A case report of extremely severe 93% total body surface area burns in a 5-year-old boy.

BACKGROUND: Large surface area burns with concurrent severe burn sepsis are a rare phenomenon, particularly when the wounds are closed in a short timeframe. CASE REPORT: This study describes a 5-year-old patient with 93% total body surface area (TBSA) burns and severe burn sepsis, who was managed through the use of a 54-day brickwork-mixed graft of self-allogeneic skin operation. The mechanisms of skin healing, in this case, are also discussed. CONCLUSIONS: The brickwork-mixed graft of self-allogeneic skin may be an effective treatment option for patients with large surface area burns and severe burn sepsis. Further research is required to establish the generalizability of these findings. Early wound management and anti-infection measures are crucial in treating severe burns, and the clinical outcomes of the patient and the impact of the chosen treatment method on the patient's recovery and prognosis should be assessed.

[Effects of novel bioactive glasses on promoting remineralization of artificial dentin caries].

OBJECTIVE: To investigate the effects of novel bioactive glasses (BG) including PSC with high phosphorus component and FBG with fluorine-doped element on promoting remineralization of artificial dentin caries. METHODS: (1) BGs were used in this study as follows: PSC (10.8%P2O5-54.2%SiO2-35.0%CaO, mol.%) were synthesized using phytic acid as the phosphorus precursor through sol-gel method. FBG (6.1%P2O5-37.0%SiO2-53.9%CaO-3.0%CaF2, mol.%) and 45S5(6.0%P2O5-45.0%SiO2-24.5%CaO-24.5%Na2O, mol.%) were synthesized by traditional melt method. (2) The above BGs were soaked in simulated body fluid (SBF) for 24 hours. Then X-ray diffraction (XRD) was used to analyze the formation of hydroxyapatite (HA) crystals. (3) Prepared 1 mm thick dentin slices were soaked in 17% ethylene diamine tetraacetic acid (EDTA) for 1 week to demineralize the dentin. Then the dentin slices treated by BG were soaked in SBF for 1 week. Field emission scanning electron micro-scopy (FE-SEM) was used to observe the surface morphology of the dentin slices. (4) Four cavities were prepared to 1 mm depth in each 2 mm thick dentin slice, then were treated with lactic acid for 2 weeks to form the artificial dentin caries. Wax, mineral trioxide aggregate (MTA), PSC and FBG were used to fill four cavities as blank control group, MTA group, PSC group and FBG group respectively. Then the spe-cimens were soaked in SBF for 4 weeks. The changes of depth and density of demineralized dentin were analyzed using Micro-CT before filling and after 2 and 4 weeks filling. RESULTS: (1) PSC and FBG promoted mineral formation on the surfaces of the demineralized dentin. And the speed was faster and crystallinity was higher in PSC group than the FBG and 45S5 groups. (2) The increased mineral density of artificial dentin caries in PSC group were (185.98 ± 55.66) mg/cm3 and (213.64 ± 36.01) mg/cm3 2 and 4 weeks after filling respectively, which were significantly higher than the control group [(20.38 ± 7.55) mg/cm3, P=0.006; (36.46 ± 10.79) mg/cm3, P=0.001]. At meanwhile, PSC group was also higher than MTA group [(57.29 ± 10.09) mg/cm3; (111.02 ± 22.06) mg/cm3], and it had statistical difference (P=0.015; P=0.006). The depth of remineralized dentin in PSC group were (40.0 ± 16.9) µm and (54.5 ± 17.8) µm 2 and 4 weeks respectively, which were also statistically different from the control group (P =0.010;P=0.001). There were no statistical differences between the control group and MTA group. The above effects of FBG group were between PSC and MTA. CONCLUSION: PSC has advantages in the speed, quality and depth of mineral deposition in the demineralized layer of artificial dentin caries. It would be expected to be an ideal material to promote the remineralization of dentin caries.

Therapeutic effect of interleukin-10 in keloid fibroblasts by suppression of TGF-ß/Smad pathway.

