Comparison between intramedullary nail and conventional plate for displaced intra-articular calcaneal fractures: A meta-analysis.

OBJECTIVES: This study aimed to compare the efficacy and safety of the intramedullary nail and conventional plate for the treatment of displaced intra-articular calcaneal fractures from clinical comparative trials. MATERIALS AND METHODS: A comprehensive search of English databases was carried out in the Springer, PubMed, ScienceDirect, Web of Science, and Cochrane Library databases until September 2023. Studies on calcaneal fractures treated by an intramedullary nail or a plate were considered for inclusion. Endpoints included duration of operation, length of hospital stay, the Visual Analog Scale (VAS) score, postoperative functional score, radiological parameters, and complications. The mean difference (MD) and risk difference (RD) as the combined variables, as well as the 95% confidence intervals, (CIs) were calculated. RESULTS: Five retrospective controlled studies covering 473 feet at the one-year follow-up met the inclusion criteria. The meta-analysis demonstrated that there were significant differences in the duration of operation (MD: -10.81; 95% CI: -16.32, -5.31; p=0.0001), length of hospital stay (MD: -3.65; 95% CI: -4.35, -2.95; p<0.00001). No significant differences were found regarding postoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (MD: 0.36; 95% CI: -3.89, 4.61; p=0.87), VAS (MD: 1.95; 95% CI: -0.30, 4.21; p=0.09), or postoperative Böhler angle (MD: 0.94; 95% CI: -0.04, 1.92; p=0.06) between the two groups. The incidence of total complications (RD: -0.31; 95% CI: -0.46, -0.17; p<0.0001) and wound-healing complications (RD: -0.16; 95% CI: -0.30, -0.03; p=0.02) were lower in the intramedullary nail group. There were no significant differences in the incidences of revision surgery, implant removal, superficial wound infection, deep infection, and nonunion. CONCLUSION: Compared to conventional plates, the intramedullary nail showed a shorter duration of operation, reduced length of hospital stay, and fewer postoperative total complications and wound-healing complications in treating displaced intra-articular calcaneal fractures.

Treatment of Complex Central Talar Fractures with Lateral Plate Combination with Medial Screw Fixation.

OBJECTIVE: The treatment of talar neck and/or body fractures is known to be difficult and challenging, with significant impact on the long-term functional outcome for the patient. The optimal management, including the choice of surgical approaches and implants, are still under constant discussion. The purpose of the study was to investigate the clinical effects of lateral mini-plate combined with medial lag screws for the treatment of complicated central talar fractures. METHODS: The data of eight patients with complex central talus fractures treated between June 2019 and January 2021 were retrospectively analyzed. There were six males and two females, ranging in age from 15 to 66 years, with an average age of 37.4 years. There were three cases on the left and five cases on the right. All fractures were comminuted, including talar neck with talar body fracture in seven cases and talar body comminuted with subluxation of subtalar joint in one case. All patients were treated with the anteromedial combined anterolateral approach, lateral talar mini-plate fixation and medial lag screw fixation. Fracture reduction quality, union time, and complications were recorded, and functional outcomes were evaluated using the American Orthopedic Foot & Ankle Society (AOFAS) scoring system. RESULTS: The time from injury to surgery was 1-6 days, with an average of 3.38 days. The follow-up period was 34-53 months (mean 44.88 months). All fractures healed with a mean healing time of 16.75 weeks (13-23 weeks). Anatomical reduction was observed in six cases and near in two cases. After operation, there was no loosening or breakage of implant, loss of fracture reduction, and irritation of skin and soft tissue by internal fixation. The average AOFAS score was 87.38 (48-100), with excellent five cases, good two cases and poor one case, and the excellent and good rate was 87.5%. Superficial skin necrosis in one surgical incision healed after dressing exchange. No deep infection occurred. One case (1/8, 12.5%) developed avascular necrosis of the talus without collapse. Posttraumatic arthritis was found in four cases (4/8, 50%). CONCLUSION: The utilization of lateral mini-plates in combination with medial screws for treating complex central talar fractures results in satisfactory reduction and stable fixation, mitigating complications associated with poor reduction. However, due to the absence of an anatomical mini-plate, pre-contouring is necessary when applying the lateral plate. This demands a surgeon's thorough familiarity with the anatomical morphology of the talus and proficiency in surgical techniques. Posttraumatic arthritis is the most common complication of complex central talar fractures.

