Calibrate the Inter-observer Segmentation Uncertainty via Diagnosis-first Principle.

Many of the tissues/lesions in the medical images may be ambiguous. Therefore, medical segmentation is typically annotated by a group of clinical experts to mitigate personal bias. A common solution to fuse different annotations is the majority vote, e.g., taking the average of multiple labels. However, such a strategy ignores the difference between the grader expertness. Inspired by the observation that medical image segmentation is usually used to assist the disease diagnosis in clinical practice, we propose the diagnosis-first principle, which is to take disease diagnosis as the criterion to calibrate the inter-observer segmentation uncertainty. Following this idea, a framework named Diagnosis-First segmentation Framework (DiFF) is proposed. Specifically, DiFF will first learn to fuse the multi-rater segmentation labels to a single ground-truth which could maximize the disease diagnosis performance. We dubbed the fused ground-truth as Diagnosis-First Ground-truth (DF-GT). Then, the Take and Give Model (T&G Model) to segment DF-GT from the raw image is proposed. With the T&G Model, DiFF can learn the segmentation with the calibrated uncertainty that facilitate the disease diagnosis. We verify the effectiveness of DiFF on three different medical segmentation tasks: optic-disc/optic-cup (OD/OC) segmentation on fundus images, thyroid nodule segmentation on ultrasound images, and skin lesion segmentation on dermoscopic images. Experimental results show that the proposed DiFF can effectively calibrate the segmentation uncertainty, and thus significantly facilitate the corresponding disease diagnosis, which outperforms previous state-of-the-art multi-rater learning methods.

Open Fundus Photograph Dataset with Pathologic Myopia Recognition and Anatomical Structure Annotation.

Pathologic myopia (PM) is a common blinding retinal degeneration suffered by highly myopic population. Early screening of this condition can reduce the damage caused by the associated fundus lesions and therefore prevent vision loss. Automated diagnostic tools based on artificial intelligence methods can benefit this process by aiding clinicians to identify disease signs or to screen mass populations using color fundus photographs as inputs. This paper provides insights about PALM, our open fundus imaging dataset for pathological myopia recognition and anatomical structure annotation. Our databases comprises 1200 images with associated labels for the pathologic myopia category and manual annotations of the optic disc, the position of the fovea and delineations of lesions such as patchy retinal atrophy (including peripapillary atrophy) and retinal detachment. In addition, this paper elaborates on other details such as the labeling process used to construct the database, the quality and characteristics of the samples and provides other relevant usage notes.

GAMMA challenge: Glaucoma grAding from Multi-Modality imAges.

Glaucoma is a chronic neuro-degenerative condition that is one of the world's leading causes of irreversible but preventable blindness. The blindness is generally caused by the lack of timely detection and treatment. Early screening is thus essential for early treatment to preserve vision and maintain life quality. Colour fundus photography and Optical Coherence Tomography (OCT) are the two most cost-effective tools for glaucoma screening. Both imaging modalities have prominent biomarkers to indicate glaucoma suspects, such as the vertical cup-to-disc ratio (vCDR) on fundus images and retinal nerve fiber layer (RNFL) thickness on OCT volume. In clinical practice, it is often recommended to take both of the screenings for a more accurate and reliable diagnosis. However, although numerous algorithms are proposed based on fundus images or OCT volumes for the automated glaucoma detection, there are few methods that leverage both of the modalities to achieve the target. To fulfil the research gap, we set up the Glaucoma grAding from Multi-Modality imAges (GAMMA) Challenge to encourage the development of fundus & OCT-based glaucoma grading. The primary task of the challenge is to grade glaucoma from both the 2D fundus images and 3D OCT scanning volumes. As part of GAMMA, we have publicly released a glaucoma annotated dataset with both 2D fundus colour photography and 3D OCT volumes, which is the first multi-modality dataset for machine learning based glaucoma grading. In addition, an evaluation framework is also established to evaluate the performance of the submitted methods. During the challenge, 1272 results were submitted, and finally, ten best performing teams were selected for the final stage. We analyse their results and summarize their methods in the paper. Since all the teams submitted their source code in the challenge, we conducted a detailed ablation study to verify the effectiveness of the particular modules proposed. Finally, we identify the proposed techniques and strategies that could be of practical value for the clinical diagnosis of glaucoma. As the first in-depth study of fundus & OCT multi-modality glaucoma grading, we believe the GAMMA Challenge will serve as an essential guideline and benchmark for future research.

