Key risk factors and adverse outcomes in metachronous vertebral osteomyelitis following periprosthetic joint infection: A 5-year retrospective study.

Purpose: Periprosthetic joint infection (PJI) is a leading cause of joint arthroplasty failure, potentially leading to critical complications like vertebral osteomyelitis (VO). The factors contributing to VO after PJI and the outcomes for these patients are not well understood. Our study aims to (1) identify risk factors for VO following PJI and (2) assess the clinical outcomes in these cases. Methods: We included PJI patients treated surgically at our centre from January 2006 to December 2020, excluding those with simultaneous VO post-PJI. Our focus was on patients with VO occurring after PJI, monitored for at least 5 years. Analysis included patient comorbidities, PJI treatment approaches, pathogen identification and clinical outcomes. Results: Of 1701 PJI cases, 21 (1.23%) developed VO. Key risk factors for VO post-PJI were identified: systemic inflammatory response syndrome, substance misuse, polymicrobial infection and undergoing at least three stages of resection arthroplasty (odds ratios: 1.86, 54.28, 52.33 and 31.88, respectively). Adverse outcomes were noted in VO patients, with recurrent VO in 6/21 and repeated PJIs in 18/21 cases. Conclusions: Patients with PJI, especially those with certain risk factors, have an increased likelihood of developing VO and encountering negative outcomes. The potential role of bacteremia in the development of VO after PJI needs further exploration. Level of Evidence: Level III.

MicroRNAs in Umbilical Cord Blood and Development in Full-Term Newborns: A Prospective Study.

Background: Exploring the epigenetic regulations, such as microRNA, in newborns holds significant promise for enhancing our ability to address and potentially prevent early-life developmental delays. Objectives: Hence, this research seeks to investigate if the expression of miRNA in the umbilical cord blood of infants can forecast their developmental outcomes as they grow older. Design and method: We enrolled 143 full-term newborns, delivered either via cesarean section (CS) or through natural spontaneous delivery (NSD). We then analyzed the profiles of specific miRNAs (miR-486-5p, miR-126-5p, miR-140-3p, miR-151a-3p, miR-142-5p, and miR-30e-5p) in the umbilical cord blood of these infants. Subsequently, we performed follow-up assessments using Bayley-III scores when the cohort reached 1 year of age. Furthermore, we conducted pathway-enrichment analyses on the target genes associated with these examined miRNAs. Results: When comparing newborns delivered via cesarean section (CS) to those born via natural spontaneous delivery (NSD), we observed notable differences. Specifically, newborns through NSD displayed significantly higher ΔCt values for miR-486-5p, alongside lower ΔCt values for miR-126-5p and miR-151a-3p in their cord blood. At 1 year of age, cognitive development was significantly linked to the ΔCt values of miR-140-3p and miR-142-5p, while language development showed a significant association with the ΔCt values of miR-140-3p. Moreover, our pathway enrichment analyses revealed that the target genes of these miRNAs were consistently involved in the pathways related to neurons, such as axon guidance and the neurotrophin signaling pathway. Conclusion: In summary, this study represents a pioneering effort in elucidating the potential connections between miRNA levels in cord blood and the health indicators and neurodevelopment of newborns at 1 year of age. Our findings underscore the significance of miRNA levels at birth in influencing mechanisms related to neurodevelopment.

Effects of Sapindus mukorossi Seed Oil on Bone Healing Efficiency: An Animal Study.

