Visual Perception and Convolutional Neural Network-Based Robotic Autonomous Lung Ultrasound Scanning Localization System.

Under the situation of severe COVID-19 epidemic, lung ultrasound (LUS) has been proved to be an effective and convenient method to diagnose and evaluate the extent of respiratory disease. However, the traditional clinical ultrasound (US) scanning requires doctors not only to be in close contact with patients but also to have rich experience. In order to alleviate the shortage of medical resources and reduce the work stress and risk of infection for doctors, we propose a visual perception and convolutional neural network (CNN)-based robotic autonomous LUS scanning localization system to realize scanned target recognition, probe pose solution and movement, and the acquisition of US images. The LUS scanned targets are identified through the target segmentation and localization algorithm based on the improved CNN, which is using the depth camera to collect the image information; furthermore, the method based on multiscale compensation normal vector is used to solve the attitude of the probe; finally, a position control strategy based on force feedback is designed to optimize the position and attitude of the probe, which can not only obtain high-quality US images but also ensure the safety of patients and the system. The results of human LUS scanning experiment verify the accuracy and feasibility of the system. The positioning accuracy of the scanned targets is 15.63 ± 0.18 mm, and the distance accuracy and rotation angle accuracy of the probe position calculation are 6.38 ± 0.25 mm and 8.60° ±2.29° , respectively. More importantly, the obtained high-quality US images can clearly capture the main pathological features of the lung. The system is expected to be applied in clinical practice.

Human umbilical cord mesenchymal stem cells prevent glucocorticoid-induced osteonecrosis of the femoral head by promoting angiogenesis.

The impairment of angiogenesis is an outstanding pathogenic characteristic of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). Human umbilical cord mesenchymal stem cells (hUC-MSCs) have been used in several diseases models, which were reported to be involved in the angiogenesis. However, whether hUC-MSCs suppress the GC-induced ONFH via promoting angiogenesis is still unclear. hUC-MSCs were isolated from the Wharton's jelly using the explant culture method. A GC-induced ONFH model was established in vitro and in vivo. The angiogenesis, proliferation and migration ability of HMECs were determined using the tube-forming, CCK-8, transwell and scratching assays in vitro. The protective role of hUC-MSCs in GC-induced ONFH was evaluated using micro-CT scanning and histological, immunohistochemical (IHC) and Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assays in vivo. The results showed that hUC-MSCs treatment improved the tube-forming, proliferation and migration ability of HMECs in vitro. Moreover, hUC-MSCs treatment enhanced the integrity of trabecular bone of the femoral head, and the tube-forming ability in vivo. hUC-MSCs prevent the femoral head against necrosis and damage caused by GCs though promoting angiogenesis.

Human Umbilical Cord Mesenchymal Stem Cells Improve the Necrosis and Osteocyte Apoptosis in Glucocorticoid-Induced Osteonecrosis of the Femoral Head Model through Reducing the Macrophage Polarization.

Background and Objectives: Apoptosis is an outstanding determinant of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). Human umbilical cord mesenchymal stem cells (hUC-MSCs) have been demonstrated to be associated with apoptosis in diseases models. However, the role of hUC-MSCs in GC-induced ONFH via regulating apoptosis still needs further study. Methods and Results: In the present study, a GC-induced ONFH model was built in vivo through a consecutive injection with lipopolysaccharide (LPS) and methylprednisolone. The necrosis and apoptosis of the femoral head was evaluated by histological and Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL) assay. The level of collagen and TRAP positive cells were determined by Masson and TRAP staining, respectively. M1 macrophage polarization was assessed using immunofluorescence assay. The level of proinflammatory cytokines including tumor necrosis factor (TNF)-α, Interleukin (IL)-1ß and IL-6 of femoral head was determined by enzyme-linked immunosorbent assay (ELISA) kits. The protein expression of AKT, mTOR, p-AKT and p-mTOR was detected using western blot assay. The results showed that hUC-MSCs treatment prominently promoted the GC-induced the decrease of the collagen level and the increase of TRAP positive cells. Besides, hUC-MSCs treatment decreased necrosis and apoptosis, macrophage polarization, the level of TNF-α, IL-1ß and IL-6, the protein expression of p-AKT and p-mTOR, and the radio of p-AKT to AKT and p-mTOR to mTOR of femoral head in vivo. Conclusions: Therefore, the present study revealed that hUC-MSCs improved the necrosis and osteocyte apoptosis in GC-induced ONFH model through reducing the macrophage polarization, which was associated with the inhibition of AKT/mTOR signaling pathway.

