Mechanical stretch preconditioned adipose-derived stem cells elicit polarization of anti-inflammatory M2-like macrophages and improve chronic wound healing.

Transplantation of adipose-derived stem cells (ASCs) is a promising option in the field of chronic wounds treatment. However, the effectiveness of ASCs therapies has been hampered by highly inflammatory environment in chronic wound areas. These problems could be partially circumvented using efficient approaches that boost the survival and anti-inflammatory capacity of transplanted ASCs. Here, by application of mechanical stretch (MS), we show that ASCs exhibits increased survival and immunoregulatory properties in vitro. MS triggers the secretion of macrophage colony stimulating factor (M-CSF) from ASCs, a chemokine that is linked to anti-inflammatory M2-like macrophages polarization. When the MS-ASCs were transplanted to chronic wounds, the wound area yields significantly faster closure rate and lower inflammatory mediators, largely due to macrophages polarization driven by transplanted MS-ASCs. Thus, our work shows that mechanical stretch can be harnessed to enhance ASCs transplantation efficiency in chronic wounds treatment.

Combining Patient-specific Implant With Malar Reduction to Repair Mid-facial Asymmetry Caused by Craniofacial Fractures in Asians.

Mid-facial asymmetry caused by bone defect or deformation resulted from craniofacial fracture was a common secondary complication needed to repair. Patient-specific implant (PSI) designed with the unaffected side as a template is a good choice to repair this kind of facial asymmetry. However, in Asians, the broad and prominent zygomatic bone in unaffected side is not an optimal template, because the oval facial shape was considered as a more attractive appearance in Asian esthetic concept. To repair the mid-facial asymmetry and to improve the facial contour, the authors combined PSI implantation with malar reduction in one-stage surgery. The authors referred the facial proportion index (the optimal ratio of mid and lower face was 1.27) as a basis for preoperative precise design to determine the ideal facial shape of unaffected side, and used mirror image overlay technique with the ideal shape of unaffected side as a template to design the PSI. With this surgical strategy, patients not only can repair facial asymmetry but also can get a more attractive appearance.

Hoarseness and arytenoid dislocation: A rare complication after facial bony contouring surgery.

BACKGROUND: Arytenoid dislocation is a rare complication after endotracheal intubation and may result in permanent hoarseness, which cannot be tolerated during cosmetic surgeries, such as facial bony contouring surgery. This study aimed to identify the clinical characteristics of this patient subgroup and share the process of diagnosis and treatment. METHODS: We retrospectively collected the medical records of patients who underwent facial bony contouring surgery under general anesthesia with endotracheal intubation from September 2017 to July 2022. We divided the patients into a nondislocation group and a dislocation group. Demographic, anesthetic, and surgical characteristics were collected and compared. RESULTS: 441 patients were enrolled, and 5 (1.1%) were diagnosed with arytenoid dislocation. The patients in the dislocation group were more likely to be intubated with the video laryngoscope (P = 0.049), and head-neck movement during surgery may predispose patients to arytenoid dislocation (P = 0.019). The patients in the dislocation group were diagnosed around 5-37 days after surgery. Three of them regained their normal voice after close reduction, and two recovered with speech therapy. CONCLUSION: Arytenoid dislocation may result from multiple factors instead of one high-risk factor. Head-neck movement, the skills and experience of anesthetists, the time of intubation, and the use of intubation tools may all predispose patients to arytenoid dislocation. To acquire timely diagnosis and treatment, patients should be fully informed of this complication before surgery and observed closely afterward. Any postoperative voice or laryngeal symptoms lasting more than 7 days need a specialist evaluation.

Are the recently described fossil Mole Crickets of Myanmar amber real gryllotalpids? (Orthoptera: Gryllotalpidae & Gryllidae).

