A Fast-scanning Protocol of Optical Coherence Tomography Angiography Based on Structure-Aware Attention.

Oral diseases have imposed a heavy social and financial burden on many countries and regions. If left untreated, severe cases can lead to malignant tumours. Common devices can no longer meet the high-resolution and non-invasive requirement, while Optical Coherence Tomography Angiography (OCTA) provides an ideal perspective for detecting vascular microcirculation. However, acquiring high-quality OCTA images takes time and can result in unpredictable motion artefacts. Therefore, we propose a systematic workflow for rapid OCTA data acquisition. Initially, we implement a fourfold reduction in sampling points to enhance the scanning speed. Then, we apply a deep neural network for rapid image reconstruction, elevating the resolution to the level achieved through full scanning. Specifically, it is a hybrid attention model with a structure-aware loss to extract local and global information on angiography, which improves the visualisation performance and quantitative metrics of numerous classical and recent-presented models by 3.536%-9.943% in SSIM and 0.930%-2.946% in MS-SSIM. Through this approach, the time of constructing one OCTA volume can be reduced from nearly 30 s to about 3 s. The rapid-scanning protocol of high-quality imaging also presents feasibility for future real-time detection applications.

A robot-assisted tracheal intubation system based on a soft actuator?

PURPOSE: Tracheal intubation is the gold standard of airway protection and constitutes a pivotal life-saving technique frequently employed in emergency medical interventions. Hence, in this paper, a system is designed to execute tracheal intubation tasks automatically, offering a safer and more efficient solution, thereby alleviating the burden on physicians. METHODS: The system comprises a tracheal tube with a bendable front end, a drive system, and a tip endoscope. The soft actuator provides two degrees of freedom for precise orientation. It is fabricated with varying-hardness silicone and reinforced with fibers and spiral steel wire for flexibility and safety. The hydraulic actuation system and tube feeding mechanism enable controlled bending and delivery. Object detection of key anatomical features guides the robotic arm and soft actuator. The control strategy involves visual servo control for coordinated robotic arm and soft actuator movements, ensuring accurate and safe tracheal intubation. RESULTS: The kinematics of the soft actuator were established using a constant curvature model, allowing simulation of its workspace. Through experiments, the actuator is capable of 90° bending as well as 20° deflection on the left and right sides. The maximum insertion force of the tube is 2 N. Autonomous tracheal intubation experiments on a training manikin were successful in all 10 trials, with an average insertion time of 45.6 s. CONCLUSION: Experimental validation on the manikin demonstrated that the robot tracheal intubation system based on a soft actuator was able to perform safe, stable, and automated tracheal intubation. In summary, this paper proposed a safe and automated robot-assisted tracheal intubation system based on a soft actuator, showing considerable potential for clinical applications.

Dietary rutin improves the antidiarrheal capacity of weaned piglets by improving intestinal barrier function, antioxidant capacity and cecal microbiota composition.

BACKGROUND: Early weaning is prone to damage intestinal barrier function, resulting in diarrhea, whereas rutin, as a natural flavonoid with multiple biological functions, shows potential in piglets. Therefore, the effects of dietary rutin on growth, antidiarrheal, barrier function, antioxidant status and cecal microbiota of weaned piglets were investigated with the control group (CON) (basal diet) and Rutin (basal diet+500 mg kg-1 rutin) groups fed for 14 days. RESULTS: The results showed that dietary 500 mg kg-1 rutin significantly decreased diarrhea index, serum diamine oxidase activity and total aerobic bacterial population in mesenteric lymph nodes, whereas it significantly increased the gain-to-feed ratio (G:F) and serum growth hormone content, jejunal villus height and villus height to crypt depth ratio, and also enhanced jejunal claudin-1 and zonula occludens-1 mRNA and protein expression. Meanwhile, dietary rutin significantly decreased inflammation-associated mRNA expression, malondialdehyde (MDA) content, swollen mitochondrial number and mitochondrial area in the jejunum, whereas it increased the total superoxide dismutase (T-SOD) and glutathione peroxidase activities and activated the Nrf2 signaling pathway. Moreover, dietary rutin significantly increased Firmicutes abundance and decreased Campylobacterota abundance, which were closely associated with the decreased diarrhea index and MDA content or increased Claudin-1 expression and T-SOD activity. CONCLUSION: Dietary 500 mg kg-1 rutin increased G:F by improving intestinal morphology, and alleviated diarrhea by enhancing intestinal barrier, which might be associated with the enhanced antioxidant capacity via activating the Nrf2/Keap1 signaling pathway and the improved cecal microbial composition in weaned piglets. © 2024 Society of Chemical Industry.

