lung tumor. Subsequent postoperative pathology revealed pulmonary adenocarcinoma coexisting with PPC. However, 2 months later, distant metastases were detected during a follow‐up examination. The patient encountered difficulty in tolerating the adverse effects of chemotherapy, prompting the initiation of PD‐1 inhibitor treatment. Notably, both patients underwent one cycle of PD‐1 inhibitor therapy without encountering significant adverse reactions, and their responses proved to be promising during re‐examinations. These findings suggest that surgery combined with immunotherapy PD‐1 inhibitor therapy may represent an effective approach for the treatment of PPC.

Abstract The six species of lungfish possess both lungs and gills and are the closest extant relatives of tetrapods. Here, we report a single-cell transcriptome atlas of the West African lungfish (Protopterus annectens). This species manifests the most extreme form of terrestrialization, a life history strategy to survive dry periods that can last for years, characterized by dormancy and reversible adaptive changes of the gills and lungs. Our atlas highlights the cell type diversity of the West African lungfish, including gene expression consistent with phenotype changes of terrestrialization. Comparison with terrestrial tetrapods and ray-finned fishes reveals broad homology between the swim bladder and lung cell types as well as shared and idiosyncratic changes of the external gills of the West African lungfish and the internal gills of Atlantic salmon. The single-cell atlas presented here provides a valuable resource for further exploration of the respiratory system evolution in vertebrates and the diversity of lungfish terrestrialization.

The accurate prediction of blade loading is crucial to designing efficient turbomachinery, but traditional methods often neglect the impact of compressibility, leading to inaccuracies at high speeds. This study investigates the effect of compressibility on the blade loading parameters, particularly the Zweifel coefficient (Zw) and lift coefficient (CL), in turbine cascades. A novel intermediate method (IM), with averaged flow properties derived from both inlet and outlet conditions, is proposed to enhance the accuracy of Zw and CL calculations in compressible flow regimes. This method is based on the extended Kutta–Joukowski theorem for compressible flow and incorporates the Mach number directly into the modified definitions of Zw and CL. The analysis reveals that the averaged flow angle (αm), calculated by using a velocity-weighted approach, serves as a crucial parameter for blade similarity studies. The proposed correction method is applied and validated based on CFD simulations of the VKI-RG turbine cascade. The IM and modified definitions provide a robust framework for accurately predicting blade loading at high speeds, enabling improved design and analysis of turbomachinery.

Hydrogen has the potential to serve as a new energy resource, reducing greenhouse gas emissions that contribute to climate change. Natural hydrogenases exhibit impressive catalytic abilities for hydrogen production, but they often lack oxygen tolerance. Oxygen-tolerant hydrogenases can work under oxygen by reacting with oxygen to form inactive states, which can be reactivated to catalytic states by oxygen atom removal. Herein, we synthesized three NiFeSe complexes: (NiSe(CH3)FeCp, NiSe(CH3)FeCp* and NiSe(PhNMe2)FeCp) with features of active sites of [NiFeSe]-H2ases, which are the oxygen-tolerant hydrogenases, and we investigated the influence of electronic and steric factors on the oxygen reaction of these “biomimetic” complexes. In our research, we found that they react with oxygen, forming 1-oxygen species, which is related to the O2-damaged [NiFeSe] active site. Through a comparative analysis of oxygen reactions, we have discovered that electronic factors and steric hindrance on Se play a significant role in determining the oxygen reactivity of NiFe complexes related to hydrogenases’ active sites.

Temporal domination of sensations (TDS) is a temporal multidimensional dynamic sensory analysis method. This method provides the evaluators with a list of the attributes of products, and the evaluators obtain dynamic multi-attribute sensory evaluation results by selecting the perceptions they think to be dominant at each moment of tasting. In this paper, the concept and process of TDS and its application in food sensory evaluation are reviewed, and future directions in the improvement of TDS are discussed. We anticipate that this paper will provide new ideas for the development of new food products based on an understanding of the dynamic changes of sensory perception during food consumption.

Abstract To explore how the thickness of the femoral lateral wall influences the effectiveness of internal fixation systems used to treat intertrochanteric fractures. CT images of the pelvis and femur of a male adult were used to construct an intertrochanteric fracture model (AO/OTA 31-A2) with various thicknesses of the femoral lateral wall (FLW). Four finite element (FE) models were created with the lateral femoral walls being 10 mm, 20 mm, 30 mm, and 40 mm thick. The fracture models were fixed with a dynamic hip screw (DHS), a proximal femoral nail anti-rotation (PFNA), and a proximal femoral locking compression plate (P-FLCP). A simulated vertical load was applied to the femoral head. The stress and displacement of the implant and femur in each model were recorded for comparison. The FE analysis of the intertrochanteric fracture models showed that the PFNA system could provide better stability than the DHS and P-FLCP with the same thickness of FLW. The FLW provided buttress support to the femoral head and neck when using a DHS and PFNA, and the buttress strength was proportional to the thickness of FLW. The maximum stress in the DHS model was recorded on the DHS plate which accommodated the lag screw. For the PFNA model, the maximum stress appeared at the connection between the nail and blade. In the P-FLCP model, the maximum stresses were highly concentrated at the connection between the cephalic nails and the proximal plate. The thickness of the femoral lateral wall should be considered an important factor when selecting a suitable internal fixation system for intertrochanteric fractures. Based on the FE analysis, intramedullary fixation, such as PFNA, experiences lower stress levels and a moderate displacement in comparison to DHS and P-FCLP when used to treat intertrochanteric fractures.