OBJECTIVE: Keloids are a skin disorder where the skin goes beyond the original border of the wound or trauma, resulting in functional and cosmetic deformities, displeasure, itching, pain, psychological stress, and patient dissatisfaction. This study aimed to explore the therapeutic effect of interleukin-10 (IL-10) on the proliferation of keloid fibroblasts. PATIENTS AND METHODS: Keloid fibroblasts were isolated, primarily cultured, and treated with IL-10 at different concentrations. Normal skin fibroblasts were used as normal control. Immunofluorescent staining was performed to identify the establishment of keloid, as well as normal skin fibroblast. Cell Counting Kit-8 (CCK-8) was carried out to monitor the proliferative variation, while Western blot was conducted to detect the expression variation of key members involved in the TGF-ß/Smad signaling pathway. RESULTS: Identified by the IF staining of Vimentin, a classical biomarker of fibroblast, both primary culture of keloid and normal skin fibroblasts have been established. Compared with control, the proliferation of Keloid fibroblasts was shown to be significantly suppressed on treatment with IL-10 in a time and dose-dependent manner. Expression of P-Smad2/3 and Smad4 were increasingly down-regulated, whereas Smad-7 was up-regulated with the increasing concentration of IL-10. By contrast, the variation of Smad 2/3 expressions was hardly influenced. Furthermore, the Collagen Type I and Collagen Type II were found to be markedly decreased after treatment with IL-10. CONCLUSIONS: IL-10 was shown to be able to significantly inhibit the proliferation of keloid fibroblasts, which was explicitly and strongly suggestive of its potential therapeutic effect in the management of keloid.

Nanocomposited silicone hydrogels with a laser-assisted surface modification for inhibiting the growth of bacterial biofilm.

Surface and interface modifications of synthetic silicone hydrogels used for wearable and implantable medical devices, e.g. catheters and contact lenses, are critical to overcome their poor mechanical properties and biofouling. In this paper, silica nanoparticles (SiO2 NPs) were incorporated within silicone hydrogels through photo-polymerization. As compared to the silicone hydrogel, the nanocomposited silicone hydrogel shows highly textured microstructures, increased swelling behaviour and improved stiffness. Meanwhile, a hydrophilic surface of silicone hydrogel is important to minimize protein fouling which forms a conditioning layer for the growth of bacterial biofilm. Here, we applied matrix-assisted pulsed laser evaporation (MAPLE) with a pulsed Nd:YAG laser at 532 nm to deposit polyethylene glycol (PEG) on the surface of the nanocomposited silicone hydrogels. The PEG deposited on the nanocomposited silicone hydrogels forms islands at the submicron-scale, which increase with increasing irradiation time (t). The protein adsorption on nanocomposited silicone hydrogel with PEG deposition decreases over 40 ± 2% when t = 2 h. Compared to the commercial silicone catheters, the nanocomposited silicone hydrogel with PEG deposition can reduce the growth of bacteria from 1.20 × 106 CFU cm-2 to 3.69 × 105 CFU cm-2. In addition, the relative cell viabilities of NIH/3T3 mouse fibroblast cells treated using the nanocomposited silicone hydrogels coated with/without PEG were studied. No toxic effect is imposed on the cells. Consequently, the MAPLE process is a controllable, contamination-free technique to modify the surface of silicone hydrogels. We expect that the nanocomposited silicone hydrogels with appropriate surface treatment can be applied in various wearable and implantable medical devices.

A semi-automatic approach to the segmentation of liver parenchyma from 3D CT images with Extreme Learning Machine.

This paper presents a semi-automatic approach to segmentation of liver parenchyma from 3D computed tomography (CT) images. Specifically, liver segmentation is formalized as a pattern recognition problem, where a given voxel is to be assigned a correct label - either in a liver or a non-liver class. Each voxel is associated with a feature vector that describes image textures. Based on the generated features, an Extreme Learning Machine (ELM) classifier is employed to perform the voxel classification. Since preliminary voxel segmentation tends to be less accurate at the boundary, and there are other non-liver tissue voxels with similar texture characteristics as liver parenchyma, morphological smoothing and 3D level set refinement are applied to enhance the accuracy of segmentation. Our approach is validated on a set of CT data. The experiment shows that the proposed approach with ELM has the reasonably good performance for liver parenchyma segmentation. It demonstrates a comparable result in accuracy of classification but with a much faster training and classification speed compared with support vector machine (SVM).

Classification ability of single hidden layer feedforward neural networks.