We report five new Myanmar amber specimens attributable to "Mole Cricket" †Pherodactylus rectanguli n. comb., hitherto regarded as a Mole Cricket (Orthoptera: Grylloptalpidae). The new material includes two adult males, two adult females, and one nymph. The specimens are redescribed, and additional new characters are provided for their delimitation and corresponding species identification. We carry out a comparison between these new specimens with other taxa of mole crickets from Myanmar amber and extant true crickets. The result indicates that some species merely represent different nymphal development stages or adults of †Pherodactylus rectanguli n. comb., however, they were misidentified as different species. We also treated genera †Tresdigitus n. syn. and †Chunxiania n. syn. as synonyms of genus †Pherodactylus Poinar, Su & Brown, 2020, and treat †Tresdigitus gracilis Jiang, Xu, Jarzembowski & Xiao, 2022 n. syn. and †Chunxiania fania n. syn. as synonyms of †Pherodactylus rectanguli n. comb. †Burmagryllotalpa longa is valid, because its shape of the pronotum curved without lateral carinae. The morphological convergences and specializations of subterranean dwelling species are discussed. The robust fore tibia and long apical spurs of †P. micromorphus, †P. rectanguli n. comb. and †B. longa are insufficient evidence for an assignment to the family Gryllotalpidae. Instead, we suggest place them into the subfamily Gryllinae (Gryllidae), tribe Sclerogryllini, and group them into their own subtribe Pherodactylina n. subtr.. A key to the identification of recent and fossil Sclerogryllini is also provided. Their taxonomy and morphology are discussed.

Changes in Facial Symmetry Following Computer-Assisted Secondary Correction of Craniofacial Fractures.

OBJECTIVE: For patients without dysfunctions, the main purpose of secondary correction for craniofacial fractures is restoring facial symmetry. Computer-assisted surgery techniques including virtual surgical planning and intraoperative navigation provide the help to restore the bony symmetry as much as possible. The authors retrospectively quantitatively analyzed patients who received computer-assisted secondary correction for craniofacial fractures on facial symmetry pre and postoperation. METHODS: This observational study reviewed the medical records of 17 patients requiring secondary correction for craniofacial fractures. Pre and postoperative computed tomography data were used to quantitatively analyze the changes in facial symmetry and enophthalmos. RESULT: All patients enrolled in this study showed mid-facial asymmetry but without dysfunctions except for enophthalmos, and 5 patients had bone defects in the frontal-temporal area. The corrective surgical techniques were different for each patient according to their specific condition. Virtual surgical planning with or without intraoperative navigation was performed for all patients. Compared with the preoperative condition, their facial symmetry was significantly improved. The maximum discrepancy value between the affected side and the mirrored unaffected side decreased from 8.10 ± 2.69 to 3.74 ± 2.02 mm postoperatively, and the mean discrepancy value decreased from 3.58 ± 1.29 to 1.57 ± 0.68 mm. In addition, the Enophthalmos Index decreased from 2.65 to 0.35 mm. CONCLUSION: This observational study objectively demonstrated that computer-assisted secondary correction for craniofacial fractures can significantly improve facial symmetry. And the authors recommend that virtual surgical planning and intraoperative navigation should be a must step in craniofacial fracture correction.

Efficacy and Safety of Expanded Polytetrafluoroethylene Implantation in the Correction of Long-Term Posttraumatic Enophthalmos.

