The effect of external fixator on bone metabolism in patients with open fracture of extremities.

This experiment aimed to explore the influence mechanism of external fixator on open fracture. A total of 128 patients with open tibiofibular fractures were included in this study. The patients were randomly divided into external fixator group (n=64) and control group (n=64) according to the order of admission. Double-blind controlled observation was used. The levels of osteocalcin (BGP), ß-CTX, P1 NP, BALP, including haptoglobin (Hp), ceruloplasmin (CER), serum adrenocorticotropic hormone (ACTH), cortisol (COR), C-reactive protein (CRP), white blood cell (WBC) and interleukin-6 (IL-6) were recorded in different groups. The postoperative VAS score and quality of life were recorded. Log-rank was used to analyze the difference in postoperative adverse reaction rates among different groups. External fixation stent treatment increased BGP, PINP, and BALP expression and decreased ß-CTX, Hp, CER, ACTH, COR, CRP, WBC, and IL-6 levels. Patients in the external fixation stent group had significantly lower VAS score quality of life scores and incidence of adverse events than the control group. External fixation stents protect open fracture patients by promoting bone metabolism.

East Asia Superciliary Arch Augmentation With Silicone Implant.

OBJECTIVE: A flat superciliary arch is relatively common in East Asian women. Superciliary arch augmentation aims to increase the facial three-dimensionality of the upper face. However, there are few reports in the literature specifically introducing the surgery. In this study, the authors present the clinical outcomes after a series of superciliary arch augmentation with silicone implants. METHODS: From May 2020 to December 2022, 54 patients underwent superciliary arch augmentation with silicone implants. Silicone implants generally have a length of 50 to 60 mm, a width of 13 to 14 mm, and an arc of 170 degrees. The thickness was 2 to 7 mm. The implant was placed subperiosteal at the lower edges of the eyebrows through a 7 mm incision below the brow tail. All patients evaluated the outcome according to the Global Esthetic Improvement Scale. Four plastic surgeons evaluated postsurgery results with a 5-point Likert Scale (5 = excellent, 4 = good, 3 = fair, 2 = no change, and 1 = worse). RESULTS: Fifty-four patients were successfully enrolled. The mean follow-up period was 12.02 ± 3.38 months. The mean thickness was 4.55 ± 0.67 mm for the thickest part of the implant. The minor complication rate was 44.44%. They all subsided within 1 month without treatment. Patients' outcome ratings were 4.45 ± 0.55 (3 mo), 4.51 ± 0.48 (6 mo), and 4.51 ± 0.45 (1 y). The surgeons' outcome scoring was 4.49 ± 0.31. CONCLUSIONS: Superciliary arch augmentation with silicone implants is a quite simple, effective, inexpensive, and safe strategy to improve the three-dimensionality and contour of the upper face in East Asians.

Exploring the Unknown: Evaluating ChatGPT's Performance in Uncovering Novel Aspects of Plastic Surgery and Identifying Areas for Future Innovation.

We have perused with keen interest the scholarly article titled "Exploring the Unknown: Evaluating ChatGPT's Performance in Uncovering Novel Aspects of Plastic Surgery and Identifying Areas for Future Innovation" penned by Lim et al. in the esteemed journal "Aesthetic Plastic Surgery". This paper evaluates ChatGPT's potential application in plastic surgery, exploring its responses on various themes including pioneers, advancements, and techniques, as well as flap grafting. While it offers valuable insights, questions arise. Firstly, ChatGPT's attribution of plastic surgery's progenitor to Sir Harold Delf Gillies raises concerns of underlying biases in its responses. Secondly, its assertion on paramount contributions prompts reflection on its discernment criteria. Can targeted training enhance its accuracy? Lastly, the discourse questions biases favoring reconstructive over cosmetic procedures. ChatGPT's responses, while proficient in addressing medical queries, face ongoing veracity challenges, necessitating clinician scrutiny. However, this scrutiny may surpass user expertise, requiring additional measures for accuracy assurance. Artificial Intelligence (AI) replicates human cognitive abilities but lacks human richness, potentially affecting transformative insights in plastic surgery's future trajectory. LEVEL OF EVIDENCE V: 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 steerable non-paraxial Gaussian beam expansion for a steerable parametric array loudspeaker.

