Artificial intelligence-assisted system for the assessment of Forrest classification of peptic ulcer bleeding: a multicenter diagnostic study.

BACKGROUND: Inaccurate Forrest classification may significantly affect clinical outcomes, especially in high risk patients. Therefore, this study aimed to develop a real-time deep convolutional neural network (DCNN) system to assess the Forrest classification of peptic ulcer bleeding (PUB). METHODS: A training dataset (3868 endoscopic images) and an internal validation dataset (834 images) were retrospectively collected from the 900th Hospital, Fuzhou, China. In addition, 521 images collected from four other hospitals were used for external validation. Finally, 46 endoscopic videos were prospectively collected to assess the real-time diagnostic performance of the DCNN system, whose diagnostic performance was also prospectively compared with that of three senior and three junior endoscopists. RESULTS: The DCNN system had a satisfactory diagnostic performance in the assessment of Forrest classification, with an accuracy of 91.2% (95%CI 89.5%-92.6%) and a macro-average area under the receiver operating characteristic curve of 0.80 in the validation dataset. Moreover, the DCNN system could judge suspicious regions automatically using Forrest classification in real-time videos, with an accuracy of 92.0% (95%CI 80.8%-97.8%). The DCNN system showed more accurate and stable diagnostic performance than endoscopists in the prospective clinical comparison test. This system helped to slightly improve the diagnostic performance of senior endoscopists and considerably enhance that of junior endoscopists. CONCLUSION: The DCNN system for the assessment of the Forrest classification of PUB showed satisfactory diagnostic performance, which was slightly superior to that of senior endoscopists. It could therefore effectively assist junior endoscopists in making such diagnoses during gastroscopy.

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study.

PURPOSE: To investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. METHODS: A retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. RESULTS: Fifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). CONCLUSION: Patients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. LEVEL OF EVIDENCE: Level III; retrospective cohort study.

Advancing Ultrasonic Defect Detection in High-Speed Wheels via UT-YOLO.

In the context of defect detection in high-speed railway train wheels, particularly in ultrasonic-testing B-scan images characterized by their small size and complexity, the need for a robust solution is paramount. The proposed algorithm, UT-YOLO, was meticulously designed to address the specific challenges presented by these images. UT-YOLO enhances its learning capacity, accuracy in detecting small targets, and overall processing speed by adopting optimized convolutional layers, a special layer design, and an attention mechanism. This algorithm exhibits superior performance on high-speed railway wheel UT datasets, indicating its potential. Crucially, UT-YOLO meets real-time processing requirements, positioning it as a practical solution for the dynamic and high-speed environment of railway inspections. In experimental evaluations, UT-YOLO exhibited good performance in best recall, mAP@0.5 and mAP@0.5:0.95 increased by 37%, 36%, and 43%, respectively; and its speed also met the needs of real-time performance. Moreover, an ultrasonic defect detection data set based on real wheels was created, and this research has been applied in actual scenarios and has helped to greatly improve manual detection efficiency.

Catalpol ameliorates dexamethasone-induced osteoporosis by promoting osteogenic differentiation of bone marrow mesenchymal stem cells via the activation of PKD1 promoter.

OBJECTIVE: To investigate the effects of CA on glucocorticoid-induced osteoporosis (GIOP) and lucubrate the underlying mechanism of CA via the activation of polycystic kidney disease-1(PKD1) in bone marrow mesenchymal stem cells (BMSCs). METHODS: In vivo, a GIOP model in mice treated with dexamethasone (Dex) was established. Biomechanical, micro-CT, immunofluorescence staining of OCN, ALP and PKD1 and others were severally determined. qRT-PCR and Western blot methods were adopted to elucidate the particular mechanisms of CA on GIOP. In addition, BMSCs cultured in vitro were also induced by Dex to verify the effects of CA. Finally, siRNA and luciferase activity assays were performed to confirm the mechanisms. RESULTS: We found that CA could restore the destroyed bone microarchitecture and increase the bone mass in GIOP mice. CA could also upregulate PKD1 protein expression, reduce oxidative stress, and promote mRNA expression of bone formation-associated markers in GIOP mice. Furthermore, it was also observed that CA reduced oxidative stress and promoted osteogenic differentiation in Dex-induced BMSCs. Mechanically, CA could promote protein expression via increasing the activity of PKD1 promoter. CONCLUSION: This study provides important evidences for CA in the further clinical treatment of GIOP, reveals the activation of PKD1 promoter as the underlying mechanism.