Decoding Coordinated Directions of Bimanual Movements From EEG Signals.

Bimanual coordination is common in human daily life, whereas current research focused mainly on decoding unimanual movement from electroencephalogram (EEG) signals. Here we developed a brain-computer interface (BCI) paradigm of task-oriented bimanual movements to decode coordinated directions from movement-related cortical potentials (MRCPs) of EEG. Eight healthy subjects participated in the target-reaching task, including (1) performing leftward, midward, and rightward bimanual movements, and (2) performing leftward and rightward unimanual movements. A combined deep learning model of convolution neural network and bidirectional long short-term memory network was proposed to classify movement directions from EEG. Results showed that the average peak classification accuracy for three coordinated directions of bimanual movements reached 73.39 ± 6.35 %. The binary classification accuracies achieved 80.24 ± 6.25 , 82.62 ± 7.82 , and 86.28 ± 5.50 % for leftward versus midward, rightward versus midward and leftward versus rightward, respectively. We also compared the binary classification (leftward versus rightward) of bimanual, left-hand, and right-hand movements, and accuracies achieved 86.28 ± 5.50 %, 75.67 ± 7.18 %, and 77.79 ± 5.65 %, respectively. The results indicated the feasibility of decoding human coordinated directions of task-oriented bimanual movements from EEG.

[The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy for hallux valgus with severe metatarsal adduction].

OBJECTIVE: To explore clinical effect of the first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating hallux valgus with severe metatarsal adduction. METHODS: From March 2017 to August 2021, 37 patients ( 69 feet ) with severe plantar adductor hallux valgus were treated with the first metatarsophalangeal joint fusion combined with rotational Weil osteotomy were retrospectively analyzed, including 8 males(11 feet) and 29 females (58 feet), aged from 67 to 83 years old with an average of (70.03±2.87) years old;3 cases on the left side, 2 cases on the right side and 32 cases on both sides. Visual analogue scale(VAS) was used to evaluate degree of pain relief before operation, 6 weeks after operation and at the final follow-up. American Orthopaedic Foot and Ankle Surgery (AOFAS) forefoot score was used to evaluate function of the affected foot before operation and final follow-up. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured before operation and at the final follow-up. RESULTS: Thirty-seven patients(69 feet) were followed up from 12 to 48 months with an average of(22.8±0.6) months. Bone healing was achieved at the first metatarsophalangeal joint from 7 to 10 weeks with an average of (8.00±1.21) weeks after operation, without delay and nonunion. HVA was increased from (44.30±2.84)° before operation to (15.20±2.13) °at the final follow-up, and had statistical difference(t=65.781, P<0.05);while no difference in IMA before and after operation(P>0.05). VAS was decreased from (6.73±1.48) points to (2.78±0.71) points at 6 months after operation(t=3.279, P<0.05), and had difference compared with the latest follow-up(1.16±1.12)(t=4.859, P<0.05). AOFAS forefoot score increased from (52.14±5.78) preoperatively to (86.70±4.86) at the fonal follow-up, and 25 feet got excellent results, 40 feet good and 4 feet fair. CONCLUSION: The first metatarsophalangeal joint fusion combined with lateral toe rotation Weil osteotomy in treating severe plantar adduction hallux valgus could significantly relieve pain and appearance of forefoot, stabilize the first sequence, and significantly improve walking function.

Continuous Bimanual Trajectory Decoding of Coordinated Movement From EEG Signals.