Comparison of efficacy and safety of complementary and alternative therapies for scapulohumeral periarthritis: A protocol for Bayesian network meta-analysis.

BACKGROUND: Scapulohumeral periarthritis is a disease with high incidence and great pain. The current western treatments with many side effects, poor efficacy cannot fundamentally solve the problem. Complementary and alternative therapies have played an excellent role in the treatment of scapulohumeral periarthritis. However, it is not clear which complementary and alternative therapy is more effective. Therefore, we propose a protocol to compare the efficacy and safety of various complementary and alternative therapies through network meta-analysis (NMA) to provide choice guidance for the therapy. METHODS: A comprehensive search will be conducted for randomized controlled trials of complementary and alternative therapy for scapulohumeral periarthritis as well as ongoing trials. The time limit is from the establishment of the database until January 2021. Literature and data extraction were completed independently by two researchers. Through pairwise comparison and meta-analysis of Bayesian NMA, all the evidences are evaluated comprehensively. STATA16.0 and WinBUGS1.4.3 software will be used for data processing and analysis, and recommendation evaluation will be used to develop and assess grades to classify the quality of NMA evidence. RESULTS: Through the analysis, we will obtain the ranking of the efficacy and safety of different complementary and alternative therapies in the treatment of scapulohumeral periarthritis, in order to provide reference for clinical selection of treatment methods. CONCLUSION: Complementary and alternative therapies of scapulohumeral periarthritis plays a positive role in improving the symptoms of scapulohumeral periarthritis. This study can provide evidence support for clinicians and patients.International Platform of Registered Systematic Review and Meta-Analysis Protocols registration number: INPLASY202140044.

Analysis on the expression and value of CCL2 and CCL3 in patients with osteoarthritis.

In this study, we investigated the clinical value of CC chemokine ligand 2 (CCL2) and CC chemokine ligand 3 (CCL3) in osteoarthritis (OA). A prospective analysis was performed on 126 patients with rheumatoid arthritis of the knee (observation group (OG)) who admitted to Qilu hospital from August 2016 to August 2018 and 135 healthy controls (control group (CG)) who underwent physical examinations during the same period. The concentrations of CCL2 and CCL3 in peripheral blood were compared between the two groups, and the predictive value of the two on the occurrence, efficacy and prognosis of recurrence of OA were analyzed. In addition, an OA rat model was established to detect the relative protein levels of CCL2 and CCL3 in rat knee joint tissues. There were no statistically significant differences between the two groups in baseline data such as age, body mass index (BMI), gender, smoking, drinking, educational level, family medical history and living environment (P > 0.05). CCL2 and CCL3 increased in peripheral blood of patients in the OG (P < 0.05), both of which were positively correlated with rheumatoid factor (RF) (P < 0.001). CCL2 and CCL3 were of good predictive value for the occurrence, efficacy and prognosis of recurrence of OA (P < 0.001). The relative protein levels of CCL2 and CCL3 in bone and joint tissues of OA rats were significantly higher than those of normal rats (P < 0.001). CCL2 and CCL3 are elevated in peripheral blood of OA patients, which have good predictive value for the occurrence, efficacy and prognosis of recurrence of OA, indicating their potential roles as excellent markers for diagnosis and treatment of OA in the future.

Chitosan/hydroxyapatite modified carbon/carbon composites: synthesis, characterization and in vitro biocompatibility evaluation.

Carbon/carbon composite (C/C), due to its bio-inert property, is prone to cause bone consolidation defects and bacterial infections in clinical applications. Therefore, there is a great demand in practical applications to prevent implant infections and enhance its bone consolidation capability. In this study, we have developed a facile approach to construct a chitosan/hydroxyapatite composite modified layer on C/C surface by electrochemical deposition and a covalent grafting technique, and the modified layer has both the antibacterial activity of chitosan (CS) and the bioactivity of hydroxyapatite (HAP). The microstructure and chemical composition of the modified layer were analyzed using scanning electron microscopy (SEM), Fourier transform infrared (FTIR) spectroscopy, X-ray photoelectron spectroscopy (XPS) and water contact angle measurements. The biological properties of the composites were evaluated using cell culture, antimicrobial test and real-time quantitative PCR in vitro. The results showed that the CS/HAP modified C/C exhibited excellent biocompatibility, bacteriostasis and osteoinductive ability. These properties are beneficial for the potential application of the modified C/C composite as a bone tissue replacement material.