A steerable parametric array loudspeaker (PAL) aims to steer a highly directional audio beam without the need to mechanically rotate the source. The Gaussian beam expansion (GBE) method is often used to model PALs because it is a computationally efficient approach, however the method relies on a paraxial approximation that can result in significant inaccuracies at large steering angles. To address this limitation, a steerable non-paraxial GBE is proposed in this article, where the mainlobe of the steered ultrasonic beam is included in the calculation by rotating the coordinate system. A non-paraxial approximation is then used to improve the accuracy of the method when integrating the virtual audio sources. The numerical results obtained using the proposed method are compared against those using the conventional GBE, as well as an exact solution. For a typical configuration, it is shown that for a conventional GBE the prediction error can be more than 30 dB at large angles, whereas the proposed method reduces this to less than 1 dB. The advantage of the proposed method is more significant at large steering angles, low audio frequencies, and those locations outside of the paraxial region. This improvement in performance is achieved with a computational cost that remains the same as the conventional GBE.

Reconstructive Operation of Severe Orbital Hypertelorism With Computer-Assisted Precise Virtual Plan.

Orbital hypertelorism correction is still a less precise procedure, with a simple preoperative design and surgical results often depending on the operator's experience. In recent years, computer-assisted technology has been fully utilized in craniofacial surgery. This article aims to explore the clinical results of computer-assisted technology in orbital hypertelorism correction and discuss its advantages and effects on treatment. Four patients with orbital hypertelorism underwent intracranial and extracranial combined box osteotomy correction. Preoperative computed tomography scans were performed, and 3-dimensional 3D digital technology was used to measure the orbital spacing, virtually design the 3D cutting scheme, and guide the intraoperative 3D cutting to improve the accuracy of periorbital osteotomy and reduce the surgical risk. Four patients underwent successful surgery, and the average distance of the medial orbital wall was decreased from 43.6 to 23.4 mm. Computer-assisted box osteotomy shortens the operative time and provides better corrective results.

Wind noise suppression in filtered-x least mean squares-based active noise control systems.

Wind noise is notorious for its detrimental impacts on audio devices. This letter evaluates the influence of wind noise on the active noise control performance of headphones in a wind tunnel, and the noise reduction is found to decrease with wind speeds. To improve the performance of noise control systems in windy environments, the filtered-x least mean squares algorithm is modified based on the total least squares technique, taking the characteristics of wind noise into account. Computer simulations with real-recorded data demonstrate that the proposed algorithm could improve the noise reduction by approximately 3 dB in windy conditions.

Chamomile: A Review of Its Traditional Uses, Chemical Constituents, Pharmacological Activities and Quality Control Studies.

Matricaria chamomilla L. (MC) and Chamaemelum nobile (L.) All. (CN) are two varieties of Chamomile. These herbs have been used for thousands of years in Greece, Rome and ancient Egypt. Chamomile has been used for the treatment of stomach problems, cramps, dermatitis, and minor infections. The purpose of this study was to introduce the botanical characteristics and geographical distribution, traditional uses, chemical constituents, pharmacological activities, toxicity studies and quality control studies, and lay a theoretical foundation for the rational development and utilization of chamomile. This review powered that chemical constituents include flavonoids, coumarins, volatile oils, terpenes, organic acids, polysaccharides, and others. These compounds possess anticancer, anti-infective, anti-inflammatory, antithrombotic, antioxidant, hypolipidaemic, hypoglycaemic, antihypertensive, antidepressant, neuroprotective activities, among others. Chamomile is a widely used herb in traditional medicine. It brings great economic value due to its numerous pharmacological effects and traditional uses. However, more toxicity tests should be carried out to confirm its safety. There is need for further research to provide concrete scientific evidence and validate its medicinal properties.

Modification of frequency-domain active noise control algorithm without secondary path modeling.

The phase-shifting based active noise control (ANC) algorithm without secondary path modeling is appealing due to its simple implementation and high computational efficiency. However, the algorithm suffers from the influence of an implicit circular convolution caused by directly applying the most appropriate phase shift to the reference signal in the frequency domain. The implicit circular convolution results in a poor linear relationship between the phase-shifted reference signal and the error signal, which considerably degrades the convergence performance of the ANC system. In this paper, two methods are proposed to deal with this problem. In the first method, the circular wraparound artifacts are removed by the time-domain constraining operation. In the second method, a noncausal phase-shifting filter is used to regularize the phase of the reference signal. Compared with the standard frequency-domain implementation, the two proposed algorithms both eliminate the influence caused by the wraparound artifacts of the circular convolution and improve the linear relationship between the phase-shifted reference signal and the error signal, leading to a higher level of noise attenuation with a tolerable increase in computational complexity. Simulation results validate the better noise attenuation ability of the proposed algorithms.

