Semi-automatic proximal humeral trabecular bone density assessment tool: technique application and clinical validation.

PURPOSE: This study aimed to apply a newly developed semi-automatic phantom-less QCT (PL-QCT) to measure proximal humerus trabecular bone density based on chest CT and verify its accuracy and precision. METHODS: Subcutaneous fat of the shoulder joint and trapezius muscle were used as calibration references for PL-QCT BMD measurement. A self-developed algorithm based on a convolution map was utilized in PL-QCT for semi-automatic BMD measurements. CT values of ROIs used in PL-QCT measurements were directly used for phantom-based quantitative computed tomography (PB-QCT) BMD assessment. The study included 376 proximal humerus for comparison between PB-QCT and PL-QCT. Two sports medicine doctors measured the proximal humerus with PB-QCT and PL-QCT without knowing each other's results. Among them, 100 proximal humerus were included in the inter-operative and intra-operative BMD measurements for evaluating the repeatability and reproducibility of PL-QCT and PB-QCT. RESULTS: A total of 188 patients with 376 shoulders were involved in this study. The consistency analysis indicated that the average bias between proximal humerus BMDs measured by PB-QCT and PL-QCT was 1.0 mg/cc (agreement range - 9.4 to 11.4; P > 0.05, no significant difference). Regression analysis between PB-QCT and PL-QCT indicated a good correlation (R-square is 0.9723). Short-term repeatability and reproducibility of proximal humerus BMDs measured by PB-QCT (CV: 5.10% and 3.41%) were slightly better than those of PL-QCT (CV: 6.17% and 5.64%). CONCLUSIONS: We evaluated the bone quality of the proximal humeral using chest CT through the semi-automatic PL-QCT system for the first time. Comparison between it and PB-QCT indicated that it could be a reliable shoulder BMD assessment tool with acceptable accuracy and precision. This study developed and verify a semi-automatic PL-QCT for assessment of proximal humeral bone density based on CT to assist in the assessment of proximal humeral osteoporosis and development of individualized treatment plans for shoulders.

Neighboring Molecular Engineering in Diels-Alder Chemistry Enabling Easily Recyclable Carbon Fiber Reinforced Composites.

Although a variety of dynamic covalent bonds have been successfully used in the development of diverse sustainable thermosetting polymers and their composites, solving the trade-off between recovery efficiency and comprehensive properties is still a major challenge. Herein, a "one-stone-two-birds" strategy of lower rotational energy barrier (Er ) phosphate-derived Diels-Alder (DA) cycloadditions was proposed for easily recyclable carbon fiber (CF)-reinforced epoxy resins (EPs) composites. In such a strategy, the phosphate spacer with lower Er accelerated the segmental mobility and dynamic DA exchange reaction for network rearrangement to achieve high-efficiency repairing, reprocessing of the EPs matrix and its composites and rapid nondestructive recycling of CF; meanwhile, incorporating phosphorus-based units especially reduced their fire hazards. The resulting materials simultaneously showed excellent thermal/mechanical properties, superb fire safety and facile recyclability, realizing the concept of recycling for high-performance thermosetting polymers and composites. This strategy is of great significance for understanding and enriching the molecular connotation of DA chemistry, making it potentially applicable to the design and development of a wide range of dynamic covalent adaptable materials toward practical cutting-edge-tech applications.

Development and clinical validation of deep learning for auto-diagnosis of supraspinatus tears.