Comprehensive advancement in endoscopy: optical design, algorithm enhancement, and clinical validation for merged WLI and CBI imaging.

As endoscopic imaging technology advances, there is a growing clinical demand for enhanced imaging capabilities. Although conventional white light imaging (WLI) endoscopy offers realistic images, it often cannot reveal detailed characteristics of the mucosa. On the other hand, optical staining endoscopy, such as Compound Band Imaging (CBI), can discern subtle structures, serving to some extent as an optical biopsy. However, its image brightness is low, and the colors can be abrupt. These two techniques, commonly used in clinical settings, have complementary advantages. Nonetheless, they require different lighting conditions, which makes it challenging to combine their imaging strengths on living tissues. In this study, we introduce a novel endoscopic imaging technique that effectively combines the advantages of both WLI and CBI. Doctors don't need to manually switch between these two observation modes, as they can obtain the image information of both modes in one image. We calibrated an appropriate proportion for simultaneous illumination with the light required for WLI and CBI. We designed a new illumination spectrum tailored for gastrointestinal examination, achieving their fusion at the optical level. Using a new algorithm that focuses on enhancing specific hemoglobin tissue features, we restored narrow-band image characteristics lost due to the introduction of white light. Our hardware and software innovations not only boost the illumination brightness of the endoscope but also ensure the narrow-band feature details of the image. To evaluate the reliability and safety of the new endoscopic system, we conducted a series of tests in line with relevant international standards and validated the design parameters. For clinical trials, we collected a total of 256 sets of images, each set comprising images of the same lesion location captured using WLI, CBI, and our proposed method. We recruited four experienced clinicians to conduct subjective evaluations of the collected images. The results affirmed the significant advantages of our method. We believe that the novel endoscopic system we introduced has vast potential for clinical application in the future.

Extent of surgical resection for radiologically subsolid T1N0 invasive lung adenocarcinoma: When is a wedge resection acceptable?

OBJECTIVE: To evaluate whether wedge resection (WR) was appropriate for the patients with peripheral T1 N0 solitary subsolid invasive lung adenocarcinoma. METHODS: Patients with peripheral T1N0 solitary subsolid invasive lung adenocarcinoma who received sublobar resection were retrospectively reviewed. Clinicopathologic characteristics, 5-year recurrence-free survival, and 5-year lung cancer-specific overall survival were analyzed. Cox regression model was used to elucidate risk factors for recurrence. RESULTS: Two hundred fifty-eight patients receiving WR and 1245 patients receiving segmentectomy were included. The mean follow-up time was 36.87 ± 16.21 months. Five-year recurrence-free survival following WR was 96.89% for patients with ground-glass nodule (GGN) ≤2 cm and 0.25< consolidation-to-tumor ratio (CTR) ≤0.5, not statistically different from 100% for those with GGN≤2 cm and CTR ≤0.25 (P = .231). The 5-year recurrence-free survival was 90.12% for patients with GGN between 2 and 3 cm and CTR ≤0.5, significantly lower than that of patients with GGN ≤2 cm and CTR ≤0.25 (P = .046). For patients with GGN≤2 cm and 0.25

A Monocular Variable Magnifications 3D Laparoscope System Using Double Liquid Lenses.