While many voluntary movements involve bimanual coordination, few attempts have been made to simultaneously decode the trajectory of bimanual movements from electroencephalogram (EEG) signals. In this study, we proposed a novel bimanual brain-computer interface (BCI) paradigm to reconstruct the continuous trajectory of both hands during coordinated movements from EEG. The protocol required human subjects to complete a bimanual reaching task to the left, middle, or right target while EEG data were collected. A multi-task deep learning model combining the EEGNet and long short-term memory network (LSTM) was proposed to decode bimanual trajectories, including position and velocity. Decoding performance was evaluated in terms of the correlation coefficient (CC) and normalized root mean square error (NRMSE) between decoded and real trajectories. Experimental results from 13 human subjects showed that the grand-averaged combined CC values achieved 0.54 and 0.42 for position and velocity decoding, respectively. The corresponding combined NRMSE values were 0.22 and 0.23. Both CC and NRMSE were significantly superior to the chance level (p<0.05). Comparative experiments also indicated that the proposed model significantly outperformed some other commonly-used methods in terms of CC and NRMSE for continuous trajectory decoding. These findings demonstrated the feasibility of simultaneously decoding bimanual trajectory from EEG, indicating the potential of bimanual control for coordinated tasks.

Comparison of Effect of Three Different Surgical Procedures on Ankle Joint Function Rehabilitation of Patients with Hepple V Talus Osteochondral Injury.

Objective: To discuss and compare the effects of three different surgical procedures on ankle function rehabilitation of patients with Hepple V talus osteochondral injury. Methods: A total of 60 patients with Hepple V talus osteochondral injury admitted to our hospital from January 2020 to January 2021, among which 17 patients in study group 1 received microfracture surgery, 20 patients in study group 2 received osteochondral autologous transplantation, and 23 patients in study group 3 received with periosteal iliac bone transplantation. The range of motion (ROM) of the patients' angle was evaluated by the goniometer before and after the treatment. The ankle function was evaluated by the ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS). The ankle joint pain was evaluated by visual analogue score (VAS). The surgical efficacy was evaluated 12 months after surgery, and complications and nursing satisfaction were observed and recorded. Results: There was no significant difference in ROM, AOFAS score, and VAS score among the three groups before the treatment (P > 0.05). ROM and AOFAS score of the three groups were improved, and VAS score was decreased at 6 months and 12 months after treatment (P < 0.05). ROM and AOFAS score of group 2 and group 3 were higher than those of group 1, while the VAS score was lower than that of group 1, indicating significant difference (P < 0.05). There was no significant difference in ROM, AOFAS, and VAS score between group 2 and group 3 (P > 0.05). The surgical efficacy of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), while there was no significant difference in the surgical significance between group 2 and group 3 (P > 0.05). There was no significant difference in complication rate among the three groups (P > 0.05), and the treatment satisfaction of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), but there was no significant difference between group 2 and group 3 (P > 0.05). Conclusion: Three different surgical procedures have good therapeutic effect for Hepple V talus osteochondral injury. Osteochondral autologous transplantation and periosteal iliac bone transplantation can reduce the pain of ankle joint, promote the effect of ankle joint function recovery, which can effectively improve patient satisfaction. It is suggested to choose the surgical procedure according to the actual situation of patients.

Validating automated eye disease screening AI algorithm in community and in-hospital scenarios.

Purpose: To assess the accuracy and robustness of the AI algorithm for detecting referable diabetic retinopathy (RDR), referable macular diseases (RMD), and glaucoma suspect (GCS) from fundus images in community and in-hospital screening scenarios. Methods: We collected two color fundus image datasets, namely, PUMCH (556 images, 166 subjects, and four camera models) and NSDE (534 images, 134 subjects, and two camera models). The AI algorithm generates the screening report after taking fundus images. The images were labeled as RDR, RMD, GCS, or none of the three by 3 licensed ophthalmologists. The resulting labels were treated as "ground truth" and then were used to compare against the AI screening reports to validate the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the AI algorithm. Results: On the PUMCH dataset, regarding the prediction of RDR, the AI algorithm achieved overall results of 0.950 ± 0.058, 0.963 ± 0.024, and 0.954 ± 0.049 on sensitivity, specificity, and AUC, respectively. For RMD, the overall results are 0.919 ± 0.073, 0.929 ± 0.039, and 0.974 ± 0.009. For GCS, the overall results are 0.950 ± 0.059, 0.946 ± 0.016, and 0.976 ± 0.025. Conclusion: The AI algorithm can work robustly with various fundus camera models and achieve high accuracies for detecting RDR, RMD, and GCS.