SUMMARY: Long-term enophthalmos is a common orbital fracture sequela. Various autografts and alloplastic materials have been studied in posttraumatic enophthalmos repair. However, expanded polytetrafluoroethylene (ePTFE) implantation in late enophthalmos repair has rarely been reported. The authors report novel use of ePTFE for late posttraumatic enophthalmos repair. This retrospective study included patients with posttraumatic long-term enophthalmos who underwent hand-carved ePTFE intraorbital implantation for enophthalmos correction. Computed tomography data were collected preoperatively and at follow-up. The volume of ePTFE, the degree of proptosis (DP), and enophthalmos were measured. Postoperative and preoperative DP and enophthalmos were compared using the paired t test. The correlation between ePTFE volume and DP increment was established using linear regression. Complications were identified by chart review. From 2014 to 2021, 32 patients were included, with a mean follow-up of 19.59 months. The mean volume of implanted ePTFE was 2.39 ± 0.89 mL. After surgery, the DP of the affected globe improved significantly, from 12.75 ± 2.12 mm to 15.06 ± 2.50 mm ( P < 0.0001). A significant linear correlation was found between ePTFE volume and DP increment ( P < 0.0001). Enophthalmos was substantially ameliorated from 3.35 ± 1.89 mm to 1.09 ± 2.07 mm ( P < 0.0001). Twenty-five patients (78.23%) had postoperative enophthalmos of less than 2 mm. Infection and implant dislocation were not observed. The authors concluded that ePTFE intraorbital implantation exhibited long-term efficacy and safety for late posttraumatic enophthalmos repair and represents an effective and predictable alternative. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Classification of Alar Dynamic Aesthetic in an Asian Female Population: Experts or Automatic Algorithms?

AIM: To provide referenced classifications of alar dynamic aesthetics from both subjective and objective perspectives for determining proper surgical strategies in alarplasty. METHODS: A total of 150 healthy Asian female participants were instructed to perform two standardized facial movements including a resting pose and a maximum smile while taking care not to show their teeth. The participants were recorded using a dynamic three-dimensional surface imaging system. Frames depicting the resting position and the alar maximum enlargement during the smile were exported separately for anthropometric analysis and classification. The alar dynamic aesthetic was assessed through measurement of the anthropomorphic changes comparing the resting and maximum smile statuses and then transformed into quantitative analysis through the algorithm [Formula: see text]. Subjective classification and evaluation of the subject cosmetic deficiencies and proposals for therapeutic interventions to improve the subjects' alar dynamic aesthetic were performed by three senior plastic surgeons through visualization of the resting and smiling images. The surgeons were asked to divide and classify the subjects into three groups (Class I, Class II and Class III) according to the surgeons' perceptions of degree of the subjects' deficiencies in alar dynamic aesthetic. The more deficiency there was in the aesthetic, the higher the class that the subject was assigned into. The surgeons were presented with the full set of images of the patients on two separate occasions each three months apart, to assess interobserver reliability. Clustering analysis, which is based on machine learning, was applied for objective classification of the images. RESULTS: According to the senior plastic surgeon experts' subjective classification, the subjects' alar flaring mobility was judged as follows: Class I (6.78 ± 3.84%), Class II (10.35 ± 4.18%), and Class III (18.68 ± 4.15%), while alar base mobility was judged as Class I (12.71 ± 7.57%), Class II (20.06 ± 10.06%), and Class III (30.86 ± 13.20%). By clustering analysis, alar flaring mobility was determined to be Class I (7.01 ± 3.51%), Class II (11.18 ± 4.76%), and Class III (12.72 ± 5.66%), while alar base mobility was Class I (9.07 ± 4.23%), Class II (21.88 ± 4.25%), and Class III (38.59 ± 7.08%). No statistical significance was found in the distribution and assignment of classes between the two methodologies. CONCLUSION: Classifications of alar dynamic aesthetics could arouse attention to facial dynamic aesthetics and provide referenced quantitative parameters for plastic surgeons to determine appropriate treatments for alarplasty. For patients with Class I mobility, treatments are not recommended, while minimally invasive treatments can be deemed to be optional for patients with Class II alar mobility to potentially improve alar dynamic aesthetics. For patients with Class III alar mobility, surgical treatments are strongly recommended as options. Combing subjective classification with automated algorithms can provide a novel perspective and improve reliability for facial aesthetic classification analysis. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Two new species of the genus Diestramima from China (Orthoptera: Rhaphidophoridae: Aemodogryllinae).