Characteristics of the Sphenoid Bone in Crouzon Syndrome.

BACKGROUND: The goal of this study is to analyze the safety of reconstructive surgeries for Crouzon syndrome, and to understand the deformities and complications related to the surgical procedure. METHODS: Thirty-nine subjects underwent preoperative computed tomographic scans were included (Crouzon, n = 19; controls, n = 20) in this study. Craniofacial cephalometric measurements were analyzed by Materialise software. RESULTS: The overall average distance from the pterygoid junction to the coronal plane in the patients with Crouzon syndrome was 21.34 mm (standard deviation [SD] 5.13), which was deeper than that in the controls by 35% (P = 0.000).The overall average distances between the left and right foramen ovale and pterion on the sphenoid bone in the subjects were 64.93 mm (SD 7.56) and 67.83 mm (SD 8.57), which were increased by 13% (P = 0.001) and 14% (P = 0.001) compared with those in the controls.The overall distances between the most inferior point of the left and right lateral pterygoid plate and the medial pterygoid plate in the subjects were 51.09 mm (SD 6.68) and 51.51 mm (SD 10.98), which was not statically different from the controls (P = 0.887, P = 0.991, respectively). CONCLUSIONS: This study characterized the surgically relevant anatomy of the sphenoidal bone. The pterygomaxillary junction is located in the posterior of the skull. Though there are some anatomical differences due to age, it is well known that the cranial cavity of the sphenoid side is likely to be enlarged in Crouzon syndrome, which may contribute to the other complications of the disease.

Micro-refractive optical elements fabricated by multi-exposure lithography for laser speckle reduction.

Laser speckle reduction with a macro refractive optical element (mROE) is restricted by the limited entrance facet size of light pipe. Here, we have fabricated a micro-ROE (µROE) that incorporates three-dimensional micro-optical structures. The µROE with 2 × 2 duplicated multi-level cells is made of SU-8 photoresist with the help of multi-exposure lithography process. When the µROE works together with the mROE, objective speckle contrast is reduced to 0.2, where the light source is a low-coherence multimode laser diode. In principle, more speckle reduction can be obtained by fabricating µROEs with more cells and larger height differences among the cells.

Connection between T regulatory cell enrichment and collagen deposition in keloid.

Keloid is a dermal tumor with high recurrence rate. The immune system plays a critical role in preventing pathogen infiltration, inducing inflammation, initiating downstream processes, and recruiting fibrocytes in keloids. Interestingly, we observed a local, but not systemic, enrichment of Treg cells and Treg-associated gene expression at the keloid lesions compared to non-keloid tissues. Concurrently, keloid tissues presented significantly elevated expression of type I and type III collagen. Moreover, the level of collagen III and the collagen III-to-collagen I ratio were positively correlated with the level of FOXP3. To investigate whether Treg cells could directly promote the expression of collagen, fibrocytes were cocultured with autologous Treg cells. Activated Treg cells, but not quiescent Treg cells, were capable of promoting collagen expression. This response was more pronounced in keloid patients than in non-keloid controls, and required the secretion of TGF-ß. Overall, these findings demonstrated a connection between collagen overexpression and imbalance and Treg dysregulation in keloid tissues.

Effects of geometric properties of a static pressure tube on its frequency response.

Static pressure tubes are widely used to measure the static pressure in turbulent flows. Existing work focuses on the alteration of the static pressure tubes to the flow field. This paper investigates the effects of the geometric properties of a static pressure tube on the frequency response. A theoretical formulation is developed to describe the relationship between the sound pressure inside and outside the tube. The numerical simulation results show that the peaks in the frequency response move to lower frequencies when the tube diameter, tube length, and orifice depth increase and when the orifice diameter decreases. Experiments with a 3D-printed static pressure tube were conducted to verify the analytical results. The proposed model can be used to optimize the static pressure tube in the design stage or to correct the measurement results afterwards instead of cumbersome experimental calibration.

A note on wind velocity and pressure spectra inside compact spherical porous microphone windscreens.

Simultaneous measurements of wind velocity and pressure fluctuations were conducted in a wind tunnel to investigate the wind noise source inside compact spherical open celled porous windscreens. The existing outdoor wind noise models are found to be inadequate to predict the wind noise inside a wind tunnel. This paper proposes a model to predict the interior stagnation pressure, which agrees with the wind noise measured inside the windscreen within a bandwidth, where the exterior turbulence-turbulence interaction pressure overestimates the wind noise level. The limitations of the proposed model and other potential sources for wind noise inside porous windscreens are discussed.