Understanding the Cathode-Electrolyte Interfacial Chemistry in Rechargeable Magnesium Batteries.

Rechargeable magnesium batteries (RMBs) have garnered significant attention due to their potential to provide high energy density, utilize earth-abundant raw materials, and employ metal anode safely. Currently, the lack of applicable cathode materials has become one of the bottleneck issues for fully exploiting the technological advantages of RMBs. Recent studies on Mg cathodes reveal divergent storage performance depending on the electrolyte formulation, posing interfacial issues as a previously overlooked challenge. This minireview begins with an introduction of representative cathode-electrolyte interfacial phenomena in RMBs, elaborating on the unique solvation behavior of Mg2+, which lays the foundation for interfacial chemistries. It is followed by presenting recently developed strategies targeting the promotion of Mg2+ desolvation in the electrolyte and alternative cointercalation approaches to circumvent the desolvation step. In addition, efforts to enhance the cathode-electrolyte compatibility via electrolyte development and interfacial engineering are highlighted. Based on the abovementioned discussions, this minireview finally puts forward perspectives and challenges on the establishment of a stable interface and fast interfacial chemistry for RMBs.

Structural Engineering of Anode Materials for Low-Temperature Lithium-Ion Batteries: Mechanisms, Strategies, and Prospects.

The severe degradation of electrochemical performance for lithium-ion batteries (LIBs) at low temperatures poses a significant challenge to their practical applications. Consequently, extensive efforts have been contributed to explore novel anode materials with high electronic conductivity and rapid Li+ diffusion kinetics for achieving favorable low-temperature performance of LIBs. Herein, we try to review the recent reports on the synthesis and characterizations of low-temperature anode materials. First, we summarize the underlying mechanisms responsible for the performance degradation of anode materials at subzero temperatures. Second, detailed discussions concerning the key pathways (boosting electronic conductivity, enhancing Li+ diffusion kinetics, and inhibiting lithium dendrite) for improving the low-temperature performance of anode materials are presented. Third, several commonly used low-temperature anode materials are briefly introduced. Fourth, recent progress in the engineering of these low-temperature anode materials is summarized in terms of structural design, morphology control, surface & interface modifications, and multiphase materials. Finally, the challenges that remain to be solved in the field of low-temperature anode materials are discussed. This review was organized to offer valuable insights and guidance for next-generation LIBs with excellent low-temperature electrochemical performance.

Covalently Cross-Linked Chemistry of a Three-Dimensional Network Binder at Limited Dosage Enables Practical Si/C Composite Electrode Applications.

Currently, Si (or SiOx, 1 < x < 2) and graphite composite (Si/C) electrodes (e.g., Si/C450 and Si/C600 with specific capacities of 450 and 600 mAh g-1 at 0.1 C, respectively) have become the most promising alternative to traditional graphite anodes toward high-energy lithium-ion battery (LIB) applications by virtue of their higher specific capacity compared to graphite ones and improved cycle performance compared to Si (or SiOx) ones. However, such composite electrodes remain challenging to practical for implementation owing to electrode structure disintegration and interfacial instability caused by a large volume change of inner Si-based particles. Herein, we develop a covalent-bond cross-linking network binder for Si/C450 and Si/C600 electrodes via reversible addition-fragmentation chain transfer (RAFT) polymerization. The as-developed binder with a 3 mol % cross-linker of other monomers [termed P(SH-BA3%)] achieves improved mechanical and adhesive properties and decreased Si/C anode volume expansion, compared to the linear binder counterpart. Impressively, the P(SH-BA3%) binder at only 3 wt % dosage enables 83.56% capacity retention after 600 cycles at 0.5 C in Si/C450 anode based half-cells and retains 86.42% capacity retention at 0.3 C after 200 cycles and 80.95% capacity retention at 0.5 C after 300 cycles in LiNi0.8Co0.1Mn0.1O2 cathode (15 mg cm-2) based homemade soft package full cells. This work provides insight into binder cross-linking chemistry under limited dosage and enlightens cross-linking binder design toward practical Si/C electrode applications.

Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model.