BACKGROUND: Accurately diagnosing supraspinatus tears based on magnetic resonance imaging (MRI) is challenging and time-combusting due to the experience level variability of the musculoskeletal radiologists and orthopedic surgeons. We developed a deep learning-based model for automatically diagnosing supraspinatus tears (STs) using shoulder MRI and validated its feasibility in clinical practice. MATERIALS AND METHODS: A total of 701 shoulder MRI data (2804 images) were retrospectively collected for model training and internal test. An additional 69 shoulder MRIs (276 images) were collected from patients who underwent shoulder arthroplasty and constituted the surgery test set for clinical validation. Two advanced convolutional neural networks (CNN) based on Xception were trained and optimized to detect STs. The diagnostic performance of the CNN was evaluated according to its sensitivity, specificity, precision, accuracy, and F1 score. Subgroup analyses were performed to verify its robustness, and we also compared the CNN's performance with that of 4 radiologists and 4 orthopedic surgeons on the surgery and internal test sets. RESULTS: Optimal diagnostic performance was achieved on the 2D model, from which F1-scores of 0.824 and 0.75, and areas under the ROC curves of 0.921 (95% confidence interval, 0.841-1.000) and 0.882 (0.817-0.947) were observed on the surgery and internal test sets. For the subgroup analysis, the 2D CNN model demonstrated a sensitivity of 0.33-1.000 and 0.625-1.000 for different degrees of tears on the surgery and internal test sets, and there was no significant performance difference between 1.5 and 3.0 T data. Compared with eight clinicians, the 2D CNN model exhibited better diagnostic performance than the junior clinicians and was equivalent to senior clinicians. CONCLUSIONS: The proposed 2D CNN model realized the adequate and efficient automatic diagnoses of STs, which achieved a comparable performance of junior musculoskeletal radiologists and orthopedic surgeons. It might be conducive to assisting poor-experienced radiologists, especially in community scenarios lacking consulting experts.

Surgical management of chronic calcific deposit resembling tendon sheath infection in the index finger: A rare case report and literature review.

Background: Calcific tendonitis rarely occurs in the fingers, and it is easily misdiagnosed. Herein we describe the case of a patient with multiple calcific lesions within the flexor digitorum superficialis and the extensor digitorum tendons of the distal interphalangeal joints of the right index finger, and the surgical treatment of those lesions. Case presentation: The patient was a 66-year-old man who reported pain and swelling in his right index finger for one year. He was diagnosed with chronic calcific tendonitis based on his symptoms and radiology images. He was successfully treated surgically, and histopathological examination confirmed the diagnosis. After one month, the patient had healed well, and there was no recurrence. Conclusions: This is the first report of a patient suffering from chronic calcific tendonitis in a finger who failed conservative treatment and was successfully treated with surgery. The outcome demonstrates that surgical debridement can yield a good outcome in patients with chronic calcific tendonitis.

Progress of polymer-based strategies in fungal disease management: Designed for different roles.

Fungal diseases have posed a great challenge to global health, but have fewer solutions compared to bacterial and viral infections. Development and application of new treatment modalities for fungi are limited by their inherent essential properties as eukaryotes. The microorganism identification and drug sensitivity analyze are limited by their proliferation rates. Moreover, there are currently no vaccines for prevention. Polymer science and related interdisciplinary technologies have revolutionized the field of fungal disease management. To date, numerous advanced polymer-based systems have been developed for management of fungal diseases, including prevention, diagnosis, treatment and monitoring. In this review, we provide an overview of current needs and advances in polymer-based strategies against fungal diseases. We high light various treatment modalities. Delivery systems of antifungal drugs, systems based on polymers' innate antifungal activities, and photodynamic therapies each follow their own mechanisms and unique design clues. We also discuss various prevention strategies including immunization and antifungal medical devices, and further describe point-of-care testing platforms as futuristic diagnostic and monitoring tools. The broad application of polymer-based strategies for both public and personal health management is prospected and integrated systems have become a promising direction. However, there is a gap between experimental studies and clinical translation. In future, well-designed in vivo trials should be conducted to reveal the underlying mechanisms and explore the efficacy as well as biosafety of polymer-based products.

Highly Flame-Retardant and Low Heat/Smoke-Release Wood Materials: Fabrication and Properties.