Natural products have attracted great interest in the development of tissue engineering. Recent studies have demonstrated that unsaturated fatty acids found in natural plant seed oil may exhibit positive osteogenic effects; however, few in vivo studies have focused on the use of plant seed oil for bone regeneration. The aim of this study is to investigate the effects of seed oil found in Sapindus mukorossi (S. mukorossi) on the osteogenic differentiation of mesenchymal stem cells and bone growth in artificial bone defects in vivo. In this study, Wharton-jelly-derived mesenchymal stem cells (WJMSCs) were co-cultured with S. mukorossi seed oil. Cellular osteogenic capacity was assessed using Alizarin Red S staining. Real-time PCR was carried out to evaluate ALP and OCN gene expression. The potential of S. mukorossi seed oil to enhance bone growth was assessed using an animal model. Four 6 mm circular defects were prepared at the parietal bone of New Zealand white rabbits. The defects were filled with hydrogel and hydrogel-S. mukorossi seed oil, respectively. Quantitative analysis of micro-computed tomography (Micro-CT) and histological images was conducted to compare differences in osteogenesis between oil-treated and untreated samples. Although our results showed no significant differences in viability between WJMSCs treated with and without S. mukorossi seed oil, under osteogenic conditions, S. mukorossi seed oil facilitated an increase in mineralized nodule secretion and upregulated the expression of ALP and OCN genes in the cells (p < 0.05). In the animal study, both micro-CT and histological evaluations revealed that new bone formation in artificial bone defects treated with S. mukorossi seed oil were nearly doubled compared to control defects (p < 0.05) after 4 weeks of healing. Based on these findings, it is reasonable to suggest that S. mukorossi seed oil holds promise as a potential candidate for enhancing bone healing efficiency in bone tissue engineering.

Total knee replacement with an accelerometer-based, hand-held navigation system improves knee alignment: reliable in all patients.

BACKGROUND: Achieving adequate alignment has traditionally been an important goal in total knee arthroplasty to achieve long-term implant survival. While accelerometer-based hand-held navigation systems (ABN) has been introduced as a way to achieve alignment, there is a limited body of evidence on its accuracy, especially in patients under 65 years with differing etiologies for knee arthritis. This study aimed to assess the precision of a specific ABN system in restoring the mechanical axis and report surgical variables and complications, with particular attention to younger patients. METHODS: We conducted a retrospective review of 310 primary TKA performed with ABN from May 2016 to February 2021. The mean patient age was 67.4 (SD 8.9) years, with 43% under 65 years and mean body mass index of 33.2 (SD 6.8). The average surgical time was 96.8 min (57-171) and the average follow-up was 3.3 years (1.9-6.7). Data regarding length of stay, pain, range of motion (ROM), complications, and reinterventions were collected from the institutional joint arthroplasty registry and the medical records. Preoperative mechanical axis measurements and postoperative radiological data, including mechanical axis, component alignment and mechanical alignment outliers were analyzed. RESULTS: The mean preoperative mechanical axis was 175.4° (SD 7.6), with 248 knees (80%) in preoperative varus. The mean postoperative mechanical axis was 179.5° (SD 1.96) with 98% of knees falling within ± 3° of the neutral mechanical axis. Only 6 knees (2 varus, 4 valgus) fell outside the ± 3° range. And 3 knees (1 varus, 2 valgus) fell outside the ± 5° range. In the sagittal plane, 296 knees (95.5%) knees were within ± 3° of goal of 3 degrees of femoral flexion and 302 (97.4%) knees were within ± 2° of goal 1° of slope for tibial component. Far outliers (alignment outside ± 5° of targeted position) were found in 3 knees. Factors such as posttraumatic arthrosis, previous surgery, presence of retained hardware, and age below 65 years were not associated with increase in alignment outliers and far outliers. No complications related to the navigation system were observed. There were 22 complications and 20 reoperations, including 2 revisions for periprosthetic joint infection and 1 revision for flexion instability. Patients that required knee manipulation achieved an ultimate flexion of 110° (SD 14.1). CONCLUSIONS: The ABN system proved to be user-friendly and accurate in reducing alignment outliers in both coronal and sagittal planes in all patient populations. It offers a straightforward navigation solution while preserving surgeon autonomy and the use of traditional surgical tools. These findings advocate for the integration of this navigation system as a valuable tool to enhance the precision of TKA surgery in all patient groups.

Impact of unplanned second debridement, antibiotics and implant retention on long-term outcomes in knee exchange arthroplasty: Elevated risk of failure and reinfection.