PURPOSE: To explore the critical role of the tumor margin irregularity degree (TMID) of renal tumors in predicting adverse pathology of patients with clinical T1/2 (cT1/2) renal cell carcinoma (RCC). METHODS: A total of 821 patients with cT1/2 RCC undergoing nephrectomy in the Second Hospital of Tianjin Medical University between January 2017 and December 2020 were reviewed. The tumor margin irregularity (TMI) was classified into renal mass with locally raised protrusion and smooth margin called 'lobular', sharply and unsmooth nodular margin called 'spiculation', blurred margins between tumor and renal parenchyma or a completely irregular and non-elliptical shape. The ratio between the number of irregular cross-sections (X) and the number of total cross-sections from top to bottom occupied (Y) was defined as TMID (X/Y). The logistic regression was performed to determine the independent predictors of adverse pathology, and the Kaplan-Meier curve and log-rank test were used to analyze the survival outcomes. RESULTS: Among 821 cT1/2 RCC patients, 245 (29.8%) had adverse pathology. The results of the univariate and multivariate logistic regressions showed that the age, tumor size, hemoglobin, and TMID were the independent predictors of adverse pathology. Incorporation of TMID could increase the discrimination of the predictive model with the area under curve (AUC) of ROC curves increasing from 0.725 to 0.808. Patients with adverse pathology or higher TMID both had significantly shorter recurrence-free survival (RFS). CONCLUSION: The nomogram model incorporated with TMID for predicting adverse pathology could increase its discrimination, calibration, and clinical application values, compared with the models without TMID.

A Perspective on Uniform Plating Behavior of Mg Metal Anode: Diffusion Limited Theory versus Nucleation Theory.

Utilizing metal anode is the most attractive way to meet the urgent demand for rechargeable batteries with high energy density. Unfortunately, the formation of dendrites, which is caused by uneven plating behavior, always threaten the safety of the batteries. To explore the origin of different plating behavior and predict the plating morphology of anode under a variety of operating conditions, multifarious models have been developed. However, abuse of models has led to conflictive views. In this perspective, to clarify the controversial reports on magnesium (Mg) metal plating behavior, the previously proposed models are elaborated that govern the plating process. Through linking various models and clarifying their boundary conditions, a scheme is drawn to illustrate the strategy for achieving the most dense and uniform plating morphology, which also explains the seemingly contradictory of diffusion limited theory and nucleation theory on uniform plating. This perspective will undoubtedly enhance the understanding on the metal anode plating process and provide meaningful guidance for the development of metal anode batteries.

Comparison of different internal fixation implants in the treatment of talar neck fractures: A finite element analysis.

OBJECTIVES: This study aimed to analyze the biomechanics of cannulated screws (CS) with or without a lateral locking plate (LLP) in talar neck fractures through a finite element analysis. PATIENTS AND METHODS: The computed tomography image of the talus from a healthy volunteer (adult male) was used to reconstruct a three-dimensional talar model. The method for fixing talar neck fractures with CS and an LLP was planned using computer-aided design software. Afterward, the three-dimensional models of comminuted talar neck fractures were used to simulate fixation with anteroposterior parallel dual CS, single CS+LLP, and dual CS+LLP. Finally, finite element analysis was carried out to compare the outcomes of dual CS+LLP to those of single CS+LLP and to those of using dual CS alone. The displacement and von Mises stress values of the three groups with different internal fixation were analyzed. RESULTS: For a simple talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.407 mm), while dual CS (0.459 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (5.38 MPa), while dual CS (8.749 MPa) showed the highest amount of total peak stresses. For a comminuted talar neck fracture, the lowest amount of displacement was obtained with CS+LLP (0.398 mm), while dual CS (0.408 mm) showed the highest amount of total displacement; the lowest amount of peak stresses was obtained with CS+LLP (129.9 MPa), while dual CS (205.9 MPa) showed the highest amount of peak stresses. CONCLUSION: Compared to the other two groups, the dual CS+LLP group had better biomechanics properties in the displacement and stress peak of the talus and implant. Thus, the use of dual CS+LLP fixation is recommended for the surgical treatment of comminuted talar neck fractures.

Highly Sensitive Detection of Formaldehyde by Laser-Induced Graphene-Coated Silver Nanoparticles Electrochemical Sensing Electrodes.

