Correlation Analysis of Apparent Diffusion Coefficient Histogram Parameters and Clinicopathologic Features for Prognosis Prediction in Uveal Melanoma.

Purpose: To investigate the correlation between apparent diffusion coefficient (ADC) histograms and high-risk clinicopathologic features related to uveal melanoma (UM) prognosis. Methods: This retrospective study included 53 patients with UM who underwent diffusion-weighted imaging (DWI) between August 2015 and March 2024. Axial DWI was performed with a single-shot spin-echo echo-planar imaging sequence. ADC histogram parameters of ADCmean, ADC50%, interquartile range (IQR), skewness, kurtosis, and entropy were obtained from DWI. The relationships between histogram parameters and high-risk clinicopathological characteristics including tumor size, preoperative retinal detachment, histological subtypes, Ki-67 index, and chromosome status, were analyzed by Spearman correlation analysis, Mann-Whitney U test, or Kruskal-Wallis test. Results: A total of 53 patients (mean ± SD age, 55 ± 15 years; 22 men) were evaluated. The largest basal diameter (LBD) was correlated with kurtosis (r = 0.311, P = 0.024). Tumor prominence (TP) was correlated with entropy (r = 0.581, P < 0.001) and kurtosis (r = 0.273, P = 0.048). Additionally, significant correlations were identified between the Ki-67 index and ADCmean (r = -0.444, P = 0.005), ADC50% (r = -0.487, P = 0.002), and skewness (r = 0.394, P = 0.014). Finally, entropy was correlated with monosomy 3 (r = 0.541, P = 0.017). Conclusions: The ADC histograms provided valuable insights into high-risk clinicopathologic features of UM and hold promise in the early prediction of UM prognosis.

The accuracy of cup anteversion measurement on postoperative pelvic radiographs: A comparative retrospective cohort study between DDH and non-DDH patients.

Rationale and objectives: Postoperative pelvic radiographs remain a vital tool for assessing cup orientation after total hip arthroplasty (THA), with the accuracy influenced by various factors. The objective of this study is to investigate the accuracy of cup anteversion measurement in developmental dysplasia of the hip (DDH) patients and others based on postoperative pelvic radiographs conducted under the current heavy workload conditions. Materials and methods: Patients who underwent THA at our hospital with both postoperative X-ray and CT images from January 2020 to December 2022 were included in this retrospective cohort study. Virtual X-ray films were generated using digitally reconstructed radiographs (DRR) technology from CT images, with pelvic position perfectly controlled. Radiographic anteversion (RA) was measured on 3D-CT, virtual X-rays, and actual postoperative X-rays, abbreviated as RA_3D, RA_DRR, and RA_Xray, respectively. A repeated-measures analysis of covariance (ANCOVA) was utilized to evaluate the variations in RA within and between different groups across three methods. The Bland-Altman plot analysis showed the variations among methods in DDH and non-DDH patients, setting a clinically acceptable limits of agreement (LOA) at ±5°. Results: This study included 154 hip cases, with 63 DDH and 91 other diseases. Repeated-measures ANCOVA revealed a descending trend in RA across three methods, with differences of 2.64° (DDH) vs. 2.74° (others) from 3D to DRR, and 4.89° (DDH) vs. 1.07° (others) from DRR to X-ray. The group by methods interaction effect were significant (p = 0.002). Significant statistical differences in RA_Xray (P = 0.035) were observed between DDH and non-DDH patients, but not in RA_3D and RA_DRR. Bland-Altman plots showed 71.4 % of DDH patients exceeded the clinically acceptable LOA, compared to 36.3 % of other patients. Conclusion: Our study indicated that under the current intense workload, the reliability of assessing cup anteversion using postoperative pelvic radiographs is challenged, especially in patients with DDH.

An osteosarcoma-on-a-chip model for studying osteosarcoma matrix-cell interactions and drug responses.

Marrow niches in osteosarcoma (OS) are a specialized microenvironment that is essential for the maintenance and regulation of OS cells. However, existing animal xenograft models are plagued by variability, complexity, and high cost. Herein, we used a decellularized osteosarcoma extracellular matrix (dOsEM) loaded with extracellular vesicles from human bone marrow-derived stem cells (hBMSC-EVs) and OS cells as a bioink to construct a micro-osteosarcoma (micro-OS) through 3D printing. The micro-OS was further combined with a microfluidic system to develop into an OS-on-a-chip (OOC) with a built-in recirculating perfusion system. The OOC system successfully integrated bone marrow niches, cell‒cell and cell-matrix crosstalk, and circulation, allowing a more accurate representation of OS characteristics in vivo. Moreover, the OOC system may serve as a valuable research platform for studying OS biological mechanisms compared with traditional xenograft models and is expected to enable precise and rapid evaluation and consequently more effective and comprehensive treatments for OS.