Purpose: This study investigates the outcomes of two-stage exchange arthroplasty (EA) for periprosthetic joint infection (PJI) following initial or unplanned repeat debridement antibiotics, and implant retention (DAIR). Methods: We retrospectively reviewed cases of knee arthroplasty infection treated with two-stage EA after DAIR, spanning from January 1994 to December 2010. A total of 138 patients were included, comprising 112 with initial DAIR and 26 with an unplanned second DAIR. Data on demographics, comorbidities, infection characteristics and causative organisms were analyzed. The primary outcome was implant failure or reinfection, observed over a minimum follow-up of 10 years. Results: The overall success rate for two-stage EA was 87% (119/138 patients). Factors identified for treatment failure included reinfection with the same pathogen for unplanned second DAIR (hazard ratio [HR] = 3.41; 95% confidence interval [CI] = 1.35-4.38; p = 0.004), higher reinfection rates in patients undergoing EA after an unplanned second DAIR, especially with a prior history of PJI within 2 years (HR = 4.23; 95% CI = 2.39-5.31; p = 0.002), pre-first DAIR C-reactive protein (CRP) levels over 100 mg/dL (HR = 2.52; 95% CI = 1.98-3.42; p = 0.003) and recurrence with the same pathogen (HR = 2.35; 95% CI = 1.32-4.24; p = 0.007). Additional factors such as male gender (HR = 3.92; 95% CI = 1.21-5.25; p = 0.007) and osteoporosis (T score < -2.5; HR = 3.27; 95% CI = 1.23-5.28; p = 0.005) were identified as risk factors for implant failure in all EA cases. Conclusions: This study identifies key risk factors for worse knee EA outcomes following DAIR, including a pre-first DAIR CRP level over 100 mg/L, same pathogen recurrence, and PJI history within 2 years. It shows implant failure rates remain constant across EA cases, regardless of DAIR sequence, particularly with risk factors like male gender and severe osteoporosis (T score < -2.5). These results underscore the need for careful evaluation before an unplanned second DAIR, given its significant impact on EA success. Level of Evidence: Level III.

The Femur-First Technique for Oxford Medial Unicompartmental Knee Arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is a reliable procedure to treat medial compartment knee osteoarthritis (OA). The reported survivorship of UKA has varied in the literature3-7. In part, the higher failure rates of UKA seen in registries could be related to the caseload and experience of the reporting surgeon8. The introduction of techniques that make procedures more reliable, especially in the hands of inexperienced surgeons, can decrease the rate of failure. With the Oxford UKA implant (Zimmer Biomet), the recommended surgical technique involves cutting the tibia first, followed by the femoral preparation. However, a technique that allows for preparation of the femur first, as well as the use of the femoral component as a reference for the tibial cut, may reduce the common technical errors seen with the procedure. We have utilized the femur-first technique in cases of medial Oxford UKA. Description: The femur-first method outlined in the present article does not require any unique instruments beyond what is supplied by the manufacturer. Before beginning, the femoral positional guide needs to be decoupled from its base. To start, the intramedullary guide is introduced approximately 1 cm anterior and medial to the intercondylar notch. Once the femoral osteophytes are removed, the surgeon identifies the center of the femoral condyle and marks it. The posterior tibial cartilage is then removed with a saw to facilitate the placement of the appropriately sized femoral spherical guide. The size of the femoral component is determined by selecting the implant that aligns best with the width of the femoral condyle. The femoral drill guide is detached from its base because there is not enough space for the base, as the tibia has not yet been resected. The decoupled femoral guide is connected to the intramedullary rod, allowing the precise positioning of the femoral component in approximately 10° of flexion relative to the femoral sagittal plane and drilling of the 2 peg holes. The posterior condylar resection guide is impacted into position, and the osteotomy of the posterior condyle is made. The distal femur is then milled with use of a number-0 spigot, and the femoral component trial is positioned into place. The femoral condyle is "resurfaced" with the femoral component, which restores joint obliquity and the natural height, a critical element of the femur-first technique. Following this, the 1-mm (size-dependent) spherical gauge is placed around the femoral component trial. The tibial guide is secured with the G-clamp and a number-0 resection block, and is pinned into place. We recommend swapping the number-0 cutting guide for a +2 when making the cut in order to avoid over-resection. Recutting is advised if a minimum 3-mm feeler gauge does not adequately occupy the flexion space. The final step is to balance the flexion and extension gaps in the usual fashion. Alternatives: The alternative technique is a traditional tibia-first approach, in which tibial resection is performed prior to femoral resection. As described in the original manufacturer's manual, the tibial cut is accomplished with use of a number-0 cutting guide, and the tibial rotation is based on the axis formed by the anterior superior iliac spine and knee center, irrespective of the femoral condyle. Rationale: The femur-first technique is advantageous in several ways. When performing the femoral cut first, the surgeon can better align the drill guide at the center of medial femoral condyle. This will result in the femoral component being positioned more in line with the coronal plane of the femoral condyle. Additionally, the tibial resection is made with the femoral trial in place; therefore, the depth of resection can be more accurate, potentially avoiding excessive bone resection. Finally, with the femoral trial in place, the surgeon can judge the rotation and medial-lateral position of the tibial component more precisely, hence lowering the possibility of bearing spin-out, impingement, and dislocation or unexplained pain. Expected Outcomes: The femur-first technique is a bone-preserving procedure that results in thinner bearings when compared with a tibia-first approach1. The femur-first approach also improves radiographic outcomes, including femoral coronal, femoral sagittal, and tibial sagittal alignments, while tibial coronal alignment does not differ. There is an early trend toward improved 5-year survivorship with the femur-first (98%) versus tibia-first (94%, p = 0.35) techniques. There has been no significant difference reported in Knee Society Scores between techniques. Important Tips: Perform a preliminary cut of the posterior tibial cartilage in order to allow insertion of the femoral drill guide under the femoral condyle.Make sure the femoral drill guide lies in the center of the marked medial femoral condyle.Align the tibial sagittal cut with the femoral component trial in order to avoid bearing impingement.Be conservative in the tibial cutting by utilizing a +2 cutting guide (since the coupling is performed with the intramedullary guide in place, which drives the tibial guide distally). Acronyms and Abbreviations: UKA = unicompartmental knee arthroplastyFF = femur-firstM-L = medial-lateralAP = anteroposteriorPA = posteroanteriorASA = acetylsalicylic acid (aspirin)BID = bis in die, twice a dayPT = physical therapyTF = tibia-firstFCA = femoral coronal angleFSA = femoral sagittal angleTSA = tibial sagittal angleIM = intramedullaryOA = osteoarthritis.

