FOUR LIPS plays a role in meristemoid-to-GMC fate transition during stomatal development in Arabidopsis.

Meristemoids, which are stomatal precursor cells, exhibit self-renewal and differentiation abilities. However, the only known core factor associated with meristemoid division termination and fate transition is the heterodimer formed by the basic helix-loop-helix proteins MUTE and SCREAMs (SCRMs). FOUR LIPS (FLP), a well-known transcription factor that restricts guard mother cell (GMC) division, is a direct target of MUTE. Whether FLP involves in meristemoid differentiation is unknown. Through sensitized genetic screening of flp-1, we identified a mute-like (mutl) mutant with arrested meristemoids. The mutant carried a novel allele of the MUTE locus, i.e., mute-4. Intriguingly, mute-4 is a hypomorphic allele that exhibits wild-type appearance with slightly delayed meristemoid-to-GMC transition, whereas it renders an unexpected mutl epidermis with most meristemoids arrested and very few stomata when combined with flp (flp mute-4), suggesting that FLP is a positive regulator during this transition process. Consistently, the expression of FLP increased during GMC commitment, and the number of cells at this stage was markedly increased in flp. flp scrm double mutants produced arrested meristemoids similar to mute, and FLP was able to interact physically with SCRM. Taken together, our results demonstrate that FLP functions together with MUTE and SCRMs to direct meristemoid-to-GMC fate transition.

The effect of marathon running on the lower extremity kinematics and muscle activities during walking and running tasks.

Patellofemoral pain syndrome (PFPS) is a common injury among runners, and it is thought that abnormal lower extremity biomechanics contribute to its development. However, the relationship between biomechanical changes after a marathon and PFPS injury remains limited. This study aims to investigate whether differences in knee and hip kinematics and lower extremity muscle activities exist in recreational runners before and after a marathon. Additionally, it aims to explore the relationship between these biomechanical changes and the development of PFPS injury. 12 recreational runners participated in the study. Kinematics and muscle activities of the lower extremity were recorded during walking (5 km/h) and running (10 km/h) tasks within 24 hours before and within 5 hours after a marathon. After the marathon, there was a significant decrease in peak knee flexion (walking: p = 0.006; running: p = 0.006) and an increase in peak hip internal rotation (walking: p = 0.026; running: p = 0.015) during the stance phase of both walking and running compared to before the marathon. The study demonstrates a decrease in knee flexion and an increase in hip internal rotation during the stance phase of gait tasks after completing a marathon, which may increase the risk of developing PFPS injury.

Fundamental and Practical Feasibility of Electrocardiogram Reconstruction from Photoplethysmogram.

Electrocardiogram (ECG) reconstruction from contact photoplethysmogram (PPG) would be transformative for cardiac monitoring. We investigated the fundamental and practical feasibility of such reconstruction by first replicating pioneering work in the field, with the aim of assessing the methods and evaluation metrics used. We then expanded existing research by investigating different cycle segmentation methods and different evaluation scenarios to robustly verify both fundamental feasibility, as well as practical potential. We found that reconstruction using the discrete cosine transform (DCT) and a linear ridge regression model shows good results when PPG and ECG cycles are semantically aligned-the ECG R peak and PPG systolic peak are aligned-before training the model. Such reconstruction can be useful from a morphological perspective, but loses important physiological information (precise R peak location) due to cycle alignment. We also found better performance when personalization was used in training, while a general model in a leave-one-subject-out evaluation performed poorly, showing that a general mapping between PPG and ECG is difficult to derive. While such reconstruction is valuable, as the ECG contains more fine-grained information about the cardiac activity as well as offers a different modality (electrical signal) compared to the PPG (optical signal), our findings show that the usefulness of such reconstruction depends on the application, with a trade-off between morphological quality of QRS complexes and precise temporal placement of the R peak. Finally, we highlight future directions that may resolve existing problems and allow for reliable and robust cross-modal physiological monitoring using just PPG.