A Multicenter Clinical Study of the Automated Fundus Screening Algorithm.

Purpose: To evaluate the effectiveness of automated fundus screening software in detecting eye diseases by comparing the reported results against those given by human experts. Results: There were 1585 subjects who completed the procedure and yielded qualified images. The prevalence of referable diabetic retinopathy (RDR), glaucoma suspect (GCS), and referable macular diseases (RMD) were 20.4%, 23.2%, and 49.0%, respectively. The overall sensitivity values for RDR, GCS, and RMD diagnosis are 0.948 (95% confidence interval [CI], 0.918-0.967), 0.891 (95% CI, 0.855-0.919), and 0.901 (95% CI-0.878, 0.920), respectively. The overall specificity values for RDR, GCS, and RMD diagnosis are 0.954 (95% CI, 0.915-0.965), 0.993 (95% CI-0.986, 0.996), and 0.955 (95% CI-0.939, 0.968), respectively. Methods: We prospectively enrolled 1743 subjects at seven hospitals throughout China. At each hospital, an operator records the subjects' information, takes fundus images, and submits the images to the Image Reading Center of Zhongshan Ophthalmic Center, Sun Yat-Sen University (IRC). The IRC grades the images according to the study protocol. Meanwhile, these images will also be automatically screened by the artificial intelligence algorithm. Then, the analysis results of automated screening algorithm are compared against the grading results of IRC. The end point goals are lower bounds of 95% CI of sensitivity values that are greater than 0.85 for all three target diseases, and lower bounds of 95% CI of specificity values that are greater than 0.90 for RDR and 0.85 for GCS and RMD. Conclusions: Automated fundus screening software demonstrated a high sensitivity and specificity in detecting RDR, GCS, and RMD from color fundus imaged captured using various cameras. Translational Relevance: These findings suggest that automated software can improve the screening effectiveness for eye diseases, especially in a primary care context, where experienced ophthalmologists are scarce.

Global Trends in Research of Gouty Arthritis Over Past Decade: A Bibliometric Analysis.

Gouty arthritis (GA), as a multifactorial disease, is characterised by intense pain, active inflammation symptoms, and swollen joints. It has utterly complex pathogenesis, of which the amount of research publications on GA has increased during the last few decades. A bibliometric analysis was carried out to investigate the trends, frontiers, and hot spots in global scientific output in GA research over the last decade. We retrieved the Science Citation Index Expanded (SCI-Expanded) of the Web of Science Core Collection (WoSCC) for publications and recorded information published from 2012 to 2021. we carried out the bibliometric analysis and visualisation analysis of the overall distribution of annual outputs, leading countries, active institutions, journals, authors, co-cited references, and keywords with the VOSviewer and CiteSpace. The impact and quality of papers were assessed using a global citation score (GCS). We retrieved 2052 articles and reviews in total. The annual number of publications (Np) related to GA research has increased during the latest decade. China published the most papers, and the USA achieved the highest H-index and number of citations (Nc). The League of European Research Universities (LERU) and Clinical Rheumatology (Clin Rheumatol) are the most productive institutions and periodicals. The total GCS of the paper written by Kottgen, A. in 2013 was 479, ranking the first. The most common keywords were "Gout," "hyperuricemia," and "gouty arthritis." This research revealed that though there was a slight fluctuation in publications related to GA, the Np raised on the whole. China was an enormous creator, and the USA was an influential nation in this domain. The top three contributor authors were Dalbeth, N., Singh, JA., and Choi, HK. There were few investigations on the treatment of GA by Chinese medicine monomer, and the "mechanism," "pathway", "nf- kappa-b", "injury", "receptor", and "animal model" were growing research hotspots. Our research illustrated the hotspots of research and development trends in the research field of GA during the last decade. Recognition of the most critical indicators (researchers, countries, institutes, and journals for the release of GA research), hotspots in the research field of GA can be helpful for countries, scholars, and policymakers in this field to understand GA better make decisions.