Influence of respondents' Differentiation of subjective response on water knowledge stock test scale: Evaluation based on two-parameter-multidimensional IRT model.

Insufficient awareness of water issues is a crucial bottleneck restricting the sustainable utilization of water resources. To accurately measure citizens' water knowledge stock and overcome the differences between scales and respondents' characteristic levels on test results, the research focuses on developing and evaluating water knowledge stock test scales. The mechanism for identifying indicators is designed based on the grounded theory, and as a result, the water knowledge stock test indicator system is derived. The data was collected by the form of survey questionnaire developed with the test indicator system. A two-parameter multidimensional item response theoretical model is constructed based on item parameter estimation, data model fitting, and item information function. The survey data and optimization model are used to optimize the water knowledge stock test scale and verify the fitting degree with the characteristics of the respondents. The test information function and standard error function indicate that the scale is most informative for individuals with characteristic levels ranging from -2 to 3, resulting in a highly reliable test effect. The research has established a measurement indicator system, methodology, and presented results that serve as a foundation for measuring the stock of water knowledge.

Nondestructive analysis of rolling contact fatigue cracks using induced scanning thermography.

Rolling contact fatigue (RCF) produced by wheel-rail interaction is now considered to be a critical factor that causes failure. Throughout this work, induced scanning thermography (IST) for detecting RCF defects at different depths is investigated. The original thermal sequences could not utilize the features at the heat dissipation stage; thus, a data reconstruction method, including principal component analysis (PCA) and Tucker factorization, was employed to extract the spatial and time patterns. In addition, detectability was evaluated across a range of speed studies. The Tucker-PCA combination algorithms obtained defects with improved quality, showing a clear boundary over the velocity range of 1-4km/h, which dramatically suppressed background noise. A unique gradient response characteristic in the cooling phase was summarized and utilized through experimental verification in order to recognize defect width.

The advances in nanomedicine for bone and cartilage repair.

With the gradual demographic shift toward an aging and obese society, an increasing number of patients are suffering from bone and cartilage injuries. However, conventional therapies are hindered by the defects of materials, failing to adequately stimulate the necessary cellular response to promote sufficient cartilage regeneration, bone remodeling and osseointegration. In recent years, the rapid development of nanomedicine has initiated a revolution in orthopedics, especially in tissue engineering and regenerative medicine, due to their capacity to effectively stimulate cellular responses on a nanoscale with enhanced drug loading efficiency, targeted capability, increased mechanical properties and improved uptake rate, resulting in an improved therapeutic effect. Therefore, a comprehensive review of advancements in nanomedicine for bone and cartilage diseases is timely and beneficial. This review firstly summarized the wide range of existing nanotechnology applications in the medical field. The progressive development of nano delivery systems in nanomedicine, including nanoparticles and biomimetic techniques, which are lacking in the current literature, is further described. More importantly, we also highlighted the research advancements of nanomedicine in bone and cartilage repair using the latest preclinical and clinical examples, and further discussed the research directions of nano-therapies in future clinical practice.

Dominant roles of torrential floods and atmospheric deposition revealed by quantitative source apportionment of potentially toxic elements in agricultural soils around a historical mercury mine, Southwest China.

Hg pollution in soils surrounding the Wanshan mercury mine (WMM), once the largest Hg-producing center in China, has been confirmed, neglecting other potential toxic elements (PTEs). Better understanding of the sources and transport pathways of soil PTEs remains insufficient. To response these limitations, eight soil PTEs (As, Cd, Cr, Cu, Hg, Ni, Pb and Zn) at two typical agricultural sites, namely AZ and WW that are located near and far from the WMM, respectively, were systemically investigated. The results showed that AZ exhibited significantly higher concentrations of all the PTEs in the surface soil than WW (p < 0.01). Hg and Cd were recognized as the priority control PTEs, with their average concentrations of 21.54 and 1.21 mg kg-1 at AZ, and 15.79 and 0.48 mg kg-1 at WW. Those affected PTEs tended to enrich in near-river areas. Atmospheric deposition contributed more to soil Hg than did regular irrigation, but these two sources could not explain the considerable soil Hg accumulation. Three sources, including natural sources, hydraulic transport (torrential floods and regular irrigation) and atmospheric deposition, were identified and quantified based on the positive matrix factorization model, statistical methods and various auxiliary information. Hydraulic transport (mainly torrential floods) dominated the soil Hg input, which could explain 83.8% and 69.8% of the soil Hg input at AZ and WW, respectively. Atmospheric deposition dominated the soil Cd input, explaining 44.3% and 59.9% of the soil Cd input at AZ and WW, respectively. More attention should be given to the safe utilization of agricultural land and long-term monitoring of atmospheric deposition of Hg and Cd. This study could provide insights to prevent PTE diffusion along the above dominant transportation pathways while developing similar mine regions.

