[Effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament reconstruction: a randomized controlled study].

Objective: To investigate the effectiveness of preemptive analgesia with imrecoxib on analgesia after anterior cruciate ligament (ACL) reconstruction. Methods: A total of 160 patients with ACL injuries who met the selection criteria and were admitted between November 2020 and August 2021 were selected and divided into 4 groups according to the random number table method (n=40). Group A began to take imrecoxib 3 days before operation (100 mg/time, 2 times/day); group B began to take imrecoxib 1 day before operation (100 mg/time, 2 times/day); group C took 200 mg of imrecoxib 2 hours before operation (5 mL of water); and group D did not take any analgesic drugs before operation. There was no significant difference in gender, age, body mass index, constituent ratio of meniscal injuries with preoperative MRI grade 3, constituent ratio of cartilage injury Outerbridge grade 3, and visual analogue scale (VAS) score at the time of injury and at rest among 4 groups (P>0.05). The operation time, hospitalization stay, constituent ratio of perioperative American Society of Anesthesiologists (ASA) grade 1, postoperative opioid dosage, and complications were recorded. The VAS scores were used to evaluate the degree of knee joint pain, including resting VAS scores before operation and at 6, 24, 48 hours, and 1, 3, 6, and 12 months after operation, and walking, knee flexion, and night VAS scores at 1, 3, 6, and 12 months after operation. The knee injury and osteoarthritis score (KOOS) was used to evaluate postoperative quality of life and knee-related symptoms of patients, mainly including pain, symptoms, daily activities, sports and entertainment functions, knee-related quality of life (QOL); and the Lysholm score was used to evaluate knee joint function. Results: All patients were followed up 1 year. There was no significant difference in operation time, hospitalization time, or constituent ratio of perioperative ASA grade 1 among 4 groups (P>0.05); the dosage of opioids in groups A-C was significantly less than that in group D (P<0.05). Except for 1 case of postoperative fever in group B, no complications such as joint infection, deep vein thrombosis of the lower extremities, or knee joint instability occurred in each group. The resting VAS scores of groups A-C at 6 and 24 hours after operation were lower than those of group D, and the score of group A at 6 hours after operation was lower than those of group C, and the differences were significant (P<0.05). At 1 month after operation, the knee flexion VAS scores of groups A-C were lower than those of group D, the walking VAS scores of groups A and B were lower than those of groups C and D, the differences were significant (P<0.05). At 1 month after operation, the KOOS pain scores in groups A-C were higher than those in group D, there was significant difference between groups A, B and group D (P<0.05); the KOOS QOL scores in groups A-C were higher than that in group D, all showing significant differences (P<0.05), but there was no significant difference between groups A-C (P>0.05). There was no significant difference in VAS scores and KOOS scores between the groups at other time points (P>0.05). And there was no significant difference in Lysholm scores between the groups at 1, 3, 6, and 12 months after operation (P>0.05). Conclusion: Compared with the traditional analgesic scheme, applying the concept of preemptive analgesia with imrecoxib to manage the perioperative pain of ACL reconstruction can effectively reduce the early postoperative pain, reduce the dosage of opioids, and promote the early recovery of limb function.

Sequential sparse autoencoder for dynamic heading representation in ventral intraparietal area.

To navigate in space, it is important to predict headings in real-time from neural responses in the brain to vestibular and visual signals, and the ventral intraparietal area (VIP) is one of the critical brain areas. However, it remains unexplored in the population level how the heading perception is represented in VIP. And there are no commonly used methods suitable for decoding the headings from the population responses in VIP, given the large spatiotemporal dynamics and heterogeneity in the neural responses. Here, responses were recorded from 210 VIP neurons in three rhesus monkeys when they were performing a heading perception task. And by specifically and separately modelling the both dynamics with sparse representation, we built a sequential sparse autoencoder (SSAE) to do the population decoding on the recorded dataset and tried to maximize the decoding performance. The SSAE relies on a three-layer sparse autoencoder to extract temporal and spatial heading features in the dataset via unsupervised learning, and a softmax classifier to decode the headings. Compared with other population decoding methods, the SSAE achieves a leading accuracy of 96.8% ± 2.1%, and shows the advantages of robustness, low storage and computing burden for real-time prediction. Therefore, our SSAE model performs well in learning neurobiologically plausible features comprising dynamic navigational information.

