Fully automated film mounting in dental radiography: a deep learning model.

BACKGROUND: Dental film mounting is an essential but time-consuming task in dental radiography, with manual methods often prone to errors. This study aims to develop a deep learning (DL) model for accurate automated classification and mounting of both intraoral and extraoral dental radiography. METHOD: The present study employed a total of 22,334 intraoral images and 1,035 extraoral images to train the model. The performance of the model was tested on an independent internal dataset and two external datasets from different institutes. Images were categorized into 32 tooth areas. The VGG-16, ResNet-18, and ResNet-101 architectures were used for pretraining, with the ResNet-101 ultimately being chosen as the final trained model. The model's performance was evaluated using metrics of accuracy, precision, recall, and F1 score. Additionally, we evaluated the influence of misalignment on the model's accuracy and time efficiency. RESULTS: The ResNet-101 model outperformed VGG-16 and ResNet-18 models, achieving the highest accuracy of 0.976, precision of 0.969, recall of 0.984, and F1-score of 0.977 (p < 0.05). For intraoral images, the overall accuracy remained consistent across both internal and external datasets, ranging from 0.963 to 0.972, without significant differences (p = 0.348). For extraoral images, the accuracy consistently achieved the highest value of 1 across all institutes. The model's accuracy decreased as the tilt angle of the X-ray film increased. The model achieved the highest accuracy of 0.981 with correctly aligned films, while the lowest accuracy of 0.937 was observed for films exhibiting severe misalignment of ± 15° (p < 0.001). The average time required for the tasks of image rotation and classification for each image was 0.17 s, which was significantly faster than that of the manual process, which required 1.2 s (p < 0.001). CONCLUSION: This study demonstrated the potential of DL-based models in automating dental film mounting with high accuracy and efficiency. The proper alignment of X-ray films is crucial for accurate classification by the model.

Electrochemical Molecule Trap-Based Sensing of Low-Abundance Enzymes in One Living Cell.

Measuring the activity of low-abundance enzymes, down to a few molecules in one living cell, is important but challenging to elucidate their biological function. Here, an electrochemical molecule trap is established at the tip of a nanopipette with an electrochemical detector, in which the diffusion of the molecules away from the electrochemical detector is prevented by electro-osmotic flow (EOF). Accordingly, a limited amount of enzymes is trapped to continuously catalyze the conversion of the substrate to generate a sufficient amount of the byproduct hydrogen peroxide for electrochemical measurements. The resistive pulse sensing of the enzymes in single liposomes validates the detection sensitivity down to 15 molecules. Using this ultrasensitive electrochemical strategy, the activity of 60 sphingomyelinase molecules inside single unstimulated living J774 cells is measured, which was hardly detected by previous methods. The established electrochemical molecule trap-based sensing approach opens the door toward single-molecule electrochemical detection in one living cell. This success will solve the long-standing problem regarding the study of the activity of low-abundance proteins in cells in their native physiological state and greatly enhance the understanding of the roles of proteins in cellular behavior.

Design of a UCST Polymer with Strong Hydrogen Bonds and Reactive Moieties for Facile Polymer-Protein Hybridization.

Polymer-protein hybrids have been extensively used in biomedical fields. Polymers with upper critical solution temperature (UCST) behaviors can form a hydrated coacervate phase below the cloud point (Tcp), providing themselves the opportunity to directly capture hydrophilic proteins and form hybrids in aqueous solutions. However, it is always a challenge to obtain a UCST polymer that could aggregate at a high temperature at a relatively low concentration and also efficiently bind with proteins. In this work, a UCST polymer reactive with proteins was designed, and its temperature responsiveness and protein-capture ability were investigated in detail. The polymer was synthesized by the reversible addition-fragmentation chain transfer (RAFT) polymerization of acrylamide (AAm) and N-acryloxysuccinimide (NAS). Interestingly, taking advantage of the partial hydrolysis of NAS into acrylic acid (AAc), the obtained P(AAm-co-NAS-co-AAc) polymer exhibited an excellent UCST behavior and possessed good protein-capture ability. It showed a relatively higher Tcp (81 °C) at a lower concentration (0.1 wt %) and quickly formed polymer-protein hybrids with high protein loading and without losing protein bioactivity, and both the polymer and polymer-protein nanoparticles showed good cytocompatibility. All the findings are attributed to the unique structure of the polymer, which provided not only the strong and stable hydrogen bonds but also the quick and mild reactivity. The work offers an easy and mild strategy for polymer-protein hybridization directly in aqueous solutions, which may find applications in biomedical fields.