Phantom limb is a disabling neuropsychiatric condition among amputees resulting in pain and disturbance that impact their functions, quality of life, and autonomy. While pharmacological approaches appeared to be ineffective, the emergence and integration of X-reality, including virtual reality, augmented reality, and mixed reality, might elevate the effectiveness of mirror therapy in managing phantom limb. The objective of this study is to review X-reality for managing phantom pain. A systematic search was conducted on PubMed, Scopus, Web of Science, PsycINFO, Embase, and CINAHL. Sixteen (n = 16) studies containing 66 lower-limb and 53 upper-limb amputees were included for the review over the thematic framework of amputee characteristics and intervention designs, while thirteen (n = 13) studies were further proceeded for the meta-analysis. We found eleven studies on virtual reality (n = 11), four studies on marker-based augmented reality (n = 4) and one study on mixed reality (n = 1) with a total of 40 game/task themes involving, motor skills, motor control, and stimulus-sensing. Regardless, all these interventions adopted the movement representation strategies with different techniques. Overall, the X-reality interventions reduced the pain level of the amputees (mean difference: -2.30, 95% CI, -3.38 to -1.22), especially the virtual reality subgroup (mean difference: -2.83, 95% CI, -4.43 to -1.22). However, there were substantial heterogeneity and partially explained by the subgroup analysis on publication year. The strength of evidence was limited by case reports and case series in this review.

Objective Leucocyte esterase (LE) strip test is the most rapid, convenient, and cheap method to diagnose chronic periprosthesis joint infection (PJI). However, the determination of LE strip mainly relies on colorimetric method with strong subjectivity, which leads to low diagnostic accuracy. Therefore, we try to convert LE strip images into digital data through the RGB photometric system to achieve objective diagnosis. This method will greatly improve the accuracy of LE strip detection and diagnosis of PJI. Methods From January 2021 to September 2021, 46 patients with suspected PJI after total hip and knee arthroplasty underwent diagnostic joint puncture. After effective joint fluid samples were harvested, they were divided into original fluid and centrifuged fluid for LE strip detection. Real‐time images of LE strip were taken at 90 s, 3 min, 5 min, 10 min, and 15 min after sampling, and their brightness (Y) was obtained after they were input into an RGB photometric system. Grouping was based on centrifugation, infection, and time points, and then the differences in brightness among groups were compared. The correlation between LE strip image brightness and WBC count was evaluated. Student t‐test was used for the parametric data and chi‐square test for qualitative data. Simple linear regression was utilized to analyze the correlation between brightness and WBC count in each group. Results Included were 19 cases of PJI and 27 Non‐PJI subjects diagnosed against ICM2018 diagnostic criteria. The brightness was lower in the PJI group than in Non‐PJI group (p

Abstract Objective This study described a minimally invasive approach for the management of early-stage avascular necrosis of the femoral head, which integrated arthroscopic intra-articular decompression and core decompression by drilling multiple small holes. Method A total of 126 patients with 185 hip avascular necrosis were included between March 2005 and January 2008, and the hips were classified, based on the Association Research Circulation Osseous staging system, into stage I (n = 43), stage II (n = 114), and stage III (n = 28). Arthroscopic intra-articular inspection and debridement, along with drilling of multiple small holes for core decompression, were performed. The Modified Harris hip score system and radiographs were used to assess the pre- and post-surgery outcomes. Results One hundred and three patients (involving 153 hips) were followed up successfully for an average of 10.7 ± 3.4 years (range: 9–12 years). After surgery, the overall survival rate was 51.6% (79 hips), and the clinical survival rates were 79%, 72%, 52%, 32%, and 10% for patients with stage I, IIa, IIb, IIc, and III, respectively. The outcomes of patients with Association Research Circulation Osseous Stages I or IIA were better than those of other stages, while hips with a large necrotic area had poor results. This approach preserved the original biomechanical strength of the femoral head after core decompression and eliminated arthritis factors in the hip joint. Conclusion The core decompression with multiple small-size holes is an effective method for treating early-stage avascular necrosis of the femoral head, particularly in those with pathological changes in the hip joint. Level of evidence Therapeutic study, Level IV.

Abstract Background CSF-soluble platelet-derived growth factor receptor beta (sPDGFRβ) is closely associated with pericyte damage. However, the changes in CSF sPDGFRβ levels and their role in blood–brain barrier (BBB) leakage at different stages of Alzheimer’s disease (AD), with or without cerebral small vessel disease (CSVD) burden, remain unclear. Methods A total of 158 individuals from the China Aging and Neurodegenerative Disorder Initiative cohort were selected, including 27, 48, and 83 individuals with a clinical dementia rating (CDR) score of 0, 0.5, and 1–2, respectively. CSF total tau, phosphorylated tau181 (p-tau181), Aβ40, and Aβ42 were measured using the Simoa assay. Albumin and CSF sPDGFRβ were measured by commercial assay kits. CSVD burden was assessed by magnetic resonance imaging. Results CSF sPDGFRβ was the highest level in the CDR 0.5 group. CSF sPDGFRβ was significantly correlated with the CSF/serum albumin ratio (Q-alb) in the CDR 0–0.5 group (β = 0.314, p = 0.008) but not in the CDR 1–2 group (β = − 0.117, p = 0.317). In the CDR 0–0.5 group, CSF sPDGFRβ exhibited a significant mediating effect between Aβ42/Aβ40 levels and Q-alb (p = 0.038). Q-alb, rather than CSF sPDGFRβ, showed a significant difference between individuals with or without CSVD burden. Furthermore, in the CDR 0.5 group, CSF sPDGFRβ was higher in subjects with progressive mild cognitive impairment than in those with stable mild cognitive impairment subjects (p < 0.001). Meanwhile, CSF sPDGFRβ was significantly associated with yearly changes in MMSE scores in the CDR 0.5 group (β = − 0.400, p = 0.020) and CDR 0.5 (A+) subgroup (β = − 0.542, p = 0.019). Conclusions We provide evidence that increased CSF sPDGFRβ is associated with BBB leakage in the early cognitive impairment stage of AD, which may contribute to cognitive impairment in AD progression.