Ecological and human health risk assessment of heavy metals based on their source apportionment in cropland soils around an e-waste dismantling site, Southeast China.

An accurate understanding of soil heavy metal (HM) pollution characteristics and source apportionment, and a recognition of the major factors influencing ecological and human health risks (HHRs) are essential for soil HM pollution control and remediation. In this study, 212 surface soils (0-20 cm) and 15 profile soils (0-100 cm) were collected from cropland soils around an e-waste dismantling site in Taizhou city, Zhejiang Province, China. Spatial analysis was used to evaluate the pollution characteristics of HMs (Cd, Cu, Pb, Zn, Cr and Ni). Principal component analysis (PCA) and positive matrix factorization (PMF) were also conducted to quantify their source contributions. A modified source-oriented HHR assessment integrated source-oriented ecological risk and source-oriented HHR assessment was developed to describe the major factors that influenced HHR. Results showed that 94.81 %, 88.21 %, 36.79 % and 47.17 % of Cd, Cu, Pb and Zn, respectively, in surface soils exceeded their screening values in the soil environmental quality standard for agricultural soils (GB 15618-2018). Spatial analysis indicated that high values of Cd, Cu, Pb and Zn were distributed near the e-waste dismantling site. The results of PCA and PMF showed that the primary sources of HMs in the study area are e-waste dismantling activities, natural sources and atmospheric deposition, which contribute 27 %, 46 % and 27 % of HM pollutants, respectively. The results of source-oriented ecological risk and HHR assessment indicated that e-waste dismantling activities and natural sources were primary sources for ecological risk and HHR. However, source-oriented HHR assessment may underestimate the contribution of e-waste dismantling activities by ignoring HM pollution levels. The modified source-oriented HHR assessment highlights that e-waste dismantling activities were major factor that affect noncarcinogenic risk. This study could provide important data support for subsequent environmental remediation of soil HM pollution in cropland soils around e-waste dismantling sites.

Excessive phosphorus inputs dominate soil legacy phosphorus accumulation and its potential loss under intensive greenhouse vegetable production system.

Phosphorus (P) is an essential element for crop growth and it plays a critical role in agricultural production. Excessive P applications has become a serious concern in Chinese greenhouse vegetable production (GVP) systems. Nevertheless, P accumulation (legacy P) in GVP profile soils and its potential loss remain poorly documented. Hence, this study aimed to response this issue via paired collection of 136 soil samples (0-30, 30-60 and 60-90 cm depth) and 41 vegetable samples from both plastic greenhouses (PG) and solar greenhouses (SG) in Shouguang, Shandong province. Results showed that the annual input of P ranged from 772 to 2458 kg ha-1 for different vegetables through the whole growing season versus little vegetable P uptake (ranging from 47.8 to 155 kg ha-1). Results also revealed significant P accumulation in both SG and PG profile soils. Compared to arable soils (background soils), legacy P to the depth of 90 cm in PG and SG soils were 3.28 and 11.16 Mg P ha-1, respectively. The content of total P in PG and SG soils significantly increased with cultivation duration. The maximum environmental capacity of P in SG soils was 187 Mg ha-1, and the maximum number of years for safe planting was 38 yrs. After four years of cultivation, P loss would occur in these soils and the loss rate of P increased with cultivation duration. Opposite to PG soils, a potentially higher risk of P losses took place in SG soils. Our results also demonstrated that excessive P inputs driven by intensive agricultural practices dominated legacy P accumulation within the profile soils and its losses in GVP systems. Site-specific P managements, including improving P use efficiency, reducing further P surplus and reusing legacy P in soils, are urgently needed to minimize P loss. At the same time, the potential loss of subsoil P could not be neglected.