A Radiographic Analysis of Coronal Morphological Parameters of Lower Limbs in Chinese Non-knee Osteoarthritis Populations.

OBJECTIVES: Analyzing the lower limb coronal morphological parameters in populations without knee osteoarthritis (KOA) holds significant value in predicting, diagnosing, and formulating surgical strategies for KOA. This study aimed to comprehensively analyze the variability in these parameters among Chinese non-KOA populations, employing a substantial sample size. METHODS: A cross-sectional retrospective analysis was performed on the Chinese non-KOA populations (n = 407; 49.9% females). The study employed an in-house developed artificial intelligence software to meticulously assess the coronal morphological parameters of all 814 lower limbs. The parameters evaluated included the hip-knee-ankle angle (HKAA), weight-bearing line ratio (WBLR), joint line convergence angle (JLCA), mechanical lateral-proximal-femoral angle (mLPFA), mechanical lateral-distal-femoral angle (mLDFA), mechanical medial-proximal-tibial angle (mMPTA), and mechanical lateral-distal-tibial angle (mLDTA). Differences in these parameters were compared between left and right limbs, different genders, and different age groups (with 50 years as the cut-off point). RESULTS: HKAA and JLCA exhibited left-right differences (left vs. right: 178.2° ± 3.0° vs. 178.6° ± 2.9° for HKAA, p = 0.001; and 1.8° ± 1.5° vs. 1.4° ± 1.6° for JLCA, p < 0.001); except for the mLPFA, all other parameters show gender-related differences (male vs. female: 177.9° ± 2.8° vs. 179.0° ± 3.0° for HKAA, p < 0.001; 1.5° ± 1.5° vs. 1.8° ± 1.7° for JLCA, p = 0.003; 87.1° ± 2.1° vs. 88.1° ± 2.1° for mMPTA, p < 0.001; 90.2° ± 4.0° vs. 91.1° ± 3.2° for mLDTA, p < 0.001; 38.7% ± 12.9% vs. 43.6% ± 14.1% for WBLR, p < 0.001; and 87.7° ± 2.3° vs. 87.4° ± 2.7° for mLDTA, p = 0.045); mLPFA increase with age (younger vs. older: 90.1° ± 7.2° vs. 93.4° ± 4.9° for mLPFA, p < 0.001), while no statistical difference exists for other parameters. CONCLUSIONS: There were differences in lower limb coronal morphological parameters among Chinese non-KOA populations between left and right sides, different genders, and age.

Cartilage morphometry and magnetic susceptibility measurement for knee osteoarthritis with automatic cartilage segmentation.

Background: Automatic segmentation of knee cartilage and quantification of cartilage parameters are crucial for the early detection and treatment of knee osteoarthritis (OA). The aim of this study was to develop an automatic cartilage segmentation method for three-dimensional water-selective (3D_WATS) cartilage magnetic resonance imaging (MRI) and conduct cartilage morphometry and magnetic susceptibility measurements such as cartilage thickness, volume, and susceptibility values for knee OA assessment. Methods: Sixty-five consecutively sampled subjects, who had undergone health checks at our hospital, were enrolled in this cross-sectional study and were divided into three groups: 20 normal, 20 mild OA, 25 severe OA. Sagittal 3D_WATS sequence was used to image cartilage at 3T. The raw magnitude images were used for cartilage segmentation and the phase images were used for quantitative susceptibility mapping (QSM)-based assessment. Manual cartilage segmentation was performed by two experienced radiologists, and the automatic segmentation model was constructed using nnU-Net. Quantitative cartilage parameters were extracted from the magnitude and phase images based on the cartilage segmentation. Pearson correlation coefficient and intra-class correlation coefficient (ICC) were then used to assess the consistency of obtained cartilage parameters between automatic and manual segmentation. Cartilage thickness, volume, and susceptibility values among different groups were compared using one-way analysis of variance (ANOVA). Support vector machine (SVM) was used to further verify the classification validity of automatically extracted cartilage parameters. Results: The constructed cartilage segmentation model based on nnU-Net achieved an average Dice score of 0.93. The consistency of cartilage thickness, volume, and susceptibility values calculated using automatic and manual segmentations ranged from 0.98 to 0.99 (95% CI: 0.89-1.00) for the Pearson correlation coefficient, and from 0.91-0.99 (95% CI: 0.86-0.99) for ICC, respectively. Significant differences were found in OA patients; including decreases in cartilage thickness, volume, and mean susceptibility values (P<0.05), and increases in standard deviation (SD) of susceptibility values (P<0.01). Moreover, the automatically extracted cartilage parameters can achieve an AUC value of 0.94 (95% CI: 0.89-0.96) for OA classification using the SVM classifier. Conclusions: The 3D_WATS cartilage MR imaging allows simultaneously automated assessment of cartilage morphometry and magnetic susceptibility for evaluating the severity of OA using the proposed cartilage segmentation method.

