Determination of the Optimal Volume of 0.5% Ropivacaine in Single-Injection Retroclavicular Brachial Plexus Block for Arthroscopic Shoulder Surgery: A Phase I/II Trial.

BACKGROUND: A brachial plexus block plays an important role in providing perioperative analgesia for shoulder surgery; however, the inherent risk of phrenic nerve block and resulting hemidiaphragmatic paralysis may limit its use in patients with compromised pulmonary function. This study aimed to evaluate safety, efficacy, the maximum tolerated volume, and the optimal biological volume of 0.5% ropivacaine used in a single-injection retroclavicular brachial plexus block for arthroscopic shoulder surgery. METHODS: In this seamless single-arm exploratory phase I/II trial, a novel Bayesian optimal interval design was used to guide volume escalation for determination of the maximum tolerated volume, followed by sequential volume expansion using Bayesian optimal phase 2 design to establish the optimal biological volume. Fifty-four patients who underwent arthroscopic shoulder surgery received a single-injection retroclavicular brachial plexus block with 0.5% ropivacaine ranging from 15 mL to 40 mL. The primary outcomes were complete or partial hemidiaphragmatic paralysis in phase I, measured using ultrasound 30 min after block completion, and the block success in phase II, defined as achieving a total sensorimotor score ≥12 points and the total sensory score ≥3, measured through manual sensorimotor testing. RESULTS: The maximum tolerated volume for the single-injection retroclavicular brachial plexus block was determined to be 35 mL of 0.5% ropivacaine, with a hemidiaphragmatic paralysis rate of 0.09 (95% credible interval, 0 to 0.29). The optimal biological volume was found to be 25 mL, with a block success rate of 1.0 (95% credible interval, 0.95 to 1.0) and a negligible hemidiaphragmatic paralysis rate of 0.01 (95% credible interval, 0 to 0.06). CONCLUSIONS: A single-injection retroclavicular brachial plexus block using 25 mL of 0.5% ropivacaine produced consistent block success with a minimal HDP rate, suggesting the need for further studies to confirm this result in arthroscopic shoulder surgery.

Aboveground Biomass Mapping and Analysis of Spatial Drivers in the Qinghai-Xizang Plateau Permafrost Zone: A Case Study of the Beilu River Basin.

Aboveground biomass (AGB) serves as a crucial measure of ecosystem productivity and carbon storage in alpine grasslands, playing a pivotal role in understanding the dynamics of the carbon cycle and the impacts of climate change on the Qinghai-Xizang Plateau. This study utilized Google Earth Engine to amalgamate Landsat 8 and Sentinel-2 satellite imagery and applied the Random Forest algorithm to estimate the spatial distribution of AGB in the alpine grasslands of the Beiliu River Basin in the Qinghai-Xizang Plateau permafrost zone during the 2022 growing season. Additionally, the geodetector technique was employed to identify the primary drivers of AGB distribution. The results indicated that the random forest model, which incorporated the normalized vegetation index (NDVI), the enhanced vegetation index (EVI), the soil-adjusted vegetation index (SAVI), and the normalized burn ratio index (NBR2), demonstrated robust performance in regards to AGB estimation, achieving an average coefficient of determination (R2) of 0.76 and a root mean square error (RMSE) of 70 g/m2. The average AGB for alpine meadows was determined to be 285 g/m2, while for alpine steppes, it was 204 g/m2, both surpassing the regional averages in the Qinghai-Xizang Plateau. The spatial pattern of AGB was primarily driven by grassland type and soil moisture, with q-values of 0.63 and 0.52, and the active layer thickness (ALT) also played a important role in AGB change, with a q-value of 0.38, demonstrating that the influences of ALT should not be neglected in regards to grassland change.

Molecular insights into sarcopenia: ferroptosis-related genes as diagnostic and therapeutic targets.