During minimal invasive surgery (MIS), the laparoscope only provides a single viewpoint to the surgeon, leaving a lack of 3D perception. Many works have been proposed to obtain depth and 3D reconstruction by designing a new optical structure or by depending on the camera pose and image sequences. Most of these works modify the structure of the conventional laparoscopes and cannot provide 3D reconstruction of different magnification views. In this study, we propose a laparoscopic system based on double liquid lenses, which provide doctors with variable magnification rates, near observation, and real-time monocular 3D reconstruction. Our system composes of an optical structure that can obtain auto magnification change and autofocus without any physically moving element, and a deep learning network based on the Depth from Defocus (DFD) method, trained to suit inconsistent camera intrinsic situations and estimate depth from images of different focal lengths. The optical structure is portable and can be mounted on conventional laparoscopes. The depth estimation network estimates depth in real-time from monocular images of different focal lengths and magnification rates. Experiments show that our system provides a 0.68-1.44x zoom rate and can estimate depth from different magnification rates at 6fps. Monocular 3D reconstruction reaches at least 6mm accuracy. The system also provides a clear view even under 1mm close working distance. Ex-vivo experiments and implementation on clinical images prove that our system provides doctors with a magnified clear view of the lesion, as well as quick monocular depth perception during laparoscopy, which help surgeons get better detection and size diagnosis of the abdomen during laparoscope surgeries.

Diffusion MRI is valuable in brainstem glioma genotyping with quantitative measurements of white matter tracts.

OBJECTIVES: To investigate the value of diffusion MRI (dMRI) in H3K27M genotyping of brainstem glioma (BSG). METHODS: A primary cohort of BSG patients with dMRI data (b = 0, 1000 and 2000 s/mm2) and H3K27M mutation information were included. A total of 13 diffusion tensor and kurtosis imaging (DTI; DKI) metrics were calculated, then 17 whole-tumor histogram features and 29 along-tract white matter (WM) microstructural measurements were extracted from each metric and assessed within genotypes. After feature selection through univariate analysis and the least absolute shrinkage and selection operator method, multivariate logistic regression was used to build dMRI-derived genotyping models based on retained tumor and WM features separately and jointly. Model performances were tested using ROC curves and compared by the DeLong approach. A nomogram incorporating the best-performing dMRI model and clinical variables was generated by multivariate logistic regression and validated in an independent cohort of 27 BSG patients. RESULTS: At total of 117 patients (80 H3K27M-mutant) were included in the primary cohort. In total, 29 tumor histogram features and 41 WM tract measurements were selected for subsequent genotyping model construction. Incorporating WM tract measurements significantly improved diagnostic performances (p < 0.05). The model incorporating tumor and WM features from both DKI and DTI metrics showed the best performance (AUC = 0.9311). The nomogram combining this dMRI model and clinical variables achieved AUCs of 0.9321 and 0.8951 in the primary and validation cohort respectively. CONCLUSIONS: dMRI is valuable in BSG genotyping. Tumor diffusion histogram features are useful in genotyping, and WM tract measurements are more valuable in improving genotyping performance. CLINICAL RELEVANCE STATEMENT: This study found that diffusion MRI is valuable in predicting H3K27M mutation in brainstem gliomas, which is helpful to realize the noninvasive detection of brainstem glioma genotypes and improve the diagnosis of brainstem glioma. KEY POINTS: • Diffusion MRI has significant value in brainstem glioma H3K27M genotyping, and models with satisfactory performances were built. • Whole-tumor diffusion histogram features are useful in H3K27M genotyping, and quantitative measurements of white matter tracts are valuable as they have the potential to improve model performance. • The model combining the most discriminative diffusion MRI model and clinical variables can help make clinical decision.

A Segmentation Framework With Unsupervised Learning-Based Label Mapper for the Ventricular Target of Intracranial Germ Cell Tumor.