Repairing Cranial Defect With Autogenous Mandibular Outer Plate.

BACKGROUND: Autogenous bone is the best material in cranioplasty because of biological advantages. Previously, skull, rib, ilium, and fibula have been used in the reconstruction of cranial defects. However, the application of autologous mandibular outer plate in the treatment of skull defect is rarely reported. This study evaluated the application of the autogenous mandibular outer plate in the reconstruction of cranial defect. METHODS: Eleven patients who underwent cranioplasty with mandibular outer plate were recruited. Three-dimensional tomography data were collected to calculate the preoperative, immediate postoperative, and long-term follow-up volume of the bone graft area and donor bone site, and then the absorption rate and the regeneration rate of autogenous bone were analyzed. RESULTS: The majority of the patients were satisfied with the reconstructive outcome. There are statistical differences in the volumetric measurements of the bone graft area and bone donor site at different time periods (P<0.05). The mean absorptivity of mandibular outer plate implanted in the cranial defect area was (17.30 ±â€Š5.03)% after 3 to 24 months postoperatively, the average regeneration rate of mandibular outer plate volume was (41.65 ±â€Š9.85)% at the same period. CONCLUSION: This report shows that the cranioplasty with mandibular outer plate bone graft may be an optional surgical procedure.

GGP modified daunorubicin plus dioscin liposomes inhibit breast cancer by suppressing epithelial-mesenchymal transition.

Tumor invasion and metastasis are the nodus of anti-tumor. Epithelial cell-mesenchymal transition is widely regarded as one of the key steps in the invasion and metastasis of breast cancer. In this study, GGP modified daunorubicin plus dioscin liposomes are constructed and characterized. GGP modified daunorubicin plus dioscin liposome has suitable particle size, narrow PDI, zeta potential of about -5 mV, long cycle effect, and enhanced cell uptake due to surface modification of GGP making the liposome could enter the inside of the tumor to fully exert its anti-tumor effect. The results of in vitro experiments show that the liposome has superior killing effect on tumor cells and invasion. In vivo results indicate that the liposome prolongs the drug's prolonged time in the body and accumulates at the tumor site with little systemic toxicity. In short, the targeted liposome can effectively inhibit tumor invasion and may provide a new strategy for the treatment of invasive breast cancer.

Macrophages in keloid are potent at promoting the differentiation and function of regulatory T cells.

The mechanistic details of keloid formation are still not understood. Given that the immune system is engaged in skin lesion repair, we examined the CD14+ macrophages and CD3+ T cells in keloid tissues and in the normal skin. Compared to the normal skin, keloid tissues presented significantly elevated infiltration by CD14+ macrophages. Moreover, the transcription and protein expression of iNOS, IL-12, IL-10, and TGF-ß were significantly higher in keloid macrophages than in normal skin macrophages, in which the expression of M2-associated genes were further elevated compared to M1-associated genes in keloid. We also observed that keloid tissues presented higher infiltration by CD3+ T cells, of which the majority was CD4+ T cells. Notably, the frequency of Foxp3+ regulatory T cells (Tregs) in keloid tissues was significantly higher compared to that in the peripheral blood. Furthermore, macrophages from keloid tissues possessed potent capacity to induce Foxp3 expression in circulating CD3+ T cells. Together, this study suggested that macrophages in keloid tissues presented high activation status and were polarized toward the M2 subtype; moreover, these macrophages could promote Treg differentiation by upregulating Foxp3 expression.

Modulating effects of preconditioning exercise in the expression of ET-1 and BNP via HIF-1α in ischemically injured brain.

It is well-known that in ischemia-induced hypoxia, hypoxia-inducible factor -1α (HIF-1α) is critical in triggering expression of its downstream target genes to produce several products, such as erythropoietin (EPO), vascular endothelial growth factor (VEGF), nitric oxide synthesis (NOS), glucose transportor-1 (GLUT-1), insulin-like growth factor (IGF), which further promote erythropoiesis, angiogenesis, vasodilation and capitalization of glucose to overcome hypoxia. Meanwhile, as the factors with opposite effects on blood vessels, endothelin-1 (ET-1) and brain natriuretic peptide (BNP) also stand out strikingly in ischemic pathophysiology. To this day, several preconditioning manners have been used to induce tolerance to ischemia. During our research, exercise preconditioning was applied and it was demonstrated that HIF-1α triggered expression of ET-1 and BNP, which confirmed their downstream target genes for HIF-1α. And ET-1 may influcence expression of BNP to some degree but not the only factor which regulates BNP expression. Therefore, our findings suggest exercise preconditioning may provide protection to the ischemic brain tissue via HIF-1α which in turn increases expression of BNP to cause vasodilation in cooperation with some other factors, such as VEGF and EPO, to increase the blood flow in the ischemic area and then relieve the injuries induced by ischemia.