The genus Rosa is globally popular with well-established applications since it has a high edible and medicinal value. However, relatively limited research has been conducted on the composition and quality of wild Rosa fruits. The present study aimed to compare the properties and chemical components of five wild edible Rosa fruits, Rosa roxburghii, Rosa sterilis, Rosa laevigata, Rosa davurica, and Rosa sericea. The UPLC-ESI-MS/MS approach identified the key metabolites among the five Rosa fruits as flavonoids, phenolic acids, and organic acids. The main differential metabolites among the five fruits are flavonoids (22.29–45.13%), phenolic acids (17–22.27%), and terpenoids (7.7–24%), respectively. In total, 125 compounds served as potential markers for the five Rosa species. Differential metabolic pathways of five Rosa fruits were analyzed using the KEGG approach. Rosa laevigata fruits showed the highest total polysaccharide (TPS) content of 64.48 g/100 g. All the five Rosa extracts effectively decreased the levels of malondialdehyde while increasing the activities of superoxide dismutase and glutathione peroxidase in the H2O2-induced HaCaT cell model, demonstrating high potential for antioxidant development. Our findings suggest that the five studied Rosa fruits exhibit biological activity and edible value worth further exploration.

Introduction Nowadays, invasive prostate biopsy is the standard diagnostic test for patients with suspected prostate cancer (PCa). However, it has some shortcomings such as perioperative complications, economic and psychological burden on patients, and some patients may undergo repeated prostate biopsy. In this study protocol, our aim is to provide a non-invasive diagnostic strategy we call the ‘prostate-specific membrane antigen (PSMA) combined model’ for the diagnosis of PCa. If patients are diagnosed with PCa using PSMA combined model, we want to prove these patients can receive radical prostatectomy directly without prior prostate biopsies.Methods The SNOTOB trial adopts a prospective, single-centre, single-arm, open-label study design. The PSMA combined model consists of a diagnostic model based on what we previously reported and 18F-PSMA-1007 positron emission tomography/CT (18F-PSMA-1007 PET/CT) examinations in series. First, patients use the diagnostic model (online address: https://ustcprostatecancerprediction.shinyapps.io/dynnomapp/) to calculate the risk probability of clinically significant PCa (csPCa). When the risk probability of csPCa is equal or greater than 0.60, 18F-PSMA-1007 PET/CT will be applied for further diagnosis. If patients are still considered as csPCa after 18F-PSMA-1007 PET/CT examinations, we define this condition as positive results of PSMA combined model. Subsequently, we will recommend these patients to accept radical prostatectomy without prostate biopsy directly. Finally, the diagnostic performance of PSMA combined model will be verified with the pathological results. Totally, 57 patients need to be enrolled in this clinical trial.Ethics and dissemination This study was approved by the ethics committee of The First Affiliated Hospital of USTC (No. 2022KY-142). The results of this study will be published in peer-reviewed journals and reported at academic conferences.Trial registration number NCT05587192.

IntroductionPrematurity is due to a number of factors, especially genetics. This study was designed to evaluate the impact of a pharmacist-led patient-centered medication therapy management trial on iron deficiency and medication adherence among premature infants receiving iron supplementation at a tertiary hospital in Shaoxing, China.MethodsIn this randomised controlled trial, eighty-one premature infants, with or without genetic factors, born at 26 to 30 weeks and 6 days gestational age, will be recruited and randomised to an intervention group or a control group. The intervention group will receive a pharmacist-driven discharge counseling on iron supplements from recruitment, until 12 months. The control group will receive care as usual. The main outcomes were haemoglobin (g/L), serum iron (μg/L), medication adherence estimation and differentiation scale, the satisfaction with information about medicines scale, beliefs about medicines questionnaire and the Bayley scales for infant development.ResultsA total of 81 patients were enrolled in the study. After intervention, results for the haemoglobin and serum iron differed significantly between the control group and the intervention group (101.36 vs. 113.55, P < 0.0001 and 51.13 vs. 101.36, P = 0.004). Additionally, there was a substantial difference between the intervention group and the control group in terms of patient medication adherence estimation and differentiation scale (27 vs. 34, P = 0.0002). the intervention group had better mental development index and psychomotor development index, compared with the control group (91.03 vs. 87.29, P = 0.035 and 95.05 vs. 90.00, P = 0.022).DiscussionIn premature infants with iron deficiency, our pharmacist-led team significantly improved clinical outcomes and medication adherence.