Ferroptosis, characterized by iron accumulation and lipid peroxidation, leads to cell death. Growing evidence suggests the involvement of ferroptosis in sarcopenia. However, the fundamental ferroptosis-related genes (FRGs) for sarcopenia diagnosis, prognosis, and therapy remain elusive. This study aimed to identify molecular biomarkers of ferroptosis in sarcopenia patients. Gene expression profiles were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) between normal and sarcopenia samples were identified using the 'limma' package in R software. FRGs were extracted from GeneCards and FerrDB databases. Functional enrichment analysis determined the roles of DEGs using the 'clusterProfiler' package. A protein-protein network was constructed using Cytoscape software. Immune infiltration analysis and receiver operating characteristic (ROC) analysis were performed. mRNA-miRNA, mRNA-TF, and mRNA-drug interactions were predicted using ENCORI, hTFtarget, and CHIPBase databases. The network was visualized using Cytoscape. We identified 46 FRGs in sarcopenia. Functional enrichment analysis revealed their involvement in critical biological processes, including responses to steroid hormones and glucocorticoids. KEGG enrichment analysis implicated pathways such as carbon metabolism, ferroptosis, and glyoxylate in sarcopenia. Totally, 11 hub genes were identified, and ROC analysis demonstrated their potential as sensitive and specific markers for sarcopenia in both datasets. Additionally, differences in immune cell infiltration were observed between normal and sarcopenia samples. The hub genes identified in this study are closely associated with ferroptosis in sarcopenia and can effectively differentiate sarcopenia from controls. CDKN1A, CS, DLD, FOXO1, HSPB1, LDHA, MDH2, and YWHAZ show high sensitivity and specificity for sarcopenia diagnosis.Communicated by Ramaswamy H. Sarma.

Integrated single-cell and bulk RNA sequencing analysis identified pyroptosis-related signature for diagnosis and prognosis in osteoarthritis.

Osteoarthritis (OA), a degenerative disease of the joints, has one of the highest disability rates worldwide. This study investigates the role of pyroptosis-related genes in osteoarthritis and their expression in different chondrocyte subtypes at the individual cell level. Using OA-related datasets for single-cell RNA sequencing and RNA-seq, the study identified PRDEGs and DEGs and conducted Cox regression analysis to identify independent prognostic factors for OA. CASP6, NOD1, and PYCARD were found to be prognostic factors. Combined Weighted Gene Correlation Network Analysis with PPI network, a total of 15 hub genes related to pyroptosis were involved in the notch and oxidative phosphorylation pathways, which could serve as biomarkers for the diagnosis and prognosis of OA patients. The study also explored the heterogeneity of chondrocytes between OA and normal samples, identifying 19 single-cell subpopulation marker genes that were significantly different among 7 chondrocyte cell clusters. AGT, CTSD, CYBC, and THYS1 were expressed differentially among different cell subpopulations, which were associated with cartilage development and metabolism. These findings provide valuable insights into the molecular mechanisms underlying OA and could facilitate the development of new therapeutic strategies for this debilitating disease.

Effects of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fracture.

OBJECTIVE: To investigate the effect of depressive symptoms on osteoporotic bone metabolism and prognosis of joint replacement surgery in elderly male patients with femoral neck fractures. METHOD: 102 elderly male patients with femoral neck fractures hospitalized in the Beijing Hospital from January 2017 to January 2019 were included. The patients with femoral neck fractures were divided into the depression group and the control group. The observation indicators included: bone mineral density, serum alkaline phosphatase, serum calcium, serum phosphorus, 25-hydroxy-vitamin D, osteocalcin, Type I procollagen amino-terminal propeptide, serum ß-isomer of C-terminal telopeptide of type I collagen, hip function scores, and pain visual analogue scale at pre- and post-operative examinations. RESULTS: The BMD was significantly lower in the depressed group than in the control group [either for lumbar spine or hip, P < 0.05]. Serum 25-(OH)-D levels and serum OC levels were lower (both P < 0.05) in the depression group, while serum -CTX levels were higher in the depression group than in the control group (P < 0.05). Depression severity (GDS score) was negatively correlated with BMD (r = -0.456, P < 0.05), 25(OH)D (r = -0.546, P < 0.05), and OC (r = -0.215, P < 0.05), while positively correlated with ß-CTX (r = 0.372, P < 0.05). The Harris scores of the depression group were lower than the control group (P < 0.001). In the control group, VAS scores decrease at 12 months postoperatively while in the depressed group, VAS scores increased (P < 0.001). CONCLUSION: Depression is a risk factor for low bone mineral density and fracture, and adversely affects functional recovery and pain relief after artificial femoral head replacement. Special care should be taken for those patients with depressive symptoms in orthopedic practice.