Wood is an important renewable material exhibiting excellent physical and mechanical properties, environmental friendliness, and sustainability, and has been widely applied in daily life. However, its inherent flammability and susceptibility to fungal attack greatly limit its application in many areas. Use of fire-retardant coatings and preservatives has endowed wood with improved safety performance; importantly, the cooperative effect of dual treatments on the burning behavior and flame retardancy of wood needs to be better understood. Here, a two-step treatment for wood is proposed, with a copper-boron preservative (CBP) and a fire-retardant coating. The thermal degradation and burning behavior of treated wood were investigated. The CBP formed a physical barrier on the wood surface, facilitating a charring process at high temperatures and thus suppressing the release of heat and smoke. Notably, the dual-treated wood exhibited lower heat release and reduced smoke emission compared with the mono-treated wood, indicating a cooperative effect between CBP and fire-retardant coatings, beneficial to the improvement of fire safety. This experimental work improved fire retardance and suppressed smoke release in flammable materials, and offers a new design for developing fire-retardant coatings.

Fully Automatic Knee Joint Segmentation and Quantitative Analysis for Osteoarthritis from Magnetic Resonance (MR) Images Using a Deep Learning Model.

BACKGROUND We aimed to develop and evaluate a deep learning-based method for fully automatic segmentation of knee joint MR imaging and quantitative computation of knee osteoarthritis (OA)-related imaging biomarkers. MATERIAL AND METHODS This retrospective study included 843 volumes of proton density-weighted fat suppression MR imaging. A convolutional neural network segmentation method with multiclass gradient harmonized Dice loss was trained and evaluated on 500 and 137 volumes, respectively. To assess potential morphologic biomarkers for OA, the volumes and thickness of cartilage and meniscus, and minimal joint space width (mJSW) were automatically computed and compared between 128 OA and 162 control data. RESULTS The CNN segmentation model produced reasonably high Dice coefficients, ranging from 0.948 to 0.974 for knee bone compartments, 0.717 to 0.809 for cartilage, and 0.846 for both lateral and medial menisci. The OA-related biomarkers computed from automatic knee segmentation achieved strong correlation with those from manual segmentation: average intraclass correlations of 0.916, 0.899, and 0.876 for volume and thickness of cartilage, meniscus, and mJSW, respectively. Volume and thickness measurements of cartilage and mJSW were strongly correlated with knee OA progression. CONCLUSIONS We present a fully automatic CNN-based knee segmentation system for fast and accurate evaluation of knee joint images, and OA-related biomarkers such as cartilage thickness and mJSW were reliably computed and visualized in 3D. The results show that the CNN model can serve as an assistant tool for radiologists and orthopedic surgeons in clinical practice and basic research.

Investigation of sag behaviour for aluminium conductor steel reinforced considering tensile stress distribution.

Sag calculation plays an important role in overhead line design. Since the tensile stress of aluminium conductor steel reinforced (ACSR) is required for the sag calculation, an analysis on sag behaviour when considering the tensile stress distribution can be very useful to improve the accuracy of sag results. First, this paper analyses the ACSR tensile stress distribution arising from the temperature maldistribution through proposing a new calculation formula. A finite-element analysis (FEA) model of ACSR is conducted for the solution of the new formula. By using the results, the error and limitations of the existing sag calculation methods for ACSR are discussed. As the critical point of sag calculation, knee-point temperature is solved iteratively involving the tensile stress maldistribution phenomenon in aluminium wires. Based on this iterative solution, an improved analytical method for the ACSR sag calculation considering the creep effect is presented and also compared with the hybrid sag method. The results show that these two methods are basically coincident without the consideration of creep effect, while there are non-negligible differences between them as the creep strain is involved. Compared with the existing analytical methods, the improved sag calculation method proposed in this paper can be applied in more extensive situations.

[Application of percutaneous pie-crusting deep medial collateral ligament release for posterior horn surgery of medial meniscus].

OBJECTIVE: To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment. METHODS: From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation. RESULTS: All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference(P>0.05). Lysholm score was improved from 53.4±8.8 before operation to 91.5±4.6 at 24 months after operation;IKDC score was increased from 50.7±9.2 before operation to 90.6±3.9 at 24 months after operation;there was statistically significant (P<0.05). Valgus stress test was performed on 0 ° and 30 ° position of knee flexion in affected side and compared with ipsilateral side, all patients showed negative. CONCLUSION: For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.

Enhancing ZnO-NP Antibacterial and Osteogenesis Properties in Orthopedic Applications: A Review.