Enhancing Lower Eyelid Suspension Outcomes Through Pre-surgical Facial Nerve Reanimation: A Comparative Study.

BACKGROUND: Lower eyelid suspension, a common therapeutic procedure for facial paralysis-induced eyelid retraction, faces challenges due to high recurrence in patients lacking facial muscle function and impedes wider adoption. This research aims to explore the potential effects of restoring orbicularis oculi muscle tension through facial nerve reanimation prior to lower eyelid suspension and to define the indications for lower eyelid suspension. METHODS: The study encompassed 32 individuals with complete facial paralysis, segmented into group A (reanimation group) and group B (non-reanimation group), based on whether the orbicularis oculi muscle's tension was restored through facial nerve reconstruction prior to lower eyelid suspension. Subjective assessments of eyelid closure (the inter-eyelid gap upon gentle closure) and objective methods measures of scleral show (the distance from the pupil's center to the lower eyelid margin, MRD2) were used to provide a comprehensive analysis of long-term effectiveness. RESULTS: The group A exhibited significantly greater long-term improvement in lagophthalmos and lower eyelid ectropion. The alterations in MRD2 measured 2.66 ± 0.27 mm in the group A versus 2.08 ± 0.53 mm in the group B, denoting a statistically significant variance (p < 0.001). Moreover, while the ratio of MRD2 preoperative 6 months postoperative revealed no significant difference between groups, a significant difference emerged in 12 months postoperative (group A: 1.02 ± 0.21; group B: 1.18 ± 0.24; p < 0.05), with the values in group A closer to 1, indicative of enhanced symmetry. CONCLUSIONS: Restoring the tension in the orbicularis oculi muscle through facial nerve reconstruction prior to palmaris longus tendon sling could effectively sustain long-term outcomes of lower eyelid retraction correction and reduce the recurrence rate. 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 .

Uniformly Hybrid Surface Containing Adjustable Hydrophobic/Hydrophilic Components Obtained by Programmed Strain for Synergistic Anti-Icing.

Sufficient efforts have been put into the design of anti-icing materials to eliminate the icing hazard. Among the currently approved anti-icing concepts, hydrophilic/hydrophobic hybrid anti-icing materials inspired by antifreeze proteins show excellent properties in inhibiting ice nucleation, inhibiting ice crystal growth, and reducing ice adhesion. However, it is still a great challenge to accurately regulate the hydrophilic and hydrophobic hybrid components of the coating surface to clarify the synergistic mechanism. This work proposes a strain-manipulated surface modification strategy, and an anti-icing coating with adjustable hydrophilic/hydrophobic hybrid components prepared by combining chemical vapor deposition and siloxane chemistry is obtained. According to the ice resistance experiment at -15 °C, the performance of anti-icing is closely related to the proportion of hydrophilic and hydrophobic hybrids. The icing delay time and ice adhesion strength of the material with the optimal hydrophilic/hydrophobic components are 280 s and 18.6 kPa, respectively. These unique properties can be attributed to the synergistic effect of hydrophilic and hydrophobic structures on the regulation of interfacial water.

Transparent ionic conductive elastomers with high mechanical strength and strong tensile properties for strain sensors.

Stretchable ionic conductive elastomers have been extensively studied due to their great application potential in the fields of sensors, batteries, capacitors and flexible robots. However, it is still challenging to prepare multifunctional ionic conductive elastomers with high mechanical strength and excellent tensile properties by a green and efficient method. In this study, we prepared PDES-DMA ionic conductive elastomers by a "one step" rapid in situ polymerization of AA/ChCl-type polymerizable deep eutectic solvents (PDES) and N,N-dimethylacrylamide (DMA) under ultraviolet (UV) irradiation. In addition to the characteristics of high mechanical strength (tensile strength of 9.27 MPa) and excellent tensile properties (elongation at break of 1071%), the PDES-DMA elastomer also has high transparency (>80%), strong self-adhesion (adhesion strength with glass surface 133.8 kPa) and self-healing properties. In addition, sensors based on the ionic conductive elastomer can be used to detect human movements such as finger, wrist, elbow, ankle and knee bending. Considering the convenience of the preparation method and the excellent versatility of the prepared PDES-DMA ionic conductive elastomer, we believe that the method proposed in this study has potential application prospects in the field of flexible electronics.