Klebsiella pneumoniae is an important Gram-negative opportunistic pathogen that is responsible for a variety of nosocomial and community-acquired infections. Klebsiella pneumoniae has become a major public health issue owing to the rapid global spread of extensively-drug resistant (XDR) and hypervirulent strains. Biofilm formation is an important virulence trait of K. pneumoniae. A biofilm is an aggregate of microorganisms attached to an inert or living surface by a self-produced exo-polymeric matrix that includes proteins, polysaccharides and extracellular DNA. Bacteria within the biofilm are shielded from antibiotics treatments and host immune responses, making it more difficult to eradicate K. pneumoniae-induced infection. However, the detailed mechanisms of biofilm formation in K. pneumoniae are still not clear. Here, we review the factors involved in the biofilm formation of K. pneumoniae, which might provide new clues to address this clinical challenge.

Abstract Accurate and efficient extraction of water body information from remote sensing images is of great help to monitor water resources at the macro level, natural disaster prediction, and water pollution detection and prevention. Although many large models have achieved extremely high accuracy in remote sensing image water segmentation tasks, lightweight models are still a non‐negligible choice for many application scenarios because of the limitation of computing and storage resources. Here, WaterSegformer is described, an efficient and powerful lightweight water body segmentation model based on Segformer‐b0. The Deepmask module is designed to make the model pay more attention to the details in the image and use Lovász loss to improve IoU. In addition, DeepLabv3+ is used as the teacher model to guide the training of the model in the way of relational knowledge distillation. WaterSegformer realizes 95.06% mIoU on the test set with only 6.38 G and 3.72 M of FLOPs and parameters, respectively. Experimental results show that WaterSegformer achieves an excellent balance between accuracy, computational complexity and model size, which is hardware‐friendly, easy to deploy and enables real‐time segmentation. This method provides a new idea for water body information extraction from remote sensing images in practical applications.

Abstract Background Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA. Methods This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction. Results A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P

This paper proposes a distribution locational marginal pricing (DLMP) based bi-level Stackelberg game framework between the internet service company (ISC) and distribution system operator (DSO) in the data center park. To minimize electricity costs, the ISC at the upper level dispatches the interactive workloads (IWs) across different data center buildings spatially and schedules the battery energy storage system temporally in response to DLMP. Photovoltaic generation and static var generation provide extra active and reactive power. At the lower level, DSO calculates the DLMP by minimizing the total electricity cost under the two-part tariff policy and ensures that the distribution network is uncongested and bus voltage is within the limit. The equilibrium solution is obtained by converting the bi-level optimization into a single-level mixed-integer second-order cone programming optimization using the strong duality theorem and the binary expansion method. Case studies verify that the proposed method benefits both the DSO and ISC while preserving the privacy of the ISC. By taking into account the uncertainties in IWs and photovoltaic generation, the flexibility of distribution networks is enhanced, which further facilitates the accommodation of more demand-side resources.

Background & Aims: Hepatic immune system disorder plays a critical role in the pathogenesis of acute liver injury. The intrinsic signaling mechanisms responsible for dampening excessive activation of liver macrophages are not completely understood. The Notch and Hippo-YAP signaling pathways have been implicated in immune homeostasis. In this study, we investigated the interactive cell signaling networks of Notch1/YAP pathway during acute liver injury. Methods: Myeloid-specific Notch1 knockout (Notch1M-KO) mice and the floxed Notch1 (Notch1FL/FL) mice were subjected to lipopolysaccharide/D-galactosamine toxicity. Some mice were injected via the tail vein with bone marrow–derived macrophages transfected with lentivirus-expressing YAP. Some mice were injected with YAP siRNA using an in vivo mannose-mediated delivery system. Results: We found that the activated Notch1 and YAP signaling in liver macrophages were closely related to lipopolysaccharide/D-galactosamine-induced acute liver injury. Macrophage/neutrophil infiltration, proinflammatory mediators, and hepatocellular apoptosis were markedly ameliorated in Notch1M-KO mice. Importantly, myeloid Notch1 deficiency depressed YAP signaling and facilitated M2 macrophage polarization in the injured liver. Furthermore, YAP overexpression in Notch1M-KO livers exacerbated liver damage and shifted macrophage polarization toward the M1 phenotype. Mechanistically, macrophage Notch1 signaling could transcriptionally activate YAP gene expression. Reciprocally, YAP transcriptionally upregulated the Notch ligand Jagged1 gene expression and was essential for Notch1-mediated macrophage polarization. Finally, dual inhibition of Notch1 and YAP in macrophages further promoted M2 polarization and alleviated liver damage. Conclusions: Our findings underscore a novel molecular insight into the Notch1-YAP circuit for controlling macrophage polarization in acute liver injury, raising the possibility of targeting macrophage Notch1-YAP circuit as an effective strategy for liver inflammation–related diseases.