The genus Diestramima comprises 41 species from Asia with 31 species distributed in China. In this study, we reconstruct the phylogeny tree of Diestramima species by maximum likelihood and Bayesian inference based on three mitochondrial genes (COI, 12S and 16S). The result indicates that the phylogenetic results are coherent with that based on five molecular markers (COI, 12S, 16S, 18S and 28S). Moreover, two new species, D. pingmengensis sp. nov. He & Zong and D. gulinjingensis. sp. nov. Zong & He are described. Their validities are also supported by morphological features. Furthermore, D. sichuanensis Zhu & Shi, 2022 is treated as a junior synonym of D. guangxiensis Qin, Wang, Liu & Li, 2016 based on both morphological and molecular features.

Senataxin and RNase H2 act redundantly to suppress genome instability during class switch recombination.

Class switch recombination generates distinct antibody isotypes critical to a robust adaptive immune system, and defects are associated with autoimmune disorders and lymphomagenesis. Transcription is required during class switch recombination to recruit the cytidine deaminase AID-an essential step for the formation of DNA double-strand breaks-and strongly induces the formation of R loops within the immunoglobulin heavy-chain locus. However, the impact of R loops on double-strand break formation and repair during class switch recombination remains unclear. Here, we report that cells lacking two enzymes involved in R loop removal-senataxin and RNase H2-exhibit increased R loop formation and genome instability at the immunoglobulin heavy-chain locus without impacting its transcriptional activity, AID recruitment, or class switch recombination efficiency. Senataxin and RNase H2-deficient cells also exhibit increased insertion mutations at switch junctions, a hallmark of alternative end joining. Importantly, these phenotypes were not observed in cells lacking senataxin or RNase H2B alone. We propose that senataxin acts redundantly with RNase H2 to mediate timely R loop removal, promoting efficient repair while suppressing AID-dependent genome instability and insertional mutagenesis.

The immune system is a complex network of cells and molecules, which helps to protect the body from invaders. The adaptive immune system can recognise millions of assailants, kill them, and 'learn' from this experience to mount an even quicker defence the next time the body is infected. To achieve this level of protection, specific immune cells, called B cells, divide when they come into contact with a molecule from a foreign particle, the antigen. The cloned B cells then produce millions of protective proteins, the antibodies, which patrol the blood stream and tag harmful particles for destruction. An antibody resembles a Y-shaped structure that contains a 'variable' region, which gives it the specificity to interact with an antigen, and a 'constant' region, which interacts with components of the immune system and determines the mechanisms used to destroy a pathogen. Based on the constant region, antibodies can be divided into five main classes. B cells are able to switch their production from one antibody class to another in an event known as class switch recombination, by making changes to the constant region. They do this by cutting out a portion of the genes for the constant region from their DNA and fusing the remaining DNA. The resulting antibodies still recognise the same target, but interact with different components of the immune system, ensuring that all the body's forces are mobilised. R-loops are temporary structures that form when a cell 'reads' the instructions in its DNA to make proteins. R-loops provide physical support by anchoring the transcription template to the DNA. They help control the activity of genes, but if they stay on the DNA for too long they could interfere with any form of. DNA repair ­ including the cutting and fusing mechanisms during class switch recombination. To find out more about this process, Zhao et al. used B-cells from mice lacking two specific proteins that usually help to remove R-loops. Without these proteins, the B cells generated more R-loops than normal. Nevertheless, the B-cells were able to undergo class switch recombination, even though their chromosomes showed large areas of DNA damage, and DNA sections that had been repaired contained several mistakes. Errors that occur during class switch recombination have been linked to immune disorders and B cell cancers. The study of Zhao et al. shows that even if R-loops do not affect some processes in B cells, they could still impact the overall health of their DNA. A next step would be to test if an inability to remove R-loops could indeed play a role in immune disorders and B-cell cancers.

Prussian Blue Nanozyme Promotes the Survival Rate of Skin Flaps by Maintaining a Normal Microenvironment.