Femoral Coronal Malalignment is Associated With Failure in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty.

BACKGROUND: Femur-first (FF) technique for mobile-bearing medial unicompartmental knee arthroplasty (UKA) has been described as an alternative to tibia-first (TF) technique. The aim of this study was to compare the radiographic results in UKAs using FF or TF techniques and their influence on failure rates. METHODS: We retrospectively reviewed 288 UKAs with a minimum 2-year follow-up. There were 147 knees in the TF and 141 knees in the FF cohorts. Alignment parameters and overhang were assessed as outliers and far outliers. The mean follow-up was 6 years (range, 2 to 16), the mean age was 63 years (range, 27 to 92), and 45% of patients were women. Univariate and multivariate statistical analyses were carried out with Cox regression models. RESULTS: There were 13 and 6 revisions in the TF and FF cohorts, respectively. The FF had lower rates of femoral coronal alignment (FCA) or femoral sagittal alignment outliers compared to the TF (5.7% versus 19%, P = .011). Tibial coronal alignment and tibial sagittal alignment did not significantly differ between the techniques (22.7% in FF versus 29.9% in TF, P = .119). Overhang outliers did not differ significantly between the groups. Younger age was associated with a higher revision rate (P = .006), while FF versus TF, sex, body mass index, and postoperative mechanical axis did not show statistically significant associations. In multivariate analysis, FCA outliers and younger age were significantly associated with revision. CONCLUSIONS: The FF technique in mobile-bearing UKA resulted in fewer FCA outliers compared to TF. Despite improved knee alignment with the FF technique, FCA outliers and younger age were associated with a higher revision rate, independent of technique.

Development of a zinc chloride-based chemo-mechanical system for potential minimally invasive dental caries removal system.

Background/purpose: The chemo-mechanical caries-removal technique is known to offer advantages of selective dentin caries treatment while leaving healthy dental tissues intact. However, current sodium hypochlorite based reagents usually excessively damage dentin collagen. Therefore, the purpose of this study was to develop a novel chemo-mechanical caries-removal system to preserve the collagen network for subsequent prosthetic restorations. Materials and methods: The calfskin-derived collagen was chosen as a model system to investigate the dissolution behavior of collagen under different operating conditions of chemical-ultrasonic treatment systems. The molecular weight, triple-helix structure, the morphology, and functional group of collagen after treatment were investigated. Results: Various concentrations of sodium hypochlorite or zinc chloride together with ultrasonic machinery were chosen to investigate. The outcomes of circular dichroism (CD) spectra demonstrated stability of the triple-helix structure after treatment of a zinc chloride solution. In addition, two apparent bands at molecular weights (MWs) of 130 and 121 kDa evidenced the stability of collagen network. The positive 222 nm and 195 nm negative CD absorption band indicated the existence of a triple-helix structure for type I collagen. The preservation of the morphology and functional group of the collagen network on the etched dentin surface were investigated by in vitro dentin decalcification model. Conclusion: Unlike NaOCl, the 5 wt% zinc chloride solution combined with ultra-sonication showed dissolution rather than denature as well as degradation of the dentin collagen network. Additional in vivo evaluations are needed to verify its usefulness in clinical applications.

