Transformer for Image Harmonization and Beyond.

Image harmonization, aiming to make composite images look more realistic, is an important and challenging task. The composite, synthesized by combining foreground from one image with background from another image, inevitably suffers from the issue of inharmonious appearance caused by distinct imaging conditions, i.e., lights. Current solutions mainly adopt an encoder-decoder architecture with convolutional neural network (CNN) to capture the context of composite images, trying to understand what it should look like in the foreground referring to surrounding background. In this work, we seek to solve image harmonization with Transformer, by leveraging its powerful ability of modeling long-range context dependencies, for adjusting foreground light to make it compatible with background light while keeping structure and semantics unchanged. We present the design of our two vision Transformer frameworks and corresponding methods, as well as comprehensive experiments and empirical study, demonstrating the power of Transformer and investigating the Transformer for vision. Our methods achieve state-of-the-art performance on the image harmonization as well as four additional vision and graphics tasks, i.e., image enhancement, image inpainting, white-balance editing, and portrait relighting, indicating the superiority of our work. Code, models, more results and details can be found at the project website http://ouc.ai/project/HarmonyTransformer.

Effect of anemia and erythrocyte indices on hemoglobin A1c levels among pregnant women.

BACKGROUND: Anemia is a common disorder among pregnant women; however, the effect of anemia on hemoglobin A1c (HbA1c) levels has not been adequately explored. We aim to examine the influence of anemia on the HbA1c concentration and investigate the relationship between erythrocyte indices and HbA1c levels during pregnancy. METHODS: We performed a retrospective analysis of 1369 pregnant Chinese women. The clinical and analytical data were collected. Independent t-test and Analysis of Variance were used for comparative studies, and multiple linear regression analysis was used to identify the association between erythrocyte indices and HbA1c. RESULTS: The differences in HbA1c between non-anemia and mild anemia were negligible, and the differences in HbA1c between non-anemia and moderate anemia were well within the allowable variability for clinical practice (≥0.5% absolute changes). Mean corpuscular hemoglobin (MCH) correlated with HbA1c significantly, independent of pregnancy, trimester, and anemia. The distinction of HbA1c levels between grades of Hb became no significant (P = 0.955), while differences between trimesters persisted after adjusting for MCH. CONCLUSION: Mild and moderate anemia should not be the primary concern when using HbA1c to monitor blood glucose in pregnancy. MCH showed negative correlations with HbA1c independently, suggesting a previously unknown mechanism affecting HbA1c levels.

[Finite element optimization analysis of minimally invasive screw treatment for Sanders typeâ ¡calcaneal fracture].

OBJECTIVE: To explore biomechanical characteristics of minimally invasive different screw fixations in treating Sanders typeⅡcalcaneal fractures. METHODS: Dicom data of calcaneus by CT scan were input into Mimics 21.0 software and Ansys15.0 software to construct three-dimensional finite element digital model of calcaneus;this model was input into UG NX 10.0 software, and calcaneus was cut according to Sanders classification to establish Sanders typeⅡ calcaneus model with posterior articular surface collapse;then simulated minimally invasive screw internal fixation after calcaneal fracture:a screw from posterior articular surface was used to outside-in fix sustentaculum tali, other 4 screws were used to fix calcaneus by different methods through calcaneal tuberosity, and 4 different calcaneal models were obtained. Under the same conditions, 4 types of internal fixation models were loaded respectively, and nonlinear finite element analysis was performed to calculate the stress distribution of different internal fixation models. RESULTS: Under the same condition of loading, the model 3 had smaller displacement value, maximum calcaneus displacement value and maximum equivalent stress value of the screw than other three internal fixation models, and the stress was more dispersed. CONCLUSION: In minimally invasive screw internal fixation of calcaneus fracture, after 1 sustentaculum tali screw fixation, 2 screws crossed fix posterior articular surface from calcaneal tuberosity, 2 screws fix parallelly calcaneocuboid joint from calcaneal tuberosity are more suitable for biomechanical requirements, and could provide basic theory for clinical treatment.

[Application of reverse dermal revascularization combined with vacuum sealing drainage in the large area of skin avulsion of the lower extremities].

