Favorable effects of open surgery on patients with extensive skull base osteoradionecrosis through a personalized sequential approach: A case series.

The present study aimed to investigate outcomes following open surgery for extensive skull base ORN. Open surgery through a personalized sequential approach was employed to deal with five cases of extensive skull base ORN. Two patients with mild cases underwent regional debridement and sequestrectomy, and three patients with severe cases underwent extensive resection with reconstruction using free anterolateral thigh (ALT) flap. Biological glues and vascularized flaps were used for obturation of the skull base bony defect to prevent postoperative cerebrospinal fluid (CSF) leakage. The infections were controlled by antibiotic administrations which strictly followed the principles of antimicrobial stewardship (AMS). As results, both regional debridement plus sequestrectomy and extensive resection achieved satisfied outcomes in all patients. No severe complications and delayed hospitalization occurred. During the follow-up period (8-19 months), all patients were alive, pain free, without crusting or purulent discharge, and no sequestration or CSF leakage occurred. In conclusion, a personalized sequential approach including open surgery, pedicled/vascularized free flap reconstruction and AMS was advocated for patients with extensive skull base ORN.

Improved STMask R-CNN-based defect detection model for automatic visual inspection of an optics lens.

A lens defect is a common quality issue that has seriously harmed the scattering characteristics and performance of optical elements, reducing the quality consistency of the finished products. Furthermore, the energy hotspots coming from the high-energy laser through diffraction of optical component defects are amplified step by step in multi-level laser conduction, causing serious damage to the optical system. Traditional manual detection mainly relies on experienced workers under a special light source environment with high labor intensity, low efficiency, and accuracy. The common machine vision techniques are incapable of detecting low contrast and complex morphological defects. To address these challenges, a deep learning-based method, named STMask R-CNN, is proposed to detect defects on the surface and inside of a lens in complex environments. A Swin Transformer, which focuses on improving the modeling and representation capability of the features in order to improve the detection performance, is incorporated into the Mask R-CNN in this case. A challenge dataset containing more than 3800 images (18000 defect sample targets) with five different types of optical lens defects was created to verify the proposed approach. According to our experiments, the presented STMask R-CNN reached a precision value of 98.2%, recall value of 97.7%, F1 score of 97.9%, mAP@0.5 value of 98.1%, and FPS value of 24 f/s, which outperformed the SSD, Faster R-CNN, and YOLOv5. The experimental results demonstrated that the proposed STMask R-CNN outperformed other popular methods for multiscale targets, low contrast target detection and nesting, stacking, and intersecting defects sample detection, exhibiting good generalizability and robustness, as well as detection speed to meet mechanical equipment production efficiency requirements. In general, this research offers a favorable deep learning-based method for real-time automatic detection of optical lens defects.

Malignant transformation of an aneurysmal bone cyst of the femoral neck: A case report.

Aneurysmal bone cyst (ABC) is a benign, distending, osteolytic and locally aggressive bone tumor that is mostly associated with trauma. Approximately 1% of bone tumors are ABCs, which are most prevalent in adolescents and are usually detected in the spine and long tubular bones. The diagnosis of ABC mainly relies on histopathology, malignant transformation is rare, and the chance of malignancy increases if there are multiple recurrences. Due to the rarity of reports of malignant transformation of ABCs into osteosarcoma, there is still considerable debate on the appropriate treatment strategy. The current paper presents a case of aneurysmal bone cyst malignant to osteosarcoma and the therapeutic measures to provide expertise for the diagnosis and treatment of ABCs that are malignant to osteosarcoma.

A systematic review and meta-analysis comparing outcomes following total knee arthroplasty for rheumatoid arthritis versus for osteoarthritis.

PURPOSE: Total knee arthroplasty (TKA) in patients with osteoarthritis (OA) are considered to be a successful procedure, but with little being known about outcomes in patients with rheumatoid arthritis (RA). The aim of this study was to compare the outcomes of TKA in patients with RA versus OA. METHODS: Data were obtained from PubMed, Cochrane Library, EBSCO and Scopus for all available studies comparing the outcomes of THA in RA and OA patients (From January 1, 2000 to October 15, 2022). Outcomes of interest included infection, revision, venous thromboembolism (VTE), mortality, periprosthetic fractures, prosthetic loosening, length of stay, and satisfaction. Two reviewers independently assessed each study for quality and extracted data. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). RESULTS: Twenty-four articles with a total 8,033,554 patients were included in this review. The results found strong evidence for increased risk of overall infection (OR = 1.61, 95% CI, 1.24-2.07; P = 0.0003), deep infection (OR = 2.06, 95% CI, 1.37-3.09; P = 0.0005), VTE (OR = 0.76, 95% CI, 0.61-0.93; P = 0.008), pulmonary embolism (PE) (OR = 0.84, 95% CI, 0.78-0.90; P<0.00001), periprosthetic fractures (OR = 1.87, 95% CI, 1.60-2.17; P<0.00001); and reasonable evidence for increased risk of deep venous thrombosis (DVT) (OR = 0.74, 95% CI, 0.54-0.99; P = 0.05), and length of stay (OR = 0.07, 95% CI, 0.01-0.14; P = 0.03) after TKA in patients with RA versus OA. There were no significant differences in superficial site infection (OR = 0.84,95% CI, 0.47-1.52; P = 0.57), revision (OR = 1.33,95% CI, 0.79-2.23; P = 0.28), mortality (OR = 1.16,95% CI, 0.87-1.55; P = 0.32), and prosthetic loosening (OR = 1.75, 95% CI, 0.56-5.48; P = 0.34) between the groups. CONCLUSION: Our study demonstrated that patients with RA have a higher risk of postoperative infection, VTE, periprosthetic fracture, and lengths of stay, but did not increase revision rate, prosthetic loosening and mortality compared to patients with OA following TKA. In conclusion, despite RA increased incidence of postoperative complications, TKA should continue to be presented as an effective surgical procedure for patients whose conditions are intractable to conservative and medical management of RA.

