A survey of label-noise deep learning for medical image analysis.

Several factors are associated with the success of deep learning. One of the most important reasons is the availability of large-scale datasets with clean annotations. However, obtaining datasets with accurate labels in the medical imaging domain is challenging. The reliability and consistency of medical labeling are some of these issues, and low-quality annotations with label noise usually exist. Because noisy labels reduce the generalization performance of deep neural networks, learning with noisy labels is becoming an essential task in medical image analysis. Literature on this topic has expanded in terms of volume and scope. However, no recent surveys have collected and organized this knowledge, impeding the ability of researchers and practitioners to utilize it. In this work, we presented an up-to-date survey of label-noise learning for medical image domain. We reviewed extensive literature, illustrated some typical methods, and showed unified taxonomies in terms of methodological differences. Subsequently, we conducted the methodological comparison and demonstrated the corresponding advantages and disadvantages. Finally, we discussed new research directions based on the characteristics of medical images. Our survey aims to provide researchers and practitioners with a solid understanding of existing medical label-noise learning, such as the main algorithms developed over the past few years, which could help them investigate new methods to combat with the negative effects of label noise.

Harvesting Vibration Energy for Efficient Cocatalyst-Free Sonocatalytic H2 Production over Magnetically Separable Ultra-Low-Cost Fe3O4.

The cavitation effect is an important geochemical phenomenon, which generally exists under strong hydrodynamic conditions. Therefore, developing an economical and effective sonocatalyst becomes a vital method in capitalizing on the cavitation effect for energy generation. In this study, we first report a novel Fe3O4 sonocatalyst that can be easily separated using a magnetic field and does not require any additional cocatalysts for H2 production from H2O. When subjected to ultrasonic vibration, this catalyst achieves an impressive H2 production rate of up to 175 µmol/h/USD (where USD stands for dollars), surpassing most previously reported mechanical catalytic materials. Furthermore, the ease and efficiency of separating this catalyst using an external magnetic field, coupled with its effortless recovery, highlight its significant potential for practical applications. By addressing the key limitations of conventional sonocatalysts, our study not only demonstrates the feasibility of using Fe3O4 as a highly efficient sonocatalyst but also showcases the exciting possibility of using a new class of magnetically separable sonocatalysts to productively transform mechanical energy into chemical energy.

Defect Engineered Microcrystalline Cellulose for Enhanced Cocatalyst-Free Piezo-Catalytic H2 Production.

Mechanical energy driven piezocatalytic hydrogen (H2 ) production is a promising way to solve the energy crisis . But limited by the slow separation and transfer efficiency of piezoelectric charges generated on the surface of piezocatalysts , the piezocatalytic performance is still not satisfactory. Here, defect engineering is first used to optimize the piezocatalytic performance of microcrystalline cellulose (MCC). The piezocatalytic H2 production rate of MCC with the optimal defect concentration can reach up to 84.47 µmol g-1 h-1 under ultrasonic vibration without any co-catalyst, which is ≈3.74 times higher than that of the pure MCC (22.65 µmol g-1 h-1 ). The enhanced H2 production rate by piezoelectric catalysis is mainly due to the introduction of defect engineering on MCC, which disorders the symmetry of MCC crystal structure, improves the electrical conductivity of the material, and accelerates the separation and transfer efficiency of piezoelectric charges. Moreover, the piezocatalytic H2 production rate of MCC with the optimal defect concentration can still reach up to 93.61 µmol g-1 h-1 in natural seawater, showingits commendable practicability. This study presents a novel view for designing marvelous-performance biomass piezocatalysts through defect engineering, which can efficiently convert mechanical energy into chemical energy .

Heterojunction construction by a coordination bond between metal-organic frameworks and CdIn2S4 for improved photocatalytic performance.