Ischemia-reperfusion (I/R) injury leads to a low success rate of skin flap transplantation in reconstruction surgery, thus requiring development of new treatments. Necroptosis and apoptosis pathways, along with overexpression of reactive oxygen species and pro-inflammatory factors in skin flap transplantation, are deemed as potential therapeutic targets. This study provides a paradigm for nanozyme-mediated microenvironment maintenance to improve the survival rate of the transplanted skin flap. Prussian blue nanozyme (PBzyme) with multiple intrinsic biological activities was constructed and selected for this proof-of-concept study. The prepared PBzyme shows anti-inflammatory, antiapoptotic, antinecroptotic, and antioxidant activities in both in vitro and in vivo models of I/R injured skin flaps. The multiple inhibitory effects of PBzyme maintained a normal microenvironment and thus significantly promoted the survival rate of the I/R injured skin flap (from 37.21 ± 8.205% to 79.61 ± 7.5%). Of note, PBzyme regulated the expression of the characteristic signal molecules of necroptosis, including Rip 1, Rip 3, and pMLKL, indicating that PBzyme may be a therapeutic agent for necroptosis-related diseases. This study shows great prospects for clinical application of PBzyme in the treatment of skin flaps via local administration.

Cell-free fat extract attenuates osteoarthritis via chondrocytes regeneration and macrophages immunomodulation.

BACKGROUND: The prevalence of osteoarthritis (OA) is increasing, yet clinically effective and economical treatments are unavailable. We have previously proposed a cell-free fat extract (CEFFE) containing multiple cytokines, which possessed antiapoptotic, anti-oxidative, and proliferation promotion functions, as a "cell-free" strategy. In this study, we aimed to evaluate the therapeutic effect of CEFFE in vivo and in vitro. METHODS: In vivo study, sodium iodoacetate-induced OA rats were treated with CEFFE by intra-articular injections for 8 weeks. Behavioral experiments were performed every two weeks. Histological analyses, anti-type II collagen, and toluidine staining provided structural evaluation. Macrophage infiltration was assessed by anti-CD68 and anti-CD206 staining. In vitro study, the effect of CEFFE on macrophage polarization and secretory factors was evaluated by flow cytometry, immunofluorescence, and quantitative reverse-transcription polymerase chain reaction (qRT-PCR). The effect of CEFFE on cartilage regeneration was accessed by cell counting kit-8 assay and qRT-PCR. The generation of reactive oxygen species (ROS) and levels of ROS-related enzymes were investigated by qRT-PCR and western blotting. RESULTS: In rat models with sodium iodoacetate (MIA)-induced OA, CEFFE increased claw retraction pressure while decreasing bipedal pressure in a dose-dependent manner. Moreover, CEFFE promoted cartilage structure restoration and increased the proportion of CD206+ macrophages in the synovium. In vitro, CEFFE decreased the proportion of CD86+ cells and reduced the expression of pro-inflammatory factors in LPS + IFN-γ induced Raw 264.7. In addition, CEFFE decreased the expression of interleukin-6 and ADAMTs-5 and promoted the expression of SOX-9 in mouse primary chondrocytes. Besides, CEFFE reduced the intracellular levels of reactive oxygen species in both in vitro models through regulating ROS-related enzymes. CONCLUSIONS: CEFFE inhibits the progression of OA by promoting cartilage regeneration and limiting low-grade joint inflammation.

Application of Segmented Template in Three-Dimensionally Guided Mandibular Angle Osteotomy.