Effects of Conventional Surfactants on the Activity of Designed Antimicrobial Peptide.

In this article, the interaction between a designed antimicrobial peptide (AMP) G(IIKK)3I-NH2 (G3) and four typical conventional surfactants (sodium dodecyl sulfonate (SDS), hexadecyl trimethyl ammonium bromide (C16TAB), polyoxyethylene (23) lauryl ether (C12EO23), and tetradecyldimethylamine oxide (C14DMAO)) has been studied through surface tension measurement and circular dichroism (CD) spectroscopy. The antimicrobial activities of AMP/surfactant mixtures have also been studied with Gram-negative Escherichia coli, Gram-positive Staphylococcus aureus, and the fungus Candida albicans. The cytotoxicity of the AMP/surfactant mixtures has also been assessed with NIH 3T3 and human skin fibroblast (HSF) cells. The surface tension data showed that the AMP/SDS mixture was much more surface-active than SDS alone. CD results showed that G3 conformation changed from random coil, to ß-sheet, and then to α-helix with increasing SDS concentration, showing a range of structural transformation driven by the different interactions with SDS. The antimicrobial activity of G3 to Gram-negative and Gram-positive bacteria decreased in the presence of SDS due to the strong interaction of electrostatic attraction between the peptide and the surfactant. The interactions between G3 and C16TAB, C12EO23, and C14DMAO were much weaker than SDS. As a result, the surface tension of surfactants with G3 did not change much, neither did the secondary structures of G3. The antimicrobial activities of G3 were little affected in the presence of C12EO23, slightly improved by C14DMAO, and clearly enhanced by cationic surfactant C16TAB due to its strong cationic and antimicrobial nature, consistent with their surface physical activities as binary mixtures. Although AMP G3 did not show activity to fungus, the mixtures of AMP/C16TAB and AMP/C14DMAO could kill C. albicans at high surfactant concentrations. The mixtures had rather high cytotoxicity to NIH 3T3 and HSF cells although G3 is nontoxic to cells. Cationic AMPs can be formulated with nonionic, cationic, and zwitterionic surfactants during product development, but care must be taken when AMPs are formulated with anionic surfactants, as the strong electrostatic interaction may undermine their antimicrobial activity.

Modulation of Antimicrobial Peptide Conformation and Aggregation by Terminal Lipidation and Surfactants.

The function and properties of peptide-based materials depend not only on the amino acid sequence but also on the molecular conformations. In this paper, we chose a series of peptides Gm(XXKK)nX-NH2 (m = 0, 3; n = 2, 3; X = I, L, and V) as the model molecules and studied the conformation regulation through N-terminus lipidation and their formulation with surfactants. The structural and morphological transition of peptide self-assemblies have also been investigated via transmission electron microscopy, atomic force microscopy, circular dichroism spectroscopy, and small-angle neutron scattering. With the terminal alkylation, the molecular conformation changed from random coil to ß-sheet or α-helix. The antimicrobial activities of alkylated peptide were different. C16-G3(IIKK)3I-NH2 showed antimicrobial activity against Streptococcus mutans, while C16-(IIKK)2I-NH2 and C16-G3(IIKK)2I-NH2 did not kill the bacteria. The surfactant sodium dodecyl sulfonate could rapidly induce the self-assemblies of alkylated peptides (C16-(IIKK)2I-NH2, C16-G3(IIKK)2I-NH2, C16-G3(VVKK)2V-NH2) from nanofibers to micelles, along with the conformation changing from ß-sheet to α-helix. The cationic surfactant hexadecyl trimethyl ammonium bromide made the lipopeptide nanofibers thinner, and nonionic surfactant polyoxyethylene (23) lauryl ether (C12EO23) induced the nanofibers much more intensively. Both the activity and the conformation of the α-helical peptide could be modulated by lipidation. Then, the self-assembled morphologies of alkylated peptides could also be further regulated with surfactants through hydrophobic, electrostatic, and hydrogen-bonding interactions. These results provided useful strategies to regulate the molecular conformations in peptide-based material functionalization.

