Intravenous Tranexamic Acid Has Benefit for Reducing Blood Loss after Open-Wedge High Tibial Osteotomy: A Randomized Controlled Trial.

(1) Background: the purpose of this study was to investigate the efficacy and safety of intravenous (IV) administration of tranexamic acid (TXA) in patients undergoing medial opening wedge high tibial osteotomy (MOWHTO). (2) Methods: a total of 73 patients were randomly allocated into two groups (TXA group and control group). The primary outcome was total perioperative calculated blood loss after MOWHTO. Secondary outcomes included self-reported pain severity using a 10-point visual analog scale (VAS) and the EuroQol-5 Dimension (EQ-5D) questionnaire. The postoperative allogeneic transfusion rate and wound complications were compared. Deep vein thrombosis (DVT) incidence was compared by conducting DVT computed tomography imaging. (3) Results: the total blood loss after surgery was 470.9 mL in the TXA group and 739.3 mL in the control group, showing a significant difference (p < 0.001). There were no differences in pain VAS scores between the two groups (all p > 0.05). No difference in preoperative EQ-5D scores for any items existed between the two groups. No transfusion was performed in either group. There was no difference in DVT incidence or the rate of wound complications between the two groups. (4) Conclusion: in patients undergoing MOWHTO, IV TXA reduces total blood loss and drainage amount. However, no additional benefits in clinical outcomes, transfusion rate, or wound complications were apparent, with similar DVT incidence rates.

Evaluation of Modified Sequential Multiplex PCR for Streptococcus pneumoniae Serotyping.

The aims of this study were to develop modified sequential multiplex PCR (SM-PCR) primer sets and to evaluate their ability and efficiency for serotype determination. We selected target serotypes for SM-PCR testing according to serotype prevalence as reported in Asian publications. The modified SM-PCR consisted of 6 groups of PCR reactions, and each reaction was performed using 5 primer pairs. We evaluated the efficiency and performance of this modified multiplex PCR using 378 pneumococcal strains by comparing the findings with the results of the Quellung reaction. A total of 30 primer pairs were used in a consecutive set of 6 reactions. All results were concordant with those of the Quellung reaction and there was no cross-reactivity to unintended serotypes. We could identify the final serotypes of 370 isolates (97.9%). The coverage rates of modified SM-PCR were 42.6%, 65.9%, and 79.4% in reactions1, 2, and 3, respectively. The modified SM-PCR showed acceptable performance for detecting pneumococcal serotypes and can serve as useful alternative to the Quellung reaction.

Goldfish, Carassius auratus, as an infection model for studying the pathogenesis of Edwardsiella piscicida.

This study demonstrates the feasibility of using goldfish as an infection model to investigate the pathogenesis of Edwardsiella piscicida. Goldfish were found to be susceptible to acute E. piscicida-induced disease and died in a dose-dependent manner. E. piscicida was further shown to replicate rapidly in the head kidneys and livers of infected goldfish from 1 d post-injection, and bacteria numbers were significantly decreased 5 d post-injection. Immune responses were successfully induced in goldfish injected with E. piscicida strains and 60% of goldfish inoculated with an attenuated E. piscicida strain were found to survive subsequent injection with a pathogenic strain. The results of differential leukocyte count experiments suggested that leukocytes were immediately recruited as an innate immune response against the infection. Thus, this well-characterized goldfish species is a suitable infection model for studying E. piscicida pathogenesis, and might be applicable to research on other fish diseases.

Surgical accuracy, function, and quality of life of simultaneous versus staged bilateral Total hip Arthroplasty in patients with Osteonecrosis of the femoral head.

BACKGROUND: The optimal surgical option for patients requiring bilateral hip replacement remains controversial. The purpose of this study was to compare surgical accuracy; functional outcome and health-related quality of life; and prosthetic-related complications and revision surgery of a simultaneous bilateral total hip arthroplasty (THA) with those of a staged bilateral THA with an interval between procedures <12 months. METHODS: A total of 123 unselected consecutive patients (mean age, 43.3 years) who underwent bilateral THAs for osteonecrosis of the femoral head (ONFH) with a minimum follow-up of two years (mean, 60.2 months) were studied retrospectively; 63 simultaneous procedures served as a test group and 60 staged procedures served as a control group. RESULTS: The mean postoperative leg-length discrepancy (LLD) and the percentage of patients who had an LLD >3 mm were significantly lower in the simultaneous group (P < 0.001 and P = 0.001, respectively). A higher number of cups within the safe zones, a higher correction rate, and a lower failure rate for the cup placement in the second-operated hip were also identified in the simultaneous group. The mean Harris hip score, EuroQol-5D index, and EuroQol-visual analogue scale score were all better in the simultaneous group at the latest follow-up (P < 0.001, in all comparisons). We found that the simultaneous procedure was associated with a lower incidence of postoperative prosthetic-related complications and revision surgery. CONCLUSIONS: We suggest that bilateral ONFH could be treated with a simultaneous THA rather than a staged THA to achieve a better surgical outcome.

Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Isolates Causing Invasive and Noninvasive Pneumococcal Diseases in Korea from 2008 to 2014.

Introduction. Streptococcus pneumoniae is an important pathogen with high morbidity and mortality rates. The aim of this study was to evaluate the distribution of common serotypes and antimicrobial susceptibility of S. pneumoniae in Korea. Methods. A total of 378 pneumococcal isolates were collected from 2008 through 2014. We analyzed the serotype and antimicrobial susceptibility for both invasive and noninvasive isolates. Results. Over the 7 years, 3 (13.5%), 35 (10.8%), 19A (9.0%), 19F (6.6%), 6A (6.1%), and 34 (5.6%) were common serotypes/serogroups. The vaccine coverage rates of PCV7, PCV10, PCV13, and PPSV23 were 21.4%, 23.3%, 51.9%, and 62.4% in all periods. The proportions of serotypes 19A and 19F decreased and nonvaccine serotypes increased between 2008 and 2010 and 2011 and 2014. Of 378 S. pneumoniae isolates, 131 (34.7%) were multidrug resistant (MDR) and serotypes 19A and 19F were predominant. The resistance rate to levofloxacin was significantly increased (7.2%). Conclusion. We found changes of pneumococcal serotype and antimicrobial susceptibility during the 7 years after introduction of the first pneumococcal vaccine. It is important to continuously monitor pneumococcal serotypes and their susceptibilities.

MALDI-TOF MS is more accurate than VITEK II ANC card and API Rapid ID 32 A system for the identification of Clostridium species.

All 50 Clostridium difficile strains were definitely identified by Vitek2 system, Rapid ID 32A system, and MALDI-TOF. For 18 non-difficile Clostridium strains, the identification results were correct in 2, 0, and 17 strains by Vitek2, Rapid ID 32A, and MALDI-TOF, respectively [corrected].

Clinical Relevance of the SRS-Schwab Classification for Degenerative Lumbar Scoliosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to evaluate the clinical relevance of the SRS-Schwab classification for degenerative lumbar scoliosis (DLS). SUMMARY OF BACKGROUND DATA: The SRS-Schwab classification has been presented and validated as a useful tool for adult spinal deformity (ASD). This classification includes various types of ASD (degenerative de novo scoliosis or adult form of idiopathic scoliosis). However, DLS has different clinical characteristics and pathophysiology compared with other forms of ASD. METHODS: In this retrospective cohort study, 216 (146 conservatively treated and 70 surgically treated) DLS patients were enrolled. The average patient age was 72.1 ±â€Š7.4 years. Clinical parameters for disability were measured using Oswestry disability index (ODI) and back and leg pain numerical rating scale. Radiographic parameters included SRS-Schwab sagittal modifiers (pelvic tilt [PT]; sagittal vertical axis [SVA];pelvic incidence-lumbar lordosis [PI-LL]), T1 pelvic angle, and coronal parameters (Cobb's angle [CA]; coronal imbalance [CI]; coronal deviation distance [CDD]; tilting angle [TA]). Correlations between clinical parameters and radiographic parameters were assessed and surgical rates along the SRS-Schwab sagittal modifiers were evaluated. RESULTS: Only PI-LL as a sagittal radiographic parameter showed a weak correlation with clinical parameters (r = 0.137-0.176) (P < 0.05). Coronal parameters such as CA, CI, CDD, and TA also showed weak correlation with clinical parameters (r = 0.137-0.202) (P < 0.05). Multiple regression analysis identified CA, CI, CDD, and PI-LL to be correlated with clinical parameters. On analysis for clinical outcomes (surgical rates and patient self-reported disability) along the grades of the SRS-Schwab sagittal modifiers, PT and SVA were not related to higher surgical rates or disability. CONCLUSION: Even though some radiological parameters showed statistically significant results, correlation between radiological and clinical parameters was weak. Not only deformity but also other clinical factors should be considered when evaluating DLS. LEVEL OF EVIDENCE: 4.

Centroid neural network with a divergence measure for GPDF data clustering.