Photocatalytic water splitting using a semiconductor is one of the most effective ways to obtain clean energy. However, a pure semiconductor exhibits a poor photocatalytic performance because of its harsh charge carrier recombination, limited light harvesting ability and deficiency of surface reactive sites. Herein, the hydrothermal method is employed to synthesize a new UiO-66-NH2/CdIn2S4 (NU66/CIS) heterojunction nanocomposite, constructed via a coordination bond between NU66 and CIS. Benefitting from the great specific surface area, the UiO-66-NH2 provides abundant reactive sites on its surface to boost the water reduction. Moreover, the amino groups in the UiO-66-NH2 are supplied as coordination sites to establish strong interactions between NU66 and CIS, thus forming the heterojunction with intimate connections. Therefore, the electrons produced by photoexcitation of CIS can be more effectively promoted to transfer to NU66, and then react with H+ in water to produce H2. Accordingly, the optimized 8% NU66/CIS heterojunction exhibits a considerable photocatalytic efficiency for water splitting, in which the H2 production rate is 7.8 times higher than that of bare CIS, and 3.5 times as high as that of the two materials combined by simple physical mixing. This research offers a creative and innovative idea for the construction of active MOF-based photocatalysts for H2 evolution.

Integrating Covalent Organic Framework with Transition Metal Phosphide for Noble-Metal-Free Visible-Light-Driven Photocatalytic H2 Evolution.

2D covalent organic frameworks (COFs) are considered as one kind of the most promising crystalline porous materials for solar-driven hydrogen production. However, adding noble metal co-catalysts into the COFs-based photocatalytic system is always indispensable. Herein, through a simple solvothermal synthesis method, TpPa-1-COF, a typical 2D COF, which displays a wide light absorption region, is rationally combined with transition metal phosphides (TMPs) to fabricate three TMPs/TpPa-1-COF hybrid materials, named Ni12 P5 (Ni2 P or CoP)/TpPa-1-COF. The incorporated TMPs can be served as electron collectors for accelerating the transfer of charges on TpPa-1-COF, thus the composites are demonstrated to be efficient photocatalysts for promoting water splitting. Benefitting from the richer surface reactive sites and lower H* formation energy barrier, the Ni12 P5 can most effectively improve the photocatalytic performance of the TpPa-1-COF, and the H2 evolution rate can reach up to 31.6 µmol h-1 , approximately 19 times greater than pristine TpPa-1-COF (1.65 µmol h-1 ), and is comparable to the Pt/TpPa-1-COF (38.8 µmol h-1 ). This work is the first example of combining COFs with TMPs to construct efficient photocatalysts, which may offer new insight for constructing noble-metal-free COF-based photocatalysts.

MPF-net: An effective framework for automated cobb angle estimation.

In clinical practice, the Cobb angle is the gold standard for idiopathic scoliosis assessment, which can provide an important reference for clinicians to make surgical plan and give medical care to patients. Currently, the Cobb angle is measured manually on both anterior-posterior(AP) view X-rays and lateral(LAT) view X-rays. The clinicians first find four landmarks on each vertebra, and then they extend the line from landmarks and measure the Cobb angle by rules. The whole process is time-consuming and subjective, so that the automated Cobb angle estimation is required for efficient and reliable Cobb angle measurement. The noise in X-rays and the occlusion of vertebras are the main difficulties for automated Cobb angle estimation, and it is challenging to utilize the information between the multi-view X-rays of the same patient. Addressing these problems, in this paper, we propose an effective framework named MPF-net by using deep learning methods for automated Cobb angle estimation. We combine a vertebra detection branch and a landmark prediction branch based on the backbone convolutional neural network, which can provide the bounded area for landmark prediction. Then we propose a proposal correlation module to utilize the information between neighbor vertebras, so that we can find the vertebras hidden by ribcage and arms on LAT X-rays. We also design a feature fusion module to utilize the information in both AP and LAT X-rays for better performance. The experiment results on 2738 pair of X-rays show that our proposed MPF-net achieves precise vertebra detection and landmark prediction performance, and we get impressive 3.52 and 4.05 circular mean absolute errors on AP and LAT X-rays respectively, which is much better than previous methods. Therefore, we can provide clinicians with automated, efficient and reliable Cobb angle measurement.