Impact on lung function among children exposed to home new surface materials: The seven Northeastern Cities Study in China.

We conducted a cross-sectional study to investigate the associations between recent home renovation exposure and lung function in children. We randomly recruited 7326 school children residing in 24 districts from seven cities in northeastern China. We collected information about home renovations from parents using a questionnaire and lung function measurements from children using spirometer recordings gathered by trained professionals and expressed as the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), maximal mid-expiratory flow (MMEF), and peak expiratory flow (PEF). We identified higher odds of diminished lung function among these with home renovation in the previous 2 years compared to those without home renovation in the previous 2 years, for FVC (odds ratios [ORs] = 1.84 [95%CI: 1.58, 2.15]; FEV1: ORs = 2.82 [95%CI: 2.36, 3.36]; PEF: ORs = 1.51 [95%CI: 1.24, 1.83]; and MMEF: ORs = 1.90 [95%CI: 1.60, 2.24]). The associations were stronger among children exposed to new polyvinyl chloride (PVC) flooring compared to children exposed to other surface materials. Our results were consistent throughout the analysis of each type of renovation materials. In conclusion, recent home renovation exposure was associated with poor lung function among children. Strategies to protect home owners and their families from respiratory hazards during and after renovation are required.

Tensile strength and failure load of sutures for robotic surgery.

BACKGROUND: Robotic surgical platforms have seen increased use among minimally invasive gastrointestinal surgeons (von Fraunhofer et al. in J Biomed Mater Res 19(5):595-600, 1985. doi: 10.1002/jbm.820190511 ). However, these systems still suffer from lack of haptic feedback, which results in exertion of excessive force, often leading to suture failures (Barbash et al. in Ann Surg 259(1):1-6, 2014. doi: 10.1097/SLA.0b013e3182a5c8b8 ). This work catalogs tensile strength and failure load among commonly used sutures in an effort to prevent robotic surgical consoles from exceeding identified thresholds. Trials were thus conducted on common sutures varying in material type, gauge size, rate of pulling force, and method of applied force. METHODS: Polydioxanone, Silk, Vicryl, and Prolene, gauges 5-0 to 1-0, were pulled till failure using a commercial mechanical testing system. 2-0 and 3-0 sutures were further tested for the effect of pull rate on failure load at rates of 50, 200, and 400 mm/min. 3-0 sutures were also pulled till failure using a da Vinci robotic surgical system in unlooped, looped, and at the needle body arrangements. RESULTS: Generally, Vicryl and PDS sutures had the highest mechanical strength (47-179 kN/cm2), while Silk had the lowest (40-106 kN/cm2). Larger diameter sutures withstand higher total force, but finer gauges consistently show higher force per unit area. The difference between material types becomes increasingly significant as the diameters decrease. Comparisons of identical suture materials and gauges show 27-50% improvement in the tensile strength over data obtained in 1985 (Ballantyne in Surg Endosc Other Interv Tech 16(10):1389-1402, 2002. doi: 10.1007/s00464-001-8283-7 ). No significant differences were observed when sutures were pulled at different rates. Reduction in suture strength appeared to be strongly affected by the technique used to manipulate the suture. CONCLUSIONS: Availability of suture tensile strength and failure load data will help define software safety protocols for alerting a surgeon prior to suture failure during robotic surgery. Awareness of suture strength weakening with direct instrument manipulation may lead to the development of better techniques to further reduce intraoperative suture breakage.

Augmented Anticancer Effects of Cantharidin with Liposomal Encapsulation: In Vitro and In Vivo Evaluation.