OBJECTIVE: To summarize the clinical effect of emergency subcutaneous vascular network reverse skin replantation combined with vacuum sealing after drainage of large area skin avulsion injury. METHODS: Clinical data of 30 patients with extensive skin avulsion of the lower limb treated between July 2010 and March 2018 were collected. There were 20 males and 10 females, ranging in age from 16 to 67 years old, with an average of(48±13) years old. Cause of injury: 19 cases of car accident injury, 11 cases of crush injury. The surgery time was 3 to 10 h, with an average of (5±1) h. All cases were completely debrided in stage I. The subdermal vascular network was reversed and skin grafted with multiple incision drainage combined with negative pressure closed drainage technique for 7 to 10 days. The wounds were removed by VSD observation:if the necrotic area is large, debridement is required. After the granulation growth of the wound is satisfactory, the skin grafting is performed again after electrification; the small area of necrotic skin strengthens the dressing and heals. RESULTS: 30 patients were followed up for 7 to 48 months, with an average of (20±11) months.No infection in 1 case appeared, 30 patients, living area more than 85% of the wound after treatment survival in the stage I; The skin necrosis ranged from about 12% in 5 patients in the stage II. The second stage was healed after redebriding free skin grafts. The other patients were healed after the dressing, capillary meshwork layer of skin color, good elasticity, feeling, wearable pressure, each joint activities is good, no obvious skin adhesion cause physical activity is limited. CONCLUSIONS: Reverse skin grafting combined with VSD for the treatment of large skin avulsion of lower limb can greatly reduce wound infection rate, promote the application of skin and wound, conducive to drainage, improve the survival rate of reverse skin grafting and improve the function of lower limb joints.

MicroRNA-181c Suppresses the Biological Progression of Osteosarcoma via Targeting SMAD7 and Regulating Transforming Growth Factor-ß (TGF-ß) Signaling Pathway.

BACKGROUND Osteosarcoma is a primary bone aggressive cancer, affecting adolescents worldwide. Increasing evidence suggests that dysfunction of microRNAs (miRNAs) plays a pivotal role in malignancies. The aim of this study was to evaluate the potential functions of miR-181c and verifying its regulatory effects on SMAD7 in osteosarcoma. MATERIAL AND METHODS The expressions of miR-181c and SMAD7 in osteosarcoma were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation, invasion and migration abilities were assessed using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and Transwell assay. Bioinformatics analysis and luciferase reporter assay were used to explore the interaction between miR-181c and SMAD7. Western blot was performed to determine the functions of miR-181c on osteosarcoma cell epithelial-to-mesenchymal transition (EMT) and transforming growth factor-ß (TGF-ß) signaling pathway. RESULTS Decreased expression levels of miR-181c and SMAD7 were identified in osteosarcoma using qRT-PCR. The downregulated miR-181c and SMAD7 expressions indicated poor prognosis of osteosarcoma patients. Moreover, miR-181c overexpression prominently repressed osteosarcoma cell proliferation, invasion, and migration abilities via modulating EMT and TGF-ß signaling pathway. SMAD7 functioned as an important target for miR-181c in osteosarcoma cells. Furthermore, upregulation of miR-181c dramatically suppressed osteosarcoma tumorigenesis in vivo. CONCLUSIONS These findings indicated that miR-181c suppressed osteosarcoma progression, providing new insight into the pathogenesis and representing a potential therapeutic target for osteosarcoma.

Decreased expression of STAT5A predicts poor prognosis in osteosarcoma.

BACKGROUND: Signal transducer and activator of transcription 5 (STAT5) plays a key role in the malignancy of many tumors and has been identified as a therapeutic target. However, the role of STAT5A in osteosarcoma is still unclear. METHODS: 98 osteosarcoma patients were obtain from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET). The relationship between STAT5A and clinical features was analyzed using the Wilcoxon signed-rank test and logistic regression. Kaplan-Meier method, univariate and multivariate Cox regression analyses were performed to assess the prognostic value in event-free survival (EFS) and overall survival (OS). Gene Set Enrichment Analysis (GSEA) was performed. RESULTS: STAT5A low expression was not linked to age, gender, tumor site, surgical approach, tumor region, histologic response, and metastasis, but was correlated with progression (OR = 5.2, P = 0.012). Kaplan-Meier survival curve showed that patients with STAT5A low expression had worse EFS and OS than those with STAT5A high expression (P < 0.01). Furthermore, the multivariate analysis revealed STAT5A was an independent prognostic factor for poor OS (HR = 3.29, P = 0.0408)) and EFS (HR = 7.29, P = 0.0025). GSEA showed that the complemen, metabolism, apoptosis, interferon-gamma response, inflammatory response, Notch, Kras, reactive oxygen species, VEGF, IL-6/JAK/STAT3, IL-2/Stat5, B-cell receptor, and p53 pathways were significantly associated with the STAT5A gene. CONCLUSIONS: STAT5A may be a novel prognostic factor for osteosarcoma and may act as a molecular target in the treatment of osteosarcoma.