Worldwide Research Trends on Diabetic Foot Ulcers (2004-2020): Suggestions for Researchers.

OBJECTIVES: Diabetic foot ulcer (DFU) is one of the devastating complications of diabetes. It has high mortality and disability rates. The number of research articles on DFUs has increased. This study was designed to explore the global trends and research hotspots of DFUs to benefit researchers in shaping future research directions. METHODS: Literatures relating to DFU from 2004 to 2020 were retrieved from the Science Citation Index Expanded (SCI-expanded) of Web of Science Core Collection (WoSCC). The current status of DFU research (including publications, journals, the performances of relevant countries, institutions, and authors and the research trends and hotspots of DFU) was analyzed with the WoSCC. VOSviewer v1.6.10.0 was utilised for cocitation, coauthorship, cooccurrence analyses, and bibliographic coupling. RESULTS: A total of 5869 publications on DFUs were retrieved. We performed a longitudinal review of publications over 17 years: 4500 articles and 865 review articles on DFUs published from 2004 to 2020 were analyzed. The total citation was 107,296. The USA (n = 1866), England (n = 606), and China (n = 599) were the three largest contributors. The University of Washington had the greatest number of publications within this time period (n = 103), and it had the most cooperative units and was in the core position in all research institutions, followed by the University of Manchester (n = 94) and the University of Miami (n = 92). Armstrong DG (91/1.69%) and Lavery LA (55/1.19%) should be regarded as scholars who have made outstanding contributions. The top journal with the greatest total link strength was Diabetes Care. Analysis showed that the global research hotspots of DFU focused on lower limb amputation, diabetic foot infection, and treatment and management of DFU. Studies on osteomyelitis, wound therapy and management, multidisciplinary integration and mechanism of DFUs, and its related diseases are the research fronts that should be closely watched in the future. CONCLUSIONS: This study revealed the current research status and hotspots in the domain of DFU over the past 17 years, which can help researchers to further pinpoint potential perspectives on hot topics and research frontiers.

Advances in Experimental and Clinical Research of the Gouty Arthritis Treatment with Traditional Chinese Medicine.

Gouty arthritis (GA) is a multifactorial disease whose pathogenesis is utterly complex, and the current clinical treatment methods cannot wholly prevent GA development. Western medicine is the primary treatment strategy for gouty arthritis, but it owns an unfavorable prognosis. Therefore, the prevention and treatment of GA are essential. In China, traditional Chinese medicine (TCM) has been adopted for GA prevention and treatment for thousands of years. Gout patients are usually treated with TCM according to their different conditions, and long-term results can be achieved by improving their physical condition. And TCM has been proved to be an effective method to treat gout in modern China. Nevertheless, the pharmacological mechanism of TCM for gout is still unclear, which limits its spread. The theory of prevention and treatment of gout with TCM is more well acknowledged in China than in abroad. In this article, Chinese herbs and ancient formula for gout were summarized first. A total of more than 570 studies published from 2004 to June 2021 in PubMed, Medline, CNKI, VIP, Web of Science databases and Chinese Pharmacopoeia and traditional Chinese books were searched; the current status of TCM in the treatment of GA was summarized from the following aspects: articular chondrocyte apoptosis inhibition, antioxidative stress response, inflammatory cytokine levels regulation, uric acid excretion promotion, immune function regulation, uric acid reduction, and intestinal flora improvement in subjects with gout. The literature review concluded that TCM has a specific curative effect on the prevention and treatment of GA, particularly when combined with modern medical approaches. However, lacking a uniform definition of GA syndrome differentiation and the support of evidence-based medicine in clinical practice have provoked considerable concern in previous studies, which needs to be addressed in future research.

Needle knife therapy plus sodium hyaluronate injection for knee osteoarthritis: A protocol for a systematic review and meta-analysis.