PEGylated liposomes have received much attention as pharmaceutical carriers to deliver chemotherapeutic agents for therapeutic purpose. The aim of this study was to prepare and characterize PEGylated liposome of cantharidin and investigate its therapeutic effect on human hepatocellular carcinoma treatment in vitro and in vivo. Liposomal cantharidin was evaluated for their anticancer effects in vitro using human hepatocellular carcinoma HepG2 cells and in vivo using HepG2-bearing nude mice compared to free drug. PEGylated liposome of cantharidin had a particle size of 129.9 nm and a high encapsulation efficacy of approximately 88.9%. The liposomal cantharidin had a higher anti-proliferative effect vis-à-vis free cantharidin in inducing G2/M cell cycle arrest and apoptosis. Liposomal cantharidin killed more HepG2 cancer cells at the same concentration equivalent to free cantharidin. Further study in vivo also showed that liposomal cantharidin achieved a higher tumor growth inhibition efficacy than free drug on hepatocellular carcinoma. As our study exhibited enhanced cytotoxicity against HepG2 cells and augmented tumor inhibitory effects in vivo, the results validate the potential value of cantharidin-liposome in improving the therapeutic efficacy of cantharidin for liver cancer.

Biocompatible gold nanorods: one-step surface functionalization, highly colloidal stability, and low cytotoxicity.

The conjugation of gold nanorods (AuNRs) with polyethylene glycol (PEG) is one of the most effective ways to reduce their cytotoxicity arising from the cetyltrimethylammonium bromide (CTAB) and silver ions used in their synthesis. However, typical PEGylation occurs only at the tips of the AuNRs, producing partially modified AuNRs. To address this issue, we have developed a novel, facile, one-step surface functionalization method that involves the use of Tween 20 to stabilize AuNRs, bis(p-sulfonatophenyl)phenylphosphine (BSPP) to activate the AuNR surface for the subsequent PEGylation, and NaCl to etch silver from the AuNRs. This method allows for the complete removal of the surface-bound CTAB and the most active surface silver from the AuNRs. The produced AuNRs showed far lower toxicity than other methods to PEGylate AuNRs, with no apparent toxicity when their concentration is lower than 5 µg/mL. Even at a high concentration of 80 µg/mL, their cell viability is still four times higher than that of the tip-modified AuNRs.

Novel chitosan hydrogel formed by ethylene glycol chitosan, 1,6-diisocyanatohexan and polyethylene glycol-400 for tissue engineering scaffold: in vitro and in vivo evaluation.

Traditional chitosan hydrogels were prepared by chemical or physical crosslinker, and both of the two kinds of hydrogels have their merits and demerits. In this study, researchers attempted to prepare one kind of chitosan hydrogel by slightly crosslinker, which could combine the advantages of the two kinds of hydrogels. In this experiment, the crosslinker was formed by a reaction between the isocyanate group of 1,6-diisocyanatohexan and the hydroxyl group of polyethylene glycol-400 (PEG-400), then the crosslinker reacted with the amidine and the hydroxyl group of ethylene glycol chitosan to form the network structure. Physical properties of the hydrogel were tested by Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and biodegradation. Biocompatibility was assessed by cell implantation in vitro and the scaffold was used as a cartilage tissue engineering scaffold to repair a defect in rabbit knee joints in vivo. FTIR results show the formation of a covalent bond during thickening of the ethylene glycol chitosan. SEM and degradation experiments showed that the ethylene glycol chitosan hydrogel is a 3-D, porous, and degradable scaffold. The hydrogel contained 2% ethylene glycol chitosan and 10 µl crosslinker was selected for the biocompatibility experiment in vitro and in vivo. After chondrocytes were cultured in the ethylene glycol chitosan hydrogel scaffold for 1 week cells exhibited clustered growth and had generated extracellular matrix on the scaffold in vitro. The results in vivo showed that hydrogel-chondrocytes promoted the repair of defect in rabbits. Based on these results, it could be concluded that ethylene glycol chitosan hydrogel is a scaffold with excellent physicochemical properties and it is a promising tissue engineering scaffold.

Enucleation of jaw cyst combined with intentional replantation to retain cyst-involved teeth.

