A comparative quantitative assessment of 3D-printed PEKK and PEEK thin meshes in customized alveolar bone augmentation.

OBJECTIVE: Customized nonabsorbable membranes are widely used in severe alveolar bone defects and provide sufficient and precise regenerated bone tissue for subsequent dental implant placement. Although 3D-printed polyetheretherketone (PEEK) meshes have confirmed successful use in clinical cases, the performance of a PEEK mesh is not satisfactory. Compared with PEEK, polyetherketoneketone (PEKK) has better mechanical and processing properties. However, whether PEKK is suitable for making customized membranes remains unclear. The objectives of this study were (1) to evaluate the printing precision, surface characteristics, mechanical characteristics and biocompatibility of the PEKK mesh and (2) to compare the properties of the PEKK and PEEK meshes. MATERIALS AND METHODS: Both PEKK and PEEK meshes were designed and manufactured via additive manufacturing technology combined with computer-aided design (CAD). The printing precision was evaluated with a high-resolution extraoral scanner. The surface characteristics were evaluated with a contact angle system and three-dimensional optical microscopy. The mechanical characteristics were evaluated via three-point bending tests and tensile tests. The biocompatibility was evaluated with a CCK-8 assay, live/dead viability assay and qRT-PCT. RESULTS: Compared with the PEEK mesh, the PEKK mesh exhibited better control in terms of the thickness and aperture area. Both the PEKK mesh and the PEEK mesh had a hydrophobic surface, but the PEKK mesh had a smoother surface. Compared with the PEEK mesh, the PEKK mesh has better compression and tensile properties. Both the PEKK mesh and the PEEK mesh had good biocompatibility. The proliferation of cells on the PEKK mesh was slightly lower than that on the PEEK mesh. CONCLUSIONS: Compared with PEEK mesh, PEKK mesh has greater printing accuracy, smoother surfaces, better mechanical properties and similar biocompatibility and is expected to be used in the production of customized barrier membranes for the augmentation of severe bone defects. To ensure the stability of the mesh for clinical application, it is best to control the aperture diameter of the PEKK mesh to less than 2 mm with a thickness of 0.2 µm.

Size-dependent reactivity of VnO+ (n = 1-9) clusters with ethane.

Cost-effective and readily accessible 3d transition metals (TMs) have been considered as promising candidates for alkane activation while 3d TMs especially the early TMs are usually not very reactive with light alkanes. In this study, the reactivity of Vn+ and VnO+ (n = 1-9) cluster cations towards ethane under thermal collision conditions has been investigated using mass spectrometry and density functional theory calculations. Among Vn+ (n = 1-9) clusters, only V3-5+ can react with C2H6 to generate dehydrogenation products and the reaction rate constants are below 10-13 cm3 molecule-1 s-1. In contrast, the reaction rate constants for all VnO+ (n = 1-9) with C2H6 significantly increase by about 2-4 orders of magnitude. Theoretical analysis evidences that the addition of ligand O affects the charge distribution of the metal centers, resulting in a significant increase in the cluster reactivity. The analysis of frontier orbitals indicates that the agostic interaction determines the size-dependent reactivity of VnO+ cluster cations. This study provides a novel approach for improving the reactivity of early 3d TMs.

Novel insights into the kinetics and mechanism of arsenopyrite bio-dissolution enhanced by pyrite.