Prognostic value of tumor-infiltrating immune cells in clinical early-stage oral squamous cell carcinoma.

BACKGROUND: Tumor-infiltrating immune cells (TIICs) are critical components of tumor immune microenvironment (TIME), which play crucial roles during tumor initiation, development, and progression. However, the prognostic value of TIICs is still not well documented in clinical early-stage oral squamous cell carcinoma (OSCC). In this study, we aimed to assess the prognostic value of TIICs in clinical early-stage OSCC and develop a nomogram based on TIICs to predict the prognosis. METHODS: Eighty patients with clinical early-stage (cT1,2N0M0) OSCC were enrolled in this study. Immunohistochemical staining was performed to evaluate the infiltration of TIICs, including CD8+ T cells, CD57+ NK cells, CD163+ macrophage, and CD20+ B cells. Overall survival (OS) and disease-free survival (DFS) curves were plotted by the Kaplan-Meier method. Cox's proportional hazards regression models were performed to assess the prognostic value of TIICs. Finally, a nomogram was established to predict the OS based on TIICs infiltration and assessed by concordance index (C-index) and calibration curve. RESULTS: High infiltrations of CD57+ NK cells and CD20+ B cells indicated a better OS in clinical early-stage OSCC. Moreover, high infiltration of CD20+ B cells favored a longer DFS. Of note, low infiltrations of CD57+ NK cells and CD20+ B cells were independent prognostic factors for poor OS in clinical early-stage OSCC. The nomogram that combined CD57+ NK cells with CD20+ B cells could predict the OS in clinical early-stage OSCC, and the C-index was 0.801 (95% CI: 0.679-0.924). The calibration plot showed that prediction and observation are well matched. CONCLUSIONS: High infiltration of CD57+ NK cells and CD20+ B cells indicate a favorable OS in clinical early-stage OSCC. The nomogram constructed based on TIICs might be used for predicting the prognosis in clinical early-stage OSCC.

Impact of Concomitant Corticosteroids on Tofacitinib Induction Efficacy and Infection Rates in Ulcerative Colitis.

BACKGROUND: Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis. AIM: To report efficacy and infection rates in patients receiving tofacitinib induction treatment, by baseline corticosteroid status. METHODS: We evaluated efficacy and safety data from OCTAVE Induction 1&2 in patients with moderately-to-severely active ulcerative colitis who received tofacitinib 10 mg twice daily or placebo for 8 weeks, based on induction baseline oral corticosteroid use (Corticosteroid-Yes/No) and dose (< 20/ ≥ 20 mg/day). Infections of interest included serious infections, herpes zoster (HZ), and adjudicated opportunistic infections (OIs). RESULTS: At OCTAVE Induction 1&2 baseline, 478/1092 (43.8%) patients were receiving corticosteroids. Tofacitinib demonstrated significant induction efficacy versus placebo for both Corticosteroid-Yes and Corticosteroid-No. With adjustment for prior tumor necrosis factor inhibitor and immunosuppressant failure, there were no statistically significant differences in remission and clinical response rates for Corticosteroid-Yes versus Corticosteroid-No. Among tofacitinib-treated patients, HZ and OIs occurred more frequently in Corticosteroid-Yes versus Corticosteroid-No, regardless of dose (< 20 mg vs. ≥ 20 mg). Infection incidence rates (regardless of severity/seriousness) during tofacitinib induction were generally similar regardless of baseline corticosteroid use. The proportion of tofacitinib-treated patients with HZ was 0.2% for Corticosteroid-No versus 1.1% for Corticosteroid-Yes < 20 mg and 1.0% for Corticosteroid-Yes ≥ 20 mg. Two out of three patients had HZ OIs. CONCLUSIONS: Tofacitinib induction efficacy (clinical response and remission) was similar in baseline corticosteroid subgroups. Infections of interest were rare; HZ and OIs occurred more frequently among those receiving tofacitinib and corticosteroids versus those receiving tofacitinib without corticosteroids. TRIAL REGISTRATION: http://www. CLINICALTRIALS: gov (NCT01465763[21/10/2011]; NCT01458951[21/10/2011]).