BACKGROUND: Jaw cysts often deeply involve adjacent tooth roots, making it difficult to preserve them. The purpose of this retrospective study was to investigate the effectiveness of an intentional replantation (IR) strategy combined with cyst enucleation in preserving cyst-involved teeth during jaw cyst removal. MATERIALS AND METHODS: Fifteen patients with jaw cysts and deeply involved teeth were treated with IR and cyst enucleation. All patients received root canal therapy prior to surgery, except for one patient who received it during surgery. The involved teeth were extracted, and the root surface was carefully cleaned before IR and cyst enucleation. Patients were followed up for 12-14 months, with indicators including clinical complaints, replanted tooth stability, and root resorption. RESULTS: No cyst recurrence was observed, and all replanted teeth survived with good local gingival condition and no marked swelling or recession. Radiographic findings showed clear periodontal space surrounding the replanted teeth. One replanted tooth exhibited slight root resorption due to occlusal trauma, but the resorption ceased after occlusal adjustment. CONCLUSIONS: IR combined with cyst enucleation is an effective strategy for thoroughly cleaning jaw cysts and preserving teeth involved in the cyst.

Development and application of a machine learning-based predictive model for obstructive sleep apnea screening.

Objective: To develop a robust machine learning prediction model for the automatic screening and diagnosis of obstructive sleep apnea (OSA) using five advanced algorithms, namely Extreme Gradient Boosting (XGBoost), Logistic Regression (LR), Support Vector Machine (SVM), Light Gradient Boosting Machine (LightGBM), and Random Forest (RF) to provide substantial support for early clinical diagnosis and intervention. Methods: We conducted a retrospective analysis of clinical data from 439 patients who underwent polysomnography at the Affiliated Hospital of Xuzhou Medical University between October 2019 and October 2022. Predictor variables such as demographic information [age, sex, height, weight, body mass index (BMI)], medical history, and Epworth Sleepiness Scale (ESS) were used. Univariate analysis was used to identify variables with significant differences, and the dataset was then divided into training and validation sets in a 4:1 ratio. The training set was established to predict OSA severity grading. The validation set was used to assess model performance using the area under the curve (AUC). Additionally, a separate analysis was conducted, categorizing the normal population as one group and patients with moderate-to-severe OSA as another. The same univariate analysis was applied, and the dataset was divided into training and validation sets in a 4:1 ratio. The training set was used to build a prediction model for screening moderate-to-severe OSA, while the validation set was used to verify the model's performance. Results: Among the four groups, the LightGBM model outperformed others, with the top five feature importance rankings of ESS total score, BMI, sex, hypertension, and gastroesophageal reflux (GERD), where Age, ESS total score and BMI played the most significant roles. In the dichotomous model, RF is the best performer of the five models respectively. The top five ranked feature importance of the best-performing RF models were ESS total score, BMI, GERD, age and Dry mouth, with ESS total score and BMI being particularly pivotal. Conclusion: Machine learning-based prediction models for OSA disease grading and screening prove instrumental in the early identification of patients with moderate-to-severe OSA, revealing pertinent risk factors and facilitating timely interventions to counter pathological changes induced by OSA. Notably, ESS total score and BMI emerge as the most critical features for predicting OSA, emphasizing their significance in clinical assessments. The dataset will be publicly available on my Github.

Preparation of silica-encapsulated ZnSe nanocrystals by mixed surfactant microemulsions.

Silica-encapsulated ZnSe nanocrystals (NCs) have been prepared by employing sodium (2-ethylhexyl)sulfonate (AOT)/water/cyclohexane microemulsions containing ZnSe quantum dots with polyoxyethylenenonylphenylether (NP5)/water/cyclohexane microemulsions containing tetraethylorthosilicate (TEOS). Size tunable silica nanoparticles were achieved by using various water-to-surfactant ratios, W ([H2O]/[surfactant]). In order to characterize as-synthesized nanocrystals, photoluminescence (PL) spectroscopy, UV-visible spectroscopy, X-ray diffraction (XRD), transmission electron microscopy (TEM) and Fourier transform infrared spectroscopy (FTIR) were employed. Cubic zinc blende quantum dots (QDs) (2.5 nm in diameter) were successfully encapsulated by silica nanoparticles (14.3-28.9 nm in diameter). The enhanced photoluminescence efficiency about 10% has been observed when compared with the results from the similar work using AOT microemulsions. The entire size of the silica-encapsulated nanocrystals increased with increasing W, then decreased slightly when free water exists in the core of the NP5/AOT microemulsion. On the other hand, the ZnSe NCs in the silica did not change their size during the synthesis. In addition, the possible mechanisms for growth of silica particles and the kinetics of silica particles formation were discussed.