BACKGROUND: Knee osteoarthritis (KOA) is a worldwide disease and more and more people are suffered from it. With the increasing number of patients, it brings a huge burden on social economy and security system. There are varieties of methods to cure KOA, such as Traditional Chinese Medicine and surgery. Needle knife therapy plus Sodium hyaluronate Injection is one of the prevalent treatments for KOA. Therefore, we perform a systematic review and meta-analysis to evaluate the evidence for the treatment of needle knife therapy plus sodium hyaluronate Injection. METHODS: Randomized controlled trials will be used to compare the effect of needle knife therapy plus sodium hyaluronate injection with needle knife alone for KOA patients. Six studies will be included in this meta-analysis, and the relative risk and weight mean difference with 95% CI for the Lysholm knee score, visual analogue scale, and effective rate will be evaluated by using RevMan 5.3 software. Besides, the bias assessment of the included studies will be evaluated using the Cochrane risk of bias tool, and the Grading of Recommendations, Assessment Development, and Evaluation system will be applied to assess the overall quality of the evidence. RESULTS: From the study we will assess the effectiveness, safety of needle knife therapy plus sodium hyaluronate injection on joint pain relief and functional improvement in patients with KOA. CONCLUSION: The study will provide a new evidence to confirm the effect of needle knife therapy plus sodium hyaluronate injection on KOA, which can further guide the selection of therapy. PROSPERO REGISTRATION NUMBER: CRD42020169602.

Acupuncture for the treatment of ankle sprain: A protocol for a systematic review and meta-analysis: study protocol.

BACKGROUND: Ankle sprain is one of the most common musculoskeletal injuries in our daily life, which may lead to chronic ankle instability, reducing the quality of patients' life and imposing a heavy burden on social medical security system. There are many kinds of methods treating ankle sprain, which can be divided into the conservative treatments and surgical intervention. Acupuncture is one of the conservative treatments for ankle sprain, especially in China. Therefore, we perform a systematic review and meta-analysis to evaluate the evidence for acupuncture's effectiveness, safety and cost benefits for the treatment. METHODS: For the acquisition of required data of eligible randomized controlled trials (RCTs), literature search will be undertaken from the following database: PubMed, Embase, Web of Science, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), VIP Database, and Wanfang database. Quality assessment of the included studies will be independently performed according to the Cochrane Risk of Bias Tool by 2 investigators and the level of evidence for results will be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis will be conducted with Revman 5.3. RESULTS: From the study we will assess the effectiveness, safety and cost benefit of acupuncture on pain relief and functional improvement in patients with ankle sprain. CONCLUSION: The conclusion of this study will provide evidence to ensure the effectiveness, safety and cost benefits of acupuncture on ankle sprain, which can further guide the selection of appropriate interventions. PROSPERO REGISTRATION NUMBER: CRD42018116829.

Simulating Broken PT-Symmetric Hamiltonian Systems by Weak Measurement.

By embedding a PT-symmetric (pseudo-Hermitian) system into a large Hermitian one, we disclose the relations between PT-symmetric quantum theory and weak measurement theory. We show that the weak measurement can give rise to the inner product structure of PT-symmetric systems, with the preselected state and its postselected state resident in the dilated conventional system. Typically in quantum information theory, by projecting out the irrelevant degrees and projecting onto the subspace, even local broken PT-symmetric Hamiltonian systems can be effectively simulated by this weak measurement paradigm.

Efficacy and safety of prophylaxis with BAY 81-8973 in Chinese patients with severe haemophilia A enrolled in the LEOPOLD II trial.