Lipid responses to perfluorooctane sulfonate exposure for multiple rat organs.

Perfluorooctane sulfonate (PFOS) is a persistent chemical that has long been a threat to human health. However, the molecular effects of PFOS on various organs are not well studied. In this study, male Sprague-Dawley rats were treated with various doses of PFOS through gavage for 21 days. Subsequently, the liver, lung, heart, kidney, pancreas, testis, and serum of the rats were harvested for lipid analysis. We applied a focusing lipidomic analytical strategy to identify key lipid responses of phosphorylcholine-containing lipids, including phosphatidylcholines and sphingomyelins. Partial least squares discriminant analysis revealed that the organs most influenced by PFOS exposure were the liver, kidney, and testis. Changes in the lipid profiles of the rats indicated that after exposure, levels of diacyl-phosphatidylcholines and 22:6-containing phosphatidylcholines in the liver, kidney, and testis of the rats decreased, whereas the level of 20:3-containing phosphatidylcholines increased. Furthermore, levels of polyunsaturated fatty acids-containing plasmenylcholines decreased. Changes in sphingomyelin levels indicated organ-dependent responses. Decreased levels of sphingomyelins in the liver, nonmonotonic dose responses in the kidney, and irregular responses in the testis after PFOS exposure are observed. These lipid responses may be associated with alterations pertaining to phosphatidylcholine synthesis, fatty acid metabolism, membrane properties, and oxidative stress in the liver, kidney, and testis. Lipid responses in the liver could have contributed to the observed increase in liver to body weight ratios. The findings suggest potential toxicity and possible mechanisms associated with PFOS in multiple organs.

Survivorship of the fixed-bearing medial unicompartmental knee arthroplasty: mean 14-year follow-up in a single medical center.

BACKGROUND: This study aimed to report the long-term survival of fixed-bearing medial unicompartmental knee arthroplasty (UKA) with a mean of 14-year follow-up, and to determine possible risk factors of failure. METHODS: We retrospectively evaluated 337 fixed-bearing medial UKAs implanted between 2003 and 2014. Demographic and radiographic parameters were measured, including pre-operative and post-operative anatomical femorotibial angle (aFTA), posterior tibial slope (PTS), and anatomical medial proximal tibial angle (aMPTA). Multivariate logistic regression analysis was applied to figure out risk factors. RESULTS: The mean follow-up time was 14.0 years. There were 32 failures categorized into implant loosening (n = 11), osteoarthritis progression (n = 7), insert wear (n = 7), infection (n = 4), and periprosthetic fracture (n = 3). Cumulative survival was 91.6% at 10 years and 90.0% at 15 years. No statistically significant parameters were found between the overall survival and failure groups. Age and hypertension were significant factors of implant loosening with odds ratio (OR) 0.909 (p = 0.02) and 0.179 (p = 0.04) respectively. In the insert wear group, post-operative aFTA and correction of PTS showed significance with OR 0.363 (p = 0.02) and 0.415 (p = 0.03) respectively. Post-operative aMPTA was a significant factor of periprosthetic fracture with OR 0.680 (p < 0.05). CONCLUSIONS: The fixed-bearing medial UKA provides successful long-term survivorship. Tibial component loosening is the major cause of failure. Older age and hypertension were factors with decreased risk of implant loosening.

Aquaporin-8 promotes human dermal fibroblasts to counteract hydrogen peroxide-induced oxidative damage: A novel target for management of skin aging.