Formaldehyde (HCHO) poses a grave threat to human health because of its toxicity, but its accurate, sensitive, and rapid detection in aqueous solutions remains a major challenge. This study proposes a novel electrochemical sensor composed of a graphene-based electrode that is prepared via laser induction technology. The precursor material, polyimide, is modified via the metal ion exchange method, and the detective electrode is coated with graphene and silver nanoparticles. And the special structure of graphene-coated Ag was demonstrated using scanning electron microscopy (SEM) and high-resolution transmission electron microscopy (HRTEM), and X-ray diffraction (XRD), Fourier transform infrared (FT-IR), and X-ray photoelectron spectroscopy (XPS) results show that graphene provides more sites for Ag NRs to be exposed and increases the surface area of contact between the solution and the detection object. In addition, differential pulse voltammetry (DPV) analysis exhibits high linearity over the HCHO concentration range from 0.05 to 5 µg/mL, with a detection limit of 0.011 µg/mL (S/N = 3). The Ag NPs in the electrochemical reaction will adsorb the intermediate •CO and •OH, catalyze their combination, and finally convert to CO2 and H2O, respectively. A microdetection device, specially designed for use with commercial micro-workstations, is employed to fully demonstrate the practical application of the electrode, which paves a way for developing formaldehyde electrochemical sensors.

A smartphone-based visual ratiometric fluoroprobe for rapid and sensitive detection hypochlorous acid based on dual-emission metal organic frameworks.

Herein, we designed/developed a mixed fluorescence system with europium metal-organic framework (EDB) and zinc metal-organic framework (ZBNB). At the 270-nm excitation wavelength, the EDB-ZBNB dually emitted at 425 and 615 nm and displayed blue solution under 365-nm UV lamp. When HOCl was fortified, the 425-nm blue emission dropped progressively, while the 615-nm red emission was relatively stable. Upon addition of ClO-, the shortened fluorescence lifetime demonstrated that the quenched 425-nm fluorescence of ZBNB was owing to the occurrence of dynamic quenching effect. Besides, amino groups are protonated in water to form -NH3+, which interact with ClO- to form hydrogen bonds, reduce the distance between -NH3+ and ClO-, produce energy transfer and result in fluorescence quenching. The ratiometric fluoroprobe provided a significant color change from blue to red, making HOCl detection visual and rapid. This fluorescent probe overcome the disadvantage of conventional redox-based fluorescent probes that can be interfered by MnO4- and other oxidants with stronger oxidizing capacity than free ClO-. Furthermore, a smartphone-based portable sensing platform was developed based on EDB-ZBNB. By using a "Thingidentify" software on smartphone, the sensing platform was used to detect HOCl in waters with a low detection limit of 28.0 nM and the fortified recoveries of 98.87-103.60%. Thus, this study provides a novel and promising platform for the detection of free ClO- in monitoring water quality.

Comparison between bioabsorbable magnesium and titanium compression screws for hallux valgus treated with distal metatarsal osteotomies: A meta-analysis.

OBJECTIVES: In this review, we discuss the efficacy and safety of biodegradable magnesium screws compared to titanium screws in the treatment of hallux valgus (HV) in patients undergoing distal metatarsal osteotomy (DMO). MATERIALS AND METHODS: Eligible scientific articles published prior to October 2022 were retrieved from the PubMed, Springer, ScienceDirect, and Cochrane Library databases. The terms used for searching included "hallux valgus", "distal metatarsal osteotomies", and "bioabsorbable magnesium screw" which were limited in the title or abstract through the text. The title and abstract were checked one by one to exclude the non-related studies. For primary identified studies and relevant systematic reviews, the full texts were accessed and browsed to finally include the eligible studies. No restriction was set on publication language and publication status. RESULTS: Two randomized-controlled trials (RCTs) and three non-RCTs that met the inclusion criteria were included. There was no significant difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score, postoperative HV angle (HVA), intermetatarsal angle (IMA), Visual Analog Scale (VAS) score, soft tissue irritation, implant fracture, reoperation, and infection rates between two groups. CONCLUSION: Bioabsorbable magnesium compression screws show comparable clinical or radiological results to titanium compression screws in the treatment of HV in patients undergoing DMO.

The identification of metabolism-related subtypes and potential treatments for idiopathic pulmonary fibrosis.