Arsenopyrite and pyrite often coexist in metal deposits and tailings, thus simultaneous bioleaching of both sulfides has economic (as well as environmental) significance. Important targets in bio-oxidation operations are high solubilization rates and minimized accumulation of Fe(III)/As-bearing secondary products. This study investigated the role of pyrite bioleaching in the enhancement of arsenopyrite dissolution. At a pyrite to arsenopyrite mass ratio of 1:1, 93.6% of As and 93.0% of Fe were solubilized. The results show that pyrite bio-oxidation can promote arsenopyrite dissolution, enhance S0 bio-oxidation, and inhibit the formation of jarosites, tooeleite, and amorphous ferric arsenate. The dry weight of the pyrite & arsenopyrite residue was reduced by 95.1% after bioleaching, compared to the initial load, while only 5% weight loss was observed when pyrite was absent. A biofilm was formed on the arsenopyrite surface in the presence of pyrite, while a dense passivation layer was observed in the absence of pyrite. As(III) (as As2O3) was a dominant As species in the pyrite & arsenopyrite residue. Novel and detailed findings are presented on arsenopyrite bio-dissolution in the presence of pyrite, and the presented approach could contribute to the development of novel cost-effective extractive bioprocesses. ENVIRONMENTAL IMPLICATION: The oxidation of arsenopyrite presents significant environmental hazards, as it can contribute to acid mine drainage generation and arsenic mobilization from sulfidic mine wastes. Bioleaching is a proven cost-effective and environmentally friendly extractive technology, which has been applied for decades in metal recovery from minerals or tailings. In this work, efficient extraction of arsenic from arsenopyrite bioleaching was presented through coupling the process with bio-oxidation of pyrite, resulting in lowered accumulation of hazardous and metastable Fe(III)/As-bearing secondary phases. The results could help improve current biomining operations and/or contribute to the development of novel cost-effective bioprocesses for metal extraction.

Unpacking the Gap Box Against Data-Free Knowledge Distillation.

Data-free knowledge distillation (DFKD) improves the student model (S) by mimicking the class probability from a pre-trained teacher model (T) without training data. Under such setting, an ideal scenario is that T can help generate "good" samples from a generator (G) to maximally benefit S. However, existing arts suffer from the non-ideal generated samples under the disturbance of the gap (i.e., either too large or small) between the class probabilities of T and S; for example, the generated samples with too large gap may exhibit excessive information for S, while too small gap leads to the limited knowledge in the samples, resulting into the poor generalization. Meanwhile, they fail to judge the "goodness" of the generated samples for S since the fixed T is not necessarily ideal. In this paper, we aim to answer what is inside the gap box; together with how to yield "good" generated samples for DFKD? To this end, we propose a Gap-Sensitive Sample Generation (GapSSG) approach, by revisiting the empirical distilled risk from a data-free perspective, which confirms the existence of an ideal teacher (T *), while theoretically implying: (1) the gap disturbance originates from the mismatch between T and T *, hence the class probabilities of T enable the approximation to those of T *; and (2) "good" samples should maximally benefit S via T's class probabilities, owing to unknown T *. To this end, we unpack the gap box between T and S as two findings: inherent gap to perceive T and T *; derived gap to monitor S and T *. Benefiting from the derived gap that focuses on the adaptability of generated sample to S, we attempt to track student's training route (a series of training epochs) to capture the category distribution of S; upon which, a regulatory factor is further devised to approximate T * over inherent gap, so as to generate "good" samples to S. Furthermore, during the distillation process, a sample-balanced strategy comes up to tackle the overfitting and missing knowledge issues between the generated partial and critical samples by training G. The theoretical and empirical studies verify the advantages of GapSSG over the state-of-the-arts.

Convolution-Enhanced Bi-Branch Adaptive Transformer With Cross-Task Interaction for Food Category and Ingredient Recognition.