Abstract Background Carbapenem resistant Enterobacteriaceae (CRE) colonization is a risk factor for CRE infection. CRE infection results in an increase in mortality in patients with cirrhosis. However, minimal data regarding the prevalence and the risk factors of CRE colonization in patients with liver disease yet without liver transplantation are available. The present study aimed to investigate the prevalence, risk factors and molecular epidemiology characteristics of CRE fecal carriage among patients with liver disease. Methods Stool specimens from 574 adult inpatients with liver disease were collected from December 2020 to April 2021. CRE were screened using selective chromogenic agar medium and identified by the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined using the broth microdilution method. Carbapenemase genes were characterized by polymerase chain reaction (PCR) and DNA sequencing. Multilocus sequence typing (MLST) was performed for Carbapenem Resistant Klebsiella pneumoniae (CR-KPN) isolates and Carbapenem Resistant Escherichia Coli (CR-ECO) isolates. Results The total number of stool specimens (732) were collected from 574 patients with liver disease. 43 non-duplicated CRE strains were isolated from 39 patients with a carriage rate of 6.79% (39/574). The carriage rate was 15.60% (17/109) in patients with acute-on-chronic liver failure (ACLF). Multivariate analysis indicated that ACLF (P = 0.018), the history of pulmonary infection within past 3 months (P = 0.001) and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months (P = 0.000) were independent risk factors of CRE colonization in patients with liver disease. Klebsiella Pnuemoniae (KPN) (51.28%) and Escherichia coli (ECO) (30.77%) were main strains in these patients. All CRE strains showed high resistance to most antimicrobials except for polymyxin B and tigecycline. Most (83.72%, 36/43) of the CRE carried carbapenemase genes. bla KPC-2 was the major carbapenemase gene. The molecular epidemiology of KPN were dominated by ST11, while the STs of ECO were scattered. Conclusions The present study revealed that CRE fecal carriage rates were higher in patients with ACLF than in patients without liver failure. ACLF, the history of pulmonary infection within past 3 months and the use of third generation cephalosporin/β-lactamases inhibitor within past 3 months were independent risk factors of CRE colonization in patients with liver disease. Regular CRE screening for hospitalized patients with liver disease should be conducted to limit the spread of CRE strain.

Abstract Background For knee osteoarthritis, the commonly used radiology severity criteria Kellgren–Lawrence lead to variability among surgeons. Most existing diagnosis models require preprocessed radiographs and specific equipment. Methods All enrolled patients diagnosed with KOA who met the criteria were obtained from **** Hospital. This study included 2579 images shot from posterior–anterior X-rays of 2,378 patients. We used RefineDet to train and validate this deep learning-based diagnostic model. After developing the model, 823 images of 697 patients were enrolled as the test set. The whole test set was assessed by up to 5 surgeons and this diagnostic model. To evaluate the model’s performance we compared the results of the model with the KOA severity diagnoses of surgeons based on K-L scales. Results Compared to the diagnoses of surgeons, the model achieved an overall accuracy of 0.977. Its sensitivity (recall) for K-L 0 to 4 was 1.0, 0.972, 0.979, 0.983 and 0.989, respectively; for these diagnoses, the specificity of this model was 0.992, 0.997, 0.994, 0.991 and 0.995. The precision and F1-score were 0.5 and 0.667 for K-L 0, 0.914 and 0.930 for K-L 1, 0.978 and 0.971 for K-L 2, 0.981 and 0.974 for K-L 3, and 0.988 and 0.985 for K-L 4, respectively. All K-L scales perform AUC > 0.90. The quadratic weighted Kappa coefficient between the diagnostic model and surgeons was 0.815 (P

Objective Imaging measurements allow assessment of the mechanical alignment before and after total knee arthroplasty (TKA). The changes in radiographic parameters in each period of time within 1 year after TKA has been poorly understood. The purpose of this study was to examine the timing and causes of imaging changes in lower extremity force lines after total knee arthroplasty with mechanical alignment. Methods A total of 93 mechanically‐aligned TKA were radiographically examined before, 3 days, 3 months, and 1 year after surgery. Radiographic parameters included hip‐knee angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), knee joint line orientation (KJLO), ankle joint line orientation (AJLO), the knee joint line relative to ankle joint line angle (KJLTA) and midpoints of the ankle distance (MAD). Paired t‐test were used to analyze the changes of these imaging parameters, By establishing a simple tibial model, the time points of changes in the imaging parameters after TKA was determined, with an attempt to understand the post‐TKA changes in these imaging parameters. Results Statistically significant differences were found between the preoperative data and the data measured 3 days after surgery in HKA, LDFA, MPTA, MAD, KJLTA, AJLO (P 0.05). Significant differences were revealed between the data measured 3 months and those collected 1 year after surgery in LDFA, MPTA, AJLO, KJLTA (P 0.05). The tibial model was made to look into the changes in postoperative imaging parameters. ΔMAD and postoperative AJLO were calculated to verify the model and hypothesis. Conclusions Postoperative changes in radiographic parameters and tibial models showed that the lower extremities were in an unnatural state within 1 year after TKA. The changes in the lower extremities force line were the results of the gradual adaptation of the lower extremities to TKA and the lateral swing of the extremities (3°) after surgery. Imaging data 1 year after surgery should be taken into account in the explanation of post‐TKA changes in lower limb force lines.