Screening for autophagy/hypoxia/ferroptosis/pyroptosis-related genes of tendon injury and repair in a rat model after celecoxib and lactoferrin treatment.

BACKGROUND: Tendon injuries are among the most common musculoskeletal disorders. Celecoxib possesses an effective anti-inflammatory activity in the tendon injury treatment. Lactoferrin has a great potential for the tendon regeneration. However, the efficacy of celecoxib combined with lactoferrin in the treatment of tendon injury has not been reported. In this study, we aimed to investigate the effect of celecoxib and lactoferrin on tendon injury and repair, and screen for the crucial genes associated with the tendon injury and repair. METHODS: The rat tendon injury models were established and divided into four groups: normal control group (n = 10), tendon injury model group (n = 10), celecoxib treatment group (n = 10), and celecoxib + lactoferrin treatment group (n = 10). Then, RNA sequencing was performed to identify differentially expressed lncRNAs (DElncRNAs), miRNAs (DEmiRNAs) and mRNAs (DEmRNAs) in celecoxib treatment group and celecoxib + lactoferrin treatment group. Next, autophagy/hypoxia/ferroptosis/pyroptosis-related DEmRNAs were further identified. Subsequently, functional enrichment, protein-protein interaction (PPI) network and transcriptional regulatory network construction for these genes were performed. RESULTS: The animal study demonstrated that combinational administration of celecoxib with lactoferrin rescued the harmful effects caused by celecoxib in the treatment of tendon injury. Compared to tendon injury model group, 945 DEmRNAs, 7 DEmiRNAs and 34 DElncRNAs were obtained in celecoxib treatment group, and 493 DEmRNAs, 8 DEmiRNAs and 21 DElncRNAs were obtained in celecoxib + lactoferrin treatment group, respectively. Subsequently, 376 celecoxib + lactoferrin treatment group-specific DEmRNAs were determined. Then, 25 DEmRNAs associated with autophagy/hypoxia/ferroptosis/pyroptosis were identified. CONCLUSIONS: Several genes, such as, Ppp1r15a, Ddit4, Fos, Casp3, Tgfb3, Hspb1 and Hspa8, were identified to be associated with tendon injury and repair.

Altered microRNA expression profiles of human spermatozoa in normal fertile men of different ages.

MicroRNAs (miRNAs) are mediators of the aging process. The purpose of this work was to analyze the miRNA expression profiles of spermatozoa from men of different ages with normal fertility. Twenty-seven donors were divided into three groups by age (Group A, n = 8, age: 20-30 years; Group B, n = 10, age: 31-40 years; and Group C, n = 9, age: 41-55 years) for high-throughput sequencing analysis. Samples from 65 individuals (22, 22, and 21 in Groups A, B, and C, respectively) were used for validation by quantitative real-time polymerase chain reaction (qRT-PCR). A total of 2160 miRNAs were detected: 1223 were known, 937 were newly discovered and unnamed, of which 191 were expressed in all donors. A total of 7, 5, and 17 differentially expressed microRNAs (DEMs) were found in Group A vs B, Group B vs C, and Group A vs C comparisons, respectively. Twenty-two miRNAs were statistically correlated with age. Twelve miRNAs were identified as age-associated miRNAs, including hsa-miR-127-3p, mmu-miR-5100_L+2R-1, efu-miR-9226_L-2_1ss22GA, cgr-miR-1260_L+1, hsa-miR-652-3p_R+1, pal-miR-9993a-3p_L+2R-1, hsa-miR-7977_1ss6AG, hsa-miR-106b-3p_R-1, hsa-miR-186-5p, PC-3p-59611_111, hsa-miR-93-3p_R+1, and aeca-mir-8986a-p5_1ss1GA. There were 9165 target genes of age-associated miRNAs. Gene Ontology (GO) analysis of the target genes identified revealed enrichment of protein binding, membrane, cell cycle, and so on. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis of age-related miRNAs for target genes revealed 139 enriched pathways, such as signaling pathways regulating stem cell pluripotency, metabolic pathways, and the Hippo signaling pathway. This suggests that miRNAs play a key role in male fertility changes with increasing age and provides new evidence for the study of the mechanism of age-related male fertility decline.

miR-215-5p regulates osteoporosis development and osteogenic differentiation by targeting XIAP.