Identification and degradation of structural extracellular polymeric substances in waste activated sludge via a polygalacturonate-degrading consortium.

By maintaining the cell integrity of waste activated sludge (WAS), structural extracellular polymeric substances (St-EPS) resist WAS anaerobic fermentation. This study investigates the occurrence of polygalacturonate in WAS St-EPS by combining chemical and metagenomic analyses that identify ∼22% of the bacteria, including Ferruginibacter and Zoogloea, that are associated with polygalacturonate production using the key enzyme EC 5.1.3.6. A highly active polygalacturonate-degrading consortium (GDC) was enriched and the potential of this GDC for degrading St-EPS and promoting methane production from WAS was investigated. The percentage of St-EPS degradation increased from 47.6% to 85.2% after inoculation with the GDC. Methane production was also increased by up to 2.3 times over a control group, with WAS destruction increasing from 11.5% to 28.4%. Zeta potential and rheological behavior confirmed the positive effect which GDC has on WAS fermentation. The major genus in the GDC was identified as Clostridium (17.1%). Extracellular pectate lyases (EC 4.2.2.2 and 4.2.2.9), excluding polygalacturonase (EC 3.2.1.15), were observed in the metagenome of the GDC and most likely play a core role in St-EPS hydrolysis. Dosing with GDC provides a good biological method for St-EPS degradation and thereby enhances the conversion of WAS to methane.

Diverse effects of gaze direction on heading perception in humans.

Gaze change can misalign spatial reference frames encoding visual and vestibular signals in cortex, which may affect the heading discrimination. Here, by systematically manipulating the eye-in-head and head-on-body positions to change the gaze direction of subjects, the performance of heading discrimination was tested with visual, vestibular, and combined stimuli in a reaction-time task in which the reaction time is under the control of subjects. We found the gaze change induced substantial biases in perceived heading, increased the threshold of discrimination and reaction time of subjects in all stimulus conditions. For the visual stimulus, the gaze effects were induced by changing the eye-in-world position, and the perceived heading was biased in the opposite direction of gaze. In contrast, the vestibular gaze effects were induced by changing the eye-in-head position, and the perceived heading was biased in the same direction of gaze. Although the bias was reduced when the visual and vestibular stimuli were combined, integration of the 2 signals substantially deviated from predictions of an extended diffusion model that accumulates evidence optimally over time and across sensory modalities. These findings reveal diverse gaze effects on the heading discrimination and emphasize that the transformation of spatial reference frames may underlie the effects.

Bioinspired Microstructured Materials for Optical and Thermal Regulation.

Precise optical and thermal regulatory systems are found in nature, specifically in the microstructures on organisms' surfaces. In fact, the interaction between light and matter through these microstructures is of great significance to the evolution and survival of organisms. Furthermore, the optical regulation by these biological microstructures is engineered owing to natural selection. Herein, the role that microstructures play in enhancing optical performance or creating new optical properties in nature is summarized, with a focus on the regulation mechanisms of the solar and infrared spectra emanating from the microstructures and their role in the field of thermal radiation. The causes of the unique optical phenomena are discussed, focusing on prevailing characteristics such as high absorption, high transmission, adjustable reflection, adjustable absorption, and dynamic infrared radiative design. On this basis, the comprehensive control performance of light and heat integrated by this bioinspired microstructure is introduced in detail and a solution strategy for the development of low-energy, environmentally friendly, intelligent thermal control instruments is discussed. In order to develop such an instrument, a microstructural design foundation is provided.

Lower Tibial Tunnel Placement in Isolated Posterior Cruciate Ligament Reconstruction: Clinical Outcomes and Quantitative Radiological Analysis of the Killer Turn.