Recently, visual food analysis has received more and more attention in the computer vision community due to its wide application scenarios, e.g., diet nutrition management, smart restaurant, and personalized diet recommendation. Considering that food images are unstructured images with complex and unfixed visual patterns, mining food-related semantic-aware regions is crucial. Furthermore, the ingredients contained in food images are semantically related to each other due to the cooking habits and have significant semantic relationships with food categories under the hierarchical food classification ontology. Therefore, modeling the long-range semantic relationships between ingredients and the categories-ingredients semantic interactions is beneficial for ingredient recognition and food analysis. Taking these factors into consideration, we propose a multi-task learning framework for food category and ingredient recognition. This framework mainly consists of a food-orient Transformer named Convolution-Enhanced Bi-Branch Adaptive Transformer (CBiAFormer) and a multi-task category-ingredient recognition network called Structural Learning and Cross-Task Interaction (SLCI). In order to capture the complex and unfixed fine-grained patterns of food images, we propose a query-aware data-adaptive attention mechanism called Bi-Branch Adaptive Attention (BiA-Attention) in CBiAFormer, which consists of a local fine-grained branch and a global coarse-grained branch to mine local and global semantic-aware regions for different input images through an adaptive candidate key/value sets assignment for each query. Additionally, a convolutional patch embedding module is proposed to extract the fine-grained features which are neglected by Transformers. To fully utilize the ingredient information, we propose SLCI, which consists of cross-layer attention to model the semantic relationships between ingredients and two cross-task interaction modules to mine the semantic interactions between categories and ingredients. Extensive experiments show that our method achieves competitive performance on three mainstream food datasets (ETH Food-101, Vireo Food-172, and ISIA Food-200). Visualization analyses of CBiAFormer and SLCI on two tasks prove the effectiveness of our method. Codes will be released upon publication. Code and models are available at https://github.com/Liuyuxinict/CBiAFormer.

Clinical efficacy of the topical application of tranexamic acid in tendon release in the hand: A randomized controlled trial.

PURPOSE: To study the clinical effectiveness of the topical application of tranexamic acid in hand tendon release. METHODS: This was a randomized controlled trial conducted after receiving approval from the local ethics committee according to guidelines from the Helsinki Declaration. Eighty patients who underwent hand tendon release operation in our hospital from January 2021 to December 2022 were included and randomly divided into 2 groups. Patients in the tranexamic acid group (40 cases) received intraoperative topical application of 2 g of tranexamic acid after tendon release, while patients in the conventional group (40 cases) did not receive topical application of tranexamic acid during operation. The operation time, perioperative hemoglobin changes, total blood loss, incidence of early postoperative complications, and total active movement (TAM) before surgery and 6 months after surgery were compared between the 2 groups. The continuous variable which follows normal distribution expressed by mean ± SD and used t-test to compare between groups. Meanwhile, categorical variables were used by Chi-square test, and a p < 0.05 indicated that the differences were statistically significant. RESULTS: Both groups were followed up for 7 - 18 months, with a mean of 10.3 months. Postoperative decrease in hemoglobin was significantly less in the tranexamic acid group than in the conventional group (t = 7.611, p < 0.001). The total blood loss in the tranexamic acid group (74.33 ± 20.50) mL was less than that in the conventional group (83.05 ± 17.73) mL, and the difference was statistically significant (p < 0.05). Both groups showed improvement in thumb/finger flexion and extension range of motion after surgery, and the TAM improved compared with those before surgery, and the difference was statistically significant (p < 0.001). The TAM improved more significantly in the tranexamic acid group (87.68° ± 10.44°) than in the conventional group (80.47° ± 10.93°) at 6 months after surgery, with a statistically significant difference (t = 3.013, p < 0.001). There was no significant difference in operation time and incidence of early postoperative complications between the 2 groups (p = 0.798, 0.499, respectively). CONCLUSION: The topical application of tranexamic acid during hand tendon release can significantly reduce postoperative bleeding and improve surgical efficacy, which is worth promoting.

[Influence of axial rotation on measurement of medial proximal tibial angle].