Background: Idiopathic pulmonary fibrosis (IPF) is caused by aberrant repair because of alveolar epithelial injury and can only be effectively treated with several compounds. Several metabolism-related biomolecular processes were found to be involved in IPF. We aimed to identify IPF subtypes based on metabolism-related pathways and explore potential drugs for each subtype. Methods: Gene profiles and clinical information were obtained from the Gene Expression Omnibus (GEO) database (GSE70867 and GSE93606). The enrichment scores for 41 metabolism-related pathways, immune cells, and immune pathways were calculated using the Gene Set Variation Analysis (GSVA) package. The ConsensusClusterPlus package was used to cluster samples. Novel modules and hub genes were identified using weighted correlation network analysis (WGCNA). Receiver operating characteristic (ROC) and calibration curves were plotted, and decision curve analysis (DCA) were performed to evaluate the model in the training and validation cohorts. A connectivity map was used as a drug probe. Results: Two subtypes with significant differences in prognosis were identified based on the metabolism-related pathways. Subtype C1 had a poor prognosis, low metabolic levels, and a unique immune signature. CDS2, LCLAT1, GPD1L, AGPAT1, ALDH3A1, LAP3, ADH5, AHCYL2, and MDH1 were used to distinguish between the two subtypes. Finally, subtype-specific drugs, which can potentially treat IPF, were identified. Conclusion: The aberrant activation of metabolism-related pathways contributes to differential prognoses in patients with IPF. Collectively, our findings provide novel mechanistic insights into subtyping IPF based on the metabolism-related pathway and potential treatments, which would help clinicians provide subtype-specific individualized therapeutic management to patients.

Aqueous MXene inks for inkjet-printing microsupercapacitors with ultrahigh energy densities.

Although inkjet-printing technology has achieved significant development in preparing scalable and adaptable energy storage devices for portable and micro devices, searching for additive-free and environmentally friendly aqueous inks is a significant challenge. Hence, an aqueous MXene/sodium alginate-Fe2+ hybrid ink (denoted as MXene/SA-Fe) with solution processability and suitable viscosity is prepared for direct inkjet printing microsupercapacitors (MSCs). The SA molecules are adsorbed on the surface of MXene nanosheets to construct three-dimensional (3D) structures, thus effectively alleviating the two notorious problems of oxidation and self-restacking of MXene. Concurrently, Fe2+ ions can compress the ineffective macropore volume and make the 3D structure more compact. Moreover, the hydrogen and covalent bonding formed between the MXene nanosheet, SA, and Fe2+ effectively protects the oxidation of MXene and thus increases its stability. Thus, the MXene/SA-Fe ink endows the inkjet-printed MSC electrode with abundant active sites for ion storage and a highly conductive network for electron transfer. As a demonstration, the MXene/SA-Fe ink is used to direct inkjet-printed MSCs with an electrode spacing of 310 µm, which exhibit remarkable capacitances of 123.8 mF cm-2 (@5 mV s-1), good rate capability, an extraordinary energy density of 8.44 µWh cm-2 at a power density of 33.70 µW cm-2, long-term cycling stability of 91.4 % capacitance retention after 10,000 cycles, and surprising mechanical durability with 90.0 % of its initial capacitance retained after 10,000 bending cycles. Therefore, MXene/SA-Fe inks are expected to create various opportunities for printable electronics.

A smartphone-based ratiometric fluoroprobe based on blue-red dual-emission signals of thiochrome and copper nanoclusters for sensitive assay of metam-sodium in cucumbers.

It is of great importance to develop the highly efficient fluorescence strategy for rapid/sensitive detection of metam-sodium (MES) in evaluating its residual safety, especially in fresh vegetables. Herein, we prepared an organic fluorophore (thiochrome, TC) and glutathione-capped copper nanoclusters (GSH-CuNCs), and their combination (TC/GSH-CuNCs) was sucessfully employed as a ratiometric fluoroprobe by means of the blue-red dual emission. The fluorescence intensities (FIs) of TC decreased upon the addition of GSH-CuNCs via the fluorescence resonance energy transfer (FRET) process. When fortified at the constant levels of GSH-CuNCs and TC, MES substantially reduced the FIs of GSH-CuNCs, while this was not the case in the FIs of TC except for the prominent red-shift of ∼30 nm. Compared to the previous fluoroprobes, the TC/GSH-CuNCs based fluoroprobe supplied wider linear range of 0.2-500 µM, lower detection limit (60 nM), and satisfactory fortification recoveries (80-107%) for MES in the cucumber samples. Based on the fluorescence quenching phenomenon, a smartphone application was used to output RGB values of the captured images for the colored solution. The smartphone-based ratiometric sensor could be utilized for the visual fluorescent quantitation of MES by virtue of the R/B values in cucumbers, which gave linear range (1-200 µM) and LOD (0.3 µM). By means of blue-red dual-emission fluorescence, the smartphone-based fluoroprobe provides a cost-effective, portable and reliable avenue for the on-site, rapid and sensitive assay of MES's residues in complex vegetable samples.