Multilayer perceptrons with hard-limiting (signum) activation functions can form complex decision regions. It is well known that a three-layer perceptron (two hidden layers) can form arbitrary disjoint decision regions and a two-layer perceptron (one hidden layer) can form single convex decision regions. This paper further proves that single hidden layer feedforward neural networks (SLFN's) with any continuous bounded nonconstant activation function or any arbitrary bounded (continuous or not continuous) activation function which has unequal limits at infinities (not just perceptrons) can form disjoint decision regions with arbitrary shapes in multidimensional cases. SLFN's with some unbounded activation function can also form disjoint decision regions with arbitrary shapes.

Is preoperative selection of patients with cystic adnexal masses essential for laparoscopic treatment?

STUDY OBJECTIVE: To analyze indications for preoperative selection of patients with cystic adnexal masses to be treated by laparoscopic surgery. DESIGN: Retrospective analysis (Canadian Task Force classification II-2). SETTING: University and military hospitals. PATIENTS: Three hundred sixteen women with adnexal masses. INTERVENTION: Before laparoscopy, 214 patients underwent evaluation (size of adnexal mass, ultrasonographic image, CA 125, suspicious clinical diagnosis); in 102 women laparoscopies were performed without taking these factors into account. MEASUREMENTS AND MAIN RESULTS: In the first center 99% of women were treated by laparoscopic surgery. One (0.4%) tumor of low malignant potential detected by deferred biopsy was operated on. In the second center 98% of cases were performed laparoscopically. In 3.9% of women carcinomas were detected intraoperatively and were treated by laparotomy (p = 0.04). CONCLUSION: Laparoscopy is appropriate management of cystic adnexal masses, with a very low risk of unintentionally operating an ovarian carcinoma if a thorough preoperative evaluation is conducted. Only in centers where surgeons have enough training to cope with ovarian cancer may this evaluation be deferred, since conversion to laparotomy should be considered a second therapeutic step, and not an incorrect indication for laparoscopy. In centers where surgeons have no such training, strict preoperative selection of patients is mandatory

Diving pattern and work schedule of construction well divers in Taiwan.

Construction well divers in Taiwan reportedly suffer a high prevalence of dysbaric osteonecrosis. We studied five divers working at the same construction site. We recorded their diving methods, diving depths, bottom times, work patterns, water temperatures, and heart rates. We also monitored gas bubbles in the subclavian vein in selected dives. A crude but effective hot-water system protected divers against hypothermia and allowed them to work in 24 degrees-27 degrees C water. Divers worked approximately 6.6 h a day and progressed approximately 3.0 m a day while excavating an average of 148 buckets of sand and rock each weighing 49.5 kg. The divers sustained a heart rate increase of 49%. Sixty percent of their equivalent single dive bottom times exceeded the U.S. Navy's no-decompression limits. Two cases of venous bubbles were detected, and one of these divers showed symptoms of decompression sickness. The prolonged bottom time and lack of a decompression schedule probably contributed to a risk of decompression sickness and dysbaric osteonecrosis.

Upper bounds on the number of hidden neurons in feedforward networks with arbitrary bounded nonlinear activation functions.

It is well known that standard single-hidden layer feedforward networks (SLFNs) with at most N hidden neurons (including biases) can learn N distinct samples (x(i),t(i)) with zero error, and the weights connecting the input neurons and the hidden neurons can be chosen "almost" arbitrarily. However, these results have been obtained for the case when the activation function for the hidden neurons is the signum function. This paper rigorously proves that standard single-hidden layer feedforward networks (SLFNs) with at most N hidden neurons and with any bounded nonlinear activation function which has a limit at one infinity can learn N distinct samples (x(i),t(i)) with zero error. The previous method of arbitrarily choosing weights is not feasible for any SLFN. The proof of our result is constructive and thus gives a method to directly find the weights of the standard SLFNs with any such bounded nonlinear activation function as opposed to iterative training algorithms in the literature.

Comments on "Approximation capability in C(R(n)) by multilayer feedforward networks and related problems".

In the above paper Chen et al. investigated the capability of uniformly approximating functions in C(Rn) by standard feedforward neural networks. They found that the boundedness condition on the sigmoidal function plays an essential role in the approximation, and conjectured that the boundedness of the sigmoidal function is a necessary and sufficient condition for the validity of the approximation theorem. However, we find that the conjecture is not correct, that is, the boundedness condition is not sufficient or necessary in C(Rn). Instead, boundedness and unequal limits at infinities conditions on the activation functions are sufficient, but not necessary in C(Rn).