The biomechanical study of rupture of Achilles Tendon and repair by different suture techniques.

OBJECTIVE: To study the biomechanical properties of different suture methods, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture. METHODS: Twenty four fresh frozen cadaver Achilles tendon specimens were collected and randomly divided into three groups (n=8), Group-A Bunnell suture method, Group-B Bosworth suture and Group-C anchor suture respectively. 5 N tensions were applied to tighten the tendon. The actual length of the tendon between the upper and lower clips was measured with a ruler. The length of the long axis and the short axis of the three sections of the tendon was measured by vernier caliper. The cross sectional area of the tendon was calculated according to the elliptical area formula and the mean value was obtained. RESULTS: There was no significant difference in the length and cross-sectional area of each tendon among three groups (F=0.26, P=0.86; F=0.09, P=0.96). There was no significant difference in the maximum load of tendon and failure displacement in Group A and B (P>0.05). The maximal load of Group-C was significantly larger than that of Group A and B (P<0.05), and there was no significant difference between the failure displacement and Group A and B (P>0.05). CONCLUSION: Three suture methods can provide good biomechanical properties, but the anchor suture is more effective in solving the shortcomings of traditional methods. It is a safe and effective method, and is worthy of promotion.

P16 protein expression as a useful predictive biomarker for neoadjuvant chemotherapy response in patients with high-grade osteosarcoma: A systematic meta-analysis under guideline of PRISMA.

BACKGROUND: Neoadjuvant chemotherapy for patients with high-grade osteosarcoma has highly improved the clinical survival. However, the prognostic and predictive role of P16 expression after neoadjuvant chemotherapy remains unclear. We first determined whether P16 expression can become a potential prognostic and predictive biomarker in high-grade osteosarcoma. METHODS: This meta-analysis was conducted based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. Eligible studies were pooled and the overall odds ratios (ORs) and hazard ratios (HRs) with the corresponding 95% confidence intervals (95% CIs) were calculated in this analysis. RESULTS: Four studies involving a total of 527 patients with high-grade osteosarcoma receiving neoadjuvant chemotherapy were identified. We did not find that P16 expression was correlated with sex status, histologic subtype, and tumor site (P > .1). P16 expression was found to be significantly associated with a "good" response to neoadjuvant chemotherapy (OR = 4.69, P < .001). A significant relationship was observed between p16 expression and pathologic complete response after neoadjuvant chemotherapy using multivariate analysis (OR = 9.63, P = .001). The expression of the P16 was not associated with clinical outcomes in overall survival (OS) and disease-free survival (DFS) by multivariate analysis (OS: P = .448; DFS: P = .263). CONCLUSIONS: The use of P16 expression could become a promising predictive biomarker of the response to neoadjuvant chemotherapy in the white population with high-grade osteosarcoma. However, it was not correlated with the prognosis of patients in OS and DFS. More clinical researches are very essential in Asians in the future.

[Comparison of fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing and ordinary screwing guide].

OBJECTIVE: To explore clinical outcomes of director for sustentaculum tali screwing for fixing sustentaculum tali of calcaneus. METHODS: From May 2012 to October 2013, totally 50 patients (60 feet) with calcaneal fractures were analyzed, and divided into director for sustentaculum calcaneous tali screwing treatment group (group A) and ordinary screwing group(group B). In group A, there were 25 patients, including 22 males and 3 females, aged from 17 to 75 years old with an average of (45.08±11.98) years; according to Sanders classification, 9 feet were type II, 16 feet were type III, and 7 feet were type IV. In group B, there were 25 patients, including 20 males and 5 females, aged from 19 to 78 years old with an average of (46.36±15.74) years; according to Sanders classification, 8 feet were type II, 13 feet were type III, and 7 feet were type IV. Radiological change, operative time, postoperative complications were observed and compared, Maryland scoring at 1 year after operation was applied to evaluate clinical outcomes. RESULTS: Fifty patients were followed up, group A was followed up from 12 to 24 months with an average of (17.72±4.08) months;while group B was followed up from 12 to 24 months with an average of (18.68±3.40) months;there was no significant difference between two groups in following-up time(P>0.05). There were significant difference in operative time, complications and fluoroscopy times between two groups(P<0.05). There were significant difference in Böhler angle and Gissanes angle between two groups before and after operation(P<0.05). Maryland score at 1 year after operation in group A was (84.94±12.75) and (76.96±15.32) in group B, had significant meaning between two groups (P<0.05). CONCLUSIONS: Fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing, has advantages of less operative time, fluoroscopy times, incidence of complications and good recovery of function, which could provide a new aiding method for treating intra-articular calcaneal fractures.