BET inhibition triggers antitumor immunity by enhancing MHC class I expression in head and neck squamous cell carcinoma.

BET inhibition has been shown to have a promising antitumor effect in multiple tumors. However, the impact of BET inhibition on antitumor immunity was still not well documented in HNSCC. In this study, we aim to assess the functional role of BET inhibition in antitumor immunity and clarify its mechanism. We show that BRD4 is highly expressed in HNSCC and inversely correlated with the infiltration of CD8+ T cells. BET inhibition potentiates CD8+ T cell-based antitumor immunity in vitro and in vivo. Mechanistically, BRD4 acts as a transcriptional suppressor and represses the expression of MHC class I molecules by recruiting G9a. Pharmacological inhibition or genetic depletion of BRD4 potently increases the expression of MHC class I molecules in the absence and presence of IFN-γ. Moreover, compared to PD-1 blocking antibody treatment or JQ1 treatment individually, the combination of BET inhibition with anti-PD-1 antibody treatment significantly enhances the antitumor response in HNSCC. Taken together, our data unveil a novel mechanism by which BET inhibition potentiates antitumor immunity via promoting the expression of MHC class I molecules and provides a rationale for the combination of ICBs with BET inhibitors for HNSCC treatment.

Targeting BRD4 attenuates the stemness and aggressiveness of ameloblastoma.

BACKGROUND: BRD4, belonging to the bromodomain extra-terminal (BET) protein family, plays a unique role in tumor progression. However, the potential impact of BRD4 in ameloblastoma (AM) remains largely unknown. Herein, we aimed to assess the expression and functional role of BRD4 in AM. METHODS: The expression level of BRD4 was assessed by immunohistochemistry. The proliferation, migration, invasion, and tumorigenic abilities of AM cells were assessed by a series of assays. To explore the molecular expression profile of BRD4-depleted AM cells, RNA sequencing (RNA-seq) was performed. Bioinformatic analysis was performed on AM expression matrices obtained from the Gene Expression Omnibus (GEO). The therapeutic efficacy of BET-inhibitors (BETi) was assessed with AM patient-derived organoids. RESULTS: Upregulation of BRD4 was observed in conventional AMs, recurrent AMs, and ameloblastic carcinomas. Depletion of BRD4 inhibited proliferation, invasion, migration, and tumorigenesis in AM. Administration of BETi attenuated the aggressiveness of AM and the growth of AM patient-derived organoids. Bioinformatic analysis indicated that BRD4 may promote AM progression by regulating the Wnt pathway and stemness-associated pathways. CONCLUSION: BRD4 increases the aggressiveness and promotes the recurrence of ameloblastoma by regulating the Wnt pathway and stemness-associated pathways. These findings highlight BRD4 as a promising therapeutic target in AM management.

Development of a Semifascicle Graft Technique to Bridge Peripheral Nerve Defect: A Case Report and Animal Study.