Ribosome assembly factor URB1 contributes to colorectal cancer proliferation through transcriptional activation of ATF4.

Ribosome assembly factor URB1 is essential for ribosome biogenesis. However, its latent role in cancer remains unclear. Analysis of The Cancer Genome Atlas database and clinical tissue microarray staining showed that URB1 expression was upregulated in colorectal cancer (CRC) and prominently related to clinicopathological characteristics. Silencing of URB1 hampered human CRC cell proliferation and growth in vitro and in vivo. Microarray screening, ingenuity pathway analysis, and JASPAR assessment indicated that activating transcription factor 4 (ATF4) and X-box binding protein 1 (XBP1) are potential downstream targets of URB1 and could transcriptionally interact through direct binding. Silencing of URB1 significantly decreased ATF4 and cyclin A2 (CCNA2) expression in vivo and in vitro. Restoration of ATF4 effectively reversed the malignant proliferation phenotype of URB1-silenced CRC cells. Dual-luciferase reporter and ChIP assays indicated that XBP1 transcriptionally activated ATF4 by binding with its promoter region. X-box binding protein 1 colocalized with ATF4 in the nuclei of RKO cells, and ATF4 mRNA expression was positively regulated by XBP1. This study shows that URB1 contributes to oncogenesis and CRC growth through XBP1-mediated transcriptional activation of ATF4. Therefore, URB1 could be a potential therapeutic target for CRC.

Quantification of closed cracks in railway using eddy current pulsed thermography.

Rolling contact fatigue cracks are common defects in rail, and they are also the source of various rail defects. When such defects occur, crack closure is caused due to interaction forces between wheels and rails during train running. In this study, eddy current pulsed thermography was applied for quantitative closed crack detection based on the isotherm analysis of temperature distributions. The differences between point-contact crack and opening crack in eddy current and temperature profile were compared in the simulation study. The angle crack test blocks with different closure depths were tested, and the simulation conclusions were consistent with experimental results. Therefore, the proposed method is an effective approach to quantify closed crack.

Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study.

BACKGROUND: Artificial intelligence (AI) methods can potentially be used to relieve the pressure that the COVID-19 pandemic has exerted on public health. In cases of medical resource shortages caused by the pandemic, changes in people's preferences for AI clinicians and traditional clinicians are worth exploring. OBJECTIVE: We aimed to quantify and compare people's preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic, and to assess whether people's preferences were affected by the pressure of pandemic. METHODS: We used the propensity score matching method to match two different groups of respondents with similar demographic characteristics. Respondents were recruited in 2017 and 2020. A total of 2048 respondents (2017: n=1520; 2020: n=528) completed the questionnaire and were included in the analysis. Multinomial logit models and latent class models were used to assess people's preferences for different diagnosis methods. RESULTS: In total, 84.7% (1115/1317) of respondents in the 2017 group and 91.3% (482/528) of respondents in the 2020 group were confident that AI diagnosis methods would outperform human clinician diagnosis methods in the future. Both groups of matched respondents believed that the most important attribute of diagnosis was accuracy, and they preferred to receive combined diagnoses from both AI and human clinicians (2017: odds ratio [OR] 1.645, 95% CI 1.535-1.763; P<.001; 2020: OR 1.513, 95% CI 1.413-1.621; P<.001; reference: clinician diagnoses). The latent class model identified three classes with different attribute priorities. In class 1, preferences for combined diagnoses and accuracy remained constant in 2017 and 2020, and high accuracy (eg, 100% accuracy in 2017: OR 1.357, 95% CI 1.164-1.581) was preferred. In class 2, the matched data from 2017 were similar to those from 2020; combined diagnoses from both AI and human clinicians (2017: OR 1.204, 95% CI 1.039-1.394; P=.011; 2020: OR 2.009, 95% CI 1.826-2.211; P<.001; reference: clinician diagnoses) and an outpatient waiting time of 20 minutes (2017: OR 1.349, 95% CI 1.065-1.708; P<.001; 2020: OR 1.488, 95% CI 1.287-1.721; P<.001; reference: 0 minutes) were consistently preferred. In class 3, the respondents in the 2017 and 2020 groups preferred different diagnosis methods; respondents in the 2017 group preferred clinician diagnoses, whereas respondents in the 2020 group preferred AI diagnoses. In the latent class, which was stratified according to sex, all male and female respondents in the 2017 and 2020 groups believed that accuracy was the most important attribute of diagnosis. CONCLUSIONS: Individuals' preferences for receiving clinical diagnoses from AI and human clinicians were generally unaffected by the pandemic. Respondents believed that accuracy and expense were the most important attributes of diagnosis. These findings can be used to guide policies that are relevant to the development of AI-based health care.