Intracranial germ cell tumors are rare tumors that mainly affect children and adolescents. Radiotherapy is the cornerstone of interdisciplinary treatment methods. Radiation of the whole ventricle system and the local tumor can reduce the complications in the late stage of radiotherapy while ensuring the curative effect. However, manually delineating the ventricular system is labor-intensive and time-consuming for physicians. The diverse ventricle shape and the hydrocephalus-induced ventricle dilation increase the difficulty of automatic segmentation algorithms. Therefore, this study proposed a fully automatic segmentation framework. Firstly, we designed a novel unsupervised learning-based label mapper, which is used to handle the ventricle shape variations and obtain the preliminary segmentation result. Then, to boost the segmentation performance of the framework, we improved the region growth algorithm and combined the fully connected conditional random field to optimize the preliminary results from both regional and voxel scales. In the case of only one set of annotated data is required, the average time cost is 153.01 s, and the average target segmentation accuracy can reach 84.69%. Furthermore, we verified the algorithm in practical clinical applications. The results demonstrate that our proposed method is beneficial for physicians to delineate radiotherapy targets, which is feasible and clinically practical, and may fill the gap of automatic delineation methods for the ventricular target of intracranial germ celltumors.

Diffusion MRI-based connectomics features improve the noninvasive prediction of H3K27M mutation in brainstem gliomas.

PURPOSE: To establish an individualized predictive model to identify patients with brainstem gliomas (BSGs) at high risk of H3K27M mutation, with the inclusion of brain structural connectivity analysis based on diffusion MRI (dMRI). MATERIALS AND METHODS: A primary cohort of 133 patients with BSGs (80 H3K27M-mutant) were retrospectively included. All patients underwent preoperative conventional MRI and dMRI. Tumor radiomics features were extracted from conventional MRI, while two kinds of global connectomics features were extracted from dMRI. A machine learning-based individualized H3K27M mutation prediction model combining radiomics and connectomics features was generated with a nested cross validation strategy. Relief algorithm and SVM method were used in each outer LOOCV loop to select the most robust and discriminative features. Additionally, two predictive signatures were established using the LASSO method, and simplified logistic models were built using multivariable logistic regression analysis. An independent cohort of 27 patients was used to validate the best model. RESULTS: 35 tumor-related radiomics features, 51 topological properties of brain structural connectivity networks, and 11 microstructural measures along white matter tracts were selected to construct a machine learning-based H3K27M mutation prediction model, which achieved an AUC of 0.9136 in the independent validation set. Radiomics- and connectomics-based signatures were generated and simplified combined logistic model was built, upon which derived nomograph achieved an AUC of 0.8827 in the validation cohort. CONCLUSION: dMRI is valuable in predicting H3K27M mutation in BSGs, and connectomics analysis is a promising approach. Combining multiple MRI sequences and clinical features, the established models have good performance.

A stiffness-tunable soft actuator inspired by helix for medical applications.

PURPOSE: This paper introduces the stiffness-tunable soft actuator (STSA), a novel device that combines a silicone body with a thermoplastic resin structure (TPRS). The STSA's design allows for the variable stiffness of soft robots, significantly increasing their potential for use in medical scenarios such as minimally invasive surgeries (MIS). By adjusting the stiffness of the STSA, it is possible to enhance the robot's dexterity and adaptability, making it a promising tool for performing complex tasks in narrow and delicate spaces. METHODS: The stiffness of the STSA can be modulated by altering the temperature of the TPRS, which has been inspired by the helix and is integrated into the soft actuator to achieve a broad range of stiffness modulation while maintaining flexibility. The STSA has been designed with both diagnostic and therapeutic functions in mind, with the hollow area of the TPRS serving as an instrument channel for delivering surgical instruments. Additionally, the STSA features three uniformly arranged pipelines for actuation by air or tendon, and can be expanded with more functional chambers for endoscopy, illumination, water injection, and other purposes. RESULTS: Experimental results show that the STSA can achieve a maximum 30-fold stiffness tuning, providing a significant improvement in load capacity and stability when compared to pure soft actuators (PSAs). Of particular importance, the STSA is capable of achieving stiffness modulation below 45 °C, thereby ensuring a safe entry into the human body and creating an environment conducive to the normal operation of surgical instruments such as endoscope. CONCLUSION: The experimental findings indicate that the soft actuator with TPRS can achieve a broad range of stiffness modulation while retaining flexibility. Moreover, the STSA can be designed to have a diameter of 8-10 mm, which satisfies the diameter requirements of a bronchoscope. Furthermore, the STSA has the potential to be utilized for clamping and ablation in a laparoscopic scenario, thereby demonstrating its potential for clinical use. Overall, these results suggest that the STSA has significant promise for use in medical applications, particularly in the context of minimally invasive surgeries.