Spatio-temporal release of NGF and GDNF from multi-layered nanofibrous bicomponent electrospun scaffolds.

Scaffolds capable of providing dual neurotrophic factor (NTF) delivery with different release kinetics, spatial delivery of NTFs at different loci and topographical guidance are promising for enhanced peripheral nerve regeneration. In this study, we have designed and fabricated multi-layered aligned-fiber scaffolds through combining emulsion electrospinning, sequential electrospinning and high-speed electrospinning (HS-ES) to modulate the release behavior of glial cell line-derived growth factor(GDNF) and nerve growth factor (NGF). GDNF and NGF were incorporated into poly(lactic-co-glycolic acid) (PLGA) fibers and poly(D,L-lactic acid) (PDLLA) fibers, respectively. Aligned fibers were obtained in each layer of multi-layered scaffolds and relatively thick tri-layered and tetra-layered scaffolds with controlled layer thickness were obtained. Their morphology, structure, properties, and the in vitro release of growth factors were examined. Dual and spatio-temporal release of GDNF and NGF with different release kinetics from multi-layered scaffolds was successfully demonstrated. High separation efficiency by PDLLA fibrous barrier layer for spatial neurotrophic factor delivery from both tri-layered scaffolds and tetra-layered scaffolds was achieved.

MiR-30a-5p inhibits osteosarcoma cell proliferation and migration by targeting FOXD1.

Despite a number of studies have emphasized the extensive role of microRNA (miRNA) in the development of multiple cancers, the role of miR-30a-5p in the progression of osteosarcoma (OS) and the underlying mechanism are still limited. We detected the expression level of MiR-30a-5p and forkhead box D1 (FOXD1) in Clinical OS specimens and found that miR-30a-5p was significantly decreased while FOXD1 was markedly increased. Dual luciferase assay confirmed that FOXD1 was directly regulated by miR-30a-5p. In vitro assay showed that inhibitior of FOXD1 suppressed cell proliferation, migration and invasion in MG63 and U2OS cells, while overexpression of FOXD1 promoted OS cell proliferation and migration. In vivo assay further showed the inhibition of tumor growth after knockdown of FOXD1. These results suggested that FOXD1 might play key roles in OS development and progression, and was negatively regulated by miR-30a-5p in OS.

Sivelestat sodium hydrate improves post-traumatic knee osteoarthritis through nuclear factor-κB in a rat model.

As a specific inhibitor of neutrophil elastase, sivelestat sodium hydrate has primarily been used in the treatment of acute lung injury caused by various factors since its approval in 2002. Sivelestat sodium hydrate also improves post-traumatic knee osteoarthritis (KOA), although its underlying mechanisms of action have yet to be elucidated. The aim of the current study was to determine if sivelestat sodium hydrate improves post-traumatic KOA through nuclear factor (NF)-κB in a rat model. Treatment with sivelestat sodium hydrate significantly inhibited the induction of structural changes and significantly increased the vertical episode count and ipsilateral static weight bearing of the joint in KOA rats (all P<0.01). Sivelestat sodium hydrate significantly inhibited tumor necrosis factor-α and interleukin-6 production, serum nitrite levels, inducible nitric oxide synthase protein expression and high mobility group box 1 (HMGB1) secretion in KOA rats compared with the model group (all P<0.01). Sivelestat sodium hydrate also significantly suppressed p50/p65 DNA binding activity and NF-κB and phosphorylated inhibitor of κB protein expression in the joints of KOA rats compared with the model group (all P<0.01). These results suggest that sivelestat sodium hydrate improves post-traumatic KOA through HMGB1 and NF-κB in rats.

[EFFECTIVENESS OF REPAIRING OR RECONSTRUCTING DEFECTS OF FOREFOOT].