BACKGROUND: The procedure of mandibular angle osteotomy (MAO) via an intraoral approach is challenging and experience-dependent due to the limited field of view and inadequate operational space. Uncertainty about the osteotomy line and plane can lead to severe complications. A three-dimensional printed guidance template based on a computer-assisted preoperative simulation is a potential solution to this problem. The current study aims to retrospectively investigate the feasibility and accuracy of using a custom-made segmented template to guide the osteotomy plane during the procedure. METHODS: Sixty patients who had segmented template-guided MAO were included in the study. Preoperative simulation using the custom-designed template and postoperative computed tomography were collected and parameters, including mandibular angle, gonion distance, and the mandibular plane angle were measured. A paired t tests and intraclass correlation coefficients (ICCs) were used to evaluate the efficacy, accuracy, and symmetry of the results. All complications were reviewed. RESULTS: The patients had a significantly larger mandibular angle and narrower gonion distance postoperatively. Preoperative simulations and postoperative outcomes were compared; ICCs were larger than 95% indicating significant agreement. Bilateral postoperative comparisons of the mandible also demonstrated excellent agreement (ICC > 95%). Numbness in the chin area was the most frequent complication but all recovered by 3 months postoperatively. CONCLUSIONS: The custom-made template can guide the osteotomy plane during the MAO procedure and achieve favorable accuracy and symmetry. Direct contact of the saw with the guidance template not only facilitates control of the osteotomy line but also the oblique angle of the osteotomy plane. This methodology may be a feasible and effective tool for mandibular contouring.

A Single-Blinded Prospective Study on Using Botulinum Toxin Type A for Reducing Alar Mobility.

BACKGROUND: With widespread utilization of instant social media, people desire a minimally invasive treatment to improve alar dynamic aesthetic, but few practical procedures on reducing alar mobility have been conducted. OBJECTIVES: This study aimed to verify the effects of botulinum toxin on reducing nasal alar mobility and provide a supplemental treatment of rhinoplasty. METHODS: This single-blind prospective study included a cohort of 20 participants with the desire to improve their alar dynamic aesthetic. The experimental group was injected with 3U botulinum toxin type A at dilator naris anterior, dilator naris vestibularis, levator labii superioris alaeque nasi, and dilator naris, and the control group received the equivalent of saline. Standardized facial movement (from rest to maximum smile without revealing teeth) was recorded with a 3-dimensional imaging system. The changes between rest and maximum smile statuses represented alar mobility and were generated by MOBILITY=WIDTHsmile-WIDTHrestWIDTHrest×100 % . Alar mobility and root mean square analysis were employed for postoperative evaluations. RESULTS: In the experimental group, alar flaring mobility decreased from 10.05% ± 6.40% to 4.91% ± 3.48%(P < 0.05), and alar base mobility decreased from 16.83% ± 5.69% to 12.50% ± 4.89% (P < 0.05), whereas no significant changes in alar mobility were found in the control group. In root mean square analysis, changes in the experimental group were significantly higher than in the control group (P < 0.05). CONCLUSIONS: Botulinum toxin type A can effectively restrain alar mobility without any significant adverse events and improve alar dynamic esthetic, which can serve as a minimally invasive method or supplemental treatment for rhinoplasty.

Midfacial Soft Tissue Changes After Reduction Malarplasty: A Computed Tomographic Study.

BACKGROUND: The reduction malarplasty has become one of the most popular esthetic surgeries among Asian women to improve facial contour. However, it is still controversial whether midfacial soft tissue changes after surgery, and more studies are needed. METHODS: This retrospective observational study reviewed 30 patients who underwent L-shaped reduction malarplasty during January 2018 and August 2019. The preoperative and postoperative soft tissue thickness and the angle of nasolabial fold of the midfacial were assessed using photographs, three-dimensional skull computerized tomography images, and the Wrinkle Severity Rating Scale. RESULTS: The postoperative average level of nasolabial fold angle was lower than that observed in preoperative conditions, with the difference being statistically significant (t = -10.262, P < 0.001). The postoperative fifth and sixth layers of soft tissue in the midface were significantly higher than those observed in preoperative tissues. CONCLUSIONS: Although L-shaped reduction malarplasty has evident effects on soft tissue changes of middle face, they are within acceptable ranges and do not affect patient satisfaction.

A Novel Study on Alar Mobility of HAN Female by 3dMD Dynamic Surface Imaging System.