BACKGROUND: The "killer turn" effect after posterior cruciate ligament (PCL) reconstruction is a problem that can lead to graft laxity or failure. Solutions for this situation are currently lacking. PURPOSE: To evaluate the clinical outcomes of a modified procedure for PCL reconstruction and quantify the killer turn using 3-dimensional (3D) computed tomography (CT). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 15 patients underwent modified PCL reconstruction with the tibial aperture below the center of the PCL footprint. Next, 2 virtual tibial tunnels with anatomic and proximal tibial apertures were created on 3D CT. All patients were assessed according to the Lysholm score, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, side-to-side difference (SSD) in tibial posterior translation using stress radiography, and 3D gait analysis. RESULTS: The modified tibial tunnel showed 2 significantly gentler turns (superior, 109.87° ± 10.12°; inferior, 151.25° ± 9.07°) compared with those reconstructed with anatomic (91.33° ± 7.28°; P < .001 for both comparisons) and proximal (99° ± 7.92°; P = .023 and P < .001, respectively) tibial apertures. The distance from the footprint to the tibial aperture was 16.49 ± 3.73 mm. All patient-reported outcome scores (mean ± SD) improved from pre- to postoperatively: Lysholm score, from 46.4 ± 18.87 to 83.47 ± 10.54 (P < .001); Tegner score, from 2.47 ± 1.85 to 6.07 ± 1.58 (P < .001); IKDC sports activities score, from 19 ± 9.90 to 33.07 ± 5.35 (P < .001); and IKDC knee symptoms score, from 17.87 ± 6.31 to 25.67 ± 3.66 (P < .001). The mean SSD improved from 9.15 ± 2.27 mm preoperatively to 4.20 ± 2.31 mm postoperatively (P < .001). The reconstructed knee showed significantly more adduction (by 1.642°), less flexion (by 1.285°), and more lateral translation (by 0.279 mm) than that of the intact knee (P < .001 for all). CONCLUSION: Lowering the tibial aperture during PCL reconstruction reduced the killer turn, and the clinical outcomes remained satisfactory. However, SSD and clinical outcomes were similar to those of previously described techniques using an anatomic tibial tunnel.

[The killer turn in the posterior cruciate ligament reconstruction: mechanism and improvement].

OBJECTIVE: To summarize the research progress of killer turn in posterior cruciate ligament (PCL) reconstruction. METHODS: The literature related to the killer turn in PCL reconstruction in recent years was searched and summarized. RESULTS: The recent studies show that the killer turn is considered to be the most critical cause of graft relaxation after PCL reconstruction. In clinic, this effect can be reduced by changing the fixation mode of bone tunnel, changing the orientation of bone tunnel, squeezing screw fixation, retaining the remnant, and grinding the bone at the exit of bone tunnel. But there is still a lack of long-term follow-up. CONCLUSION: There are still a lot of controversies on the improved strategies of the killer turn. More detailed basic researches focusing on biomechanics to further explore the mechanism of the reconstructed graft abrasion are needed.

Higher Level of Peripheral Blood CD34 Positive Cells Presented with Unfavorable Prognosis in Intermediate-Low Risk Acute Promyelocytic Leukemia.

Our previous work has demonstrated that some acute promyelocytic leukemia (APL) patients had significantly elevated circulating CD34+ cell count (≥ 10 × 106/L), and these patients with higher CD34+ cell level usually presented with high-risk disease (WBC > 10,000/µL). The aim of this study was to investigate whether circulating CD34+ cell count is a prognostic marker in intermediate-low risk APL patients. In this study, 76 intermediate-low risk APL patients and 56 age-adjusted healthy volunteers were evaluated. Enumeration of CD34+ cells was investigated before the treatment. A cut-off value of 10 × 106/L CD34+ cells could just distinguish APL patients with adverse prognostic factors from others and may have the power to predict shorter progression-free survival (PFS) and poor prognosis. Higher count of CD34+ cells was usually associated with nonclassical chromosomal translocation, PML/RARα gene complex fusion, APL history, chemotherapy-related APL, disease progression, second tumor, extramedullary infiltration, FLT3-ITD positive mutation, atypical morphology, BM promyelocyte CD56/CD34 positive expression, myelofibrosis, PCR-positive PML/RARa gene fusion but FISH-negative, marrow necrosis and shorter PFS. Our results suggest that the level of CD34+ cells can be further the stratification of disease risk, a higher CD34+ cell count may be indicative of inferior survival and serve as an adverse biomarker for intermediate-low risk APL.