INTRODUCTION: BAY 81-8973 (Kovaltry® ) is a full-length, unmodified recombinant human factor VIII approved in China for prophylaxis and on-demand treatment in patients with haemophilia A. Limited access to FVIII prophylaxis in China has historically led to this population being undertreated. This subanalysis of LEOPOLD II investigated whether the efficacy and safety of BAY 81-8973 varied between Chinese and non-Chinese patients. AIM: To evaluate BAY 81-8973 efficacy and safety in Chinese patients. METHODS: LEOPOLD II enrolled males aged 12-65 years with severe haemophilia A who were receiving on-demand treatment. Patients were randomly assigned to receive BAY 81-8973 as low-dose prophylaxis (20-30 IU/kg twice-weekly), high-dose prophylaxis (30-40 IU/kg 3 times weekly) or on-demand for 1 year. RESULTS: Data were available from 23 Chinese and 57 non-Chinese patients; Chinese patients had a higher prestudy bleeding rate and were more likely to have target joints than non-Chinese patients. 74% of patients were assigned to prophylaxis. Annualized bleeding rates (ABRs) in Chinese and non-Chinese patients receiving prophylaxis were significantly lower compared to patients treated on-demand. Median ABRs for all bleeds in the last 6 months of the study were 2.0 and 1.0 for Chinese and non-Chinese patients, respectively, in the combined prophylaxis groups, and 61.3 and 58.5 in the on-demand group. A treatment-related adverse event occurred in 1 Chinese patient; no patients developed FVIII inhibitors. CONCLUSION: BAY 81-8973 prophylaxis was efficacious and well tolerated in Chinese patients with severe haemophilia A, with ABRs comparable to those in non-Chinese patients receiving prophylaxis.

[Lapidus operation combined with bone setting manipulation in treatment of hallux valgus in elderly patients].

OBJECTIVE: To investigate the clinical effect of Lapidus operation combined with bone setting manipulation of traditional Chinese medicine in treating hallux valgus in elderly patients. METHODS: From March 2013 to October 2017, 53 elderly patients (87 feet) with hallux valgus were treated with Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine, including 12 males (18 feet) and 41 females (69 feet), ranging in age from 65 to 92 years old, with an average of (76.3±4.8) years old. Visual analogue scale(VAS) was used to evaluate the degree of relief of foot pain before and 26 months after operation. American Orthopaedic Foot and Ankle Society(AOFAS) was used to evaluate the function of foot pain. The changes of hallux valgus angle(HVA angle), interphalangeal angle (IMA angle) and metatarsal wedge angle(MCA angle) were compared on X-ray films. RESULTS: All the patients were followed up, and the duration ranged from 12 to 42 months, with an average of(26.0±2.7) months. In all patients, the first metatarsal joint reached bone fusion within 6 to 8 months, with an average of 4.7 months. The preoperative VAS score was 8.06±1.44, which was significantly different from 2.14±1.98 at 26 months(P<0.05). The preoperative AOFAS score was 53.90±7.89, which was significantly different from 92.80±2.78 at 26 months(P<0.05). The HVA, IMA and MCA were significantly improved from preoperative(38.60±2.72)°, (21.90±1.91)° and(20.90±2.20)° to the latest follow-up(17.80±1.94)°, (9.70±2.56)° and(11.70±0.48)°(P<0.05). According AOFAS score, 74 feet got an excellent result, 11 good and 2 fair. CONCLUSIONS: Lapidus operation combined with bone-setting manipulation of traditional Chinese medicine on the treatment of hallux valgus foot in elderly patients has satisfactory clinical effects, shortens the time of osteotomy and fixation, protects the soft tissue around the osteotomy end and promotes the bone fusion on the most satisfactory position.

Maximum Relative Entropy of Coherence: An Operational Coherence Measure.

The operational characterization of quantum coherence is the cornerstone in the development of the resource theory of coherence. We introduce a new coherence quantifier based on maximum relative entropy. We prove that the maximum relative entropy of coherence is directly related to the maximum overlap with maximally coherent states under a particular class of operations, which provides an operational interpretation of the maximum relative entropy of coherence. Moreover, we show that, for any coherent state, there are examples of subchannel discrimination problems such that this coherent state allows for a higher probability of successfully discriminating subchannels than that of all incoherent states. This advantage of coherent states in subchannel discrimination can be exactly characterized by the maximum relative entropy of coherence. By introducing a suitable smooth maximum relative entropy of coherence, we prove that the smooth maximum relative entropy of coherence provides a lower bound of one-shot coherence cost, and the maximum relative entropy of coherence is equivalent to the relative entropy of coherence in the asymptotic limit. Similar to the maximum relative entropy of coherence, the minimum relative entropy of coherence has also been investigated. We show that the minimum relative entropy of coherence provides an upper bound of one-shot coherence distillation, and in the asymptotic limit the minimum relative entropy of coherence is equivalent to the relative entropy of coherence.