METHODS: Between February 2006 and February 2013, 57 patients with defects of the forefoot were treated. There were 41 males and 16 females with an average age of 38.9 years (range, 19-68 years). The disease causes included motor vehicles crush injury in 28 cases, crashing injury in 17 cases, and machine extrusion injury in 12 cases. The left side was involved in 25 cases and the right side in 32 cases, with a mean disease duration of 4.7 hours (range, 0.5-75.0 hours). Defect located at the 1st metatarsus in 9 cases, at the 5th metatarsus in 8 cases, at the 1st and the 2nd metatarsus in 16 cases, at the 4th and 5th metatarsus in 11 cases, at multiple metatarsus and the forefoot in 13 cases. The bone defect ranged from 2.5 cm x 1.9 cm x 1.4 cm to 13.3 cm x 11.2 cm x 2.7 cm. The soft tissue defect ranged from 12.4 cm x 6.3 cm to 27.2 cm x 18.7 cm. The iliac bone or vascularized iliac bone or vascularized fibula bone was used to rebuild the arch of the foot, and free flap was used to repair defects of the forefoot. The donor site was sutured directly or covered with skin graft. RESULTS: Venous crisis and partial necrosis occurred in 3 and 2 flaps respectively, which healed after symptomatic treatment. The other flaps and grafted skins survived, and wounds healed primarily. Fifty-one cases were followed up 1.5-2.5 years (mean, 2.1 years). The appearance was excellent and the feeling of the flap recovered at different levels. The two-point discrimination was 8.4-19.8 mm (mean, 13.7 mm) at 1.5 years after operation. According to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, sensation recovered to 52 in 6 cases, to 53 in 18 cases, and to 54 in 27 cases. The patients began to walk with weight loading at 2-6 months after operation (mean, 3.9 months). The bone healing time was 3-6 months (mean, 4.2 months). Based on American Orthopaedic Foot and Ankle Society (AOFAS) standards, the results were excellent in 19 cases, good in 24 cases, fair in 7 case, and poor in 1 case, and the excellent and good rate was 84.3%. CONCLUSION: It is a good solution to treat defects of the forefoot to use iliac bone or vascularized iliac bone or vascularized fibula bone for rebuilding the arch of the foot and use free flap for repairing defect.

An important role of the hepcidin-ferroportin signaling in affecting tumor growth and metastasis.

Epidemiological and experimental studies have suggested that deregulated hepcidin-ferroportin (FPN) signaling is associated with the increased risk of cancers. However, the effects of deregulated hepcidin-FPN signaling on tumor behaviors such as metastasis and epithelial to mesenchymal transition (EMT) have not been closely investigated. In this study, LL/2 cancer cells were found to exhibit an impaired propensity to home into lungs, and a reduced ability to develop tumors was also demonstrated in lungs of Hamp1(-/-) mice. Moreover, hepatic hepcidin deficiency was found to considerably favor tumor-free survival in Hamp1(-/-) mice, compared with wild-type mice. These data thus underscored a contributive role of hepatic hepcidin in promoting lung cancer cell homing and fostering tumor progression. To explore the role of FPN in regulating tumor progression, we genetically engineered 4T1 cells with FPN over-expression upon induction by doxycycline. With this cell line, it was discovered that increased FPN expression reduced cell division and colony formation in vitro, without eliciting significant cell death. Analogously, FPN over-expression impeded tumor growth and metastasis to lung and liver in mice. At the molecular level, FPN over-expression was identified to undermine DNA synthesis and cell cycle progression. Importantly, FPN over-expression inhibited EMT, as reflected by the significant decrease of representative EMT markers, such as Snail1, Twist1, ZEB2, and vimentin. Additionally, there was also a reduction of lactate production in cells upon induction of FPN over-expression. Together, our results highlighted a crucial role of the hepcidin-FPN signaling in modulating tumor growth and metastasis, providing new evidence to understand the contribution of this signaling in cancers.

[Treatment of tibial traumatic osteomyelitis with vacuum sealing drainage combined with open bone graft].

OBJECTIVE: To explore the effectiveness of vacuum sealing drainage (VSD) combined with open bone graft for tibial traumatic osteomyelitis. METHODS: Between June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years (range, 22-48 years). The time from injury to admission was 7-18 months (mean, 8.6 months). There was local bone scarring in 15 cases, the size ranged from 8 cm x 4 cm to 15 cm x 8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm (mean, 2.6 cm); 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer. RESULTS: Nail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months (mean, 13.5 months). In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days (mean, 8.8 days); the bone healing time was 32-40 weeks (mean, 34.4 weeks); and the frequency of VSD was 3-6 times (mean, 4.5 times). In 12 cases of partial bone sclerosis, the infection control time was 7-12 days (mean, 8.3 days); the bone healing time was 24-31 weeks (mean, 27.3 weeks); and the frequency of VSD was 3-5 times (mean, 3.6 times). Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients. CONCLUSION: The VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.