Patient-Specific or Conventional Instrumentations: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To conduct a meta-analysis of randomized controlled trials (RCTs) to compare knee arthroplasty with patient-specific instrumentation (PSI) with the conventional instrumentation (CI). METHODS: RCTs were selected in PubMed and Embase from 2012 to 2018. Key data extracted included malalignment of mechanical axis, blood loss, surgical time, Oxford Knee Score (OKS), Knee Society Score (KSS), length of stay, and complications. Subgroup analysis was also performed regarding different PSI systems and different image processing methods. RESULTS: 29 RCTs with 2487 knees were eligible for the meta-analysis. Results showed that PSI did not improve the alignment of the mechanical axis compared with CI, but MRI-based PSI and Visionaire-specific PSI decrease the risk of malalignment significantly (P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and P = 0.04 and. CONCLUSION: PSI reduced the blood loss and improved KSS. MRI-based PSI reduced operative time and risk of malalignment of mechanical axis compared with CT-based PSI. Moreover, Visionaire-specific PSI achieves better alignment result of the mechanical axis than other systems.

Repaired or unrepaired capsulotomy after hip arthroscopy: a systematic review and meta-analysis of comparative studies.

PURPOSE: To conduct a systematic review and meta-analysis comparing the surgical techniques, clinical outcomes, rates of revision and conversion to arthroplasty and complications between a repaired and unrepaired capsulotomy after hip arthroscopy. METHODS: A search of the PubMed, Embase and Google Scholar databases was performed to identify comparative articles published prior to 10 July 2019 that reported the capsule management strategy and clinical outcomes after hip arthroscopy. A narrative analysis and meta-analysis were performed to integrate and compare the results of the 2 groups. RESULTS: 12 comparative studies (n = 1185 hips) with an average (methodological index for non-randomized studies) MINORS score of 17.45 ± 2.02 were identified for analysis, of which 5 were included in the meta-analysis. The pre- to postoperative improvements in the modified Harris Hip Score (mHHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SS), and Hip Outcome Score-Activities of Daily Living (HOS-ADL) revealed no significant differences between the repaired and unrepaired groups (p = 0.40, 0.26 and 0.61, respectively). The risk ratio of the revision rate for the 2 groups was 0.66 (p = 0.21). Evaluation of the MRI scans and the rate of heterotopic ossification also showed no significant differences. The most preferred capsulotomy techniques were interportal and T-shape. No postoperative hip instability was reported in any of the 12 studies. CONCLUSION: The currently published evidence is still not strong enough to confirm the superiority of repairing the capsule after hip arthroscopy; hence, routine repair of the capsule during surgery cannot be suggested.

Innervation of nociceptors in intact human menisci along the longitudinal axis: semi-quantitative histological evaluation and clinical implications.

BACKGROUND: The mechanism of pain after meniscus injury remains unknown. After injury, some individuals suffered from acute pain, while others suffer from delayed pain. A precise nociceptor distribution pattern may provide the answer to this question. METHODS: Twenty-two intact menisci (paired medial and lateral menisci) were obtained from 11 patients with a mean age of 28.45 years. All menisci were sectioned into five parts: the anterior horn, anterior body, middle body, posterior body, and posterior horn. Two paired menisci were stained by a modified gold chloride method. All other specimens were stained by H&E staining and were subjected to immunohistochemical staining to detect substance-P (SP). Under a microscope, measurements were made in 10 consecutive visual areas at 400x magnification. SP-positive fibres were determined using a three-grade scale, and the mean number of SP-positive fibres was assessed. RESULTS: Nerve fibres and nociceptors stained by H&E and modified gold chloride were found mainly in the vascular outer third of the menisci as observed under a microscope; the positive area was wider in the anterior and posterior horns. There were more SP+ fibres in the anterior horn and posterior horn than in the anterior body, middle body, or posterior body (p < 0.05). Regarding the bodies, the mean number of substance-P fibres was greater in the anterior body or posterior body than in the middle area (p < 0.05). No significant differences were found between the number of substance-P nerve fibres in the anterior horn vs the posterior horn or in the anterior body vs the posterior body of all menisci (p > 0.05). No significant differences were observed in the same location between the paired medial and lateral menisci in all areas of the menisci (p > 0.05). CONCLUSION: The density of nociceptors decreased along the longitudinal axis of the meniscus from both horns to the middle part of the body, which may guide future diagnostic methods and rehabilitation protocols.