BACKGROUND: Autologous nerve grafting, the criterion standard for bridging peripheral nerves, can cause complications at the donor site. We investigated a novel approach to reconstruct the nerve gap with a split cross-sectional unmatched semifascicle autograft, which was harvested from the distal part of the injured nerve. METHODS: A patient diagnosed with left-sided frontal branch facial nerve dissection underwent nerve bridging emergency surgery using a semifascicle nerve graft. A sciatic nerve model was used to validate the feasibility and mechanism of this method. Male Sprague-Dawley rats (n = 36) were randomized into (A) intact fascicle, (B) semifascicle, and (C) semifascicle + conduit groups and further subdivided into 4- and 8-week groups for histological analysis of the neurotissue area, fibers, and Schwann cells. The 8-week groups underwent weekly pain and temperature tests; the wet weight of the gastrocnemius muscle was measured after euthanasia. RESULTS: The frontalis of the patient's injured side exhibited movement at 2 months postsurgery and recovered a symmetrical appearance at 13 months. Group A exhibited more neurotissue areas and fibers than groups B and C at week 4; group B had more neurotissue than group C. Group A had greater neurotissue areas than groups B and C at week 8; groups B and C exhibited no differences. The groups displayed no differences regarding nerve fiber, pain, and temperature analysis at week 8. Muscle wet weight of groups A and B exhibited no differences and was higher than that of group C. CONCLUSION: We demonstrated the clinical translational value of semifascicle nerve grafts; the injured site was both the donor and recipient, thereby avoiding donor site damage and associated complications.

A Framework to Develop an Immersive Virtual Reality Simulation Tool for Postpartum Hemorrhage Management Nurse Training.

ABSTRACT: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality and morbidity. Effective nurse training for PPH management can reduce negative health impacts on childbearing women. This article discusses a framework for the development of an innovative immersive virtual reality simulator for PPH management training. The simulator should consist of: 1) a virtual world, including virtual physical and social environments, and simulated patients, and 2) a smart platform, providing automatic instructions, adaptive scenarios, and intelligent performance debriefing and evaluations. This simulator will provide a realistic virtual environment for nurses to practice PPH management and promote women's health.

Disruption of Zinc Homeostasis by a Novel Platinum(IV)-Terthiophene Complex for Antitumor Immunity.

Zinc homeostatic medicine is of great potential for cancer chemo-immunotherapy; however, there are few reports on antitumor compounds that can trigger Zn2+ -mediated immune responses. In this work, we developed a novel cyclometalated PtIV -terthiophene complex, Pt3, that not only induces DNA damage and cellular metabolism dysregulation, but also disrupts zinc homeostasis as indicated by the abnormal transcriptional level of zinc regulatory proteins, excess accumulation of Zn2+ in cytoplasm, and down-regulation of metallothioneins (MTs), which further caused redox imbalance. The simultaneous disruption of zinc and redox homeostasis in response to Pt3 treatment activated gasdermin-D mediated pyroptosis accompanied by cytoskeleton remodeling, thus releasing pro-inflammatory cytokines to promote dendritic cell (DC) maturation and T cell tumor-infiltration, eventually eliminating both primary and distant tumors in vivo. As far as we know, this is the first metal complex that can regulate zinc homeostasis to activate antitumor immunity.

Efficacy and Safety of Extended Induction With Tofacitinib for the Treatment of Ulcerative Colitis.

BACKGROUND & AIMS: Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). The efficacy and safety of tofacitinib were demonstrated in a dose-ranging phase 2 induction trial, 3 phase 3 randomized, placebo-controlled trials (OCTAVE Induction 1 and 2; and OCTAVE Sustain), and an ongoing, open-label, long-term extension trial (OCTAVE Open) in patients with moderately to severely active UC. Here, we assessed short- and long-term efficacy and safety of extended induction (16 weeks) with tofacitinib 10 mg twice daily (BID) in patients who failed to respond to initial induction (8 weeks) treatment. METHODS: In patients who achieved a clinical response following extended induction (delayed responders), the efficacy and safety of tofacitinib were evaluated up to Month 36 of OCTAVE Open. RESULTS: 52.2% of patients who did not achieve clinical response to 8 weeks' treatment with tofacitinib 10 mg BID in the induction studies achieved a clinical response following extended induction (delayed responders). At Month 12 of OCTAVE Open, 70.3%, 56.8%, and 44.6% of delayed responders maintained clinical response and achieved endoscopic improvement and remission, respectively. Corresponding values at Month 36 were 56.1%, 52.0%, and 44.6%. The safety profile of the subsequent 8 weeks was similar to the initial 8 weeks. CONCLUSIONS: Overall, the majority of patients achieved a clinical response after 8 or 16 weeks' induction therapy with tofacitinib 10 mg BID. Tofacitinib 10 mg BID, administered as induction therapy for up to 16 weeks, had a comparable safety profile to 8 weeks' induction therapy. Most delayed responders at Month 36 were in remission. CLINICALTRIALS: gov: NCT00787202; NCT01465763; NCT01458951; and NCT01470612.