A highly generalized classifier for osteoporosis radiography based on multiscale fractal, lacunarity, and entropy distributions.

Background: Osteoporosis is a common degenerative disease with high incidence among aging populations. However, in regular radiographic diagnostics, asymptomatic osteoporosis is often overlooked and does not include tests for bone mineral density or bone trabecular condition. Therefore, we proposed a highly generalized classifier for osteoporosis radiography based on the multiscale fractal, lacunarity, and entropy distributions. Methods: We collected a total of 104 radiographs (92 for training and 12 for testing) of lumbar spine L4 and divided them into three groups (normal, osteopenia, and osteoporosis). In parallel, 174 radiographs (116 for training and 58 for testing) of calcaneus from health and osteoporotic fracture groups were collected. The texture feature data of all the radiographs were pulled out and analyzed. The Davies-Bouldin index was applied to optimize hyperparameters of feature counting. Neighborhood component analysis was performed to reduce feature dimension and increase generalization. A support vector machine classifier was trained with only the most effective six features for each binary classification scenario. The accuracy and sensitivity performance were estimated by calculating the area under the curve. Results: Interpretable feature trends of osteoporotic pathological changes were depicted. On the spine test dataset, the accuracy and sensitivity of binary classifiers were 0.851 (95% CI: 0.730-0.922), 0.813 (95% CI: 0.718-0.878), and 0.936 (95% CI: 0.826-1) for osteoporosis diagnosis; 0.721 (95% CI: 0.578-0.824), 0.675 (95% CI: 0.563-0.772), and 0.774 (95% CI: 0.635-0.878) for osteopenia diagnosis; and 0.935 (95% CI: 0.830-0.968), 0.928 (95% CI: 0.863-0.963), and 0.910 (95% CI: 0.746-1) for osteoporosis diagnosis from osteopenia. On the calcaneus test dataset, they were 0.767 (95% CI: 0.629-0.879), 0.672 (95% CI: 0.545-0.793), and 0.790 (95% CI: 0.621-0.923) for osteoporosis diagnosis. Conclusion: This method showed the capacity of resisting disturbance on lateral spine radiographs and high generalization on the calcaneus dataset. Pixel-wise texture features not only helped to understand osteoporosis on radiographs better but also shed new light on computer-aided osteopenia and osteoporosis diagnosis.

Lateral tibial intercondylar eminence is a reliable reference for alignment correction in high tibial osteotomy.

PURPOSE: The purpose of the study is to determine whether the lateral tibial intercondylar eminence (LTIE) is a reliable reference for alignment correction in high tibial osteotomy (HTO). METHODS: A total of 1954 consecutive standing whole-leg radiography (WLR) examinations of 1373 adult patients with knee osteoarthritis between 2012 and 2019 were reviewed retrospectively; 145 patients were included, 53 males and 92 females, with a mean age of 63.3 years. Virtual simulation of HTO was performed to measure weight-bearing line (WBL) percentages and hip-knee-ankle (HKA) angles when the WBL passed through the Fujisawa, top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, and the positional relationship between the Fujisawa point and the lateral slope of the LTIE was determined. RESULTS: When the WBL passed through the top, bottom, upper 1/3, and middle points of the lateral slope of the LTIE, the mean WBL percentages were 57.7% ± 2.1%, 74.6% ± 3.3%, 63.4% ± 2.1%, and 66.2% ± 2.3%, respectively, and the mean HKA angles were 182.1° ± 0.5°, 185.9° ± 0.8°, 183.3° ± 0.5°, and 184.0° ± 0.5°, respectively. When the WBL passed through the Fujisawa point, it was passing through 28.6% ± 12.7% of the width of the lateral slope (the top and bottom points were defined as 0% and 100%, respectively). When the WBL passed through the middle and upper 1/3 points of the lateral slope of the LTIE, the majority of cases (96.1%-100%) were within the limits of acceptability, as defined by the widely accepted standard of a postoperative HKA angle ranging from 183° to 186°. CONCLUSION: The upper 1/3 and middle points of the lateral slope of the LTIE are reliable references for guiding the alignment correction in HTO. In clinical application, if 62%-66% of the postoperative WBL percentage is the acceptable target range, the upper 1/3 point of the lateral slope of the LTIE may be a better alternative than the midpoint. If the postoperative HKA angle between 183° and 186° is acceptable, the midpoint of the lateral slope of the LTIE may be better than the upper 1/3 point. These findings are crucial for the accuracy of the traditional intraoperative alignment assessment techniques. LEVEL OF EVIDENCE: IV.