Quadriceps Tendon Anterior Cruciate Ligament Reconstruction: A Systematic Review of Postoperative Rehabilitation and Complication Profiles.

PURPOSE: The purposes of this study are to explore current elements for postoperative rehabilitation protocol after quadriceps tendon-anterior cruciate ligament reconstruction (QT-ACLR), outline general timelines for progression of those elements, and explore their associated complication rates and profiles. METHODS: In accordance with PRISMA guidelines, 5 online databases (EMBASE, MEDLINE, CINAHL, Cochrane, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS: A total of 56 studies were included, with 31 studies using quadriceps tendon with bone block (B-QT) and 26 studies using all-soft tissue quadriceps tendon (S-QT). The majority of studies permitted full weightbearing and range of motion (ROM) within the first 12 postoperative weeks, and motion-controlled braces within 6 weeks. Isometric exercises were initiated within 1 week after surgery, closed-chain exercises within 12 weeks, and open-chain and sports-specific exercises within 36 weeks. Complication profiles were similar between graft types and included graft failure (1.2%-1.6%), cyclops syndrome (0.4%-0.7%), and persistent stiffness (0.9%). CONCLUSIONS: Current postoperative rehabilitation strategies in ACLR with QT offer a complication profile comparable to those reported with other graft types. Based on the included rehabilitation regimen, these protocols should focus on early ROM, specifically on achieving full extension, alongside isometric quadriceps strengthening. Progression to closed- and open-chain exercises should follow in a progressive manner, similar to existing protocols in ACLR. Adjuncts such as motion-controlled bracing and continuous passive motion machines may be used if graft protection is prioritized. This review highlights the need for comparison of defined protocols against one another in the setting of QT-ACLR. LEVEL OF EVIDENCE: IV, systematic review of Level I-IV studies.

A relation-based framework for effective teeth recognition on dental periapical X-rays.

Dental periapical X-rays are used as a popular tool by dentists for diagnosis. To provide dentists with diagnostic support, in this paper, we achieve automated teeth recognition of dental periapical X-rays by using deep learning techniques, including teeth location and classification. Convolutional neural network(CNN) is a popular method and has made large improvements in medical image applications. However, in our specific task, the performance of CNN is limited by lack of data and too many teeth positions in X-rays. Addressing this problem, we consider to utilize the prior dental knowledge, and therefore we propose a relation-based framework to handle the teeth location and classification task. According to the relation in teeth labels, we apply a special label reconstruction technique to decompose the teeth classification task, and use a multi-task CNN to classify the teeth positions. Meanwhile, for teeth location task, we design a proposal correlation module to use the information in teeth positions, and insert it into the multi-task CNN. A teeth sequence refinement module is used for the post processing. Our experiment results show that our relation-based framework achieves high teeth classification and location performance, which is a big improvement compared to the direct use of famous detection structures. With reliable teeth information, our method can provide automated diagnostic support for the dentists.

The Use of Elbow Arthroscopy for Management of the Pediatric Elbow: A Systematic Review of Indications and Outcomes.