Abstract Background GnRHa treatment was established for improving final adult height (FAH) in children presenting with Idiopathic central precocious puberty (ICPP) up to age 8, while several controversies remained for older age groups. The primary objective was to evaluate whether boys diagnosed with ICPP over 9 years of chronological age (CA) could achieve a height benefit from GnRHa treatment. Methods We retrospectively evaluated the medical records of 23 boys treated for idiopathic central precocious puberty between January 2018 and January 2021 at Jiangsu Children’s Medical Center. All patients started treatment with intramuscular depot GnRHa at a dose of 80–100 μg/kg, followed by continuous intramuscular injection every 28 days at a dose of 60–80 μg/kg. The hormonal parameters, bone age/chronological age ratio, FAH, growth velocity (GV), tanner staging and body mass index (BMI) were assessed during the treatment period. Results After one course of treatment (3 months), the basal FSH and testosterone levels were reduced, while the basal LH value was not significantly changed compared with those before treatment. Furthermore, the mean BA/CA ratio reduction was statistically significant at month 12. The mean PAH following administration of GnRHa after 12 months was statistically improved compared with those at baseline. In addition, the clinical sign of puberty and GV were significantly improved and the BMI remained unchanged as desired at month 12. Conclusions This analysis highlighted the positive outcome on the decrease in the rate of bone maturation, with a favorable effect on progression of clinical signs of puberty. Furthermore, our study confirmed PAH was improved even in the older children at onset of treatment (ages 9–10), emphasizing the importance of personalized treatment in such population.

Abstract The distributed integrated multi‐energy system (DIMS) has many advantages in terms of the utilisation of renewable energy sources and clean energy. Operation strategies for the DIMS based on a real‐time profile have been extensively studied. In a DIMS online optimisation problem, besides fluctuations in the renewable energy output and load, inconsistent time scales of the transport dynamics of different energy flows and non‐ideal communication (involving communication uncertainty and latency) result in suboptimal operation in dispatch scheduling. An online multi‐time‐scale optimal operation strategy is proposed for the DIMS to respond to the above challenges, using a hybrid algorithm comprising a model predictive control method and distributed collaborative consensus algorithm (CCA). The approach is based on a hierarchy, comprising rolling optimisation and adjustment. A rolling optimisation is established to schedule operations according to the latest forecast and status information. The rolling dispatch is then adjusted according to the ultrashort‐term adjustment using the CCA. Meanwhile, the effect of the information transmission environment on real‐time scheduling is considered, and the robust CCA is improved for the implementation of strategies under non‐ideal communication conditions. Case studies and results are presented and discussed to show the effectiveness of the proposed approach with the better matching between demand and supply.

Abstract Objective Minimal invasive approach has been increasingly used in total knee arthroplasty (TKA) and more is expected of early rehabilitation in terms of pain release and recovery of knee function. The approach type is one of the major factors that determines the early rehabilitation after TKA. The purpose of this study is to determine whether mini‐subvastus approach (MSVA) is superior to the traditional medial parapatellar approach (MPA) in TKA. Methods From 2018 to 2019, a randomized double‐blinded prospective study was conducted on 58 patients who underwent simultaneous bilateral TKA. The subjects included eight men and 50 women, with an average age of 65 years. One side was randomized using MSVA and the other side using MPA. Visual analog scale (VAS), operative duration, recovery time to straight leg raising (SLR), range of motion (ROM), HSS score, release rate of lateral retinaculum, satisfaction rate were recorded and compared. Paired‐samples T test were used for quantitative data and chi‐square test for qualitative data. Results There was no statistical difference in the ratio of left and right sides, preoperative ROM, VAS, HSS score, muscular strength of lower limbs, KL grade, operative order, and operative duration between the two groups. The average ROM (118.91 ± 8.21 vs. 107.60 ± 7.99, t = 14.320, p = 0.0000) and HSS score (72.03 ± 4.55 vs. 61.22 ± 4.36, t = 13.095, p = 0.0000) on POD 3, VAS in rest and motion on POD 1 and 3, the recovery time to SLR (1.17 ± 0.38 vs. 3.09 ± 0.76, t = 19.902, p = 0.0000), and the satisfaction rate on POD 1 (96.55% vs. 74.14%, χ2 = 9.9251, p = 0.0016) were superior in the MSVA group over MPA group. ROM in rest and motion and HSS score on POD 30 had no difference. The release rate of lateral retinaculum was less in the MSVA group than in the MPA group. The mean value of HKA, FFC, and FTC and the proportion of outliers did not differ significantly between the two groups. Conclusions Compared with MPA, MSVA can make ROM of knee and SLR recover earlier, reduce postoperative pain after TKA, improve the early postoperative satisfaction and reduce the lateral release rate. MSVA can be used as a favorable measure in the concept of enhanced recovery after surgery (ERAS).

Abstract Objectives To evaluate image quality and diagnostic performance of carotid dual-energy computed tomography angiography (DECTA) using deep learning image reconstruction (DLIR) compared with images using adaptive statistical iterative reconstruction-Veo (ASIR-V). Methods Carotid DECTA datasets of 28 consecutive patients were reconstructed at 50 keV using DLIR at low, medium, and high levels (DLIR-L, DLIR-M, and DLIR-H) and 80% ASIR-V algorithms. Mean attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) at different levels of arteries were measured and calculated. Image quality for noise and texture, depiction of arteries, and diagnostic performance toward carotid plaques were assessed subjectively by two radiologists. Quantitative and qualitative parameters were compared between the ASIR-V, DLIR-L, DLIR-M, and DLIR-H groups. Results The image noise at aorta and common carotid artery, SNR, and CNR at all level arteries of DLIR-H images were significantly higher than those of ASIR-V images (p = 0.000–0.040). The quantitative analysis of DLIR-L and DLIR-M showed comparable denoise capability with ASIR-V. The overall image quality (p = 0.000) and image noise (p = 0.000–0.014) were significantly better in the DLIR-M and DLIR-H images. The image texture was improved by DLR at all level compared to ASIR-V images (p = 0.000–0.008). Depictions of head and neck arteries and diagnostic performance were comparable between four groups (p > 0.05). Conclusions Compared with 80% ASIR-V, we recommend DLIR-H for clinical carotid DECTA reconstruction, which can significantly improve the image quality of carotid DECTA at 50 keV but maintain a desirable diagnostic performance and arterial depiction.