Efficacy of standard prophylaxis versus on-demand treatment with bayer's sucrose-formulated recombinant FVIII (rFVIII-FS) in Chinese children with severe hemophilia A.

In China, care of patients with severe hemophilia primarily involves insufficient dosing of on-demand treatment and secondary low-dose prophylaxis (10 IU/kg 2× /wk). We sought to evaluate 3× /wk, standard-dose prophylaxis with sucrose-formulated recombinant factor VIII (rFVIII-FS; Bayer) compared with on-demand treatment in Chinese children with severe hemophilia A. Children and adolescents aged 2-16 years with severe hemophilia A, no inhibitors, and no prophylaxis for >6 consecutive months before study entry were eligible for this 24-week, interventional, sequential-treatment study. Patients received rFVIII-FS on demand for 12 weeks followed by a 12-week prophylaxis period (25 IU/kg 3× /wk). The primary efficacy endpoint was comparison of the annualized bleeding rate (ABR) of all bleeds in the prophylaxis versus on-demand phase. Additional variables included ABR of joint bleeds, school attendance/activity, daily activity, and hemophilia Joint Health Score (HJHS). Thirty patients (median age, 12 years) were treated and analyzed. Compared with on-demand treatment, prophylaxis reduced median (quartile [Q1; Q3]) ABR of all bleeds (57.5 [44.5; 73.9] vs 0 [0; 4.0]) and joint bleeds (34.5 [26.1; 56.5] vs 0 [0; 4.0]). Median (range) total HJHS improved after both the prophylaxis and on-demand phases (8.0 [0-48.0] and 11.0 [0-55.0], respectively) compared with baseline (16.0 [0-56.0]). School attendance/activity and daily activity improved with prophylaxis versus on demand. No inhibitors or treatment-related adverse events were reported. In this first prospective, standard-dose, secondary prophylaxis study in China, rFVIII-FS prophylaxis reduced bleeding and improved health outcomes versus on-demand treatment in children with severe hemophilia A.

Status and trend analysis of prophylactic usage of recombinant factor VIII in Chinese pediatric patients with hemophilia A: ReCare - a retrospective, phase IV, non-interventional study.

BACKGROUND: No study has reported the status and chronological trend of prophylactic recombinant factor VIII (rFVIII) use in Chinese pediatric patients with hemophilia A (HA). OBJECTIVE: We aimed to analyze the status and trend of rFVIII-containing prophylaxis in Chinese pediatric patients with HA. METHODS: ReCARE (Retrospective study in Chinese pediatric hemophilia A patients with rFVIII contained REgular prophylaxis) was a retrospective study conducted in 12 hemophilia treatment centers across China. The trend of prophylaxis was evaluated by determining the mean duration of prophylaxis, mean injection frequency (per week), mean dose of each injection (IU/kg), mean total dose injected/week (IU) and proportion of rFVIII consumption relative to factor VIII (FVIII) consumption over the study period. RESULTS: We analyzed 183 male pediatric patients with HA (mean age, 7.1 ± 4.23 years), who received intermittent prophylaxis between 1 November 2007 and 31 May 2013. The mean duration of prophylaxis with rFVIII increased from 16.72 weeks in 2008 to 32.77 in 2012. Per injection dose of rFVIII increased significantly from 2008 to 2013 (25.89 to 28.31 IU/kg, p < .001). An increase was also reported in the mean total FVIII consumed (699.97 ± 173.25 IU in 2008 and 891.30 ± 730.341 in 2013) and mean proportion of rFVIII used (33.33 ± 57.73% in 2008 to 85.50 ± 29.077% in 2013). CONCLUSION: Our data revealed an overall improvement in treatment dosage and duration with an increase in the number of patients receiving prophylaxis. The total proportion of rFVIII also increased gradually indicating the development of economy and safety awareness. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT02263066).