OBJECTIVE: To measure and compare medial proximal tibial angle (MPTA) of lower limbs under different axial rotation angles(neutral position, 30° internal rotation, 30° external rotation) on the load position radiographs, and explore changes and significance of MPTA measured within and between groups of tibia at different axial rotation positions. METHODS: From January 2018 to December 2018, 40 patients with knee osteoarthritis (KOA) were selected, with a total of 80 limbs, including 12 males and 28 females, aged from 29 to 73 years old with an average of (59.6±12.7) years old. Full length radiographs of the lower limbs were taken on neutral tibia position, 30° internal rotation and 30° external rotation, respectively. MPTA was measured and the results were compared between groups and within groups. RESULTS: MPTA measured on the left lower extremity of neutral tibia, 30° internal rotation and 30° external rotation were (86.08±2.48) °, (88.62±2.94) ° and (83.47±3.10) °, respectively. MPTA measured on the right lower limb were (86.87±1.97) °, (89.02±2.39) ° and (83.80±2.77) °, respectively, and there were no significant difference in MPTA measured between rotation angle group (P>0.05). While there were statistical difference in MPTA on the same limb between groups (P<0.05). On 30° internal rotation, MPTA of left and right lower limbs increased by (2.54±1.74) ° and (2.15±1.78) ° compared with tibia neutral position. On 30° external rotation, MPTA of left and right lower limbs decreased (2.61±2.03) ° and (3.07±1.75) ° compared with tibial neutral position. CONCLUSION: When a full-length X-ray film is taken on the weight-bearing position of both lower limbs, if there is axial rotation or external rotation of tibia, MPTA will increase or decrease compared with neutral position, which may cause a certain degree of deviation in clinical operation based on the accurate measurement of MPTA. However, the extent to which this bias affects the clinical operation effect remains to be verified. In addition, limited by the total number of samples and the number of measurement groups, whether there is a linear relationship between MPTA deviation and tibial axial rotation needs to be further studied.

Effect of angiotensin II on irradiation exacerbated decompression sickness.

In some complicated situations, decompression sickness (DCS) combined with other injuries, such as irradiation, will seriously endanger life safety. However, it is still unclear whether irradiation will increase the incidence of DCS. This study was designed to investigate the damage effects of irradiation on decompression injury and the underlying mechanism. Sprague-Dawley rats were exposed to irradiation followed by hyperbaric decompressing and the mortality and decompression symptoms were observed. Lung tissue and bronchoalveolar lavage fluid were collected to detect the lung lesion, inflammation response, activity of the angiotensin system, oxidative stress, and relative signal pathway by multiple methods, including Q-PCR, western blot, and ELISA. As a result, pre-exposure to radiation significantly exacerbated disease outcomes and lung lesions of DCS. Mechanically, the up-regulation of angiotensin-converting enzyme expression and angiotensin II levels was responsible for the exacerbated DCS and lung lesions caused by predisposing irradiation exposure. Oxidative stress and PI3K/AKT signal pathway activation in pulmonary tissue were enhanced after irradiation plus decompression treatment. In conclusion, our results suggested that irradiation could exacerbate lung injury and the outcomes of DCS by activating the angiotensin system, which included eliciting oxidative stress and activation of the PI3K/AKT signal pathway.

Cytokine expression in gingival crevicular fluid around teeth opposing dental implants and 3-unit fixed partial dentures in a cross-sectional study.

OBJECTIVE: This study aimed to study the cytokines in gingival crevicular fluid (GCF) of the teeth opposing to dental implants and 3-unit fixed partial dentures (FPDs). MATERIALS AND METHODS: A total of 74 participants were recruited for this cross-sectional study. Based on the status of lower first molars, the participants were divided into dental implants group and 3-unit FPDs group. Social index and oral hygiene were recorded. Occlusal loading was evaluated with a T-scan. GCF was sampled from the upper first molar and assessed with a commercial cytokine assay kit. RESULTS: Forty three dental implants patients and 31 3-unit FPDs patients received all of the clinical and laboratory evaluation. The dental implants group had a higher occlusion force distribution on first molars region. IL-10, IL-17, RANK had a higher mean in dental implants group and was associated with occlusion force of first molar. There was a weakly association between IL-10 and dental implants in the binary logistic regression analyses. CONCLUSIONS: In this study, the teeth opposing implants have a higher level of cytokines in the GCF than teeth opposing to 3-unit FPDs in periodontal healthy participants because of the poor osseoperception of dental implants. IL-10 might reflect a higher occlusion force in dental implants region. CLINICAL RELEVANCE: This study provided that different tooth restoration methods could influence the periodontal status of the contact teeth.

Efficient dealkalization of red mud and recovery of valuable metals by a sulfur-oxidizing bacterium.