Effects of Dietary Nano-Zinc Oxide Supplementation on Meat Quality, Antioxidant Capacity and Cecal Microbiota of Intrauterine Growth Retardation Finishing Pigs.

As nano-zinc oxide (Nano-ZnO), a new type of nanomaterial, has antioxidant and intestinal protection effects, we hypothesized that dietary Nano-ZnO could modulate poor meat quality, oxidative stress and disturbed gut microbiota in the finishing pig model of naturally occurring intrauterine growth retardation (IUGR). A total of 6 normal-born weight (NBW) and 12 IUGR piglets were selected based on birth weight. The pigs in the NBW group received a basal diet, and IUGR pigs were randomly divided into two groups and treated with basal diet and 600 mg/kg Nano-ZnO-supplemented diet. Dietary Nano-ZnO ameliorated IUGR-associated declined meat quality by lowering the drip loss48h, cooking loss, shearing force and MyHc IIx mRNA expression, and raising the redness (a*), peak area ratio of immobilized water (P22), sarcomere length and MyHc Ia mRNA expression. Nano-ZnO activated the nuclear factor erythroid 2-related factor 2-glutamyl cysteine ligase (Nrf2-GCL) signaling pathway by promoting the nuclear translocation of Nrf2, increasing the GCL activities, and mRNA and protein expression of its catalytic/modify subunit (GCLC/GCLM), thereby attenuating the IUGR-associated muscle oxidative injury. Additionally, the composition of IUGR pigs' cecal microbiota was altered by Nano-ZnO, as seen by changes in Shannon and Simpson indexes, the enhanced UCG-005, hoa5-07d05 gut group and Rikenellaceae RC9 gut group abundance. The UCG-005 and hoa5-07d05 gut group abundance were correlated with indicators that reflected the meat quality traits and antioxidant properties. In conclusion, Nano-ZnO improved the IUGR-impaired meat quality by altering water holding capacity, water distribution and the ultrastructure of muscle, activating the Nrf2-GCL signaling pathway to alleviate oxidative status and regulating the cecal microbial composition.

The G allele of SNP rs3922 reduces the binding affinity between IGF2BP3 and CXCR5 correlating with a lower antibody production.

Effective vaccines that function through humoral immunity seek to produce high-affinity antibodies. Our previous research identified the single-nucleotide polymorphism rs3922G in the 3'UTR of CXCR5 as being associated with nonresponsiveness to the hepatitis B vaccine. The differential expression of CXCR5 between the dark zone (DZ) and light zone (LZ) is critical for organizing the functional structure of the germinal center (GC). In this study, we report that the RNA-binding protein IGF2BP3 can bind to CXCR5 mRNA containing the rs3922 variant to promote its degradation via the nonsense-mediated mRNA decay pathway. Deficiency of IGF2BP3 leads to increased CXCR5 expression, which results in the disappearance of CXCR5 differential expression between DZ and LZ, disorganized GCs, aberrant somatic hypermutations, and reduced production of high-affinity antibodies. Furthermore, the affinity of IGF2BP3 for the rs3922G-containing sequence is lower than that for the rs3922A counterpart, which may explain the nonresponsiveness to the hepatitis B vaccination. Together, our findings suggest that IGF2BP3 plays a crucial role in the production of high-affinity antibodies in the GC by binding to the rs3922-containing sequence to regulate CXCR5 expression.

Comparative life cycle assessment of ammonia production by coke oven gas via single and coproduction processes.