Development of sea urchin type silica stabilised zirconia nanospheres with enhanced antimicrobial and osteoactivity properties.

Zirconia based ceramics are giving new hope in hard tissues replacement and implants application. Among the three forms of zirconia (ZrO2), tetragonal form (t-ZrO2) possess high mechanical stability in comparison with the other two which makes it suitable for fabricating biomedical implants with enhanced osteo activity. Here, tetragonal phase nanospheres consisting of silica stabilised zirconia (1:1) were prepared via sol gel method. The nanospheres exhibit sea urchin type morphology as observed from FESEM analysis. XRD patterns confirm the formation of t -SiO2-ZrO2 binary phase after high temperature calcination at 650°C. The immersion studies in SBF help in the formation of a layer of apatite in a gradual manner over the pallets for the period of 7, 14, 21 and 28 days which was confirmed by XRD, FTIR analysis. Moreover, t- SiO2 - ZrO2 samples were subjected to cytotoxicity tests through MTT assay on MG-63 cell lines. Antibacterial properties were investigated quantitatively using colony forming unit method against both gram positive as well as gram-negative bacteria.

Integrated Bioinformatics and Experimental Analysis Identified TRIM28 a Potential Prognostic Biomarker and Correlated with Immune Infiltrates in Liver Hepatocellular Carcinoma.

Background: Since the 1970s, liver hepatocellular carcinoma (LIHC) has experienced a constant rise in incidence and mortality rates, making the identification of LIHC biomarkers very important. Tripartite Motif-Containing 28 (TRIM28) is a protein-coding gene which encodes the tripartite motif-containing proteins (TRIMs) family and is associated with specific chromatin regions. TRIM28 expression and its prognostic value and impact on the immune system in LIHC patients are being investigated for the first time. Methods: The TRIM28 expression data from TCGA database was used to analyze TRIM28 expression, clinicopathological information, gene enrichment, and immune infiltration and conduct additional bioinformatics analysis. R language was used for statistical analysis. TIMER, CIBERSORT, and ssGSEA were used to assess immune responses of TRIM28 in LIHC. Next, the results were validated using GEPIA, ROC analysis, and immunohistochemical staining pictures from the THPA. GSE14520, GSE63898, and GSE87630 datasets were analyzed using ROC analysis to further evaluate TRIM28's diagnostic value. To ultimately determine TRIM28 expression, we performed qRT-PCR (quantitative real-time polymerase chain reaction). Results: High TRIM28 expression level was associated with T classification, pathologic stage, histologic grade, and serum AFP levels. In patients with LIHC, TRIM28 was an independent risk factor for a poor prognosis. The pathways ligand-receptor interaction, which is critical in LIHC patients, were closely associated with TRIM28 expression, and the function of DC could be suppressed by overexpression of TRIM28. As a final step, our results were validated by GEO data and qRT-PCR. Conclusions: TRIM28 will shed new light on LIHC mechanisms. As an effective diagnostic and intervention tool, this gene will be able to diagnose and treat LIHC at an early stage.

Radiomics analysis using MR imaging of subchondral bone for identification of knee osteoarthritis.

BACKGROUND: To develop a magnetic resonance imaging (MRI)-based radiomics predictive model for the identification of knee osteoarthritis (OA), based on the tibial and femoral subchondral bone, and compare with the trabecular structural parameter-based model. METHODS: Eighty-eight consecutive knees were scanned with 3T MRI and scored using MRI osteoarthritis Knee Scores (MOAKS), in which 56 knees were diagnosed to have OA. The modality of sagittal three-dimensional balanced fast-field echo sequence (3D BFFE) was used to image the subchondral bone. Four trabecular structural parameters (bone volume fraction [BV/TV], trabecular thickness [Tb.Th], trabecular separation [Tb.Sp], and trabecular number) and 93 radiomics features were extracted from four regions of the lateral and medial aspects of the femur condyle and tibial plateau. Least absolute shrinkage and selection operator (LASSO) was used for feature selection. Machine learning-based support vector machine models were constructed to identify knee OA. The performance of the models was assessed by area under the curve (AUC) of the receiver operator characteristic (ROC). The correlation between radiomics features and trabecular structural parameters was analyzed using Pearson's correlation coefficient. RESULTS: Our radiomics-based classification model achieved the AUC score of 0.961 (95% confidence interval [CI], 0.912-1.000) when distinguishing between normal and knee OA, which was higher than that of the trabecular parameter-based model (AUC, 0.873; 95% CI, 0.788-0.957). The first-order, texture, and Laplacian of Gaussian-based radiomics features correlated positively with Tb.Th and BV/TV, but negatively with Tb.Sp (P < 0.05). CONCLUSIONS: Our results suggested that our MRI-based radiomics models can be used as biomarkers for the classification of OA and are superior to the conventional structural parameter-based model.