[MANUFACTURE AND CLINICAL APPLICATION OF SCREW DIRECTOR OF CALCANEOUS SUSTENTACULUM TALI FOR TREATMENT OF INTRA-ARTICULAR CALCANEAL FRACTURES].

OBJECTIVE: To evaluate the clinical results of the self-manufactured screw director of the calcaneous sustentaculum tali in the surgical treatment of intra-articular calcaneal fractures. METHODS: Between May 2012 and October 2013, 40 patients (47 feet) underwent surgical treatment of intra-articular calcaneal fractures, and the clinical data were analyzed. There were 29 males and 11 females with an average age of 46 years (range, 25-68 years). According to Sanders classification, 17 feet were rated as type II, 20 feet as type III, and 10 feet as type IV. The average time from injury to admission was 6.02 hours (range, 1-12 hours). All the patients were treated with the screw director of the calcaneous sustentaculum tali to fix the sustentaculum tali. The intraoperative times of fluoroscopy were recorded. The Böhler angle and Gissane angle were measured at pre- and post-operation. The clinical functional outcomes were evaluated according to the Maryland foot score system. RESULTS: The intraoperative times of fluoroscopy were 2-4 times (mean, 2.85 times). Radiographic examination showed 45 screws were accurately implanted into the middle of the sustentaculum tali in implanted 47 screws except 1 screw which penetrated into the anteroinferior of the sustentaculum tali and 1 screw which penetrated into the anterior of the sustentaculum tali. The accurate rate of screw implant was 95.7%. All patients were followed up for an average of 12 months (range, 8-18 months). During the follow-up, incision skin necrosis and infection occurred in 2 cases, and sural nerve injury developed in 3 cases. Bone union was achieved at an average of 12.72 weeks (range, 9-18 weeks) postoperatively. The Böhler angle was improved significantly from (6.48 ± 3.67) degrees pre-operatively to (29.40 ± 4.65) degrees post-operatively (t = -31.38, P = 0.00). The Gissane angle was improved significantly from (99.30 ± 5.85) degrees preoperatively to (130.84 ± 5.08) post-operatively (t = -28.32, P = 0.00). The Maryland foot score was 90.66 on average (range, 65-98) at last follow-up; the results were excellent in 41 feet, good in 3 feet, and fair in 3 feet with an excellent and good rate of 93.6%. CONCLUSION: The self-manufactured sc-ew director of the calcaneous sustentaculum tali can significantly improve the accuracy of the screw implanted into the sustentaculum tali and reduce the harm of intraoperative fluoroscopy to the body.

[Sustentaculum tali screw fixation for the treatment of Sanders type II and III calcaneal fractures].

OBJECTIVE: To explore the clinical outcomes of open reduction and internal fixation with calcaneal locking plates in treating Sanders type II and III calcaneal fractures. METHODS: From January 2010 and October 2012, 38 calcaneal fractures with Sanders type II or III were treated with open reduction and internal fixation with calcaneal locking plate. According to the Sanders classification, 15 fractures were classified as type II, 23 fractures as type III. The patients were divided into two groups (group A and B) according to the different fixed methods. Sustentaculum tali was fixed with one screw in group A, including 13 males and 5 females, with a mean age of (38.56±8.03) years old (ranged, 25 to 55). And sustentaculum tali was not fixed in group B, including 16 males and 4 females, with a mean age of (42.35±8.29) years old (ranged, 29 to 53). Clinical effects were evaluated according to the changes of Böhler's angle and the Maryland Foot Score and VAS score. RESULTS: All patients were followed up from 12 to 20 months with a mean of 14 months. Böhler's angles and subtalar joints obtained satisfactory reconstruction in all patients. One year after operation, the mean Maryland Foot Score was 88.61±7.59 in group A; and was 82.40±9.24 in group B; Maryland Foot Score of group A was higher and foot functional rehabilitation was better than group B. The mean VAS score was 13.39±11.47 in group A; and was 22.50±13.10 in group B; VAS score of group A was lower and foot pain was less than group B. CONCLUSION: Sustentaculum tall screw fixation has advantages of strong fixed strength, high stability, less postoperative pain, rapid functional recovery in treating Sanders type II and III calcaneal fractures.