Red mud (RM) is a highly alkaline polymetallic waste generated via the Bayer process during alumina production. It contains metals that are critical for a sustainable development of modern society. Due to a shortage of global resources of many metals, efficient large-scale processing of RM has been receiving increasing attention from both researchers and industry. This study investigated the solubilization of metals from RM, together with RM dealkalization, via sulfur (S0) oxidation catalyzed by the moderately thermophilic bacterium Sulfobacillus thermosulfidooxidans. Optimization of the bioleaching process was conducted in shake flasks and 5-L bioreactors, with varying S0:RM mass ratios and aeration rates. The ICP analysis was used to monitor the concentrations of dissolved elements from RM, and solid residues were analyzed for surface morphology, phase composition, and Na distribution using the SEM, XRD, and STXM techniques, respectively. The results show that highest metal recoveries (89% of Al, 84% of Ce, and 91% of Y) were achieved with the S0:RM mass ratio of 2:1 and aeration rate of 1 L/min. Additionally, effective dealkalization of RM was achieved under the above conditions, based on the high rates (>95%) of Na, K, and Ca dissolution. This study proves the feasibility of using bacterially catalyzed S0 oxidation to simultaneously dealkalize RM and efficiently extract valuable metals from the amassing industrial waste.

Congenital difference of the hand and foot: Pediatric macrodactyly.

BACKGROUND: Macrodactyly is a very rare congenital difference that affects hands and feet with significant developmental and psychological implications. Macrodactyly is attributed to a somatic mutation in PIK3CA, a component of the mTOR pathway-related overgrowth disorders. Other medical conditions have been associated with macrodactyly (e.g., neurofibromatosis and Proteus syndrome). A thorough investigation of the presence of these conditions should be undertaken by the multidisciplinary team. The aim of this study is to summarize the main clinical characteristics and associated conditions, with an emphasis on diagnosis and surgical treatment options. MATERIALS AND METHODS: We present several clinical cases after a retrospective chart review of macrodactyly cases and a comprehensive literature review. RESULTS: The indications for surgery include peripheral compressive neuropathies (e.g., carpal tunnel syndrome), grotesque enlargement interfering with function, psychosocial distress due to the deformity, and macrodystrophic lipomatosis with proximal upper limb involvement. The main surgical treatment options are categorized as follows: digit reduction (e.g., soft tissue debulking, skeletal shortening/ terminalization, Barsky procedure, and Tsuge technique), limitation of growth (digital nerve stripping and epiphysiodesis), and correction of deviation (wedge or angulation osteotomy, arthrodesis, Millesi procedure for thumb macrodactyly correction, toe-to-hand transfer, ray resection, and combination of bony reduction and soft tissue debulking). CONCLUSIONS: Macrodactyly correction requires surgical experience and an individualized approach. Treatment is primarily surgical; however, efforts are being made to delineate the root cause of macrodactyly and provide nonoperative management.

Thumb and first webspace reconstruction in nonsyndromic congenital mitten hand with symbrachydactyly.

INTRODUCTION: Nonsyndromic congenital mitten hand with thumb and index finger syndactyly is rare. Reconstruction of this condition is challenging, requiring repositioning of the thumb and creation of a wide and deep first webspace. The aim of this paper is to describe the characteristics of patients with this condition and also to describe our surgical technique. METHODS: We describe our technique in 16 consecutive children utilizing complete mobilization of the first metacarpal and thumb as an island flap on the neurovascular bundle, with a rotational osteotomy to reposition the thumb in pronation. In addition, a dorsal M flap was used to reconstruct the first webspace. Patients in this series also had varying degrees of symbrachydactyly with hypoplastic or aplastic phalanges of the central digits. RESULTS: There were 9 male and 7 female patients, with a mean age of 24.4 ± 22.4 months at the time of surgery. Mean follow-up was 19.1 ± 18.3 months. All reconstructions healed well. The mean thumb web distance in the affected hands was 4.2 cm (range 3.5 to 5). All reconstructed thumbs had a good opposition. Two children initially had mild hypertrophic scarring, which resolved with pressure gloves. No other complications were observed. CONCLUSION: One-stage reconstruction of the thumb and first webspace can be effectively achieved with our technique of complete mobilization of the thumb unit, rotational osteotomy, and a dorsal interdigitating M flap.