Development of a 3D-printed pelvic CT phantom combined with fresh pathological tissues of bone tumor.

Background: Computed tomography (CT) imaging is the most important and common means of detecting and diagnosing pelvic bone tumors. While phantoms with sufficient flexibility and anatomical realism are useful in CT research, using phantoms has been difficult for pelvic bone tumors because of the tumors' relatively large size and highly variable shape. By combining medical 3D printing technology and fresh tumor specimens, this study aimed to design such a hybrid phantom, test its imaging properties, and demonstrate its usefulness in optimizing the CT protocols. Methods: Two phantoms were designed for 2 patients with pelvic bone tumors who underwent surgical resection. One phantom was scanned with a routine pelvic CT protocol and compared against the patient image to test the imaging properties. We optimized the imaging protocol by assessing a series of varied settings on tube voltage (80, 100, 120, and 140 kVp), tube current (80, 120, and 160 to 200 mAs), and pitch factor (0.5, 0.8, 1.1, and 1.4) using the other phantom. These were assessed in comparison to the clinical reference of 140 kVp, 240 mAs, and 1.0 pitch, respectively. Image quality was quantified in terms of CT value, image noise, signal to noise ratio (SNR), and contrast to noise ratio (CNR) in various regions of interest. Results: With the routine protocol, the phantom image showed no significant difference in CT values of the bone and soft tissues and image noise compared to the patient image (all P values >0.05). With a lower tube voltage (80, 100, and 120 kVp) than the reference protocol, the CT value of bone tissue showed significant differences (all P values <0.001). No significant difference was found when applying a reduced tube current (all P values >0.05). With an increased helical pitch, pitches of 0.5, 0.8 and 1.1 were found to be comparable to those using the reference protocol (all P values >0.05). Conclusions: The 3D-printed phantom can simulate the radiological properties of tumors in the pelvis and was successfully used in imaging studies of pelvic bone tumors. According to our preliminary findings, a low-dose pelvic CT protocol with acceptable image quality is achievable using reduced tube current or increased pitch.

Application of 3D printing individualized guide plates in percutaneous needle biopsy of acetabular tumors.

Objective: The objective of the study was to investigate the effectiveness of applying the individualized guide plate which is based on digital image processing and 3D printing technology to percutaneous needle biopsy of periacetabular tumor. Methods: From July 2017 to August 2019, 11 patients (5 males and 6 females, aged 13-70 years, mean 42.3 years) with acetabular tumors diagnosed by needle biopsy in our hospital were enrolled in this retrospective study. Preoperative CT and MRI enhancement examination were performed routinely, and the DICOM data were collected and imported into Medraw Print software. According to the specific anatomical morphology of acetabula, this study adopted the reverse calculation and direct design to print the individualized puncture guide plate using 3D printing technology. The puncture point and sampling approaches were determined by the guide plate morphology and the "double guide-hole and slideable groove" design. First, we evaluated the fitness of the 3D guide plate to the local anatomical structure, its assisted-puncture accuracy was estimated by imaging examinations, and postoperative complications were recorded. The accuracy of the needle biopsy pathological result was estimated with reference to that of the tumor resection. Results: Our results showed that the 3D printing individualized guide plate matched the patients' pelvic skin well, the puncture approach was consistent with the preoperative design, and no significant anatomical injuries including vascular and neural complications occurred after surgery. Nine patients' (90%) biopsy results were consistent with their postoperative pathological results, and one patient gave up the tumor resection. Conclusion: Based on digital image processing and 3D printing technology, the individualized guide plate can be used to guide the needle biopsy of acetabular tumors which makes the operation simpler and more precise.

Electroplating of HAp-brushite coating on metallic bioimplants with advanced hemocompatibility and osteocompatibility properties.