Prosthesis-associated infections and aseptic loosening are major causes of implant failure. There is an urgent need to improve the antibacterial ability and osseointegration of orthopedic implants. Zinc oxide nanoparticles (ZnO-NPs) are a common type of zinc-containing metal oxide nanoparticles that have been widely studied in many fields, such as food packaging, pollution treatment, and biomedicine. The ZnO-NPs have low toxicity and good biological functions, as well as antibacterial, anticancer, and osteogenic capabilities. Furthermore, ZnO-NPs can be easily obtained through various methods. Among them, green preparation methods can improve the bioactivity of ZnO-NPs and strengthen their potential application in the biological field. This review discusses the antibacterial abilities of ZnO-NPs, including mechanisms and influencing factors. The toxicity and shortcomings of anticancer applications are summarized. Furthermore, osteogenic mechanisms and synergy with other materials are introduced. Green preparation methods are also briefly reviewed.

Tantalum boride as a biocompatible coating to improve osteogenesis of the bionano interface.

A proper biological microenvironment conducive to tissue repair and regeneration, while the bioimplant interface directly affects the local microenvironment. In this study, to improve the biological microenvironment, a nanosized tantalum boride (Ta-B) was coated on a titanium alloy substrate (Ti6Al4V, TC4) using magnetron cosputtering. The sample surface was characterized by X-ray diffraction (XRD) and transmission electron microscopy (TEM). To investigate the effects of tantalum boride coating on the microenvironment, rabbit bone marrow stromal cells (BMSCs), and RAW 264.7 cells were respectively seeded on the sample surface and relevant experiments were conducted in vitro. The pure tantalum coating (Ta) and naked TC4 were prepared as controls. Our results showed that the Ta-B coating enhanced cell proliferation and adhesion and inhibited the inflammatory response. Findings of alkaline phosphatase (ALP) staining, alizarin red staining and real-time PCR for osteoblastic gene expression indicated that Ta-B and Ta coating improve the osteogenesis, in which Ta-B coating showed higher osteogenesis than Ta coating. Thus, this study suggests that Ta-B coating with excellent biocompatibility could have new applications for wound healing in bone tissue engineering.

Fire hazards management for polymeric materials via synergy effects of pyrolysates-fixation and aromatized-charring.

Previous approaches to suppressing fire hazards are concentrated on brominated flame retardants (BFRs) or phosphorus flame retardants (PFRs). However, their chemical hazards to health and environment have not been able to be ignored currently. It is quite urgent to propose a durable and environmentally-friendly fire-safe strategy, which can eliminate migration, release, and environmental hazards of traditional flame retardants during their use, disposal, and recycling. Herein, we design a fire-responsive molecule (FRM) only containing C, H, and O elements based on full-life-cycle consideration and achieve fire safety via the synergy of specifically binding aliphatic fragments and aromatized charring in combustion. The resulting polymer shows low fire hazard with excellent self-extinguish, low organic volatiles/heat/smoke release, and good comprehensive performance. This polymer can be fabricated to fibres with potential applications for textiles, and electronics, etc. Therefore, we achieve a durable fire-safe strategy without flame-retardant chemicals hazard. This approach can fundamentally eliminate the potential chemical hazards associated with the introduction of halogen or phosphorus flame retardants and give a new vision about solving the "flame retardant chemical hazard issues" that are debated, tracked, and evaluated for several decades.

Avulsion of the femoral attachment of the medial collateral ligament in the setting of knee multiligament injury: A case report.

RATIONALE: Medial collateral ligament (MCL) injury is a common sports injury. The damage mainly occurs in ligament fibers, but MCL avulsion fracture is extremely rare and only a few reports have been published. PATIENT CONCERNS: Herein, we present a healthy 21-year-old man with an avulsion fracture of the MCL of the right knee sustained during snowboarding. DIAGNOSIS: Clinical and radiographic findings confirmed the presence of an avulsion fracture at the proximal attachment of the MCL, combined with complete anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rupture. INTERVENTIONS: The patient underwent single-stage ACL, PCL reconstruction, and MCL repair. OUTCOMES: Two weeks after the surgery, the patient developed heterotopic ossification (HO) at the medial side of the knee, HO tended to be stable and mature at the 3-month follow-up examination. One year after the operation, the patient's knee was fully functional, stable, and pain free. LESSONS: Femoral attachment avulsion fracture of the MCL is in contrast to common isolated MCL injuries. Early surgical repair is advocated for the greatest benefit. Orthopedic surgeons should keep the potential complication HO in mind and develop rational strategies for HO prevention and treatment.