BACKGROUND: Osteoporosis (OP) is a metabolic disease that involves microstructure destruction and fracture damage. The present study probed into the significance of miR-215-5p in OP progression. METHODS: Serum samples were collected from surgical patients and healthy controls. qRT-PCR analysis was utilized to determine the miR-215-5p level in clinical samples and human bone mesenchymal stem cells (hBMSCs) induced by ß-glycerol phosphate. A dual luciferase reporter assay was exploited to examine the targeted relationship between miR-215-5p and XIAP. The mineralization and calcium deposition of hBMSCs were assessed by detection of ALP activity, Alizarin red staining, and osteoblast marker expression. Protein expression was determined by western blot analysis. RESULTS: MiR-215-5p was significantly reduced in patients with OP and increased in hBMSCs treated with ß-glycerophosphate. Enhanced miR-215-5p level triggered augment in osteoblast markers (Alkaline phosphatase/ ALP, Osteocalcin/ OCN, and Runt-Related Transcription Factor 2/ Runx2), which was accompanied by the increase of ALP activity in hBMSCs and accumulation of Calcium. Functional experiments show that XIAP was a target of miR-215-5p and negatively modulated by miR-215-5p. XIAP expression levels were increased in OP samples, and decreased XIAP in ß-glycerophosphate-treated hBMSCs inhibited its' osteogenic differentiation. Functional loss and acquisition experiments depicted that miR-215-5p promoted the differentiation of hBMSCs by inhibiting the XIAP level, playing a protective role in the pathogenesis of OP. CONCLUSIONS: ß-glycerophosphate promoted the osteogenic differentiation of hBMSCs, increased miR-215-5p level, and decreased XIAP. miR-215-5p stimulated osteogenic differentiation of hBMSCs by targeting XIAP, shedding new insights for the detection and therapy of OP.

[Development of a risk stratification model for subscapularis tendon tear based on patient-specific data from 528 shoulder arthroscopy].

Objective: To identify and screen sensitive predictors associated with subscapularis (SSC) tendon tear and develop a web-based dynamic nomogram to assist clinicians in early identification and intervention of SSC tendon tear. Methods: Between July 2016 and December 2021, 528 consecutive cases of patients who underwent shoulder arthroscopic surgery with completely MRI and clinical data were retrospectively analyzed. Patients admitted between July 2016 and July 2019 were included in the training cohort, and patients admitted between August 2019 and December 2021 were included in the validation cohort. According to the diagnosis of arthroscopy, the patients were divided into SSC tear group and non-SSC tear group. Univariate analysis, least absolute shrinkage and selection operator (LASSO) method, and 10-fold cross-validation method were used to screen for reliable predictors highly associated with SSC tendon tear in a training set cohort, and R language was used to build a nomogram model for internal and external validation. The prediction performance of the nomogram was evaluated by concordance index (C-index) and calibration curve with 1 000 Bootstrap. Receiver operating curves were drawn to evaluate the diagnostic performance (sensitivity, specificity, predictive value, likelihood ratio) of the predictive model and MRI (based on direct signs), respectively. Decision curve analysis (DCA) was used to evaluate the clinical implications of predictive models and MRI. Results: The nomogram model showed good discrimination in predicting the risk of SSC tendon tear in patients [C-index=0.878; 95% CI(0.839, 0.918)], and the calibration curve showed that the predicted results were basically consistent with the actual results. The research identified 6 predictors highly associated with SSC tendon tears, including coracohumeral distance (oblique sagittal) reduction, effusion sign (Y-plane), subcoracoid effusion sign, biceps long head tendon displacement (dislocation/subluxation), multiple posterosuperior rotator cuff tears (≥2, supra/infraspinatus), and MRI suspected SSC tear (based on direct sign). Compared with MRI diagnosis based on direct signs of SSC tendon tear, the predictive model had superior sensitivity (80.2% vs. 57.0%), positive predictive value (53.9% vs. 53.3%), negative predictive value (92.7% vs. 86.3%), positive likelihood ratio (3.75 vs. 3.66), and negative likelihood ratio (0.25 vs. 0.51). DCA suggested that the predictive model could produce higher clinical benefit when the risk threshold probability was between 3% and 93%. Conclusion: The nomogram model can reliably predict the risk of SSC tendon tear and can be used as an important tool for auxiliary diagnosis.