An Effective Simulator for Intraoral Facial Skeletal Contour Surgeries.

BACKGROUND: In East Asia, intraoral facial skeletal contour surgeries (intraoral FSCSs), including reduction gonioplasty, reduction malarplasty, and genioplasty, have become increasingly popular. Nonetheless, intraoral FSCSs are technically difficult and have a steep learning curve. An effective simulator could be beneficial for intraoral FSCS training. However, there is no intraoral FSCS simulator available. We introduced an intraoral FSCS simulator and assessed its effectiveness. METHODS: An intraoral FSCS simulator was established by covering a 3-dimensional printed skull with elastic cloth. Twenty residents were enrolled and randomly divided into experimental group A and control group B. Group A performed the intraoral FSCS on the simulator for 3 times. Group B performed the intraoral FSCS on skull model for 3 times. The intraoral FSCS simulator and trainees' performance were evaluated by a trainee-reported questionnaire before and after training, the surgical outcomes were graded by 3 senior attending physicians. All questions and the surgical outcome were scored based on a 5-point Likert scale (1 = very poor, 5 = very good). The surgical times were recorded. RESULTS: The intraoral FSCS simulator (4.13 ± 0.64) simulated the surgical reality significantly better than the skull (2.6 ± 0.63). In intraoral FSCS simulator training, the restriction and compliance of the facial soft tissue were vividly mimicked (4.4 ± 0.51); the intraoral approach was vividly mimicked (4.07 ± 0.59). The intraoral FSCS simulator is significantly superior to the skull in improving participants' confidence in performing intraoral FSCS, power system control, and intraoral approach adoption (<0.001). The average surgical outcome score was 3.11 ± 0.45 in group A and 3.91 ± 0.24 in group B. The average surgical time was 177.78 ± 28.38 minutes in group A and 65.26 ± 15.38 minutes in group B. CONCLUSIONS: We developed the first intraoral FSCS simulator and proved its effectiveness preliminarily. Randomized controlled study with clinical cases is needed to further test its effectiveness.

Mandibular Augmentation With a New Sandwich Osteotomy: A Morphologic Study.

OBJECTIVE: Facial asymmetry is one of common complaints in plastic and craniofacial surgery in Orient. Hemimandibular dysplasia has considered to be the key role in facial asymmetry. Despite of the undergrow of mandibular length and height, the lackness of mandibular thickness contributes to the asymmetry. The aim of this study was to describe the therapeutic efficiency of mandibular augmentation with a new sandwich osteotomy with interpositional natural coral and coralline hydroxyapatite (CHA). METHODS: Nine goats were randomly divided into 3 groups and observed at 6, 12, and 18 months after surgery. All goats received splitting of bilateral mandibular outer cortex and interpositional grafting with natural coral and CHA, respectively (sandwich osteotomy). Data were evaluated and statistically analyzed by t-test. RESULTS: All goats were observed at 3 different time points. The computed tomography images show that the area of operation was healed and the thickness of the mandible was increased in 3 time points. In the 3 groups, mandibular thickness and volume were significantly different compared with those before operation (P < 0.05). The volume of CHA group improved better than coral group (P < 0.05). CONCLUSION: This study provides a promising alternative method for mandibular augmentation with a sandwich osteotomy and interpositional grafting with natural coral and CHA. The thickness and volume of mandible had been effectively increased in follow-ups.

Zygomatic Nonunion: A Misunderstood Complication of Reduction Malarplasty.

Reduction malarplasty is a popular facial skeletal contour surgery in East Asia. Zygomatic nonunion is a reported complication. However, it is often misunderstood and misdiagnosed. Here we present typical misdiagnosed zygomatic nonunion cases, propose and preliminarily clarify 4 major misunderstandings of zygomatic nonunion: diagnostic standard, the cause, the incidence, and the prognosis of zygomatic nonunion.