Estimation of Heavy Metals in Tailings and Soils Using Hyperspectral Technology: A Case Study in a Tin-Polymetallic Mining Area.

Rapid assessment of heavy metal (HM) pollution in mining areas is urgently required for further remediation. Here, hyperspectral technology was used to predict HM contents of multi-media environments (tailings, surrounding soils and agricultural soils) in a mining area. The correlation between hyperspectral data and HMs was explored, then the prediction models were established by partial least squares regression (PLSR) and back propagation neural networks (BPNN). The determination coefficients (R2), root mean squared error and ratios of performance to interquartile range (RPIQ) were used to evaluate the performance of the models. Results show that: (1) both PLSR and BPNN had good prediction ability, and (2) BPNN had better generalization ability (Cu (R2 = 0.89, RPIQ = 3.05), Sn (R2 = 0.86, RPIQ = 4.91), Zn (R2 = 0.74, RPIQ = 1.44) and Pb (R2 = 0.70, RPIQ = 2.10)). In summary, this study indicates that hyperspectral technology has potential application in HM estimation and soil pollution investigation in polymetallic mining areas.

Pollution Characteristics and Risk Assessment of Potential Toxic Elements in a Tin-polymetallic Mine Area Southwest China: Environmental Implications by Multi-Medium Analysis.

A multi-medium system, involving tailing area (tailings, surrounding soils and water) and downstream agricultural area (river water, sediments and farmland soils), was conceived to evaluate the pollution status of potential toxic elements (PTEs, including Fe, Mn, Ni, Cu, Zn, As, Sn, Pb, Cr and Cd) and environmental risks in a tin-polymetallic mine area southwest China. The results indicated that tailings exhibited representative enrichment and combination characteristics of Sn, Cu, Ni, Fe, As, Pb and Cr compared to surrounding soils. Acid mine drainage (AMD) from tailings and other mining-related sources greatly affected river water and farmland soils, resulting in soil acidification and accumulation of Sn, As, Cu and Pb in paddy soils. Overall, potential ecological risks posed by tailings and river sediments, and pollution risks from Cu, As and Pb in farmland should be concerned. Therefore, effective measures should be urgently taken to prevent PTEs and AMD into surrounding environmental media.

Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis.

BACKGROUND: Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). METHOD: Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. RESULTS: The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). CONCLUSIONS: The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.

How to choose kinematic or mechanical alignment individually according to preoperative characteristics of patients?

BACKGROUND: Making decisions in alignment techniques in total knee arthroplasty (TKA) remains controversial. This study aims to identify the potential patients who were suitable for the kinematic (KA) or mechanical alignment (MA). METHODS: We reviewed 296 consecutive patients (296 TKAs, including 114 KA-TKAs and 182 MA-TKAs) who underwent unilateral TKA using a computer-assisted navigation from 2016 to 2018 in our prospectively maintained database. The minimum followup was 1 year. Clinical outcomes including the range of motion (ROM) and knee society score (KSS) were compared between KA-TKAs and MA-TKAs. Multiple regression models were used to evaluate the relationship between alignment techniques and KSS at the 1-year followup. Interaction and stratified analyses were conducted according to gender, age, body mass index (BMI), preoperative hip-knee-ankle (HKA) angle, ROM and KSS. RESULTS: ROM and KSS at the 1-year followup didn't differ between MA-TKAs and KA-TKAs (all p > 0.05). Alignment techniques did not associate with postoperative ROM (Adjusted ß = 0.4, 95% confidence interval [CI]: - 0.3, 1.6; p = 0.752) or 1-year KSS (Adjusted ß = 2.2, 95%CI: - 0.7, 5.6; p = 0.107). Patients with a BMI more than 30 kg/m^2 achieved better 1-year KSS when using MA than KA (p for interaction< 0.05). Additionally, patients with preoperative HKA angle more than 10 degrees varus benefited more from KA than MA (p for interaction< 0.05). CONCLUSIONS: Patients with severe varus deformity may be suitable for the KA technique, whereas MA should be used in obese patients.