Quantum pulse coupled neural network.

Artificial neural network has been fully developed in recent years, but as the size of the network grows, the required computing power also grows rapidly. In order to take advantage of the parallel computing of quantum computing to solve the difficulties of large computation in neural network, quantum neural network was proposed. In this paper, based on the pulse coupled neural network (PCNN), quantum pulse coupled neural network (QPCNN) is proposed. In this model, the basic quantum logic gates are utilized to form quantum operation modules, such as quantum full adder, quantum multiplier, and quantum comparator. A quantum image convolution operation applicable to QPCNN is designed employing quantum full adders and neighborhood preparation module. And these modules are employed to complete the operations required for QPCNN. And based on QPCNN, an quantum image segmentation is designed. Meanwhile, the effectiveness of QPCNN is proved by simulation experiments, and the complexity analysis shows that QPCNN has exponential speedup compared with classical PCNN.

Ultrasonic biomechanics method for vortex and wall motion of left ventricle: a phantom and in vivo study.

BACKGROUND: The non-invasive quantitative evaluation of left ventricle (LV) function plays a critical role in clinical cardiology. This study proposes a novel ultrasonic biomechanics method by integrating both LV vortex and wall motion to fully assess and understand the LV structure and function. The purpose of this study was to validate the ultrasonic biomechanics method as a quantifiable approach to evaluate LV function. METHODS: Firstly, B-mode ultrasound images were acquired and processed, which were utilized to implement parameters for quantifying the LV vortex and wall motion respectively. Next, the parameters were compared in polyvinyl alcohol cryogen (PVA) phantoms with different degree of stiffness corresponding to different freezing and thawing cycles in vitro. Finally, the parameters were computed in vivo during one cardiac cycle to assess the LV function in normal and abnormal subjects in vivo. RESULTS: In vitro study, the velocity field of PVA phantom differed with stiffness (varied elasticity modulus). The peak of strain for wall motion decreases with the increase of elasticity modulus, and periodically changed values. Statistical analysis for parameters of vortex dynamics (energy dissipation index, DI; kinetic energy fluctuations, KEF; relative strength, RS; and vorticity, W) based on different elasticity (E) of phantom depicted the good viability of this algorithm. In vivo study, the results confirmed that subjects with LV dysfunction had lower vorticity and strain (S) compared to the normal group. CONCLUSION: Ultrasonic biomechanics method can obtain the vortex and wall motion of left ventricle. The method may have potential clinical value in evaluation of LV dysfunction.

MicroRNA expression profiles in the seminal plasma of nonobstructive azoospermia patients with different histopathologic patterns.