In cases of severe bone tissue injuries, the use of metallic bioimplants is quite widespread due to their high strength, high fracture toughness, hardness, and corrosion resistance. However, they lack adequate biocompatibility and show poor metal-tissue integration during the post-operative phase. To mitigate this drawback, it is beneficial to add a biocompatible polymer layer to ensure a quick growth of cell or tissue over the surface of metallic bioimplant material. Furthermore, this additional layer should possess good adherence with the underlying material and also accompany a rapid bonding between the tissue and the implant material, in order to reduce the recovery time for the patient. Therefore, in this work, we report a novel green electroplating route for growing porous hydroxyapatite-brushite coatings on a stainless steel surface. The malic acid used for the production of hydroxyapatite-brushite coatings has been obtained from an extract of locally available apple fruit (Malus domestica). We demonstrate the effect of electroplating parameters on the structural morphology of the electroplated composite layer via XRD, SEM with EDS, and FTIR characterization techniques and report an optimized set of electroplating parameters that will yield the best composite coating in terms of thickness, adherence to substrate and speed. The hemocompatibility and osteocompatibility studies on the electroplated composites coating show this technology's effectiveness and potential applicability in biomedical applications. Compared to other routes reported in the literature, this electroplating route is quicker and yields better composite coatings with faster bone tissue growth potential.

A Prognosis Marker Dynein Cytoplasmic 1 Heavy Chain 1 Correlates with EMT and Immune Signature in Liver Hepatocellular Carcinoma by Bioinformatics and Experimental Analysis.

Background: Liver hepatocellular carcinoma (LIHC) has had a continuous increase in incidence and mortality rates over the last 40 years. Dynein Cytoplasmic 1 Heavy Chain 1 (DYNC1H1) is a protein coding gene which encodes the cytoplasmic dynein heavy chain family. This is the first investigation into the expression of DYNC1H1 and its mechanisms of action in LIHC patients. Methods: Based on the DYNC1H1 expression data from the TCGA database, we performed the DYNC1H1 expression, clinicopathological data, gene enrichment, and immune infiltration analysis. TIMER and CIBERSORT were used to assess immune responses of DYNC1H1 in LIHC. GEPIA, K-M survival analysis, and immunohistochemical staining pictures from the THPA were used to validate the results. In order to evaluate the diagnostic value of DYNC1H1, GEO datasets were analyzed by using ROC analysis. And quantitative real-time polymerase chain reaction was also carried out to evaluate the expression of DYNC1H1. Results: DYNC1H1 expression levels were associated with T classification, pathologic stage, histologic grade, and serum AFP levels. DYNC1H1 is an independent factor for a poor prognosis in patients with LIHC. Further study showed that high expression of DYNC1H1 was enriched in epithelial-mesenchymal transition (EMT) and the TGF ß signaling pathway by GSEA analysis enrichment, indicating that DYNC1H1 might play a key role in the progression of CRC through EMT and immune response, which also had been validated by the experimental assays. Conclusions: DYNC1H1 will provide a novel and important perspective for the mechanisms of LIHC by regulating EMT. This gene will be able to act as an efficacious tool for the early diagnosis and effective intervention of LIHC.

Preoperative 3D Reconstruction Model in Slow Mohs Surgery for Dermatofibrosarcoma Protuberans.

Dermatofibrosarcoma protuberans (DFSP) is a type of skin cancer that is extremely rare. Its standard treatment is either surgical wide-local excision (WLE) or Mohs micrographic surgery (MMS). Which method has the lowest recurrence rate is unknown. Dermatofibrosarcoma protuberans is an uncommon soft tissue sarcoma with a high propensity for recurrence. It has always remained a clinical challenge. More technology is needed to treat the disease. We reviewed our cases and published experience and evaluated whether 3D modeling could precisely define tumor morphological characteristics and assist excision in slow Mohs surgery. There were 18 dermatofibrosarcoma protuberan cases enrolled. They were treated in Shanghai Ninth People's Hospital from 2014 to 2019. All the 18 included patients presented with primary disease and no metastasis. All subjects had undergone thorough imaging examinations including CT and MRI. The 3D tumor reconstruction models were created for their tumors. We precisely estimated tumor boundaries and sizes according to those 3D models. Afterward, patients underwent slow Mohs surgery and surgical repair of tissue defects following tumor resection. The 3D tumor reconstruction models were successfully established. The predicted tumor volumes were measured in all 18 cases. The average volume was 38.5 cm3 (range: 8.4 cm3-183.6 cm3), which allowed for accurately locating the tumor. Tumors were completely removed in one stage of slow MMS surgery. In the second-stage surgery, the defects were repaired by different surgical methods including direct soft tissue closure, skin grafting, local flaps, or free flaps. Most patients experienced no significant complications. This practice indicated that the combination of a 3D reconstruction model and slow Mohs surgery achieves more precise and complete DFSP resection to decrease the recurrence rate.

Correlation between ACL size and dimensions of bony structures in the knee joint.