Innervation of the lumbrical and interosseous muscles in hand: analysis of distribution of nerve fascicles and quantification of their surface projections.

We aimed to determine the surface locations of the nerve fascicles that innervate the lumbricals and interossei, re-examine the branching pattern of the deep branch of the ulnar nerve (dUN), and provide a clear description of their course. Eleven fresh-frozen adult cadaver hands were investigated. Nerve fascicles that innervate the lumbricals, interossei, and surface landmarks including the distal wrist crease and 2-5 proximal finger creases were marked by radio opaque fibers and subjected to X-ray. We analyzed the images and set a quadrant-linked hand surface. Subsequently, we measured the lengths of both axes and the coordinates of the branch locations in the quadrant. The surface locations of branches that innervated the lumbricals and interossei were clearly quantified. The branches of dUN exhibited a 4-group distribution pattern. Novel methods for quantitatively locating the surface anatomy of these branches and demonstration of a 4-group branching pattern of the dUN were established.

Hierarchical Deep Click Feature Prediction for Fine-Grained Image Recognition.

The click feature of an image, defined as the user click frequency vector of the image on a predefined word vocabulary, is known to effectively reduce the semantic gap for fine-grained image recognition. Unfortunately, user click frequency data are usually absent in practice. It remains challenging to predict the click feature from the visual feature, because the user click frequency vector of an image is always noisy and sparse. In this paper, we devise a Hierarchical Deep Word Embedding (HDWE) model by integrating sparse constraints and an improved RELU operator to address click feature prediction from visual features. HDWE is a coarse-to-fine click feature predictor that is learned with the help of an auxiliary image dataset containing click information. It can therefore discover the hierarchy of word semantics. We evaluate HDWE on three dog and one bird image datasets, in which Clickture-Dog and Clickture-Bird are utilized as auxiliary datasets to provide click data, respectively. Our empirical studies show that HDWE has 1) higher recognition accuracy, 2) a larger compression ratio, and 3) good one-shot learning ability and scalability to unseen categories.

Varied effects exerted on sudden sensorineural hearing loss through HBO2 therapeutic pressure.

This study aimed to compare the efficacy of two commonly used therapeutic pressures, 2.0 atmospheres absolute (ATA) versus 2.2 ATA, applied in hyperbaric oxygen (HBO2) therapy for sudden sensorineural hearing loss (SSNHL). We retrospectively reviewed the clinical records of 160 SSNHL patients treated by typical therapy or additional HBO2 therapy with pressure 2.0 or 2.2 ATA at Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College, from February 2018 to May 2020. The pure-tone threshold audiometry results pre- and post-treatment were compared across three groups. In the range of frequencies 250-500 Hz, P2.0 (20.92±26.11 dB, p=0.047) and P2.2 group (20.47±±21.54 dB, p=0.012) both acquired higher hearing gain compared to the control group (11.94±23.32 dB). While in the range of frequencies 1,000-2,000 Hz, only the P2.2 group showed significant improvement of the hearing gain compared to the control group (19.70±21.13 dB vs.10.56±25.24 dB, p=0.015). In the range of frequencies 4,000-8,000, both the P2.0 and P2.2 groups failed to reach the desired effect. Our results suggest that the therapeutic effect is associated with HBO2 therapeutic pressure when applying HBO2 treatment combined with standard medical therapy. Within the range of appropriate pressure, the higher pressure, which means higher partial pressure of oxygen, has better therapeutic efficacy for SSNHL.

Red mud regulates arsenic fate at acidic pH via regulating arsenopyrite bio-oxidation and S, Fe, Al, Si speciation transformation.

