Enhancing Preoperative Diagnosis of Subscapular Muscle Injuries with Shoulder MRI-based Multimodal Radiomics.

RATIONALE AND OBJECTIVES: Rotator cuff injury is a common ailment in the musculoskeletal system, with the subscapularis muscle being the largest and most robust muscle of the rotator cuff. The occurrence of subscapularis muscle tears is more frequent than previously reported. The main objective of this research is to harness the power of artificial intelligence to enhance the precision in diagnosing subscapularis muscle injuries via magnetic resonance imaging of the shoulder joint, prior to surgical intervention. This study seeks to integrate advanced artificial intelligence algorithms to analyze magnetic resonance imaging data, aiming to provide more accurate preoperative assessments, which can potentially lead to better surgical outcomes and patient care and promote technological progress in the field of medical imaging analysis. METHOD: This is a multicenter study that involves 324 patients from a major medical center serving as both the training and testing groups, with an additional 60 patients from two other medical centers comprising the verifying group. The imaging protocol for all these subjects included a series of shoulder magnetic resonance imaging scans: T1-weighted coronal sequences, T2-weighted coronal, axial, and sagittal images. These comprehensive imaging modalities were utilized to thoroughly examine the shoulder joint's anatomical details and to detect any signs of subscapularis muscle damage. To enhance the diagnostic accuracy before surgical procedures, radiomic analysis was employed. This technique involves the extraction of a multitude of quantitative features from the magnetic resonance imaging, which can provide a more nuanced and data-driven approach to identifying subscapularis muscle injuries. The integration of radiomics in this study aims to offer a more precise preoperative assessment, potentially leading to improved surgical planning and patient outcomes. RESULT: In the course of this study, a comprehensive extraction of 1197 radiomic features was performed for each imaging modality of every patient. The coronal T1-weighted modality, when assessed within the internal verifying cohort, delivered a diagnostic accuracy of 0.766, coupled with an AUC of 0.803. In the case of the T2-weighted modality, the coronal planes exhibited a diagnostic accuracy of 0.781 and an AUC of 0.844. The axial T2-weighted images recorded an accuracy of 0.719 and an AUC of 0.761, while the sagittal T2-weighted images scored an accuracy of 0.766 and an AUC of 0.821. The amalgamation of these imaging techniques through a multimodal strategy markedly enhanced the accuracy to 0.828, with an AUC of 0.916 for the internal verifying group. The diagnostic performance of the coronal T1-weighted modality in the external verifying cohort yielded an accuracy of 0.833, with an area under the curve (AUC) of 0.819. For the T2-weighted modality, the coronal imaging demonstrated an accuracy of 0.767 and an AUC of 0.794. The axial T2-weighted images had an accuracy of 0.783 and an AUC of 0.797, while the sagittal T2-weighted images achieved an accuracy of 0.833 and an AUC of 0.800. When combining the modalities, the multimodal approach significantly improved the accuracy to 0.867, with an AUC of 0.803 in the external verifying group, indicating a robust diagnostic capability. CONCLUSION: Our study demonstrates that the application of multimodal radiomic techniques to shoulder magnetic resonance imaging significantly enhances the precision of preoperative diagnosis for subscapularis muscle injuries. This approach leverages the comprehensive data provided by various magnetic resonance imaging modalities to offer a more detailed and accurate assessment, which is crucial for surgical planning and patient care.

MSI1 Stabilizes MACF1 to Inhibit Apoptosis of MC3T3-E1 Cells Induced by High Glucose and Promote Osteogenic Differentiation Through Wnt/ß-Catenin Signaling Pathway.