Poly(N-acryloyl glycinamide-co-N-acryloxysuccinimide) Nanoparticles: Tunable Thermo-Responsiveness and Improved Bio-Interfacial Adhesion for Cell Function Regulation.

Poly(N-acryloyl glycinamide) (PNAGA) can form high-strength hydrogen bonds (H-bonds) through the dual amide motifs in the side chain, allowing the polymer to exhibit gelation behavior and an upper critical solution temperature (UCST) property. These features make PNAGA a candidate platform for biomedical devices. However, most applications focused on PNAGA hydrogels, while few focused on PNAGA nanoparticles. Improving the UCST tunability and bio-interfacial adhesion of the PNAGA nanoparticles may expand their applications in biomedical fields. To address the issues, we established a reactive H-bond-type P(NAGA-co-NAS) copolymer via reversible addition-fragmentation chain transfer polymerization of NAGA and N-acryloxysuccinimide (NAS) monomers. The UCST behaviors and the bio-interfacial adhesion toward the proteins and cells along with the potential application of the copolymer nanoparticles were investigated in detail. Taking advantage of the enhanced H-bonding and reactivity, the copolymer exhibited a tunable UCST in a broad temperature range, showing thermo-reversible transition between nanoparticles (PNPs) and soluble chains; the PNPs efficiently bonded proteins into nano-biohybrids while keeping the secondary structure of the protein, and more importantly, they also exhibited good adhesion ability to the cell membrane and significantly inhibited cell-specific propagation. These features suggest broad prospects for the P(NAGA-co-NAS) nanoparticles in the fields of biosensors, protein delivery, cell surface decoration, and cell-specific function regulation.

Stretchable and Self-Powered Temperature-Pressure Dual Sensing Ionic Skins Based on Thermogalvanic Hydrogels.

Tactile sensors with both temperature- and pressure-responsive capabilities are critical to enabling future smart artificial intelligence. These sensors can mimic haptic functions of human skin and inevitably suffer from tensile deformation during operation. However, almost all actual multifunctional tactile sensors are either nonstretchable or the sensing signals interfere with each other when stretched. Herein, we propose a stretchable and self-powered temperature-pressure dual functional sensor based on thermogalvanic hydrogels. The sensor operates properly under stretching, which relies on the thermogalvanic effect and constant elastic modulus of hydrogels. The thermogalvanic hydrogel elastomer exhibits an equivalent Seebeck coefficient of -1.21 mV K-1 and a pressure sensitivity of 0.056 kPa-1. Combined with unit array integration, the multifunctional sensor can be used for accurately recording tactile information on human skin and spatial perception. This work provides a conceptual framework and systematic design for stretchable artificial skin, interactive wearables, and smart robots.

Co-encapsulation systems for delivery of bioactive ingredients.

To improve the solubility, stability and bioavailability of bioactive compounds, a series of delivery systems have been designed and developed in recent years. However, most delivery systems are limited to loading a single nutrient. Co-delivery systems that encapsulate two or more nutrients have great sense to enhance the nutritional values and health benefits of food products. In this paper, the recent advancements of co-encapsulation systems including emulsions, nanoparticles, microcapsules, liposomes, hydrogels, and related products have been reviewed. The co-encapsulation mechanisms of bioactive ingredients in various delivery systems were illustrated. Furthermore, the release, digestion and absorption mechanisms of bioactive ingredients in the human digestive system were also discussed. Co-encapsulation systems have the ability to mask astringency of different bioactive ingredients and enhance their stability and bioavailability, as well as to maximize the biological function of bioactive ingredients with synergistic effect. The present review provides examples for the application of co-encapsulation systems in food industries.