AIM: The aim of this study is to conduct a quantitative analysis on alar mobility of HAN females and provided referenced materials for alar dynamic aesthetic. METHODS: One hundred and fifty healthy HAN females without rhinoplasty, nasal injury, nasal deformity and craniofacial deformity were included in this study. 3dMD surface imaging system was used for anthropometric analysis. All participants were instructed to perform the desired dynamic facial expression from rest to maximum smile without reveling teeth and recorded by 3dMD dynamic surface imaging system simultaneously. Two frames of rest status and alar maximum enlargement were selected for measuring alar width, alar base width and inner-canthal distance. The difference between two status represented alar mobility, which was generated through equation: [Formula: see text]. RESULTS: Alar mobility consisted of alar flaring mobility and alar base mobility. The alar flaring mobility was (9.49 ± 4.90)%, reference range was(1.45, 17.53)% and regression equation between rest and maximum smile was Y = 7.953 + 0.886X (R2 = 0.641, p = 0.000); the alar base mobility was (17.94 ± 10.44)%, reference range was (0.88, 35.00)% and regression equation between rest and maximum smile was Y = 4.481 + 0.966X (R2 = 0.528, p = 0.000. CONCLUSION: Asian alar anatomy has great distinction from Caucasian, processing conspicuous alar movement and damaging alar aesthetic dynamically. This study novelly defined alar mobility by three-dimensional anthropometric analysis, providing objective references for alar dynamic aesthetic and arousing plastic surgeons' attention on keeping balance of static and dynamic aesthetic in rhinoplasty. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A New Time-Window Prediction Model For Traumatic Hemorrhagic Shock Based on Interpretable Machine Learning.

ABSTRACT: Early warning prediction of traumatic hemorrhagic shock (THS) can greatly reduce patient mortality and morbidity. We aimed to develop and validate models with different stepped feature sets to predict THS in advance. From the PLA General Hospital Emergency Rescue Database and Medical Information Mart for Intensive Care III, we identified 604 and 1,614 patients, respectively. Two popular machine learning algorithms (i.e., extreme gradient boosting [XGBoost] and logistic regression) were applied. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the models. By analyzing the feature importance based on XGBoost, we found that features in vital signs (VS), routine blood (RB), and blood gas analysis (BG) were the most relevant to THS (0.292, 0.249, and 0.225, respectively). Thus, the stepped relationships existing in them were revealed. Furthermore, the three stepped feature sets (i.e., VS, VS + RB, and VS + RB + sBG) were passed to the two machine learning algorithms to predict THS in the subsequent T hours (where T = 3, 2, 1, or 0.5), respectively. Results showed that the XGBoost model performance was significantly better than the logistic regression. The model using vital signs alone achieved good performance at the half-hour time window (AUROC = 0.935), and the performance was increased when laboratory results were added, especially when the time window was 1 h (AUROC = 0.950 and 0.968, respectively). These good-performing interpretable models demonstrated acceptable generalization ability in external validation, which could flexibly and rollingly predict THS T hours (where T = 0.5, 1) prior to clinical recognition. A prospective study is necessary to determine the clinical utility of the proposed THS prediction models.

An interpretable machine learning model based on a quick pre-screening system enables accurate deterioration risk prediction for COVID-19.

A high-performing interpretable model is proposed to predict the risk of deterioration in coronavirus disease 2019 (COVID-19) patients. The model was developed using a cohort of 3028 patients diagnosed with COVID-19 and exhibiting common clinical symptoms that were internally verified (AUC 0.8517, 95% CI 0.8433, 0.8601). A total of 15 high risk factors for deterioration and their approximate warning ranges were identified. This included prothrombin time (PT), prothrombin activity, lactate dehydrogenase, international normalized ratio, heart rate, body-mass index (BMI), D-dimer, creatine kinase, hematocrit, urine specific gravity, magnesium, globulin, activated partial thromboplastin time, lymphocyte count (L%), and platelet count. Four of these indicators (PT, heart rate, BMI, HCT) and comorbidities were selected for a streamlined combination of indicators to produce faster results. The resulting model showed good predictive performance (AUC 0.7941 95% CI 0.7926, 0.8151). A website for quick pre-screening online was also developed as part of the study.