An unsupervised competitive neural network for efficient clustering of Gaussian probability density function (GPDF) data of continuous density hidden Markov models (CDHMMs) is proposed in this paper. The proposed unsupervised competitive neural network, called the divergence-based centroid neural network (DCNN), employs the divergence measure as its distance measure and utilizes the statistical characteristics of observation densities in the HMM for speech recognition problems. While the conventional clustering algorithms used for the vector quantization (VQ) codebook design utilize only the mean values of the observation densities in the HMM, the proposed DCNN utilizes both the mean and the covariance values. When compared with other conventional unsupervised neural networks, the DCNN successfully allocates more code vectors to the regions where GPDF data are densely distributed while it allocates fewer code vectors to the regions where GPDF data are sparsely distributed. When applied to Korean monophone recognition problems as a tool to reduce the size of the codebook, the DCNN reduced the number of GPDFs used for code vectors by 65.3% while preserving recognition accuracy. Experimental results with a divergence-based k-means algorithm and a divergence-based self-organizing map algorithm are also presented in this paper for a performance comparison.

Recovery of image blocks using the method of alternating projections.

A technique for block-loss restoration in block-based image and video coding, dubbed recovery of image blocks using the method of alternating projections (RIBMAP), is developed. The algorithm is based on orthogonal projections onto constraint sets in a Hilbert space. For the recovery of a linear dimension N size block, a total of 8N vectors are extracted from the surrounding area of an N x N missing block. These vectors form a library from which the best matching spatial information for the missing block is extracted. Recovery vectors, including both undamaged and restored damaged pixels, are introduced. The vectors are used to find highly correlated information relating to the lost pixels. To assure continuity with the surrounding undamaged area, three additional convex constraints are formulated. Adherance to these sets is imposed using alternating projections. Simulation results using orthogonal projections demonstrate that RIBMAP recovers spatial structure faithfully. Simulation comparisons with other procedures are presented: Ancis and Giusto's hybrid edge-based average-median interpolation technique, Sun and Kwok's projections onto convex sets-based method, Hemami and Meng's interblock correlation interpolation approach, Shirani et al.'s modified interblock correlation interpolation scheme, and Alkachouh and Bellanger's fast discrete cosine transformation-based spatial domain interpolation algorithm. Characteristic of the results are those of the "Lena" JPEG image when one fourth of periodically spaced blocks in the image have errors. The peak signal-to-noise ratio of the restored image is 28.68, 29.99, 31.86, 31.69, 31.57, and 34.65 dB using that of Ancis and Giusto, Sun and Kwok, Hemami and Meng, Shirani et al., Alkachouh and Bellanger, and RIPMAP, respectively.

Content-based adaptive spatio-temporal methods for MPEG repair.

Block loss and propagation error due to cell loss or missing packet information during the transmission over lossy networks can cause severe degradation of block and predictive-based video coding. Herein, new fast spatial and temporal methods are presented for block loss recovery. In the spatial algorithm, missing block recovery and edge extention are performed by pixel replacement based on range constraints imposed by surrounding neighborhood edge information and structure. In the temporal algorithm, an adaptive temporal correlation method is proposed for motion vector (MV) recovery. Parameters for the temporal correlation measurement are adaptively changed in accordance to surrounding edge information of a missing macroblock (MB). The temporal technique utilizes pixels in the reference frame as well as surrounding pixels of the lost block. Spatial motion compensation is applied after MV recovery when the reference frame does not have sufficient information for lost MB restoration. Simulations demonstrate that the proposed algorithms recover image information reliably using both spatial and temporal restoration. We compare the proposed algorithm with other procedures with consistently favorable results.

Complex-bilinear recurrent neural network for equalization of a digital satellite channel.

Equalization of satellite communication using complex-bilinear recurrent neural network (C-BLRNN) is proposed. Since the BLRNN is based on the bilinear polynomial, it can be used in modeling highly nonlinear systems with time-series characteristics more effectively than multilayer perceptron type neural networks (MLPNN). The BLRNN is first expanded to its complex value version (C-BLRNN) for dealing with the complex input values in the paper. C-BLRNN is then applied to equalization of a digital satellite communication channel for M-PSK and QAM, which has severe nonlinearity with memory due to traveling wave tube amplifier (TWTA). The proposed C-BLRNN equalizer for a channel model is compared with the currently used Volterra filter equalizer or decision feedback equalizer (DFE), and conventional complex-MLPNN equalizer. The results show that the proposed C-BLRNN equalizer gives very favorable results in both the MSE and BER criteria over Volterra filter equalizer, DFE, and complex-MLPNN equalizer.