Carbon nanotube exposure sensitize human ovarian cancer cells to paclitaxel.

With the rapid development in design and synthesis, carbon nanotubes (CNTs) are being studied for potential applications in a variety of biomedical fields, such as site-directed drug delivery, tumor-targeted imaging, and anticancer drug development. In the present study, we observed that SWCNTs could significantly induce cell death of human ovarian cancer OVCAR3 cells. More importantly, we demonstrated that SWCNTs could sensitize OVCAR3 cells to the chemotherapeutic compound paclitaxel (PTX), resulting increased cell death. Mechanistic investigations suggested that SWCNTs provoked cell death in the absence or presence of PTX mainly via apoptosis. Taken together, our results suggest that SWCNTs contribute to regulating the chemosensitivity of ovarian cancer cells to the anticancer drug. Co-exposure of SWCNTs and chemotherapeutic drugs might thus stand for a promising approach to improve the cancer treatment.

Ten-digit replantation with seven years follow-up: A case report.

In this report, we present a case of successful replantation of 10-digit complete amputation and results of postoperative rehabilitation in 7 years follow-up. The rehabilitation program included psychotherapy, physical therapy, sensory re-education, and measurements. At the 7 years postoperatively, the static two-point discriminations of replanted digits ranged from 4 to 11 mm. Grasping powers ranged from 69 to 81 lb, and pinching powers ranged from 13 to 19 lb. The patient returned to the previous employment. Our experience has demonstrated that systemic postoperative rehabilitation and measurements could achieve satisfactory recovery of the sensory and motor functions of multiple-digit replantation.

One-stage reconstruction of complicated thumb injury with combination of microsurgical transplantations.

Complicated thumb loss of the hand still remains a great challenge to hand and microsurgeons. In this article, we report our technique and outcomes in 10 cases using one-stage microsurgical procedures. In each case, three tissue transplants in combination with a sequential vascular anastomoses was performed, i.e. the second toe for the thumb, the extensor digitorum brevis for thenar opponent muscle, and the anterolateral thigh flap for the first web space, and adjacent soft tissue defects. All the transplants survived eventually. After an average of 6 years follow-up, the results were very inspiring. Combined tissue transfer can hasten patient recovery and improve functional outcomes. However, this method needs meticulous technique and great experience in microsurgery.

[Primary repair of tissue defects of achilles tendon and skin by free grafting of anterolateral femoral skin flap and iliotibial tract].

OBJECTIVE: To observe the clinical outcome of primary repair of the tissue defects of the Achilles tendon and skin by thigh anterolateral free flap and free iliotibial tract. METHODS: From January 2000 to January 2005, the thigh anterolateral free flap and the iliotibial tract were used to primarily repair the defects of the Achilles tendon and skin in 11 patients (7 males and 4 females, aged 6-45 years). The defects of the skin and Achilles tendon were found in 6 patients, and the defects of the Achilles tendon and skin accompanied by the fracture of the calcaneus were found in 5 patients. The defect of the Achilles skin was 6 cm X 5 cm-14 cm X 8 cm in area. The defect of the Achilles tendon was 5-11 cm in length. The skin flap was 11 cm X 6 cm-17 cm X 11 cm in area. The iliotibial tract was 7-13 cm in length and 3-5 cm in width. The medial and lateral borders were sutured to from double layers for Achilles tendon reconstruction. The wound on the donor site could be sutured directly in 5 patients, and the others could be repaired with skin grafting. RESULTS: After operation, all the flaps survived and the wound healed by first intention. The follow-up of the 11 patients for 6 mouths-4 years (average, 30 months) revealed that according to Yin Qingshui's scale, the result was excellent in 6 patients, good in 4, and fair in 1. The excellent and good rate was 99%. The results showed a significant improvement in the "heel test" and the Thompson sign, and both were negative. No complications of ulceration on the heel and re-rupture of the Achilles tendon occurred. CONCLUSION: The primary repair of the tissue defects of the Achilles tendon and skin by free grafting of the anterolateral femoral skin flap and the iliotibial tract is an effective surgical method.