Red mud (RM) as waste of industrial aluminum production is piling up in huge ponds. RM could be a cost-effective adsorbent for heavy metals, but adsorption is vulnerable to pH changes, metal ions speciation and the occurrence of iron bearing minerals. In this study, the precipitation and elemental speciation transformation relevant to arsenic fate in responding to the addition of RM during arsenopyrite bio-oxidation by Sulfobacillus thermosulfidooxidans was investigated. The results show that the addition of RM significantly changed the arsenic precipitation and the solution chemistry and thus affected the arsenopyrite bio-oxidation and arsenic fate. An addition of a small amount (≤ 4 g/L) of RM substantially promoted arsenopyrite bio-oxidation with formation of SiO2 @ (As, Fe, Al, Si) spherical nanoparticles that can enhance the stability of the immobilized arsenic. The SiO2-based spherical nanoparticles precipitate was mainly composed of jarosites, amorphous ferric arsenate and crystalline scorodite, and its formation were controlled by Fe3+ concentration and solution pH. An addition of increased amount of RM (≥ 6 g/L) resulted in a significant increase of the solution pH and a decrease in the Fe2+ bio-oxidation activity, and spherical nanoparticles were not formed. Consequently, the dissolution of arsenopyrite was inhibited and the release of arsenic was blocked. This study suggests the applicability of RM in mitigation of arsenic pollution from bio-oxidation of As-bearing sulfide minerals.

[Electroacupuncture at Dong's Sanqixue combined with auricular point sticking in treatment of post-operative complications of complex anal fistula: a real world research].

OBJECTIVE: To evaluate the clinical therapeutic effect of electroacupuncture (EA) at Dong's Sanqixue combined with auricular point sticking on post-operative complications of complex anal fistula. METHODS: The data of 318 patients undergoing anal fistula surgery were analyzed retrospectively. In accordance with whether accepted the combined treatment with EA at bilateral Dong's Sanqixue and auricular point sticking or not after operation, they were divided into an observation group (157 cases) and a control group (161 cases). At the ratio of 1︰1, the nearest neighbor matching method was adopted to match 125 pairs of patients. The score of visual analogue scale (VAS) on day 1, 7 and 14 after operation, the incidence of urine retention on day 1 and 3 after operation, the anorectal dynamical indexs (anal resting pressure, rectal resting pressure, anal maximum systolic pressure and rectal minimum sensitivity) before and after operation, as well as the clinical therapeutic effect were compared in the patients between the two groups separately. RESULTS: For VAS score, there was an interaction between therapeutic method and treatment duration (P<0.05); the main effect was significant for therapeutic method (P<0.05), while, it was not significant for treatment time (P>0.05). On day 7 and 14 after operation, VAS scores were lower than those on day 1 in the two groups (P<0.05), and VAS scores on day 7 and 14 after operation in the observation group were lower than those in the control group (P<0.05). On day 3 after operation, the incidence of urine retention in the observation group was lower than that in the control group (0.8% [1/125] vs 9.6% [12/125], P<0.05). On day 14 after operation, anal resting pressure, anal maximum systolic pressure and rectal minimum sensitivity in the observation group were lower than those in the control group (P<0.05), and rectal resting pressure was higher than that in the control group (P<0.05). In 1 month after operation, the total effective rate was 96.0% (120/125) in the observation group, higher than 80.8% (101/125) in the control group (P<0.05). CONCLUSION: Electroacupuncture at Dong's Sanqixue combined with auricular point sticking therapy alleviates pain, reduces the incidence of urine retention, improves anal defecation function and clinical therapeutic effect in the patients after complex anal fistula surgery.

Changes in local bone mineral density can guide the treatment plan for patients with rupture of the anterior cruciate ligament.