PURPOSE: The purpose of this review was to systematically examine the literature surrounding elbow arthroscopy for pediatric patients and to assess indications, functional outcomes, and complication rates. METHODS: This systematic review was carried out in accordance with PRISMA guidelines. EMBASE, PubMed, and MEDLINE were searched for relevant literature from inception until December 2019, and studies were screened by 2 reviewers independently and in duplicate for those investigating elbow arthroscopy in a pediatric population (<18 years). Editorials, review articles, and case reports were excluded. Demographic data and data on surgical indications, treatment outcomes, and complications were recorded. A methodological quality assessment was performed for all included studies using the Methodological Index for Non-Randomized Studies. RESULTS: Overall, 19 studies, all of level IV evidence, were identified with a total of 492 patients (513 elbows). The patient population was 22.3% female with a mean age of 14.0 years (range, 4.0-15.7) and a mean follow-up time of 33.0 months (range, 7.4-96 months). Twelve studies (263 patients) exclusively recruited patients with osteochondritis dissecans (OCD), although other indications for elbow arthroscopy included arthrofibrosis (50 patients), elbow fracture (37 patients), medial ulnar collateral ligament injury (31 patients), and posterior impingement (17 patients). All 13 reporting studies showed a significant improvement in the elbow flexion-extension arc, and 4 of 5 that reported a functional outcome score before and after surgery demonstrating a significant improvement. Last, the overall complication rates ranged from 0% to 23.8%, with a total of 8 instances of neurological injury (5 ulnar, 2 radial, 1 unspecified), all being transient and resolving within 3 to 6 months. CONCLUSION: Although elbow arthroscopy is primarily being performed for OCD in children and adolescents, there is evidence surrounding several other potential indications. Case series published to date have demonstrated significant improvements in functional outcomes and low rates of major complications. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.

Management and Complications in Nonoperative Fractures of the Tibial Spine: A Systematic Review.

Effective options exist for acute nonoperative management of anterior tibial spine fractures, yet there exists a paucity of literature describing long-term outcomes for these patients. This systematic review thus aims to consolidate management strategies and complications for patients with nonoperative anterior tibial spine fractures. In accordance with PRISMA guidelines, 5 databases (CINAHL, MEDLINE, EMBASE, Cochrane, and Pubmed) were searched and screened in duplicate. Quality assessment was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Of 485 studies identified in the initial search, a total of 18 studies involving 369 patients were eligible for this review. These were stratified into 173 type I, 124 type II, and 72 type III injuries as described by Meyers and McKeever. All patients were treated with knee immobilization in either full extension or slight flexion, with possible closed reduction and/or aspiration of hemarthrosis. Complications at final follow-up comprised 33.9% of patients with persistent stiffness, 19.4% persistent instability, 11.1% mechanical symptoms, 6.37 delayed anterior cruciate ligament reconstruction, 4.9% delayed operative intervention for other complications, and 1.9% extension impingement. Given the lack of comparative studies in this review, definitive conclusions for nonoperative management are difficult to establish on the basis of the current body of literature alone. A modestly higher rate of arthrofibrosis and persistent laxity are seen in higher-grade injuries, however, only a minority of studies stratified complications by Meyers and McKeever classification in this review. A better understanding of variables in treatment decision making require further prospective study focused on the collection of functional and patient-reported outcome measures, whereas also further delineating complications by injury severity.

2D In-Plane CuS/Bi2WO6 p-n Heterostructures with Promoted Visible-Light-Driven Photo-Fenton Degradation Performance.

Photo-Fenton degradation of pollutants in wastewater is an ideal choice for large scale practical applications. Herein, two-dimensional (2D) in-plane CuS/Bi2WO6 p-n heterostructures have been successfully constructed by an in situ assembly strategy and characterized using XRD, XPS, SEM/TEM, EDX, UV-Vis-DRS, PL, TR-PL, ESR, and VB-XPS techniques. The XPS and the TEM results confirm the formation of CuS/Bi2WO6 heterostructures. The as-constructed CuS/Bi2WO6 showed excellent absorption in visible region and superior charge carrier separation efficiency due to the formation of a type-II heterojunctions. Under visible light irradiation, 0.1% CuS/Bi2WO6 heterostructure exhibited the best photo-Fenton-like catalytic performance. The degradation efficiency of Rhodamine B (RhB, 20 mg·L-1) can reach nearly 100% within 25 min, the apparent rate constant (kapp/min-1) is approximately 40.06 and 3.87 times higher than that of pure CuS and Bi2WO6, respectively. The degradation efficiency of tetracycline hydrochloride (TC-HCl, 40mg·L-1) can reach 73% in 50 min by employing 0.1% CuS/Bi2WO6 heterostructure as a photo-Fenton-like catalyst. The promoted photo-Fenton catalytic activity of CuS/Bi2WO6 p-n heterostructures is partly ascribed to its low carriers recombination rate. Importantly, CuS in CuS/Bi2WO6 heterostructures is conducive to the formation of heterogeneous photo-Fenton catalytic system, in which Bi2WO6 provides a strong reaction site for CuS to avoid the loss of Cu2+ in Fenton reaction, resulting in its excellent stability and reusability. The possible photo-Fenton-like catalytic degradation mechanism of RhB and TC-HCl was also elucidated on the basis of energy band structure analysis and radical scavenger experiments. The present study provides strong evidence for CuS/Bi2WO6 heterostructures to be used as promising candidates for photo-Fenton treatment of organic pollutants.