Abstract Objective This study aimed to establish a deep learning method based on convolutional networks for the preliminary study of the pathological diagnosis of prosthetic joint infections (PJI). Methods We enrolled 20 revision patients after joint replacement from the Department of Orthopedics, the First Medical Center, General Hospital of the People's Liberation Army, from January 2021 to January 2022 (10 of whom were confirmed to be infected against 2018 ICM criteria, and the remaining 10 were verified to be non-infected), and classified high-power field images according to 2018 ICM criteria. Then, we inputted 576 positive images and 576 negative images into a neural network by employing a resNET model, used to select 461 positive images and 461 negative images as training sets, 57 positive images and 31 negative images as internal verification sets, 115 positive images and 115 negative images as external test sets. Results The resNET model classification was used to analyze the pathological sections of PJI patients under high magnification fields. The results of internal validation set showed a positive accuracy of 96.49%, a negative accuracy of 87.09%, an average accuracy of 93.22%, an average recall rate 96.49%, and an F1 of 0.9482. The accuracy of external test results was 97.39% positive, 93.04% negative, the average accuracy of external test set was 93.33%, the average recall rate was 97.39%, with an F1 of 0.9482. The AUC area of the intelligent image-reading diagnosis system was 0.8136. Conclusions This study used the convolutional neural network deep learning to identify high-magnification images from pathological sections of soft tissues around joints, against the diagnostic criteria for acute infection, and a high precision and a high recall rate were accomplished. The results of this technique confirmed that better results could be achieved by comparing the new method with the standard strategies in terms of diagnostic accuracy. Continuous upgrading of extended training sets is needed to improve the diagnostic accuracy of the convolutional network deep learning before it is applied to clinical practice.

Objective Robot‐assisted surgery has been promoted worldwide in recent years. The development of a domestic orthopaedic robot and its clinical application are therefore of great significance. This study aimed to compare the early clinical and radiographic outcomes of domestic robot‐assisted total knee arthroplasty (RA‐TKA) with conventional manual total knee arthroplasty (CM‐TKA). Methods A total of 77 patients who underwent primary single‐sided TKA from June to December 2020 were prospectively enrolled; resulting in the inclusion of 72 patients. The patients were randomly divided into the RA‐TKA group (37 cases, with TKA being assisted by the Yuanhua Orthopaedic Robotic System) and the CM‐TKA group (35 cases, with TKA being performed using conventional tools). Knee function was evaluated by the knee range of motion (ROM), the American Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Postoperative radiographic results were evaluated by full‐length weight‐bearing X‐rays of the lower limb and anteroposterior and lateral X‐rays of the knee were obtained preoperatively and at 90 days postoperative. The operative duration, blood loss, postoperative knee function, radiographic outcomes, and incidence of complications were compared by Student's t‐test, Mann–Whitney U test, or chi‐square test. Serum levels of inflammatory markers before the operation and 1, 3, and 30 days after the operation were recorded and compared between the two groups. Results The operation was significantly longer in the RA‐TKA group than in the CM‐TKA group (154.3 vs 115.2 min, p 0.05). The incidence of postoperative deep vein thrombosis was not statistically different between the two groups. In the radiographic findings at 90 days postoperatively we found the frequency of lateral tibial component (LTC) angle outliers was significantly lower in the RA‐TKA group (3.0% vs 29.4%, p = 0.003). The neutrophil‐to‐lymphocyte ratio (NLR) was significantly lower in the RA‐TKA group than in the CM‐TKA group on day 1 after surgery (9.9 vs 12.7, p = 0.024). Conclusions RA‐TKA requires more time than CM‐TKA, which may be related to the learning curve and intraoperative registration. The short‐term postoperative knee functional outcomes had no differences between the two groups, and RA‐TKA improved the accuracy of tibial component alignment. Further follow‐up studies are required to investigate the long‐term outcomes.

BackgroundCraniopharyngioma is a benign tumor originating from the sellar region. Damages in this area caused by the tumor itself, surgery, or radiotherapy may result in severe hypothalamic-pituitary dysfunction (HPD) and eventually lead to a significant impairment in the long-term quality of life of patients. This study aimed to investigate the characteristics of HPD in patients with adamantinomatous craniopharyngioma (ACP) or papillary craniopharyngioma (PCP) and to identify the factors affecting HPD after surgery.MethodsIn this single-center retrospective study, a total of 742 patients with craniopharyngioma were included. The neuroendocrine function of these patients before and after surgery was investigated. The differences in hypothalamic-pituitary function between the ACP and PCP groups were compared. The factors influencing the aggravation of HPD after surgery were identified.ResultsThe median follow-up after surgery was 15 months. Before surgery, the proportion of patients with diabetes insipidus (DI) and hyperprolactinemia in the PCP group was significantly higher than that in the ACP group (P