Enhanced degradation of ibuprofen by heterogeneous electro-Fenton at circumneutral pH.

Fenton based reactions are effective for pharmaceutical removals, but traditional Fenton processes have drawbacks of pH adjustment and large amount of produced iron sludge. To overcome these challenges, a heterogeneous electro-Fenton process was proposed for effective contaminant degradation at circumneutral pH without iron sludge production. The anti-inflammatory drug ibuprofen (a common pharmaceutical in natural waters) was used as a representative contaminant. Activated carbon fibers (ACFs) supported ferric citrate (Cit-Fe/ACFs) was synthesized and used as the cathode, and RuO2/Ti was used as the anode. H2O2 was electro-generated in situ from O2 reduction and the production rate of OH per unit area was 6.8 µM W-1 cm-2 using Cit-Fe/ACFs cathode. A maximal ibuprofen degradation of 97% was obtained after 120 min at the current density of 7 mA cm-2. The electrical energy per order (EEO) varied from 0.24±0.03 to 2.65±0.04 kWh log-1 m-3 when the current density ranged from 1 to 7 mA cm-2. The Cit-Fe/ACFs cathode showed relatively good reusability and ∼85% IBP removal was achieved after 6 cycles of degradation. Our results showed that the prepared Cit-Fe/ACFs cathode was promising for the treatment of pharmaceutical contaminants.

[Research progress of rehabilitation after autologous chondrocyte implantation on knee].

Objective: To summarize the research progress of rehabilitation after autologous chondrocyte implantation (ACI). Methods: The literature related to basic science and clinical practice about rehabilitation after ACI in recent years was searched, selected, and analyzed. Results: Based on the included literature, the progress of the graft maturation consists of proliferation phase (0-6 weeks), transition phase (6-12 weeks), remodeling phase (12-26 weeks), and maturation phase (26 weeks-2 years). To achieve early protection, stimulate the maturation, and promote the graft-bone integrity, rehabilitation protocol ought to be based on the biomechanical properties at different phases. Weight-bearing program, range of motion (ROM), and options or facilities of exercise are importance when considering a rehabilitation program. Conclusion: It has been proved that the patients need a program with an increasingly progressive weight-bearing and ROM in principles of rehabilitation after ACI. Specific facilities can be taken at a certain phase. Evidences extracted in the present work are rather low and the high-quality and controlled trials still need to improve the rehabilitation protocol.

Discovery of 6-(difluoro(6-(4-fluorophenyl)-[1,2,4]triazolo[4,3-b][1,2,4]triazin-3-yl)methyl)quinoline as a highly potent and selective c-Met inhibitor.

c-Met/HGF overexpression has been detected in many human malignancies including tumors which are resistant to anticancer therapy. Disrupting the aberrant c-Met/HGF axis has enjoyed significant progress in both preclinical and clinical antitumor campaign. To eliminate the OCH2-related metabolic deficiency of our previously reported triazolotriazine 2, we synthesized a series of CH2-/CF2-linked triazolotriazines and assessed their c-Met activities, leading to the highly potent compound 23 with IC50 values of 0.24 nM of enzymatic activity in c-Met and 0.85 nM of cellular activity in EBC-1 cancer cell line, as well as with complete tumor regression in EBC-1 xenograft mice model at dose of 25 mg/kg via oral administration. Based on its potent anti-proliferative activities and favorable pharmacokinetic properties, 23 has been selected as a drug candidate for preclinical investigation.