[Research progress of Rehmanniae Radix in prevention and treatment of osteoporosis].

Osteoporosis fracture with high disability and mortality is a difficult problem that seriously affects the life quality of individuals. At present, there is still a lack of anti-osteoporosis drugs with clear target and significant efficacy in the clinical practice. Rehmanniae Radix and its prescriptions have significant clinical effects. In this regard, more and more studies have reported the effects and mechanisms of Rehmanniae Radix and its active components, and the certain research outputs have been achieved. In this article, the PubMed, Web of science, China National Knowledge Infrastructure, and Wanfang database were searched to collect and organize the latest research progress of Rehmanniae Radix treatment of osteoporosis in the recent 10 years. We summarized the research dynamics as well as the function indexes and mechanisms of the raw and processed Rehmanniae Radix, active ingredients such as catalpol, aucubin, acteoside and Rehmanniae Radix polysaccharide, and their formulating prescriptions, and then excavated the potential active ingredients, targets and signaling pathways, including the effect on bone marrow mesenchymal stem cells, promoting the osteoblast proliferation and promoting osteogenesis differentiation(increasing alkaline phosphatase, typeⅠ collagen, osteoprotegerin, and osteocalcin and promoting calcium deposits), increasing the bone density, inhibiting the osteoclast quantity and differentiation, promoting the osteoclast apoptosis, and reducing tartrate resistant acid phosphatase and bone resorption pit area to provide the reference and develop new ideas for developing Rehmanniae Radix prescriptions for treatment of osteoporosis and exploring its mechanism.

Lymph node yield, survival benefit, and safety of high and low ligation of the inferior mesenteric artery in colorectal cancer surgery: a systematic review and meta-analysis.

PURPOSE: The aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes. RESULTS: In total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively. CONCLUSIONS: LL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.

Efficacy and safety of radiofrequency ablation versus minimally invasive liver surgery for small hepatocellular carcinoma: a systematic review and meta-analysis.

BACKGROUND: The aim of this study was to compare radiofrequency ablation (RFA) with minimally invasive liver surgery (MIS) in the treatment of small hepatocellular carcinoma (SHCC) and to assess short-term and long-term clinical outcomes. METHODS: PubMed, Embase, Cochrane Library, Web of science, and CBM were systematically searched for articles from inception to July 2018, comparing RFA and MIS in SHCC treatment. We evaluated overall survival (OS), disease-free survival (DFS), local recurrence, and complication rates, as well as hospitalization duration and operation times. RESULTS: Six retrospective studies were analyzed, including a total of 597 patients, 313 treated with RFA and 284 treated with MIS. OS rates were significantly higher in patients treated with MIS at 3 years, when compared to RFA (OR 0.55; 95% CI 0.36 to 0.84). The 3-year DFS MIS rates were also superior to RFA (OR 0.63; 95% CI 0.41 to 0.98). In contrast, when compared to MIS, RFA demonstrated a significantly higher rate of local intrahepatic recurrences, (OR 2.24; 95% CI 1.47 to 3.42), and a lower incidence of postoperative complications (OR 0.34; 95% CI 0.22 to 0.53), as well as shorter operation times (OR - 145.31, 95% CI - 200.24 to - 90.38) and hospitalization duration (OR - 4.02,95% CI - 4.94 to - 3.10). CONCLUSIONS: We found that MIS led to higher OS, DFS, and lower local recurrences in SHCC patients. Meanwhile, RFA treatments led to significantly lower complication rates, shorter operation times, and hospitalization duration. Considering long-term outcomes, MIS was found to be superior to RFA. However, RFA may be an alternative treatment for patients presenting a single SHCC nodule (≤ 3 cm), given its minimally invasive nature and its comparable long-term efficacy with MIS. Nevertheless, our findings should be explained with caution due to the low level of evidence obtained.