In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility.

PURPOSE: This review explores the current literature regarding both the clinical indications and utility of minimally invasive in-office needle arthroscopy (IONA) relative to conventional imaging modalities. METHODS: In compliance with R-AMSTAR (Revised Assessment of Multiple Systematic Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched in July 2018, in addition to the conference abstract databases of 5 prominent meetings between 2013 and 2018, for studies using IONA for diagnostic purposes. Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. RESULTS: Among 932 conference abstracts and 369 studies identified, 11 publications involving 404 patients (395 knees and 9 shoulders) were included, with 9 clinical studies and 2 cost analyses. The median Methodological Index for Non-Randomized Studies (MINORS) score was 9 for noncomparative and 23 for comparative studies. Among the 9 clinical studies, IONA had a superior sensitivity, specificity, positive predictive value, and negative predictive value to magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis, anterior cruciate ligament insufficiency, and meniscal tears. IONA was comparable or inferior to MRI in the same parameters for the diagnosis of osteochondral defects and rotator cuff tears. In the 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. CONCLUSIONS: IONA holds potential for cost savings and improved diagnostic accuracy relative to MRI, primarily for intra-articular meniscal, ligamentous, and chondral defects of the knee. However, its current indications for use in other joints are limited to rotator cuff tears in the shoulder, making its diagnostic value in other joints much more limited. The current quality and breadth of evidence are significantly lacking, with numerous practical shortcomings. To improve acceptance of IONA, priority should be placed on establishing defined protocols, indications, contraindications, and patient perspectives for the procedure. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III, and IV studies.

A deep learning approach to automatic teeth detection and numbering based on object detection in dental periapical films.

We propose using faster regions with convolutional neural network features (faster R-CNN) in the TensorFlow tool package to detect and number teeth in dental periapical films. To improve detection precisions, we propose three post-processing techniques to supplement the baseline faster R-CNN according to certain prior domain knowledge. First, a filtering algorithm is constructed to delete overlapping boxes detected by faster R-CNN associated with the same tooth. Next, a neural network model is implemented to detect missing teeth. Finally, a rule-base module based on a teeth numbering system is proposed to match labels of detected teeth boxes to modify detected results that violate certain intuitive rules. The intersection-over-union (IOU) value between detected and ground truth boxes are calculated to obtain precisions and recalls on a test dataset. Results demonstrate that both precisions and recalls exceed 90% and the mean value of the IOU between detected boxes and ground truths also reaches 91%. Moreover, three dentists are also invited to manually annotate the test dataset (independently), which are then compared to labels obtained by our proposed algorithms. The results indicate that machines already perform close to the level of a junior dentist.

Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes.

PURPOSE: Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario. METHODS: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS: Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection. CONCLUSIONS: The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation. LEVEL OF EVIDENCE: Level V, systematic review of Level II, III, IV, and V studies.

Associations Between Colonic Motor Patterns and Autonomic Nervous System Activity Assessed by High-Resolution Manometry and Concurrent Heart Rate Variability.