Polymer-Water Interaction Enabled Intelligent Moisture Regulation in Hydrogels.

The water-vapor transition is critical for hydrogels in a collection of applications. However, how the polymer-water interaction along with the nature of the structure affect the macroscopic water-vapor transition remains a challenging question to answer. In this work, we tested the moisture transfer behaviors of a series of hydrogels at different humidities and found some hydrogels capable of lowering their surface vapor pressure to stop dehydration at low humidity and absorbing water from ambient air to recover toward initial states at high humidity. Through molecular dynamic simulations, we demonstrate that water inside these hydrogels undergoes increasing intensive intermolecular bonding during evaporation. The increased intermolecular bonding reduces the vapor pressure of the hydrogels and leads to the self-regulation. More interestingly, we demonstrate the self-regulation is closely related to the Young's modulus of hydrogels. These results provide further insight into the mechanism of the water-vapor transition in hydrogels and show potential in a broad range of future applications.

Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report.

RATIONALE: Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel. PATIENT CONCERNS: A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us. DIAGNOSIS: Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma. INTERVENTIONS: The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle. OUTCOMES: The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up. LESSONS: The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.

Prenatal exposure to perfluoroalkyl substances is associated with lower hand, foot and mouth disease viruses antibody response in infancy: Findings from the Guangzhou Birth Cohort Study.

BACKGROUND: Perfluoroalkyl substances (PFASs) are synthetic chemicals widely used in industry and for commercial products. Their immunomodulatory effects are a growing health concern in children. Hand, Foot and Mouth Disease (HFMD) is a common childhood viral infection, and increased incidence of which has parallel the rise in PFAS exposure in the Asia-Pacific region. OBJECTIVE: We conducted the first study to assess whether prenatal exposure to PFAS was associated with a reduction in HFMD virus antibodies in infants. METHODS: We enrolled 201 mother-infant pairs from the Guangzhou Birth Cohort Study from July to October 2013. High performance liquid chromatography-mass spectrometry was employed to determine concentrations of specific PFAS isomers in cord blood. Neutralizing antibodies titers were measured against two HFMD viruses, enterovirus 71 (EV71) and coxsackievirus A 16 (CA16), in cord blood serum and blood serum at three months of age. RESULTS: Higher umbilical cord blood PFAS concentrations were associated with lower EV71 and CA16 antibody concentrations. A doubling in the composite sum of cord blood PFASs in three month old infants was associated with significant increase in the risk of HFMD antibody concentration below clinical protection level (≥1:8 titers) for CA16 (odds ratio, OR: 2.74 [95% confidence interval (CI): 1.33, 5.61] and for EV71 (OR = 4.55, 95% CI: 1.45, 4.28). This association was higher in boys at three months of age for CA16. CONCLUSIONS: Our findings suggest that cord blood PFAS exposure is associated with lower HFMD antibody in infancy. Given the widespread nature of PFAS exposures and the high global incidence of HFMD globally, these findings have substantial public health implications and therefore, these associations need to be replicated in a larger study to more definitively address the risk.

Superpixel-Based Foreground Extraction With Fast Adaptive Trimaps.

Extracting the foreground from a given complex image is an important and challenging problem. Although there have been many methods to perform foreground extraction, most of them are time-consuming, and the trimaps used in the matting step are labeled manually. In this paper, we propose a fast interactive foreground extraction method based on the superpixel GrabCut and image matting. Specifically, we first extract superpixels from a given image and apply GrabCut on them to obtain a raw mask. Due to that the resulting mask border is hard and toothing, we further propose fast and adaptive trimaps (FATs), and construct an FATs-based shared matting for computing a refined mask. Finally, by interactive processing, we can obtain the final foreground. Experimental results on the BSDS500 and alphamatting datasets demonstrate that our proposed method is faster than five representative methods, and performs better than the interactive representative methods in terms of the three evaluation criteria: 1) mean square error; 2) sum of absolute difference; and 3) execution time.