The skin is subjected to various external factors that contribute to aging including oxidative stress from hydrogen peroxide (H2O2). This study investigated the distribution of aquaporin-8 (AQP8), a protein that transports H2O2 across biological membranes, in skin cells, and its effects in mitigating H2O2-induced oxidative damage. Human dermal fibroblasts were treated with increasing concentrations of H2O2 to evaluate oxidative damage. Cell viability, reactive oxygen species (ROS) generation, and the expression of specific genes associated with skin aging (IL-10, FPR2, COL1A1, KRT19, and Aggrecan) were evaluated and AQP8 expression was assessed via quantitative polymerase chain reaction and western blotting. Small-interfering RNA was used to silence the AQP8 gene and evaluate its significance. The results show that H2O2 treatment reduces cell viability and increases ROS generation, leading to oxidative damage that affects the expression of target molecules. Interestingly, H2O2-treated cells exhibit high levels of AQP8 expression and gene silencing of AQP8 reverses high levels of ROS and low levels of COL1A1, KRT19, and Aggrecan expression in stressed cells, indicating that AQP8 plays a vital role in preventing oxidative damage and consequent aging. In conclusion, AQP8 is upregulated in human dermal fibroblasts during H2O2-induced oxidative stress and may help prevent oxidative damage and aging. These findings suggest that AQP8 could be a potential therapeutic target for skin aging. Further research is necessary to explore the feasibility of using AQP8 as a preventive or therapeutic strategy for maintaining skin health.

Enhanced Thermoelectric Properties of P-Type Sn-Substituted Higher Manganese Silicides.

This study introduces Sn-substituted higher manganese silicides (MnSi1.75, HMS) synthesized via an arc-melting process followed by spark plasma sintering (SPS). The influences of Sn concentrations on the thermoelectric performance of Mn(Si1-xSnx)1.75 (x = 0, 0.001, 0.005, 0.01, 0.015) are systematically investigated. Our findings reveal that metallic Sn precipitates within the Mn(Si1-xSnx)1.75 matrix at x ≥ 0.005, with a determined solubility limit of approximately x = 0.001. In addition, substituting Si with Sn effectively reduces the lattice thermal conductivity of HMS by introducing point defect scattering. In contrast to the undoped HMS, the lattice thermal conductivity decreases to a minimum value of 2.0 W/mK at 750 K for the Mn(Si0.999Sn0.001)1.75 sample, marking a substantial 47.4% reduction. Consequently, a figure of merit (ZT) value of ~0.31 is attained at 750 K. This considerable enhancement in ZT is primarily attributed to the suppressed lattice thermal conductivity resulting from Sn substitution.

Effect of various post-curing light intensities, times, and energy levels on the color of 3D-printed resin crowns.

Background/purpose: Current 3D-printing technology has been widely used for creating dental resin restorations. This study aimed to evaluate the effect of light intensity, time, and energy post-curing on the surface color of 3D-printed resin crowns. However, the influences of post-curing parameters on the restoration after printing still need to be explored. Therefore, this project investigates the effect of post-cure conditions on resin color. Materials and methods: Specimens from single-crown (SC) and pontic (PO) specimens underwent post-curing at various light intensities (105, 210, 420, 630, and 860 mW/cm2) for 5, 10, and 15 min. Specimens were observed at three predetermined points and measured using a commercial spectrophotometer that utilizes the CIE Lab∗ color space. Subsequently, samples were analyzed for color differences (ΔE). Results: ΔE color differences in evaluated samples were influenced by the light intensity, time, and energy post-curing. SC samples showed a significant color difference (P < 0.05), with the lowest value at 5 min of 16 (860 mW/cm2), while 10 and 15 min had a difference of 4 (210 mW/cm2). PO samples exhibited a significant decrease in the color difference (P < 0.05) at 5 and 10 min of 16 (860 mW/cm2), and at 15 min of 12 (630 mW/cm2). Conclusion: The results of this study indicate that exposing a resin crown to a high light intensity results in color stability and allows shorter post-curing times.

Applying machine learning to assess the morphology of sculpted teeth.