OBJECTIVE: To investigate microRNA (miRNA) expression profiles in the seminal plasma of nonobstructive azoospermia (NOA) patients with different histopathologic patterns and evaluate potential noninvasive diagnostic biomarkers of NOA. DESIGN: Sequencing and validation using quantitative reverse transcription polymerase chain reaction (qRT-PCR). SETTING: Reproductive center and research institute. PATIENT(S): Thirteen patients with NOA (7 Sertoli cell-only syndrome [SCOS] and 6 hypospermatogenesis to spermatogenesis arrest [SA]) and 7 normal fertile controls for sequencing, six samples per group for validation; 54 patients with NOA (27 SCOS and 27 SA) and 19 normal fertile controls for large-sample qRT-PCR analysis. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): MicroRNA expression profiles in the seminal plasma of patients with NOA with different histopathologic patterns were assessed using high-throughput sequencing and validated using qRT-PCR. RESULT(S): There were 78 overexpressed and 132 underexpressed miRNAs in patients with SCOS and 32 up-regulated and 90 down-regulated miRNAs in patients with SA compared with fertile men with normozoospermia. Two down-regulated and one up-regulated miRNA were validated using qRT-PCR, which indicated that the qRT-PCR and sequencing results were basically consistent. Hsa-miR-34c-5p expression was significantly lower in the seminal plasma of patients with NOA than normal fertile controls. The area under the receiver operating characteristic curve(AUC) for hsa-miR-34c-5p was 0.979 and 0.987 in the seminal plasma of patients with SA and patients with SCOS, respectively, compared with normal fertile controls. The AUC was 0.799 for hsa-miR-34c-5p in the seminal plasma between patients with SA and patients with SCOS. Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis of differentially expressed miRNA target genes revealed that the Notch signaling pathway was one of the most abundant signaling pathways. The expression of Hes5, an effector of the Notch signaling pathway, was significantly higher in the seminal plasma of patients with NOA than normal fertile controls. CONCLUSION(S): MicroRNA expression profiles in seminal plasma were altered in patients with NOA compared with normal fertile controls. The profiles differed in patients with NOA with different pathologic patterns. We speculate that miR-34c-5p in seminal plasma could be a potential noninvasive biomarker to diagnose patients with NOA and distinguish different pathologic types of NOA. The Notch signaling pathway may be involved in the pathogenesis of NOA.

A Data Fusion Modeling Framework for Retrieval of Land Surface Temperature from Landsat-8 and Modis Data.

Land surface temperature (LST) is a critical state variable of land surface energy equilibrium and a key indicator of environmental change such as climate change, urban heat island, and freezing-thawing hazard. The high spatial and temporal resolution datasets are urgently needed for a variety of environmental change studies, especially in remote areas with few LST observation stations. MODIS and Landsat satellites have complementary characteristics in terms of spatial and temporal resolution for LST retrieval. To make full use of their respective advantages, this paper developed a pixel-based multi-spatial resolution adaptive fusion modeling framework (called pMSRAFM). As an instance of this framework, the data fusion model for joint retrieval of LST from Landsat-8 and MODIS data was implemented to generate the synthetic LST with Landsat-like spatial resolution and MODIS temporal information. The performance of pMSRAFM was tested and validated in the Heihe River Basin located in China. The results of six experiments showed that the fused LST was high similarity to the direct Landsat-derived LST with structural similarity index (SSIM) of 0.83 and the index of agreement (d) of 0.84. The range of SSIM was 0.65-0.88, the root mean square error (RMSE) yielded a range of 1.6-3.4 °C, and the averaged bias was 0.6 °C. Furthermore, the temporal information of MODIS LST was retained and optimized in the synthetic LST. The RMSE ranged from 0.7 °C to 1.5 °C with an average value of 1.1 °C. When compared with in situ LST observations, the mean absolute error and bias were reduced after fusion with the mean absolute bias of 1.3 °C. The validation results that fused LST possesses the spatial pattern of Landsat-derived LSTs and inherits most of the temporal properties of MODIS LSTs at the same time, so it can provide more accurate and credible information. Consequently, pMSRAFM can be served as a promising and practical fusion framework to prepare a high-quality LST spatiotemporal dataset for various applications in environment studies.

Association between osteoporosis and hepatitis B cirrhosis: a case-control study.

BACKGROUND AND AIMS: Hepatitis B virus (HBV)-related cirrhosis is associated with decreased bone mineral density (BMD); however, the mechanism is yet unknown. To assess the incidence of osteoporosis in patients with HBV-associated cirrhosis and relevant mechanisms. METHODS: A total of 80 hospitalized patients with HBV-associated cirrhosis and 80 healthy controls were enrolled. The levels of serum osteocalcin, total procollagen type 1 amino-terminal propeptide, ß-C-terminal telopeptide of type I collagen (ß-CTX), and 25-hydroxy vitamin D3 (25(OH)D3) was evaluated in the cirrhosis group. RESULTS: The BMDs of the lumbar spine (P<0.001) and hip joints (P=0.015) in the cirrhosis group were significantly lower than those in the controls. The incidence of osteoporosis in the cirrhosis group was significantly higher than that in the control group (P<0.001). Compared to the patients of the Child-Pugh grade A and B, the BMD of lumbar spine and 25(OH)D3 was significantly decreased in patients of grade C, while ß-CTX was elevated. Patients in the cirrhosis group faced a higher risk of osteoporosis as compared to the controls(P<0.001). CONCLUSIONS: Enhanced bone resorption accounted for increased risk of osteoporosis in severe cirrhosis. Thus, HBV-associated cirrhosis was a risk factor for osteoporosis.