It is difficult to measure the dimensions of the anterior cruciate ligament (ACL) in vivo, which makes choosing an individualized graft size for ACL reconstruction particularly troublesome. The morphology and function of porcine ACL have been reported to be similar to the native human ACL. This study aimed to identify bony morphological parameters on X-ray images that were significantly correlated with features of the native ACL. Anteroposterior X-ray images of 19 porcine knees were obtained. The width, height and area of the femoral notch, the widths of the femoral and tibial condyles and the width and area of the interspinal fossa of the tibia were measured. ACL length was measured using a caliper. The ACL was then resected and the outline of the bone insertion sites were marked and photographed for measuring the areas of the insertion sites. The excised ACL substance was scanned using X-ray microscopy and reconstructed to measure the medial-lateral (ML) and anterior-posterior (AP) widths, the long and short axes and cross-sectional area of the ACL isthmus. Linear regression analyses showed that the area of the interspinal fossa of the tibia was significantly correlated with the long axis and ML width of the ACL, and with the AP / ML width (p value = 0.038, 0.032 and 0.016 respectively). The width of the femoral condyle was significantly correlated with the area of the tibial insertion and the length and ML width of the ACL (p value = 0.013, 0.000 and 0.038 respectively). The area of the interspinal fossa of the tibia / notch width index (NWI) was significantly correlated with the long axis / short axis of the ACL (p value = 0.016). The width of the interspinal fossa of tibia / NWI was significantly correlated with the short axis of the ACL isthmus (p value = 0.009). However, the dimensions of the femoral intercondylar notch and the width of the interspinal fossa of the tibia were not significantly correlated with any of the ACL parameters. In conclusion, the dimension of the interspinal fossa of the tibia and the width of the femoral condyle measured from X-ray images might be used to estimate the shape and size of the ACL, which might be helpful for choosing a suitable graft size for ACL reconstruction. DATA STATEMENT: All data relevant to the study are included in the article.

Multiparametric CT-based assessment of pretracheal anatomical relationships for safe tracheotomy: A long-forgotten issue revisited.

OBJECTIVES: To assess the anatomical relationships and variations in the pretracheal space and to guide tracheotomy procedures in a safe manner with image-based evidence. MATERIALS AND METHODS: A retrospective study was conducted on unirradiated patients requiring elective tracheotomies. Preoperative contrast-enhanced CT (CECT)/CT venography (CTV) was applied for an anatomical evaluation of the pretracheal region. Vascular morphologies were compared for three vessels: the anterior jugular vein (AJV), the innominate artery (IA) and the inferior thyroid vascular plexus (ITVP). The relationships between the thyroid isthmus and the 2nd-4th tracheal rings were also analyzed. RESULTS: A total of 120 patients were identified, most of whom (n = 110, 91.7%) had head and neck squamous cell carcinomas. Patients with recognizable AJVs (n = 118) were divided into 3 groups: single-branch (n = 11, 9.2%), double-branch (n = 105, 87.5%), and multibranch (n = 2, 1.7%). In addition, IAs were categorized as low-bifurcation (n = 51, 42.5%), high-bifurcation (n = 40, 33.3%), platform (n = 27, 22.5%) and variant types (n = 2, 1.7%). Within the platform types, high-lying IAs (n = 15, 8.3%) might have interfered with the standard tracheal incisions due to possible IA-tracheal overlay. This interference was also related to the height of intraoperative tracheal incisions (rn = 0.364, P = 0.001). Within ITVPs, independent-trunk types were found in 71 cases (59.2%), while common-trunk types were found in 45 (37.5%). In addition, a low thyroid isthmus (suprasternal-isthmus distance <3 cm) was found in 83 cases (69.2%). CONCLUSIONS: CT image-based evidence can prepare junior practitioners with important pretracheal anatomical information, thereby facilitating safer tracheotomy procedures. Our results shed light on vascular relationships for emergent tracheotomy.

HKA Angle-A Reliable Planning Parameter for High Tibial Osteotomy: A Theoretical Analysis Using Standing Whole-Leg Radiographs.