Background/purpose: Producing tooth crowns through dental technology is a basic function of dentistry. The morphology of tooth crowns is the most important parameter for evaluating its acceptability. The procedures were divided into four steps: tooth collection, scanning skills, use of mathematical methods and software, and machine learning calculation. Materials and methods: Dental plaster rods were prepared. The effective data collected were to classify 121 teeth (15th tooth position), 342 teeth (16th tooth position), 69 teeth (21st tooth position), and 89 teeth (43rd tooth position), for a total of 621 teeth. The procedures are divided into four steps: tooth collection, scanning skills, use of mathematical methods and software, and machine learning calculation. Results: The area under the curve (AUC) value was 0, 0.5, and 0.72 in this study. The precision rate and recall rate of micro-averaging/macro-averaging were 0.75/0.73 and 0.75/0.72. If we took a newly carved tooth picture into the program, the current effectiveness of machine learning was about 70%-75% to evaluate the quality of tooth morphology. Through the calculation and analysis of the two different concepts of micro-average/macro-average and AUC, similar values could be obtained. Conclusion: This study established a set of procedures that can judge the quality of hand-carved plaster sticks and teeth, and the accuracy rate is about 70%-75%. It is expected that this process can be used to assist dental technicians in judging the pros and cons of hand-carved plaster sticks and teeth, so as to help dental technicians to learn the tooth morphology more effectively.

Human transcriptome array analysis and diffusion tensor imaging in attention-deficit/hyperactivity disorder.

The mRNA markers identified using microarray assay and diffusion tensor magnetic resonance imaging (DTI) were applied to elucidate the pathophysiology of attention-deficit hyperactivity disorder (ADHD). First, we obtained total RNA from leukocytes from three children with ADHD and three healthy controls for analysis with microarray assays. Subsequently, we applied real-time quantitative polymerase chain reaction (qRT‒PCR) assays to validate the differential expression of 7 genes (COX7B, CYCS, TFAM, UTP14A, ZNF280C, IFT57 and NDUFB5) between 130 ADHD patients and 70 controls, and we built an ADHD prediction model based on the ΔCt values of aforementioned seven genes (AUROC = 0.98). Finally, in a validation group (28 patients with ADHD and 27 healthy controls), mRNA expression of the above seven genes also significantly differentiated ADHD patients from controls (AUROC value = 0.91). The DTI analysis showed increased fractional anisotropy (FA) of the forceps minor, superior corona radiata, posterior corona radiata and anterior corona radiata in ADHD patients. Moreover, the FA of the right superior corona radiata tract was positively correlated with ΔCt levels of the COX7B gene and the IFT57 gene. The results shed a new light on a genetic profile of ADHD that may help in deciphering the white matter microstructural features in disease pathogenesis.

Correlation of potential diagnostic biomarkers (circulating miRNA and protein) of bipolar II disorder.

OBJECTIVES: We previously identified certain peripheral biomarkers of bipolar II disorder (BD-II) including circulating miRNAs (miR-7-5p, miR-142-3p, miR-221-5p, and miR-370-3p) and proteins (Matrix metallopeptidase 9 (MMP9), phenylalanyl-tRNA synthetase subunit beta (FARSB), peroxiredoxin 2 (PRDX2), carbonic anhydrase 1 (CA-1), and proprotein convertase subtilisin/kexin type 9 (PCSK9)). We try to explore the connection between these biomarkers. METHODS: We explored correlations between the peripheral levels of above circulating miRNAs and proteins in our previously collected BD-II (N = 96) patients and control (N = 115) groups. We further searched TargetScan and BioGrid websites to identify direct and indirect interactions between these protein-coding genes and circulating miRNAs. RESULTS: In the BD-II group, we identified significant correlations between the miR-221-5p and CA-1 (rho = -0.323, P = 0.001), FARSB (rho = 0.251, P = 0.014), MMP-9 (rho = 0.313, P = 0.002) and PCSK9 (rho = 0.252, P = 0.014). The miR-370-3p also significantly correlated with FARSB expression (rho = 0.330, P = 0.001) and PCSK9 expression (rho = 0.221, P = 0.031) in the BD-II group. Our findings were in line with the modulating axis identified from TargetScan and BioGrid, miR-221-5p/CA-1/MMP9 and miR-370-3p/FARSB/PCSK9, suggesting their association with BD-II. CONCLUSION: Our result supported that peripheral candidate miRNA and protein biomarkers may interact in BD-II. We concluded that miR-221-5p/CA-1/MMP9 and miR-370-3p/FARSB/PCSK9 axes might act a critical role in the pathomechanism of BD-II.