As an abundant H2-rich byproduct from coking production, coke oven gas (COG) is a favorable feedstock for ammonia production. Recently, three COG-based ammonia processes have been applied, including single process, coproduction of ammonia with methanol, and coproduction of ammonia with liquefied natural gas (LNG). To systematically evaluate the environmental impacts of three COG routes, a comparative life cycle assessment was conducted with industrial data. Besides, the effects of ammonia synthesis pressure and electricity sources to the total LCA result were discussed. The results indicate that the environmental impacts of COG-based single ammonia route are mainly generated from ammonia production stage, accounting for 69.63 % of the overall normalized results, in which electricity and COG are the dominated contributors. Therefore, employing electricity from renewables like wind, solar, hydro and nuclear could dramatically mitigate the environmental impacts with a reduction of 36.3 %-70.7 % in most environmental indicators. Scenario analysis proves that reducing synthesis pressure from 31.4 MPa to 15 MPa does not show remarkable environmental benefits as expected since higher pressure is more conducive to ammonia synthesis. In comparison with coal based and natural gas-based ammonia routes, COG routes have obvious energy-saving benefit. In three COG-based ammonia routes, the two coproduction routes accounted for 49.1 % and 78.6 % of the energy depletion as single production due to highly efficient utilization of resources and energy. Coproduction of ammonia with methanol route exhibits better environmental performance than these in coproduction of ammonia with LNG route. Therefore, coproduction of ammonia with methanol route is more favorable in COG to ammonia processes. This study intends to provide a valuable reference for COG utilization and ammonia production options through the life cycle aspect.

Extensive clinical target volume in postoperative chemoradiotherapy for esophageal squamous cell carcinoma: a phase II clinical trial (ESO-Shanghai 9).

BACKGROUND: To compare the efficacy and safety of postoperative extensive target volume irradiation with elevated radiation dose and concurrent chemotherapy with radiotherapy only for the postoperative treatment of esophageal squamous cell carcinoma. METHODS: This trial was a single-arm phase II trial. Patients who underwent a radical transthoracic resection with negative margins within 3 months and histologically confirmed esophageal squamous cell carcinoma (pT3-4N0M0 or pTxN + M0, AJCC 7th) were eligible for this study. Postoperative radiotherapy was performed at a total dose of 45 Gy in 25 fractions with clinical target volumes of the tumor bed, anastomosis, bilateral supraclavicular, mediastinal, left gastric and celiac trunk lymph node areas. Five cycles of weekly TC (paclitaxel 50 mg/m2, d1, carboplatin AUC = 2, d1) were given as concurrent chemotherapy. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival, disease free survival, local-regional recurrence free survival, distant metastasis free survival and adverse events. All endpoints were compared with those in ESO-Shanghai 8 study with postoperative radiotherapy alone (40 Gy/20Fx). RESULTS: A total of 70 patients were enrolled from 2016 to 2018. The 2-year local control rate was 87.9% (95% CI: 83.3-92.3) in this study, which achieved the hypothesized 2-year local control rate of at least 83%. Overall survival, disease free survival, local-regional recurrence free survival and distant metastasis free survival in this study were also longer than those in previous ESO-Shanghai 8 study while most toxicities were increased and two patients in this study died of radiation pneumonitis. CONCLUSIONS: Postoperative extensive target volume irradiation with elevated radiation dose and concurrent chemotherapy was effective. Treatment related toxicity was increased due to higher treatment intensity. Trial registration clinicaltrials.gov: NCT02916511.

Large volume acute normovolemic hemodilution in patients undergoing cardiac surgery with intermediate-high risk of transfusion: A randomized controlled trial.