High tibial osteotomy (HTO) is a recognized treatment for early-stage medial compartment knee osteoarthritis. Preoperative planning with standing whole-leg radiographs (WLRs) is essential for ensuring optimal postoperative alignment. The primary purpose of this study is to investigate the theoretical accuracy of the wedge opening required for two different preoperative planning parameters in open-wedge HTO. The second purpose is to theoretically determine which parameter is superior. Preoperative planning for HTO was performed with standing WLRs for 39 knees with isolated medial osteoarthritis. The Miniaci preoperative planning method was applied to correct the hip-knee-ankle (HKA) angle to 3to 6 degrees of valgus and the weight-bearing line (WBL) percentage within 60 to 70% of the width of the tibial plateau. To ensure that the HKA angle was between 3 and 6 degrees of valgus, the required accuracy window for the Miniaci angle was 3.25 ± 0.03 degrees (range, 3.20-3.30°). To ensure that the WBL percentage was between 60 and 70%, the accuracy window required for the Miniaci angle was 2.35 ± 0.13 degrees (range, 2.10-2.65°). This study suggests that to correct the HKA angle and the WBL percentage within the target range on two-dimensional WLRs, the Miniaci angle must be controlled to an accuracy of ± 1.63 and ± 1.18 degrees, respectively. Theoretically, the HKA angle is highly suitable as a preoperative planning parameter for HTO with a large permissible error and a small variability in the degree of change in the Miniaci angle (ΔMiniaci).

Abnormal subchondral trabecular bone remodeling in knee osteoarthritis under the influence of knee alignment.

OBJECTIVE: This study aimed to investigate the abnormal subchondral trabecular bone (STB) remodeling in knee osteoarthritis (OA) under the influence of knee alignment [hip-knee-ankle (HKA) angle]. DESIGN: Forty-one patients with knee OA underwent radiographic examination before total knee arthroplasty (TKA) for the measurement of HKA angle. Tibial plateau specimens obtained during TKA were used for histomorphometric analyses to assess STB remodeling and cartilage degradation. Tartrate-resistant acidic phosphatase (TRAP) staining was used to test osteoclast activity. Osterix, osteocalcin, and sclerostin expression in the STB were determined using immunohistochemistry. RESULTS: The interaction between HKA angle and side (medial vs lateral of tibial plateau) was the main significant influence factor for STB remodeling and microstructure. The STB with the deviation of the knee alignment was accompanied by obvious abnormal bone remodeling and microstructural sclerosis. Bone volume fraction (BV/TV) was the only significant influence factor for OARSI score, the larger the BV/TV of STB, the higher the OARSI score of cartilage. Moreover, the tibial plateau affected by alignment had more TRAP + osteoclasts, Osterix + osteoprogenitors, and osteocalcin + osteoblasts and fewer sclerostin + osteocytes. CONCLUSIONS: The variation of tibial plateau STB remodeling activity and microstructure was associated with HKA angle and cartilage degradation. Knee malalignment may cause abnormal STB remodeling and microstructural sclerosis, which may potentially affect load stress transmission from the cartilage to the STB, thus resulting in accelerated knee OA progression.

Associations of osteoclastogenesis and nerve growth in subchondral bone marrow lesions with clinical symptoms in knee osteoarthritis.

BACKGROUND/OBJECTIVE: Subchondral bone marrow lesions (BMLs) are common magnetic resonance imaging (MRI) features in joints affected by osteoarthritis (OA), however, their clinical impacts and mechanisms remain controversial. Thus, we aimed to investigate subchondral BMLs in knee OA patients who underwent total knee arthroplasty (TKA), then evaluate the associations of osteoclastogenesis and nerve growth in subchondral BMLs with clinical symptoms. METHODS: Total 70 patients with primary symptomatic knee OA were involved, then separated into three groups based on MRI (without BMLs group, n â€‹= â€‹14; BMLs without cyst group, n â€‹= â€‹37; BMLs with cyst group, n â€‹= â€‹19). Volume of BMLs and cyst-like lesions was calculated via the OsiriX system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to assess clinical symptoms. Histology and immunohistochemistry were deployed to assess subchondral osteoclastogenesis and nerve distribution. Pearson's correlation coefficient was used to evaluate the associations between volume of BMLs and joint symptoms, and to assess the associations of osteoclastogenesis and nerve growth in subchondral BMLs with joint symptoms. RESULTS: In BMLs combined with cyst group, patients exhibited increased osteoclastogenesis and nerve distribution in subchondral bone, as shown by increased expression of tartrate resistant acid phosphatase (TRAP) and protein gene product 9.5 (PGP9.5). Volume of subchondral cyst-like component was associated with joint pain (p â€‹< â€‹0.05). Subchondral osteoclastogenesis and nerve distribution were positively associated with joint pain in BMLs with cyst group (p â€‹< â€‹0.05). CONCLUSION: The subchondral cyst-like lesion was an independent factor for inducing pain in OA patients; osteoclastogenesis and nerve growth in subchondral cyst-like lesions could account for this joint pain. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE: Our results indicated that the increased osteoclastogenesis and nerve growth in subchondral cyst-like lesions could account for the pain of OA joints. These findings may provide valuable basis for the treatment of OA.