Changes of upright body posture in the sagittal plane of men and women occurring with aging - a cross sectional study.

BACKGROUND: Body posture is a fundamental indicator for assessing health and quality of life, especially for elderly people. Deciphering the changes in body posture occurring with age is a current topic in the field of geriatrics. The aims of this study were to assess the parameters of standing body posture in the global sagittal plane and to determine the dynamics of changes in standing body posture occurring with age and differences between men and women. METHODS: The measurements were performed on 226 individuals between the ages of 20 to 89 with a new photogrammetry, via which we assessed five postural angles - neck, thorax, waist, hip and knee. The data were analyzed with t-test, one-way ANOVA, linear regression model and generalized additive model. RESULTS: Among these segments studied here, neck changed most, while the middle segments of the body, waist and hip, were relative stable. Significant differences between men and women were found with respect to the angles of neck, thorax and hip. Three of the five postural angles were significantly influenced with aging, including increasing cervical lordosis, thoracic kyphosis and knee flexion, starting from no older than around 50 yrs. showed by fitting curve derived with generalized additive model. These changes were more marked among women. Besides, this study highlights the effects of age and gender on the complex interrelation between adjacent body segments in standing. CONCLUSIONS: The presented results showed changes in the parameters describing body posture throughout consecutive ages and emphasized that for an individualized functional analysis, it is essential to consider age-and gender-specific changes in the neck, thorax and knee. This paper presents useful externally generalizable information not only for clinical purposes but also to inform further research on larger numbers of subjects.

Identification of Frailty and Its Risk Factors in Elderly Hospitalized Patients from Different Wards: A Cross-Sectional Study in China.

OBJECTIVES: To survey the difference of frailty prevalence in elderly inpatients amongdifferent wards; to compare the diagnostic performance of five frailty measurements (Clinical Frailty Scale [CFS], FRAIL, Fried, Edmonton, Frailty Index [FI]) in identifying frailty; and to explore the risk factors of frailty in elderly inpatients. PARTICIPANTS AND METHODS: This was a cross-sectional study including 1000 inpatients (mean age 75.2±6.7 years, 51.5% male; 542, 229, and 229 patients from cardiology, non-surgical, and surgical wards, respectively) in a tertiary hospital from September 2018 to February 2019. We applied the combined index to integrate the five frailty measurements mentioned above as the gold standard of frailty diagnosis. Multivariate logistic regression models were used to determine the independent risk factors of frailty. RESULTS: Frailty prevalence was 32.3% (Fried), 36.2% (CFS), 19.2% (FRAIL), 25.2% (Edmonton), 35.1% (FI) in all patients. The frailty was more common in non-surgical wards, regardless of the frailty assessment tools used (non-surgical wards: 27.5% to 51.5%; cardiology ward: 14.9% to 29.3%; surgical wards: 18.8% to 41.9%). CFS≥5 showed a sensitivity of 94.1% and a specificity of 85.2% for all patients. FI≥0.25 showed a sensitivity of 94.8% and a specificity of 87.0% for all patients. Age [odds ratio (OR) = 1.089, P<0.001], education level (OR = 0.782, P=0.001), heart rate (OR = 1.025, P<0.001), albumin (OR = 0.911, P=0.002), log D-dimer (OR = 2.940, P<0.001), ≥5 comorbidities (OR = 2.164, P=0.002), and ≥5 medications (OR = 2.819, P<0.001) were independently associated with frailty in all participants. CONCLUSION: Frailty is common among elderly inpatients, especially in non-surgical wards. CFS is a preferred screening tool and FI may be an optimal assessment tool. Old age, low educational level, fast heart rate, low albumin, high D-dimer, ≥5 comorbidities, and polypharmacy are independent risk factors of frailty in elderly hospitalized patients.