STUDY OBJECTIVE: To investigate whether large volume acute normovolemic hemodilution (L-ANH), compared with moderate acute normovolemic hemodilution (M-ANH), can reduce perioperative allogeneic blood transfusion in patients with intermediate-high risk of transfusion during cardiac surgery with cardiopulmonary bypass (CPB). DESIGN: Prospective randomized controlled trial. SETTING: University hospital. PATIENTS: Patients with transfusion risk understanding scoring tool ("TRUST") ≥2 points undergoing cardiac surgery with CPB in the Second Affiliated Hospital of Zhejiang University from May 2020 to January 2021 were included. INTERVENTIONS: The patients were randomly assigned with a 1:1 ratio to M-ANH (5 to 8 mL/kg) or L-ANH (12 to 15 mL/kg). MEASUREMENTS: The primary outcome was perioperative red blood cell (RBC) transfusion units. The composite outcome included new-onset atrial fibrillation, pulmonary infection, cardiac surgery associated acute kidney injury (CSA-AKI) class ≥2, surgical incision infection, postoperative excessive bleeding, and resternotomy. MAIN RESULTS: Total 159 patients were screened and 110 (55 L-ANH and 55 M-ANH) were included for final analysis. Removed blood volume of L-ANH is significantly higher than M-ANH (886 ± 152 vs. 395 ± 86 mL, P < 0.001). Perioperative RBC transfusion was median 0 unit ([25th, 75th] percentiles: 0-4.4) in M-ANH group vs. 0 unit ([25th, 75th] percentiles: 0-2.0) in L-ANH group (P = 0.012) and L-ANH was associated with lower incidence of transfusion (23.6% vs. 41.8%, P = 0.042, rate difference: 0.182, 95% confidence interval [0.007-0.343]). The incidence of postoperative excessive bleeding was significantly lower in L-ANH vs. M-ANH (3.6% vs. 18.2%, P = 0.029, rate difference: 0.146, 95% confidence interval [0.027-0.270]) without significant difference for other second outcomes. The volume of ANH was inversely related to perioperative RBC transfusion units (Spearman r = -0.483, 95% confidence interval [-0.708 to -0.168], P = 0.003), and L-ANH in cardiac surgery was associated with a significantly reduced risk of perioperative RBC transfusion (odds ratio: 0.43, 95% confidence interval: 0.19-0.98, P = 0.044). CONCLUSIONS: Compared with M-ANH, L-ANH during cardiac surgery inclined to be associated with reduced perioperative RBC transfusion and the volume of RBC transfusion was inversely proportional to the volume of ANH. In addition, LANH during cardiac surgery was associated with a lower incidence of postoperative excessive bleeding.

Visualization, registration and tracking techniques for augmented reality guided surgery: a review.

Augmented reality (AR) surgical navigation has developed rapidly in recent years. This paper reviews and analyzes the visualization, registration, and tracking techniques used in AR surgical navigation systems, as well as the application of these AR systems in different surgical fields. The types of AR visualization are divided into two categories ofin situvisualization and nonin situvisualization. The rendering contents of AR visualization are various. The registration methods include manual registration, point-based registration, surface registration, marker-based registration, and calibration-based registration. The tracking methods consist of self-localization, tracking with integrated cameras, external tracking, and hybrid tracking. Moreover, we describe the applications of AR in surgical fields. However, most AR applications were evaluated through model experiments and animal experiments, and there are relatively few clinical experiments, indicating that the current AR navigation methods are still in the early stage of development. Finally, we summarize the contributions and challenges of AR in the surgical fields, as well as the future development trend. Despite the fact that AR-guided surgery has not yet reached clinical maturity, we believe that if the current development trend continues, it will soon reveal its clinical utility.

A nomogram and risk classification model predicts prognosis in Chinese esophageal squamous cell carcinoma patients.

Background: A nomogram model based on gene mutations for predicting the prognosis of patients with resected esophageal squamous cell carcinoma (ESCC) has not been established. We sought to develop a risk classification system. Methods: In total, 312 patients with complete clinical and genome mutation landscapes in our previous study were chosen for the present study. Public International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA) data of ESCC were also used as an external validation set. Results: Using the least absolute shrinkage and selection operator (LASSO) method, we successfully built a 9-gene mutation-based prediction model for overall survival (OS) and a 21-gene mutation model for progression-free survival (PFS). High- and low-risk groups were stratified using the gene mutation-based classifier. Patients in the high-risk group witnessed poorer 3- and 5-year OS and PFS in both the training and validation sets (P<0.01). Moreover, calibration curves and decision curve analyses (DCAs) were used to confirm the independence and potential translational value of this predictive model. In the nomogram analysis, the risk classification model was shown to be a reliable prognostic tool. All results showed better consistency in the external ICGC and TCGA validation sets. Conclusions: We developed and validated a predictive risk model for ESCC. This practical prognostic model may help doctors make different follow-up decisions in the clinic.

Discoid medial meniscus of both knees: A case report.