Diversity of arterial cell and phenotypic heterogeneity induced by high-fat and high-cholesterol diet.

Lipid metabolism disorder is the basis of atherosclerotic lesions, in which cholesterol and low-density lipoprotein (LDL) is the main factor involved with the atherosclerotic development. A high-fat and high-cholesterol diet can lead to this disorder in the human body, thus accelerating the process of disease. The development of single-cell RNA sequencing in recent years has opened the possibility to unbiasedly map cellular heterogeneity with high throughput and high resolution; alterations mediated by a high-fat and high-cholesterol diet at the single-cell transcriptomic level can be explored with this mean afterward. We assessed the aortic arch of 16-week old Apoe-/- mice of two control groups (12 weeks of chow diet) and two HFD groups (12 weeks of high fat, high cholesterol diet) to process single-cell suspension and use single-cell RNA sequencing to anatomize the transcripts of 5,416 cells from the control group and 2,739 from the HFD group. Through unsupervised clustering, 14 cell types were divided and defined. Among these cells, the cellular heterogeneity exhibited in endothelial cells and immune cells is the most prominent. Subsequent screening delineated ten endothelial cell subsets with various function based on gene expression profiling. The distribution of endothelial cells and immune cells differs significantly between the control group versus the HFD one. The existence of pathways that inhibit atherosclerosis was found in both dysfunctional endothelial cells and foam cells. Our data provide a comprehensive transcriptional landscape of aortic arch cells and unravel the cellular heterogeneity brought by a high-fat and high-cholesterol diet. All these findings open new perspectives at the transcriptomic level to studying the pathology of atherosclerosis.

Current status and future challenges in extraction, purification and identification of Cepharanthine (a potential drug against COVID-19).

With the outbreak of the new coronavirus disease 2019 (COVID-19), the rapid spread of the virus has brought huge economic losses and life threats to the world. So far, we have entered the third year of the epidemic and there is an urgent need to provide more anti-viral treatment along with vaccination. Recent studies have confirmed that Cepharanthine (CEP) has strong antiviral efficacy, which is a potential drug against COVID-19. As a natural active alkaloid, the development of CEP-incorporated products is dependent on the extraction, purification and identification of CEP. This review gives a brief introduction of CEP, including its origin and classification, and its conventional and novel extraction techniques. In addition, the purification and identification techniques are summarized. In the last, the future research directions are proposed. It can be found from this review that the extraction from plants is still the main way to obtain CEP, and it is necessary to use innovative techniques and their hybrid extractions to extract CEP. More efficient extraction and purification techniques should be used to extract CEP in the future. This review provides a basis for the development of novel extraction and purification techniques and industrial utilization of CEP.

Investigation of the Characteristics and Mechanism of Interosseous Membrane Injuries in Typical Maisonneuve Fracture.

OBJECTIVES: Previous studies on the mechanism and scope of interosseous membrane injury in Maisonneuve fractures have been inconsistent. In order to better guide clinical treatment, the characteristics and mechanism of interosseous membrane injuries and proximal 1/3 fibular fracture in typical Maisonneuve fracture were investigated. METHODS: The study comprised 15 patients between January 2019 and June 2021 with Maisonneuve fracture. All patients received X-ray and MRI examination of the calf and ankle joint, and CT scanning of the ankle joint. The injuries of medial structure, inferior tibiofibular syndesmosis, fibula, posterior malleolus, and interosseous membrane were evaluated. RESULTS: MR images of the calf showed that the injury of interosseous membrane (IOM) was from the syndesmosis to the proximal fibular fracture site in two patients, with a range of 32.3 and 29.8 cm, respectively. In the other 13 patients, the IOM rupture was not only confined to the distal third of the calf, but also close to the fibula fracture, and the IOM was intact between the two fracture sites. The range of distal IOM rupture was 3.7-12.2 cm, with an average of 8.06 ± 2.35 cm. The proximal IOM was completely ruptured from the fibular side at the site of the fibular fracture and the range was 4.1-9.1 (average: 6.75 ± 1.64) cm. The average length of the integrate middle segment of the IOM was 14.55 ± 4.11 (5.6-20.3) cm. MR images of the calf also showed partial rupture of the posterior tibial muscle at the ending point on the fibula in 15 cases, partial rupture of soleus muscle and flexor hallucis longus in seven cases. CONCLUSIONS: The rupture of the IOM was caused by a combination of abduction and external rotation violence. It was manifested in two forms, most of which was not only distal end but also near fibular fracture site ruptures with the middle part intact, and a few were ruptures of the IOM from the ankle to the near fibular fracture site. The tibialis posterior muscle may be related to the location of the fibular fracture.