Deep Learning of Morphologic Correlations To Accurately Classify CD4+ and CD8+ T Cells by Diffraction Imaging Flow Cytometry.

The two major subtypes of human T cells, CD4+ and CD8+, play important roles in adaptive immune response by their diverse functions. To understand the structure-function relation at the single cell level, we isolated 2483 CD4+ and 2450 CD8+ T cells from fresh human splenocytes by immunofluorescent sorting and investigated their morphologic relations to the surface CD markers by acquisition and analysis of cross-polarized diffraction image (p-DI) pairs. A deep neural network of DINet-R has been built to extract 2560 features across multiple pixel scales of a p-DI pair per imaged cell. We have developed a novel algorithm to form a matrix of Pearson correlation coefficients by these features for selection of a support cell set with strong morphologic correlation in each subtype. The p-DI pairs of support cells exhibit significant pattern differences between the two subtypes defined by CD markers. To explore the relation between p-DI features and CD markers, we divided each subtype into two groups of A and B using the two support cell sets. The A groups comprise 90.2% of the imaged T cells and classification of them by DINet-R yields an accuracy of 97.3 ± 0.40% between the two subtypes. Analysis of depolarization ratios further reveals the significant differences in molecular polarizability between the two subtypes. These results prove the existence of a strong structure-function relation for the two major T cell subtypes and demonstrate the potential of diffraction imaging flow cytometry for accurate and label-free classification of T cell subtypes.

Self-Amplifying Iridium(III) Photosensitizer for Ferroptosis-Mediated Immunotherapy Against Transferrin Receptor-Overexpressing Cancer.

Photoimmunotherapy is attractive for cancer treatment due to its spatial controllability and sustained responses. This work presents a ferrocene-containing Ir(III) photosensitizer (IrFc1) that can bind with transferrin and be transported into triple-negative breast cancer (TNBC) cells via a transferrin receptor-mediated pathway. When the ferrocene in IrFc1 is oxidized by reactive oxygen species, its capability to photosensitize both type I (electron transfer) and type II (energy transfer) pathways is activated through a self-amplifying process. Upon irradiation, IrFc1 induces the generation of lipid oxidation to cause ferroptosis in TNBC cells, which promotes immunogenic cell death (ICD) under both normoxia and hypoxia. In vivo, IrFc1 treatment elicits a CD8+ T-cell response, which activates ICD in TNBC resulting in enhanced anticancer immunity. In summary, this work reports a small molecule-based photosensitizer with enhanced cancer immunotherapeutic properties by eliciting ferroptosis through a self-amplifying process.

Prognostic and clinicopathological significance of cytocapsular tubes in oral squamous cell carcinoma.

BACKGROUND: Cytocapsular tubes (CTs) provide membranous channels for cancer cells interconnection and multidirectional locomotion, which facilitate cancer cell transportation and metastasis. However, the clinicopathological significance of CTs has not been documented in oral squamous cell carcinoma (OSCC). Herein, we aimed to identify CTs and assess their clinicopathological significance in OSCC. METHODS: Operetta CLS™ high-content analysis system was used to detect the CTs originated from OSCC cells cultured in a 3D Matrigel matrix. Then, pan-cadherin and γ-actin immunostaining were performed to identify CTs in 4NQO-induced murine OSCC tissues, OSCC xenografts and 88 human primary OSCC samples. Finally, the prognostic value and clinicopathological significance of CTs in OSCC were further examined by using the Kaplan-Meier method and Cox regression analysis. RESULTS: CTs were observed in OSCC cells in a 3D Matrigel matrix. In vivo, CTs were frequently identified in 4NQO-induced murine OSCC tissues, OSCC xenografts and human primary OSCC samples. CTs density was significantly associated with T stage, lymph node metastasis, differentiation, invasive depth, tumor budding, TNM stage and tumor recurrence. Importantly, the high-CTs density indicated a decreased overall survival (OS) and progression-free survival (PFS) in OSCC patients. Cox regression models showed that CTs could serve as a prognostic factor for OS and PFS. CONCLUSION: CTs, which are correlated with the cell migration and invasion, can be readily identified in OSCC and appear to be a novel biomarker for patients at risk of metastasis.