Fabrication and In Vitro Evaluation of 3D Printed Porous Polyetherimide Scaffolds for Bone Tissue Engineering.

For bone tissue engineering, the porous scaffold should provide a biocompatible environment for cell adhesion, proliferation, and differentiation and match the mechanical properties of native bone tissue. In this work, we fabricated porous polyetherimide (PEI) scaffolds using a three-dimensional (3D) printing system, and the pore size was set as 800 µm. The morphology of 3D PEI scaffolds was characterized by the scanning electron microscope. To investigate the mechanical properties of the 3D PEI scaffold, the compressive mechanical test was performed via an electronic universal testing system. For the in vitro cell experiment, bone marrow stromal cells (BMSCs) were cultured on the surface of the 3D PEI scaffold and PEI slice, and cytotoxicity, cell adhesion, and cell proliferation were detected to verify their biocompatibility. Besides, the alkaline phosphatase staining and Alizarin Red staining were performed on the BMSCs of different samples to evaluate the osteogenic differentiation. Through these studies, we found that the 3D PEI scaffold showed an interconnected porous structure, which was consistent with the design. The elastic modulus of the 3D PEI scaffold (941.33 ± 65.26 MPa) falls in the range of modulus for the native cancellous bone. Moreover, the cell proliferation and morphology on the 3D PEI scaffold were better than those on the PEI slice, which revealed that the porous scaffold has good biocompatibility and that no toxic substances were produced during the progress of high-temperature 3D printing. The osteogenic differentiation level of the 3D PEI scaffold and PEI slice was equal and ordinary. All of these results suggest the 3D printed PEI scaffold would be a potential strategy for bone tissue engineering.

Enhanced antibacterial properties of orthopedic implants by titanium nanotube surface modification: a review of current techniques.

Prosthesis-associated infections are one of the main causes of implant failure; thus it is important to enhance the long-term antibacterial ability of orthopedic implants. Titanium dioxide nanotubes (TNTs) are biomaterials with good physicochemical properties and biocompatibility. Owing to their inherent antibacterial and drug-loading ability, the antibacterial application of TNTs has received increasing attention. In this review, the process of TNT anodizing fabrication is summarized. Also, the mechanism and the influencing factors of the antibacterial property of bare TNTs are explored. Furthermore, different antibacterial strategies for carrying drugs, as well as modifications to prolong the antibacterial effect and reduce drug-related toxicity are discussed. In addition, antibacterial systems based on TNTs that can automatically respond to infection are introduced. Finally, the currently faced problems are reviewed and potential solutions are proposed. This review provides new insight on TNT fabrication and summarizes the most advanced antibacterial strategies involving TNTs for the enhancement of long-term antibacterial ability and reduction of toxicity.

Fire-Safe Polyesters Enabled by End-Group Capturing Chemistry.

Upon heating, polyesters decompose to small molecules and release flammable volatiles and toxic gases, primarily through chain scission of their ester linkages, and therefore exhibit poor fire-safety properties, thus restricting their applications. Reported herein is an end-group-capturing effect of (bis)oxazoline groups, generated from the thermal rearrangement of the N-(2-hydroxyphenyl)phthalimide (HPI) moiety which was incorporated into the polyester chain by copolymerization. These copolyesters, as a result, exhibit high efficiency in retarding decomposition by capturing the decomposed products, particularly for the carbonyl-terminated fragments, thus increasing the fire-safety properties, such as self-extinguishing, anti-dripping, and inhibiting heat release and smoke production. The successful application of this method in both semi-aromatic and aliphatic polyesters provide promising perspectives to designing versatile fire-safe polymers.