Distributed generation and demand-side management are expected to play a more prominent role in future power systems. However, the increased number of generations and load demands pose new challenges to optimal energy management in a microgrid. In this paper, an economic dispatch model for microgrids considering Traditional Generators (TGs), energy storage units, wind turbines (WTs), and flexible loads is established. To tackle the Economic Dispatch Problem (EDP) over directed communication networks, a fully distributed algorithm developed by leveraging a two-step state information exchange mechanism is proposed. In addition, by employing a fixed stepsize, the proposed algorithm demonstrates rapid convergence. Furthermore, our algorithm is well-suited for nonquadratic convex cost functions. Subsequently, we extend our algorithm to address imperfect communication scenarios. Even in the presence of arbitrarily large yet bounded time delays, our algorithm exhibits robustness. Finally, several numerical examples are given to verify the correctness and effectiveness of the developed results.

Genome-wide physical protein–protein interaction (PPI) mapping remains a major challenge for current technologies. Here, we reported a high-efficiency BiFC-seq method, yeast-enhanced green fluorescent protein-based bimolecular fluorescence complementation (yEGFP-BiFC) coupled with next-generation DNA sequencing, for interactome mapping. We first applied yEGFP-BiFC method to systematically investigate an intraviral network of the Ebola virus. Two-thirds (9/14) of known interactions of EBOV were recaptured, and five novel interactions were discovered. Next, we used the BiFC-seq method to map the interactome of the tumor protein p53. We identified 97 interactors of p53, more than three-quarters of which were novel. Furthermore, in a more complex background, we screened potential interactors by pooling two BiFC libraries together and revealed a network of 229 interactions among 205 proteins. These results show that BiFC-seq is a highly sensitive, rapid, and economical method for genome-wide interactome mapping.

Objective To investigate associations between femoral head necrosis (FHN) and injury to the retinaculum of Weitbrecht in patients with femoral neck fractures who had undergone initial trials of either closed reduction or direct open reduction. Methods This prospective observational study included 110 patients with displaced femoral neck fractures admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University and Shanghai Tongji Hospital between January 2008 and May 2017. Among these, 25 patients underwent initial closed reductions, and 85 patients underwent an open reduction directly. Watson‐Jones anterolateral approach was used during the surgery for injury to the retinaculum of Weitbrecht, and FHN was assessed as a surgical outcome. The severity of injury to the retinaculum of Weitbrecht was evaluated using a scoring system developed by our surgical team. Follow‐up was at least 24 months. Results The initial closed reduction treatment group had significantly higher total scores of injury to the retinaculum of Weitbrecht (6.24 ± 2.20 vs 4.62 ± 2.12, p = 0.009) compared to the open reduction group. High total scores were significantly associated with initial trials of closed reduction treatment, especially for the broken and released injury to the superior and anterior retinacula (both p = 0.01). Twenty‐six patients experienced FHN postoperatively, with mean onset time of 19.42 ± 3.87 months. FHN was significantly associated with the severity of injury to the retinaculum of Weitbrecht (p

Abstract Cyber‐attack has become one of the main threats to the safe operation of the load control system in the distribution network. Currently, a large number of methods are developed to detect cyber‐attacks. However, most of these methods make decisions based on information from a single cyber layer or physical layer. If the decision is wrong, there is no way to verify it. Therefore, if the separate decisions can be made in the cyber layer and physical layer at the same time, and a final judgment is received throughout the two decisions, then the accuracy and credibility of cyber‐attack detection can be improved. First, the particle swarm optimization‐based backpropagation neural network is adopted to detect attacks in the cyber layer, at the same time, the criteria importance though intercrieria correlation‐based grey relational analysis is adopted for the assessment of node risk level in the physical layer. Then, based on the incidence matrix model between the cyber layer and the physical layer, a crosscheck mechanism is proposed to detect the cyber‐attack through the verification of the two decisions. Finally, taking the IEEE 33‐node system as an example, the validity of the proposed method to detect the denial of service attack is verified.

Life skill-based training is essential for intellectual disabled individuals to regain autonomy and social inclusion. Virtual reality (VR) could deliver a nascent application that is more engaging and secure. The objective of this study was to evaluate the training effects of the VR-based multiple life skill training program on life skill performance, self-efficacy, memory, cognitive and behavioral functions via a multicenter randomized controlled trial. A total of 145 intellectual disabled participants were recruited for a randomized controlled trial with three intervention arms: VR (n = 42); traditional (n = 53); and control (n = 50). The life skill tasks for the interventions included 1) grocery shopping, 2) cooking, and 3) kitchen cleaning. Outcome measures were performance scores for the three tasks, self-efficacy scale, digit span score, and Frontal Assessment Battery score, graded by blinded assessors. Before-after effects of each group were evaluated using separated Wilcoxon Signed-rank tests. VR significantly improved cooking, cleaning performance, and memory span, while traditional training significantly improved shopping, cooking, and cleaning tasks. The generalized estimating equation evaluated effects between groups adjusted for age, gender and intelligence quotient (IQ). VR had significantly larger improvement effects in cooking and cleaning than the control group and memory span compared to traditional training and controls groups. IQ appeared to be a significant confounder on the training effect. Future work may consider developing artificial intelligence to customize programs depending on IQ level.