A Traditional Herbal Formula Xianlinggubao for Pain Control and Function Improvement in Patients with Knee and Hand Osteoarthritis: A Multicenter, Randomized, Open-Label, Controlled Trial.

Evidence of efficacy of a traditional herbal formula Xianlinggubao (XLGB) for treatment of osteoarthritis (OA) is limited. The present study was designed to evaluate the efficacy of XLGB in the management of patients with knee and hand OA. This was a multicenter, stratified, open-label, randomized controlled trial conducted at six centers in China. People aged 40 or above, diagnosed with OA of the knee or hand, were randomly assigned to the XLGB treatment group or watchful waiting control group. Main outcome measures were the changes in the numeric pain rating scales (NPRS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) or the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) scores, from baseline to 6 months. In total 534 patients (272 to XLGB and 262 to control group) received interventions. Participants in the XLGB group exhibited significant improvement in NPRS (P < 0.001) and WOMAC score (P < 0.001) or AUSCAN score (P < 0.001) compared to control group. Treatment with XLGB at current regime significantly reduced pain and improved function of the knee and hand in patients with OA over a 6-month period, implying that XLGB could be suggested as an alternative treatment for patients with knee or hand OA.

Modulated Excitation Imaging System for Intravascular Ultrasound.

Advances in methodologies and tools often lead to new insights into cardiovascular diseases. Intravascular ultrasound (IVUS) is a well-established diagnostic method that provides high-resolution images of the vessel wall and atherosclerotic plaques. High-frequency (>50 MHz) ultrasound enables the spatial resolution of IVUS to approach that of optical imaging methods. However, the penetration depth decreases when using higher imaging frequencies due to the greater acoustic attenuation. An imaging method that improves the penetration depth of high-resolution IVUS would, therefore, be of major clinical importance. Modulated excitation imaging is known to allow ultrasound waves to penetrate further. This paper presents an ultrasound system specifically for modulated-excitation-based IVUS imaging. The system incorporates a high-voltage waveform generator and an image processing board that are optimized for IVUS applications. In addition, a miniaturized ultrasound transducer has been constructed using a Pb(Mg1/3Nb2/3)O3-PbTiO3 single crystal to improve the ultrasound characteristics. The results show that the proposed system was able to provide increases of 86.7% in penetration depth and 9.6 dB in the signal-to-noise ratio for 60 MHz IVUS. In vitro tissue samples were also investigated to demonstrate the performance of the system.

Machine learning based detection of age-related macular degeneration (AMD) and diabetic macular edema (DME) from optical coherence tomography (OCT) images.

Non-lethal macular diseases greatly impact patients' life quality, and will cause vision loss at the late stages. Visual inspection of the optical coherence tomography (OCT) images by the experienced clinicians is the main diagnosis technique. We proposed a computer-aided diagnosis (CAD) model to discriminate age-related macular degeneration (AMD), diabetic macular edema (DME) and healthy macula. The linear configuration pattern (LCP) based features of the OCT images were screened by the Correlation-based Feature Subset (CFS) selection algorithm. And the best model based on the sequential minimal optimization (SMO) algorithm achieved 99.3% in the overall accuracy for the three classes of samples.

Langerhans cell sarcoma originating from left knee subcutaneous tissue: A case report and literature review.

Langerhans cell sarcoma (LCS) is a neoplastic proliferation of Langerhans cells with notably malignant cytological features. Reports of LCS are sparsely available in English literature; to the best of our knowledge, only 55 cases have been reported. The present study reports a case of LCS originating from subcutaneous tissue of the left knee in a 75-year-old man. The diagnosis of LCS was supported by the results of magnetic resonance imaging, histological and immunohistochemical studies. The tumor began to metastasize to inguinal lymph nodes and eventually involved multiple organs. Chemotherapy and radiotherapy were administered but were ineffective, and the patient died within 2 years of diagnosis. The present case should aid in expanding the currently available knowledge concerning LCS.