The genetic polymorphisms in the SP4 gene and the risk of gastric cancer.

Aim: Gastric cancer (GC) is the leading cause of cancer death, and is associated with host genetic factors. This study aimed to determine the impact of SP4 polymorphisms on GC. Materials & methods: Four hundred and eighty-nine GC patients and 481 healthy subjects were recruited. The association between single nucleotide polymorphisms and GC risk was investigated by logistic regression analysis. Results: It was observed that rs39302 and rs7811417 were related to a decreased GC risk. Stratified analyses showed that rs39302 decreased GC susceptibility at ages ≤60 years, in men, GC patients who had previously smoked and drank. rs7811417 had a risk-decreasing impact on the patients aged ≤60 years, in men, GC patients who were nonsmoking and nondrinking. rs35929923 decreased the GC risk of patients in grade III-IV and the lymph node metastasis subgroup. Conclusion: SP4 gene polymorphisms are associated with GC risk.

Clinical assessments and gait analysis for patients with Trimalleolar fractures in the early postoperative period.

BACKGROUND: Trimalleolar fracture is a common ankle fracture with serious complications and costly healthcare problem. Most studies used clinical assessments to evaluate the functional status of the patients. Although clinical assessments are valid, they are static and subjective. Dynamic, objective and precise evaluations such as gait analysis are needed. Ankle biomechanics studies on gait in patients with trimalleolar fractures are still rare. This study aimed to investigate the clinical outcomes and gait biomechanics in patients with trimalleolar fractures in the early postoperative period and compared to healthy controls. METHODS: This was a cross-sectional study. 12 patients with trimalleolar fractures were recruited, and 12 healthy people served as controls. All patients underwent clinical assessments: Olerud and Molander ankle score (OMAS), ankle swelling and passive range of motion (ROM) of ankle, and completed gait biomechanical analysis when weight-bearing was allowed: temporal-spatial parameters, plantar pressure distributions, and surface electromyography (sEMG). The control group only performed gait test. RESULTS: Patients had poor outcomes of clinical assessments in the short-term. During gait analysis, patients presented compromised gait patterns: shorter step length, larger step width, slower walking speed and shorter single support compared to healthy controls (P < 0.001), and patients showed asymmetrical gait. Symmetry index of step width and walking speed were mainly correlated with the difference of ankle inversion ROM between two sides (R = -0.750, P = 0.005; R = -0.700, P = 0.011). During walking, patients showed abnormal dynamic plantar pressure features (mainly in the hindfoot and forefoot regions), and the IEMG (integrated electromyography) of tibial anterior muscle (TA) and peroneal longus muscle (PL) were larger than healthy controls (P = 0.002, 0.050). CONCLUSIONS: Patients with trimalleolar fractures showed physical impairments of the ankle, and presented altered gait parameters compared to healthy subjects in the short-term. The ankle stability of patients declined, and deficits in TA and PL muscle ability might contribute to it. Restoring complete muscle functions and improving passive ankle ROM are significant to promote the recovery of a normal gait pattern.

An Updated Definition of Plastic Surgery.

ABSTRACT: Modern medicine tends to provide comprehensive medical services based on disease or pathological features. As a result, the overlap between plastic surgery and other surgical departments greatly deepened. What was exclusively done by plastic surgeons are nowadays frequently practiced by other surgeons as well. Thus, generating confusion as to whether plastic surgery is an independent subject or a tool. Therefore, in this new era of modern medicine, it is necessary to reconsider the definition of plastic surgery.