Abnormal colonic motility may be associated with dysfunction of the autonomic nervous system (ANS). Our aim was to evaluate if associations between colonic motor patterns and autonomic neural activity could be demonstrated by assessing changes in heart rate variability (HRV) in healthy volunteers. A total of 145 colonic motor patterns were assessed in 11 healthy volunteers by High-Resolution Colonic Manometry (HRCM) using an 84-channel water-perfused catheter. Motor patterns were evoked by balloon distention, a meal and luminal bisacodyl. The electrocardiogram (ECG) and cardiac impedance were assessed during colonic manometry. Respiratory sinus arrhythmia (RSA) and root mean square of successive differences of beat-to-beat intervals (RMSSD) served as measures of parasympathetic reactivity while the Baevsky's Stress Index (SI) and the pre-ejection period (PEP) were used as measures of sympathetic reactivity. Taking all motor patterns into account, our data show that colonic motor patterns are accompanied by increased parasympathetic activity and decreased sympathetic activity that may occur without eliciting a significant change in heart rate. Motor Complexes (more than one motor pattern occurring in close proximity), High-Amplitude Propagating Pressure Waves followed by Simultaneous Pressure Waves (HAPW-SPWs) and HAPWs without SPWs are all associated with an increase in RSA and a decrease in SI. Hence RSA and SI may best reflect autonomic activity in the colon during these motor patterns as compared to RMSSD and PEP. SI and PEP do not measure identical sympathetic reactivity. The SPW, which is a very low amplitude pressure wave, did not significantly change the autonomic measures employed here. In conclusion, colonic motor patterns are associated with activity in the ANS which is reflected in autonomic measures of heart rate variability. These autonomic measures may serve as proxies for autonomic neural dysfunction in patients with colonic dysmotility.

Tunnel osteolysis post-ACL reconstruction: a systematic review examining select diagnostic modalities, treatment options and rehabilitation protocols.

PURPOSE: The purpose of this systematic review was to (1) identify the optimal diagnostic modality for tunnel widening in skeletally mature patients; (2) identify potentially modifiable risk factors for tunnel widening, such as graft type, and (3) determine what elements of a post-operative rehabilitation program exert the most influence on TW. METHODS: The electronic databases MEDLINE, EMBASE, PubMed, and Cochrane Library were searched from database inception to January 2018. Studies that discussed tunnel widening following anterior cruciate ligament reconstruction (ACLR) of skeletally mature patients and written in English were included. Descriptive statistics, such as means, ranges, and measures of variance (e.g. standard deviations, 95% confidence intervals (CI)) are presented where applicable. RESULTS: 103 studies (6,383 patients) were included. Plain radiographs were the most commonly used diagnostic modality, but radiographs on average required 10 months longer than CT and 2 months longer on average than MRI to diagnose tunnel widening after ACLR. Although CT was the least commonly used modality, it was the shortest time to diagnose tunnel widening at 9.5 months after ACLR. Bone-patellar tendon-bone (BPTB) allograft had the largest average tunnel widening overall. BPTB autograft had the lowest average tunnel widening overall. Double-bundle hamstring graft configuration had a lower average tunnel widening than single-bundle configuration. Rehabilitation protocols after ACLR that used a full weight-bearing prescription in rehabilitation showed a greater average femoral tunnel widening than partial weight-bearing, and partial weight-bearing showed a greater average tibial tunnel widening than full weight-bearing. CONCLUSIONS: Based on this systematic review and the descriptive data evaluated, CT demonstrated a time of 9.5 months on average from ACLR to diagnosing tunnel osteolysis post-ACLR. With respect to graft types, double-bundle hamstring autografts reported lower average femoral and tibial TW than single-bundle hamstring autografts. BPTB autografts reported the lowest average TW and BPTB allograft the largest average TW of all the grafts. Furthermore, extension-locked bracing had the lowest TW of all the brace protocols. Lastly, several other surgical technical parameters influencing tunnel osteolysis remain to be determined. No definitive recommendations can be made at this time due to the high heterogeneity of data and the lack of comparative studies analysed in this systematic review. LEVEL OF EVIDENCE: IV.