BACKGROUND: Discoid meniscus is a congenital anomaly that typically affects the lateral meniscus. The appearance of the discoid medial meniscus in both knees is extremely rare, with an incidence of only 0.012%. CASE SUMMARY: Our patient was a 30-year-old female. Under no obvious predisposing causes, she began to experience pain in both knees, which worsened while walking and squatting. The pain was aggravated after exercise, and joint flexion and extension activities were accompanied by knee snapping. Apley's test was positive on physical examination, and there was a pressing pain in the medial articular space. Plain radiographs of both knees revealed no obvious abnormalities in the bilateral knee joint space. Partial meniscectomy as well as menisci reformation were performed on both knees under arthroscopy. Under the guidance of rehabilitation, the patient's range of motion in both knees returned to normal without pain and knee snapping. CONCLUSION: This study showed that the clinical manifestations of the discoid medial meniscus injury are identical to those of the conventional medial meniscus injury, and arthroscopic surgery is effective.

Arthroscopically assisted reduction and internal fixation of a femoral anterior cruciate ligament osteochondral avulsion fracture in an 11-year-old girl: A case report.

RATIONALE: The anterior cruciate ligament (ACL) is relatively rarely injured in children and adolescents, accounting for just 0.5% of all ACL rips that occur. Avulsion fractures are more common in youngsters because their ligamentous structures are known to be stronger than their physical insertion sites. Tibial eminences have been reported to be the sites of most ACL avulsions, and both cartilaginous and osteochondral avulsion fractures have been observed, whereas the latter occurs more commonly. On the other hand, femoral osteochondral avulsion fractures of the ACL in children are uncommon, as only a few studies describe their occurrence in immature patients. PATIENT CONCERNS: In this case report, we present an 11-year-old girl who suffered an ACL femoral attachment avulsion fracture after pivoting her knee during riding. A comprehensive formal evaluation of the knee was impractical due to the persistence of pain and tight haemarthrosis. DIAGNOSES: Femoral anterior cruciate ligament osteochondral avulsion fracture. INTERVENTIONS: We used Two No.2Ethibond sutures to pick up the osteochondral fragment and passed across the lateral femoral condyle to come out laterally and fixed with a tie proximally, and we recommended the patient perform reasonable functional exercises postoperatively. OUTCOMES: The patient had no pain, instability, or activity limitations after 24 months of surgery. Physical examination of the patient revealed full and symmetric ROM, and normal Lachman and pivot shift test performance. LESSONS: ACL avulsion fractures can be accurately treated with arthroscopic reduction and sutures via an inside-out technique, which can reduce the risk of persistent ligamentous laxity and reduce open surgery-related morbidity.

Amplified Drug Delivery System with a Pair of Master Keys Triggering Precise Drug Release for Chemo-Photothermal Therapy.

A versatile drug delivery system (DDS) enabling highly effective and targeting oncotherapy has always been of great significance in medical research. In the development of a stimuli-responsive DDS, compared with a single-factor stimulation DDS, a multifactor activation DDS has higher therapeutic specificity between diseased and normal tissue, but there are challenges in drug-release efficiency and united targeting cancer therapy. Herein, a novel dual-microRNA (dual-miRNA)-mediated 1:N-amplified DDS is fabricated. The gold nanocage (AuNC) was synthesized and used as a carrier. A DNA bridge motif as a nanolock (DNA bridge nanolock) was designed and modified on the surface of AuNCs, which could seal the holes of AuNCs. Using the dual-miRNAs as a pair of master keys, through DNA strand migration and DNAzyme self-assembly, a cell endogenous substance Mg2+-dependent DNAzyme cyclic shear reaction could perform the function of the master keys to open multiple locks for the enhanced release of doxorubicin from the AuNCs. In addition, under near-infrared irradiation, via absorption of light and heat release, the AuNC is activated to perform the function of photothermal therapy. Thereby, the system achieves precise chemo-photothermal therapy. Using the in vitro and in vivo anti-tumor analysis, the DDS could be proved to present a novel design of enhanced and targeted drug-release system for highly effective cancer therapy.