Solvent-assisted assembly of reduced graphene oxide/MXene-polypyrrole composite film for flexible supercapacitors.

Two-dimensional (2D) materials represented by graphene and MXene have attracted extensive attention in the field of energy storage. However, the automatic stacking and poor stability of 2D materials considerably limit their electrochemical performance. In this article, we apply a design strategy based on combining the ternary components of reduced graphene oxide (rGO), MXene, and polypyrrole (PPy) into one electrode to form a flexible film with a sandwich structure. As a result, the resulting rGO/MXene-PPy composite electrode inherits the characteristics of high conductivity, robust mechanical properties, and pseudocapacitance. In addition to providing capacitive contributions, the PPy serves as a blocker to prevent face-to-face restacking of the 2D nanosheets and also as a coating layer to significantly protect MXene from oxidation. Consequently, the rGO/MXene-PPy electrode exhibits a high specific capacitance of 408.2 F g-1 and a superior rate performance, with 67.3% capacitance retention at an increased current density of 10.0 A g-1. Furthermore, the as-assembled asymmetric supercapacitor possesses a pronounced energy density of 11.3 Wh kg-1 (35.5 Wh L-1) at a power density of 500.0 W kg-1 (1570.0 W L-1) and remarkable cycling stability, with 8.8% capacitance deterioration after 10,000 cycles. This work demonstrates the potential for application of as-prepared rGO/MXene-PPy electrodes in flexible energy storage devices with high volumetric/gravimetric energy and power densities.

Risk Factors and Oncologic Outcomes for Clinical T1 Renal Cell Carcinoma Upstaging to Pathological T3a and The Construction of Predictive Model: A Retrospective Study.

PURPOSE: The study is intended to identify the independent predictors of clinical T1 (cT1) renal cell carcinoma upstaging to pathological T3a (pT3a) and construct the predictive nomogram model. METHODS: The data of cT1 renal cell carcinoma was collected from patients who were treated in the Second Hospital of Tianjin Medical University from January 2010 to December 2016. Mann-Whitney U and chi-square tests were performed to analyze continuous and categorical variables respectively. Univariate and multivariate logistic regression were used to identify the predictors of upstaging. Kaplan-Meier method, log-rank test and Cox regression were performed to analyze survival materials. RESULTS: Among 1,376 cT1 renal cell carcinoma patients, 75 patients were observed upstaging to pT3a, accounting for 5.5%. There were 6 potential predictors of upstaging, i.e age, clinical symptom, tumor size, Fuhrman grade, tumor necrosis and tumor edge regularity. The 5-year recurrence free survival probabilities of upstaging and non-upstaging patients were 73.3% and 91.1%, respectively and upstaging was an independent predictor of recurrence free survival. Two predictive nomograms were constructed and the C-index of them were 0.842 and 0.806, and the calibration curve and decision curve analysis showed highly clinical accuracy of the nomograms. CONCLUSION: Two nomogram models were built to predict the probability of cT1 renal cell carcinoma upstaging to pT3a with highly accuracy and specificity. Upstaging was an independent risk factor of recurrence free survival for cT1 renal cell carcinoma patients.

Deep Q networks-based optimization of emergency resource scheduling for urban public health events.

In today's severe situation of the global new crown virus raging, there are still efficiency problems in emergency resource scheduling, and there are still deficiencies in rescue standards. For the happiness and well-being of people's lives, adhering to the principle of a community with a shared future for mankind, the emergency resource scheduling system for urban public health emergencies needs to be improved and perfected. This paper mainly studies the optimization model of urban emergency resource scheduling, which uses the deep reinforcement learning algorithm to build the emergency resource distribution system framework, and uses the Deep Q Network path planning algorithm to optimize the system, to achieve the purpose of optimizing and upgrading the efficient scheduling of emergency resources in the city. Finally, through simulation experiments, it is concluded that the deep learning algorithm studied is helpful to the emergency resource scheduling optimization system. However, with the gradual development of deep learning, some of its disadvantages are becoming increasingly obvious. An obvious flaw is that building a deep learning-based model generally requires a lot of CPU computing resources, making the cost too high.