Neural Network Dynamics and Brain Oscillations Underlying Aberrant Inhibitory Control in Internet Addiction.

Previous studies have reported a role of alterations in the brain's inhibitory control mechanism in addiction. Mounting evidence from neuroimaging studies indicates that its key components can be evaluated with brain oscillations and connectivity during inhibitory control. In this study, we developed an internet-related stop-signal task with electroencephalography (EEG) signal recorded to investigate inhibitory control. Healthy controls and participants with Internet addiction were recruited to participate in the internet-related stop-signal task with 19-channel EEG signal recording, and the corresponding event-related potentials and spectral perturbations were analyzed. Brain effective connections were also evaluated using direct directed transfer function. The results showed that, relative to the healthy controls, participants with Internet addiction had increased Stop-P3 during inhibitory control, suggesting that they have an altered neural mechanism in impulsive control. Furthermore, participants with Internet addiction showed increased low-frequency synchronization and decreased alpha and beta desynchronization in the middle and right frontal regions compared to healthy controls. Aberrant brain effective connectivity was also observed, with increased occipital-parietal and intra-occipital connections, as well as decreased frontal-paracentral connection in participants with Internet addiction. These results suggest that physiological signals are essential in future implementations of cognitive assessment of Internet addiction to further investigate the underlying mechanisms and effective biomarkers.

A New Arthroscopic Classification for Chondrolabral Disease in Patients Undergoing Surgery for Developmental Dysplasia of the Hip.

BACKGROUND: Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia. PURPOSE: To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 46 hips underwent combined hip arthroscopy and PAO at our institution between September 2013 and December 2014, irrespective of symptoms or radiographic findings. PROMs were evaluated preoperatively and at 2 years postoperatively. At the time of hip arthroscopy, the chondrolabral junction was classified as normal without tear (1 hip, type 1); hypertrophic labrum without chondrolabral disruption (19 hips, type 2); chondrolabral disruption on the articular side, not extending into the capsular side (16 hips, type 3A); chondrolabral disruption extending through the capsular side (3 hips, type 3B); and exposed acetabular subchondral bone (7 hips, type 4). RESULTS: There was a significant difference in postoperative modified Harris Hip Score (mHHS) (P = .020), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (P = .037), and WOMAC total scores (P = .049) between chondrolabral junction types. Post hoc analyses demonstrated significant differences between type 2 (84.9 ± 12.9) and type 3A (67.8 ± 20.7; P = .198), and between type 2 and type 4 (59.3 ± 24.3; P = .011) in postoperative mHHS scores; and between type 2 (83.9 ± 12.9) and type 3A (68.9 ± 23.7; P = .045) in postoperative WOMAC total scores. In multivariate analysis, chondrolabral type 3 or type 4, age >35 years, and previous surgery were significantly correlated with worse mHHS scores at 2 years. CONCLUSION: This new chondrolabral classification is proposed to describe intra-articular pathology seen during combined hip arthroscopy and PAO, specifically in dysplastic hips. More advanced chondrolabral disease was associated with worse PROMs at 2 years.

Effect of Participation Motivation in Sports Climbing on Leisure Satisfaction and Physical Self-Efficacy.

This study aimed to verify the effects of participation motivation in sports climbing on leisure satisfaction and physical self-efficacy. Structural equation modeling was used to analyze the causal relationships between participation motivation in sports climbing, leisure satisfaction, and physical self-efficacy, and to determine participation motivation. This study examined this causal relationship by verifying leisure satisfaction's mediating effect on the relationship between participation motivation in sports climbing and physical self-efficacy. The participants of this study included 324 individuals over the age of 20 years with at least three months of sports climbing experience in the Seoul and Gyeonggi regions. The results indicated that among the subfactors of participation motivation in sports climbing, only skill acquisition and achievement positively affected leisure satisfaction, that leisure satisfaction positively affected physical self-efficacy, and that leisure satisfaction mediated the relationship between skill acquisition and achievement among the subfactors of participation motivation in sports climbing and physical self-efficacy. This study indicated that improved leisure satisfaction through sports climbing increases physical self-efficacy, including perceived improvement in physical abilities and confidence in interpersonal relationships. Accordingly, to expand and sustain participation, a systematic system for sports climbing instruction and educational programs is required to increase skill acquisition and a sense of accomplishment.