BACKGROUND: Many factors affect the outcomes of anterior cruciate ligament (ACL) reconstruction surgery. However, few studies have examined the effects of local bone conditions on the reconstruction of the ACL. This study investigated the changes in the local bone mineral density (BMD) of the knee after rupture of the ACL with the view of using this information to guide treatment options. METHODS: Patients with ACL rupture treated in our department from January 2017 to April 2019 were enrolled in this study. Prior to surgery, local BMD measurements were obtained from all patients and used to determine the appropriate method of ligament fixation. If the local BMD of the affected knee was not significantly lower than that of the healthy side, extrusion fixation was conducted. If the BMD was significantly lower than that of the healthy knee, suspension fixation was applied. The conditions of tunnel cutting or screw splitting, and tunnel enlargement or screw pull-out were observed during the surgery. The post-surgical function of the knee joint was evaluated regularly by physical examination, imaging data, the IKDC scale score, and the Lysholm score. RESULTS: A total of 80 patients with unilateral ACL rupture were included. There were 64 males and 16 females. Decreased BMD was observed in the affected knee compared to the healthy knee for 68 patients. Patients with an ACL history of more than 3 months had lower BMD compared to patients with a history of less than 3 months. Tunnel enlargement and screw pull-out occurred in 2 patients, screw splitting occurred in 1 patient. The fixation mode was adjusted in real-time during the surgery for 3 patients. All patients were followed up for at least 12 months (mean 20.65±5.12 months). The IKDC score increased from 43.07±2.66 pre-surgery to 89.17±3.28 at the final follow-up, and similarly, the Lysholm score increased from 43.49±2.38 pre-surgery to 89.67±2.97 post-surgery. CONCLUSIONS: The measurement of local BMD before surgery may play a significant role in guiding the type of graft fixation. It is recommended that patients undergo surgical reconstruction within 3 months after injury.

Self-supervised Agent Learning for Unsupervised Cross-Domain Person Re-identification.

Unsupervised person re-identification (Re-ID) has better scalability and practicability than supervised Re-ID in the actual deployment. However, it is difficult to learn a discriminative Re-ID model without annotations. To address the above issue, we propose an end-to-end Self-supervised Agent Learning (SAL) algorithm by exploiting a set of agents as a bridge to reduce domain gaps for unsupervised cross-domain person Re- ID. The proposed SAL model enjoys several merits. First, to the best of our knowledge, this is the first work to exploit selfsupervised learning for unsupervised person Re-ID. Second, our model has designed three effective learning mechanisms including supervised label learning in source domain, similarity consistency learning in target domain, and self-supervised learning in cross domain, which can learn domain-invariant yet discriminative representations through the principled lens of agent learning by reducing domain discrepancy adaptively. Extensive experimental results on three standard benchmarks demonstrate that the proposed SAL performs favorably against state-of-the-art unsupervised person Re-ID methods.

Reconstruction of Wassel IV-D radial polydactyly with a boot-shaped neurovascular island flap: A Consecutive series of 91 thumbs.

INTRODUCTION: Reconstruction of Wassel IV-D radial polydactyly is challenging and requires a custom strategy dependent on the relative size and shape of the radial and ulnar duplicates. Herein, we describe a technique using a boot-shaped neurovascular island flap and review our outcomes. METHODS: Ninety-one consecutive patients had reconstruction with a boot-shaped neurovascular island flap. The flap was dissected out from the thumb to be removed. Specific flap modifications were inclusion of the lateral nail fold, Bruner incisions dorsally and volarly to reduce scarring at the interphalangeal (IP) joint and also complete mobilization of the island flap on its pedicle to allow easier inset. A flexor pollicis longus and extensor tendon rebalancing technique was used to correct the deviation of the reconstructed thumb IP joint. RESULTS: All boot-shaped neurovascular island flaps survived with good contour, shape, and symmetry. The average follow-up period was 25 months (range 6-60 months). Using the Japanese Society for Surgery of the Hand (JSSH) score for classification of outcomes, seven cases were classified as excellent and 84 cases as good. The median JSSH score was 18. The median Kapandji score for opposition was 9 (range 8-10). CONCLUSION: Using a boot-shaped neurovascular island flap completely mobilized on its pedicle with a custom strategy for each radial duplicate, good outcomes can be achieved in reconstruction of Wassel IV-D radial polydactyly. LEVEL OF EVIDENCE: Therapeutic Level IV.