Characterization of Simultaneous Pressure Waves as Biomarkers for Colonic Motility Assessed by High-Resolution Colonic Manometry.

Simultaneous pressure waves (SPWs) in manometry recordings of the human colon have been associated with gas expulsion. Our hypothesis was that the SPW might be a critical component of most colonic motor functions, and hence might act as a biomarker for healthy colon motility. To that end, we performed high-resolution colonic manometry (HRCM), for the first time using an 84-sensor (1 cm spaced) water-perfused catheter, in 17 healthy volunteers. Intraluminal pressure patterns were recorded during baseline, proximal and rectal balloon distention, after a meal and following proximal and rectal luminal bisacodyl administration. Quantification was performed using software, based on Image J, developed during this study. Gas expulsion was always associated with SPWs, furthermore, SPWs were associated with water or balloon expulsion. SPWs were prominently emerging at the termination of proximal high amplitude propagating pressure waves (HAPWs); we termed this motor pattern HAPW-SPWs; hence, SPWs were often not a pan-colonic event. SPWs and HAPW-SPWs were observed at baseline with SPW amplitudes of 12.0 ± 8.5 mmHg and 20.2 ± 7.2 mmHg respectively. The SPW occurrence and amplitude significantly increased in response to meal, balloon distention and luminal bisacodyl, associated with 50.3% anal sphincter relaxation at baseline, which significantly increased to 59.0% after a meal, and 69.1% after bisacodyl. Often, full relaxation was achieved. The SPWs associated with gas expulsion had a significantly higher amplitude compared to SPWs without gas expulsion. SPWs could be seen to consist of clusters of high frequency pressure waves, likely associated with a cluster of fast propagating, circular muscle contractions. SPWs were occasionally observed in a highly rhythmic pattern at 1.8 ± 1.2 cycles/min. Unlike HAPWs, the SPWs did not obliterate haustral boundaries thereby explaining how gas can be expelled while solid content can remain restrained by the haustral boundaries. In conclusion, the SPW may become a biomarker for normal gas transit, the gastrocolonic reflex and extrinsic neural reflexes. The SPW assessment reveals coordination of activities in the colon, rectum and anal sphincters. SPWs may become of diagnostic value in patients with colonic dysmotility.

An effective teeth recognition method using label tree with cascade network structure.

In this article, we apply the deep learning technique to medical field for the teeth detection and classification of dental periapical radiographs, which is important for the medical curing and postmortem identification. We detect teeth in an input X-ray image and distinguish them from different position. An adult usually has 32 teeth, and some of them are similar while others have very different shape. So there are 32 teeth position for us to recognize, which is a challenging task. Convolutional neural network is a popular method to do multi-class detection and classification, but it needs a lot of training data to get a good result if used directly. The lack of data is a common case in medical field due to patients' privacy. In this work, limited to the available data, we propose a new method using label tree to give each tooth several labels and decompose the task, which can deal with the lack of data. Then use cascade network structure to do automatic identification on 32 teeth position, which uses several convolutional neural network as its basic module. Meanwhile, several key strategies are utilized to improve the detection and classification performance. Our method can deal with many complex cases such as X-ray images with tooth loss, decayed tooth and filled tooth, which frequently appear on patients. The experiments on our dataset show: for small training dataset, compared to the precision and recall by training a 33-classes (32 teeth and background) state-of-the-art convolutional neural network directly, the proposed approach reaches a high precision and recall of 95.8% and 96.1% in total, which is a big improvement in such a complex task.

Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement.