Modified porous microstructure for improving bone compatibility of poly-ether-ether-ketone.

Poly-ether-ether-ketone (PEEK) has been the promising implantation material since it was first applied in the medical field in the 1990s. With its irreplaceable advantages, such as high mechanical and biological properties, human-like tensile strength and elastic modulus, and excellent physical and chemical stability, PEEK has been regarded as an excellent implantation material, and has been widely used in orthopedics, reconstructive surgery, and dentistry. However, PEEK also has an obvious shortcoming of poor bone compatibility due to its inherent hydrophobicity and bio-inertia, which is a great challenge for its prospect. In the present study, based on the acknowledged fact that enhancing the roughness of PEEK can improve its bone compatibility, modified porous PEEK implants with different porosities (40%, 50%, 60% and solid) were fabricated by Fused Deposition Modeling (FDM), and experiments in vitro and in vivo were conducted to determine whether the bone compatibility can be improved, and compare the biological properties between different porosities. These results indicate that both in vitro and in vivo, the bone compatibility of the modified porous PEEK has been strongly improved, when compared to the control group (solid PEEK implants). In vitro and in vivo, the 40%-porosity-PEEK possessed the highest bone compatibility.

Necessity of facial contouring in feminization surgery for Chinese transgender females.

BACKGROUND: An increasing number of transgender females are suffering from a critical gender dysphoria, which often presents as depression and self-destructive behavior. Facial feminization surgery (FFS) is an effective method to alleviate symptoms of gender dysphoria, which could be more important than genital reassignment surgery for Chinese. Facial contour surgery is perceived as an ordinary FFS for the Chinese women to improve their facial appearance. The zygoma and jaw are key areas for feminizing the facial contour. This study mainly emphasized the necessity of FFS and discussed the importance of facial contour surgery of Chinese individuals. METHODS: The differences of facial contour before and after FFS in terms of skeletal and soft tissue were analyzed. The pre- and postoperative images were evaluated for feminization. The results of the full suite of measurements were compared to reveal the effective change of FFS. Furthermore, a surgery satisfaction survey was conducted among these patients after recovery. RESULTS: All the patients expressed their satisfaction with the reduction in the intergonial width as well as the middle face prominence. All the facial contour ratios changed significantly after surgery in both hard tissue and soft tissue. CONCLUSIONS: Facial contour surgery is crucial to changing one's facial appearance and sex impression, which significantly alleviates gender dysphoria.

A novel p.Pro871Leu missense mutation in SPECC1L gene causing craniosynostosis in a patient.

INTRODUCTION: Craniosynostosis is one of the most common craniofacial abnormalities. It involves premature closure of one or more cranial sutures. Mutations in many genes have been and continue to be identified in patients. SETTINGS AND SAMPLE POPULATION: Whole blood samples were collected from the patient and family members. MATERIAL AND METHODS: Whole exome sequencing was performed to identify potential mutations in the patient. The results were verified by Sanger sequencing by comparing SPECC1L gene sequence of blood samples from 100 unrelated population-matched controls. RESULTS: The patient presented with craniosynostosis with fusion of the bicoronal and sagittal sutures. A novel missense mutation (c.2612C>T, p.Pro871Leu) in the SPECC1L gene was identified. Gene analysis showed a missense mutation in exon1 of SPECC1L that led to an amino acid substitution in the region between coiled-coil domain 3 and calponin homology domain. CONCLUSION: Our observations expand the molecular spectrum of gene mutations in craniosynostosis and emphasize the importance of gene testing in the diagnosis of craniosynostosis. The observations also reinforce the characteristics of SPECC1L-related cranial disorders.