The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: A finite element analysis.

OBJECTIVE: In the surgery of calcaneal fracture, whether the sustentaculum tali screw should always be placed is widely controversial. The aim of this study was to explore the necessity and function of the sustentaculum tali screw placement for the treatment of Sanders type II calcaneal fracture. METHODS: The finite element analysis was used in this study. After the establishment of the finite element model of Sanders type II calcaneal fracture, the two internal fixation simulations were designed. In one model, the AO calcaneal plate was simulated on the lateral side of the calcanues with 7 screws being fixated at different position of the plate. In the other model, the calcaneus was fixated with the same AO calcaneal plate together with an additional screw being infiltrated into the sustentaculum tali. The two models were simulated under the same loading and the displacement of the fracture line and the stress distribution in the two models were calculated respectively. RESULTS: The maximum principal stress focused on the cortical bone of sustentaculum tali in both the models under the same loading. The displacement of the fracture line, the maximum principal stress of calcaneus and internal fixation system in the model with sustentaculum screw fixation were smaller than that in the model without sustentaculum screw fixation. The stress in the model with sustentaculum screw fixation was more dispersed. CONCLUSIONS: The placement of sustentaculum tali screw is essential for fixation of type II calcaneal fracture to achieve the biomechanical stability.

Ethanol extract from Artemisia vestita, a traditional Tibetan medicine, exerts anti-sepsis action through down-regulating the MAPK and NF-kappaB pathways.

Artemisia vestita Wall., a traditional Tibetan medicine, has wide clinical application for inflammatory diseases. However, its molecular mechanism of anti-inflammatory effect is poorly understood. In the present study, we investigated the anti-inflammatory activity and underlying mechanism of the ethanol extract from Artemisia vestita (AV-ext) on lipopolysaccharide (LPS)-induced sepsis. Pretreatment with AV-ext significantly decreased the levels of tumor necrosis factor-alpha (TNF-alpha) in serum and liver and lung tissues, and improved the survival of mice with experimental sepsis. AV-ext also remarkably reduced the expression levels of TNF-alpha, interleukin-1beta and cyclooxygenase-2 in LPS-stimulated RAW 264.7 macrophages and dose dependently suppressed the activation of mitogen-activated protein kinases (MAPKs), such as p38, extracellular signal-regulated kinase (ERK1/2) and c-Jun NH2-terminal kinase (JNK). Furthermore, pretreatment with AV-ext dose dependently inhibited the activation of nuclear factor-kappaB (NF-kappaB), as well as the degradation and phosphorylation of inhibitory kappaB (IkappaB) in LPS-activated RAW 264.7 macrophages. These results collectively reveal that AV-ext inhibits TNF-alpha release from macrophages by suppressing MAPK and NF-kappaB signaling pathways and suggest that AV-ext may be beneficial for the treatment of endotoxin shock or sepsis.

Interactions between metal ions and carbohydrates. Coordination behavior of neutral erythritol to Ca(II) and lanthanide ions.

The study of the sugar-metal ion interactions remains one of the main objectives of carbohydrate coordination chemistry because the interactions between metal ions and carbohydrates are involved in many biochemical processes. This paper presents a comparison of coordination structures of erythritol with alkaline-earth-metal and lanthanide chloride and nitrate in the solid state using FT-IR and X-ray diffraction. Neutral, nondeprotonated erythritol (E) reacts with CaCl(2) to give three CaCl(2)(-)erythritol (CaE(I), CaE(II), CaE(III)) complexes, showing that three of the five general features of calcium-carbohydrate complexes deduced in the reference encounter contrary examples. Different coordination structures have been observed for calcium and lanthanide chloride and nitrates. The coordination of carbohydrates to metal ions is complicated, and erythritol, chloride ions, nitrates, water molecules, and ethanol (crystallization medium and reaction solvents) have the chance to coordinate to metal ions. IR spectral results show that different lanthanide ions, from LaCl(3) to TbCl(3), have similar coordination structures with erythritol. The results show that erythritol can act as two bidentate neutral ligands (CaE(I), CaE(II), CaE(III), CaEN, PrE, NdE) or as a three-hydroxyl donor (NdEN). The IR results are consistent with the crystal structures.