PURPOSE: Femoroacetabular impingement (FAI) is a clinical entity of the hip causing derangements in range of motion, pain, gait, and function. Computer-assisted modeling and clinical studies suggest that patients with FAI have increased capsular thickness compared to those without.A retrospective chart review was performed to assess relationships between capsular thickness, hip range of motion, and demographic factors in patients with FAI. METHODS: Local Research Ethics Board approval was obtained to extract electronic medical records for 188 patients at a single institution who had undergone hip arthroscopy. Procedures were performed from 2009 to 2017 by a single, fellowship-trained, board-certified sports medicine orthopaedic surgeon. Inclusion criteria were preoperative hip range of motion testing, positive clinical impingement testing, and magnetic resonance imaging (MRI) of the affected hip. Patient demographics, hip range of motion, and time to surgery were recorded. MRIs were reviewed by a board-certified musculoskeletal radiologist blinded to clinical data. Maximum thickness of the anterior hip capsule was measured in axial, axial oblique, and sagittal oblique sequences. Anterior capsular thickness was also measured at the level of the femoral head-neck junction in axial sequences (axial midline). RESULTS: Axial midline capsular thickness was negatively correlated with hip flexion (r = - 0.196, p = 0.0042) and internal rotation (r = - 0.143, p = 0.0278). Significant differences were seen between genders in axial midline thickness (5.3 ± 1.4 mm males/4.8 ± 1.3 mm females, p = 0.0079), flexion (113° ± 18° males/120° ± 17° females, p = 0.0029), and internal rotation (23° ± 13° males/29° ± 12° females, p = 0.0155). Significant differences also existed between side affected in flexion (116° ± 17° right/119° ± 17° left, p = 0.0396) and internal rotation (26° ± 12° right/29° ± 13° left, p = 0.0029). Positive correlation was observed between axial oblique capsular thickness and flexion (r = 0.2345) (p = 0.0229). CONCLUSIONS: Increased anterior hip capsular thickness at the femoral head-neck correlates with limitations in hip range of motion in FAI. The strength of this relationship may be affected between pathologies, genders, and affected side. Pathologic thickening of the hip capsule may contribute to restricted hip mobility on clinical examination, and elucidation of this relationship may provide guidance into capsular management during hip arthroscopy. LEVEL OF EVIDENCE: 4, retrospective case series.

Inhibition of the G9a/GLP histone methyltransferase complex modulates anxiety-related behavior in mice.

Epigenetic gene-regulation abnormalities have been implicated in various neuropsychiatric disorders including schizophrenia and depression, as well as in the regulation of mood and anxiety. In addition, epigenetic mechanisms are involved in the actions of psychiatric drugs. Current anxiolytic drugs have significant shortcomings, and development of new medications is warranted. Two proteins, G9a (also known as EHMT2 or KMT1C) and GLP (G9a-like protein, also known as EHMT1 or KMT1D), which methylate lysine 9 of histone H3 (H3K9), could be promising anxiolytic targets. Postnatal genetic knock-out of G9a reduces anxiety-related behavior, consistent with the reduction of G9a levels by some medications used to treat anxiety (amitriptyline, imipramine and paroxetine). Conversely, there is increased anxiety-like behavior in mice with GLP haplodeficiency. We sought to determine whether two pharmacological inhibitors of G9a/GLP, UNC0642 and A-366, would have similar effects to genetic G9a/GLP insufficiency. We found that G9a/GLP inhibition with either compound reduced anxiety-like behaviors when administered to adult mice, in conjunction with decreased H3K9 methylation in the brain. In contrast, exposure to these compounds from embryonic day 9.5 (E9.5) until birth increased anxiety-like behaviors and decreased social interaction in adulthood, while H3K9 methylation was at normal levels in the brains of the adult mice. These findings reinforce genetic evidence that G9a/GLP has different effects on anxiety-like behavior at different stages of brain development, and suggest that targeting this histone methyltransferase pathway could be useful for developing new anxiolytic drugs. These data also suggest that antidepressant exposure in utero could have negative effects in adulthood, and further investigation of these effects is warranted.