Diabetes mellitus (DM) affects bone metabolism and causes osteoporosis. Musashi 1 (MSI1), a member of the Musashi family, regulates protein expression by targeting protein mRNA and has been reported to play an important role in osteogenic differentiation. Therefore, this paper attempts to explore the role of MSI1 in diabetic osteoporosis and discussing its specific mechanism. The glucose concentration for high glucose (HG) and control MC3T3-E1 cells were 30 and 5.5 mM. MC3T3-E1 cells induced by high glucose (HG) were used to simulate diabetic osteoporosis in vivo. The interaction between MSI1 and microtubule actin crosslinking factor 1 (MACF1) was confirmed by RNA Immunoprecipitation (RIP). The mRNA and protein expressions of MSI1 and MACF1 in MC3T3-E1 cells and HG-induced MC3T3-E1 cells after indicated transfection were tested by Real-time quantitative polymerase chain reaction (RT-qPCR) assay and western blot. After transfection, the proliferation, apoptosis, and osteogenic differentiation of HG-induced MC3T3-E1 cells were detected by cell counting kit (CCK)-8, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), alkaline phosphatase (ALP) activity assay, and alizarin red staining. The expression of Wnt/ß-catenin signaling pathway-related proteins in HG-induced MC3T3-E1 cells after transfection was detected by western blot. This work shows that MSI1 can combine with MACF1. The expression of MSI1 and MACF1 was increased in HG-induced MC3T3-E1 cells. Upregulation of MSI1 promoted the proliferative and differentiative capabilities, but inhibited the apoptosis of HG-insulted MC3T3-E1 cells, which could be reversed by MACF1 knockdown. MSI1 stabilizes MACF1 to suppress apoptosis and promote osteogenic differentiation in HG-induced MC3T3-E1 cells by inhibiting Wnt/ß-catenin signaling pathway.

[Arthroscopic debridement combined with platelet-rich plasma injection for the treatment of Kellgren-Lawrence gradeâ -â ¢ knee osteoarthritis].

OBJECTIVE: To explore clinical effect of arthroscopic debridement combined with platelet-rich plasma (PRP) injection for Kellgren-Lawrence(K-L) gradeⅠ-Ⅲ knee osteoarthritis (KOA) . METHODS: Totally 117 patients with KOA who underwent arthroscopic debridement combined with injection from November 2015 to January 2019 were retrospectively analyzed. According to different injection drugs, the patients were divided into sodium hyaluronate group(group A) and PRP group(group B). In group A, there were 60 patients, including 27 males and 33 females, aged from 49 to 67 years old with an average age of (54.1±4.8) years old;12 patients with gradeⅠ, 23 patients with gradeⅡand 25 patients with grade Ⅲ according to K-L clssification, 2 ml(20 g) sodium hyaluronate was injected into knee joint after intraoperative, 1, 2, 3 weeks after operation for 4 times. In group B, there were 57 patients, including 25 males and 32 females, aged from 47 to 70 years old with an average of (55.8±5.0) years old, 10 patients with gradeⅠ, 20 patients with gradeⅡand 27 patients with grade Ⅲ according to K-L classification, injected 5 ml PRP at the same time. Postoperative complications was recorded between two groups. Postoperative visual analogue scale(VAS) and Lysholm score at 3, 6, 12 months were used to evaluate improvement of knee pain and joint function. RESULTS: All patients were followed up for 12 to 19 months with an average of (14.1±1.6) months. There was no significant difference in postopertaive complications between group A and group B (P>0.05). Postoperative VAS score in group A at 3, 6, 12 months were 3.0±0.8, 2.0±0.8, 2.6±0.9 respectively, and 2.9±0.8, 1.9±0.7, 2.2±0.8 in group B respectively; and no differnece at 3 and 6 months after operation between two groups (P<0.05), while VAS score in group B was higher than group A at 12 months after operation(P<0.05). Postoperative Lysholm score in group A at 1, 6, 12 months (86.6±1.8, 93.1±2.0, 86.7±1.7) were lower than group B(88.9±1.9, 95.0±2.0, 89.0±1.9)(P<0.05). CONCLUSION: Arthroscopic debridement combined with sodium hyaluronate or PRP injection for K-L gradeⅠ-Ⅲ KOA could effectively relieve pain and improve joint function with higher safety in short term, but the medium-long-term effect of PRP injection is stable.

Long-range spontaneous droplet self-propulsion on wettability gradient surfaces.

The directional and long-range droplet transportation is of great importance in microfluidic systems. However, it usually requires external energy input. Here we designed a wettability gradient surface that can drive droplet motion by structural topography. The surface has a wettability gradient range of over 150° from superhydrophobic to hydrophilic, which was achieved by etching silicon nanopillars and adjusting the area of hydrophilic silicon dioxide plane. We conducted force analysis to further reveal the mechanism for droplet self-propulsion, and found that the nanostructures are critical to providing a large driving force and small resistance force. Theoretical calculation has been used to analyze the maximal self-propulsion displacement on different gradient surfaces with different volumes of droplets. On this basis, we designed several surfaces with arbitrary paths, which achieved directional and long-range transportation of droplet. These results clarify a driving mechanism for droplet self-propulsion on wettability gradient surfaces, and open up new opportunities for long-range and directional droplet transportation in microfluidic system.