Cementless total hip arthroplasty for treatment of acetabular protrusion secondary to rheumatoid arthritis.

BACKGROUND: To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). METHODS: From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6-15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. RESULTS: The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. CONCLUSIONS: Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.

Osteoblastoma of the patella, a rare benign bone tumor with an uncommon site: A case report.

Osteoblastoma is a rare, benign, bone-forming tumor that is frequently observed in the spine and long tubular bones. There are very few reports available on osteoblastoma of the patella. The present study reported an extremely rare case of a 22-year-old male adult who presented with an osteoblastoma of the patella. He was treated via intralesional curettage of the patella with subsequent bone grafting. After the intervention, he made an uneventful recovery with no recurrence after a follow-up of 2 years. Making an accurate diagnosis of osteoblastoma of the patella is challenging and important for determining the correct treatment modality and prognosis, therefore, the present case may be helpful in the diagnosis and treatment of osteoblastoma of the patella.

Comparable clinical outcomes of culture-negative and culture-positive periprosthetic joint infections: a systematic review and meta-analysis.

PURPOSE: The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic joint infection (CP PJI). METHODS: Data were obtained from Embase, Web of Science and EBSCO for all available studies comparing the clinical outcomes of CN PJI with those of CP PJI. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess clinical outcomes. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg's funnel plot. Sensitivity analysis was performed to test the stability of pooled results. RESULTS: Thirty studies with 1630 (38.7%) CN PJI and 2577 (61.3%) CP PJI were included in this meta-analysis. The pooled results of the included studies showed that overall failure rate in CN PJI group (19.0%, 309/1630) was significantly lower than that in CP PJI group (23.4%, 604/2577) (OR 0.63, 95% CI 0.47-0.84, P = 0.002). We performed the subgroup analysis based on the surgical strategies, the pooled results of nine studies for patients undergoing debridement, antibiotics and implant retention (DAIR) revealed that failure rate in CN PJI group (22.2%, 53/239) was significantly lower than that in CP PJI group (29.3%, 227/775) (OR 0.62, 95% CI 0.43-0.90, P = 0.01), the pooled results of four studies for patients undergoing one-stage revision revealed that failure rate between CN PJI group (11.5%, 11/96) and CP PJI group (7.6%, 27/355) had no significant difference (OR 1.57, 95% CI 0.75-3.26, P = 0.23), and the pooled results of 19 studies for patients undergoing two-stage revision revealed that failure rate in CN PJI group (16.1%, 171/1062) was significantly lower than that in CP PJI group (20.4%, 206/1010) (OR 0.52, 95% CI 0.34-0.79, P = 0.002). CONCLUSIONS: CN PJI group had similar or better survival rate when compared with CP PJI group for patients who underwent DAIR, one-stage or two-stage revision. Negative culture was not a worse prognostic factor for PJI.

Effect of a reused insulin needle remaining in a patient's body.

Diabetes is one of the most common chronic diseases at present, and insulin pen injection therapy plays an important role in the treatment of diabetes. However, the majority of patients might reuse disposable insulin pen needles for various reasons, which leads to related complications. As far as we know, this article is the first to describe a patient whose needle remained in the right upper limb while reusing a disposable insulin injection needle for subcutaneous insulin injection with the non-dominant hand. The patient went to the doctor 1 week later. The needle moved from the lateral area of the proximal upper arm (the injection site) to the posterolateral area of the distal upper arm. The needle was then successfully removed by surgery. The reuse of disposable insulin pen needles might lead to serious complications. It is suggested to strengthen the education of people living with diabetes to help them use insulin pen needles safely.

Clinical effects of interspace between the popliteal artery and capsule of the posterior knee block with multimodal analgesia for total knee arthroplasty: a systematic review and meta-analysis.

PURPOSE: Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty. METHODS: Data were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included. RESULTS: Seventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8-12(95%CI - 0.85 [- 1.36, - 0.34], I2 = 94%, p = 0.001), postoperative day 1 (95% CI - 0.49 [- 0.85, - 0.14], I2 = 87%, p = 0.006), and postoperative day 2 (95% CI - 0.28 [- 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI - 0.14 [- 0.33, 0.05], I2 = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8-12 (95%CI - 0.52 [- 0.92, - 0.12], I2 = 86%, p = 0.01) and postoperative day 1(95% CI - 0.49 [- 0.87, - 0.11], I2 = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI - 0.29 [- 0.63, 0.05], I2 = 80%, p = 0.09), postoperative day 3 or discharge (95% CI - 0.45 [- 0.92, 0.02], I2 = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI - 0.76 [- 1.13, - 0.39], I2 = 85%, p < 0.00001), 24-48 H (95% CI - 0.43 [- 0.85, - 0.01], I2 = 83%, p = 0.04), and total opioid use (95% CI - 0.64 [- 1.07, - 0.22], I2 = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI - 0.40 [- 0.64, - 0.15], I2 = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I2 = 87%, p = 0.04). CONCLUSION: Based on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.

A visual defect detection for optics lens based on the YOLOv5 -C3CA-SPPF network model.

Defects in the optical lens directly affect the scattering properties of the optical lens and decrease the performance of the optical element. Although machine vision instead of manual detection has been widely valued, the feature fusion technique of series operation and edge detection cannot recognize low-contrast and multi-scale targets in the lens. To address these challenges, in this study, an improved YOLOv5-C3CA-SPPF network model is proposed to detect defects on the surface and inside of the lens. The hybrid module combining the coordinate attention and CSPNet (C3) is incorporated into YOLOv5-C3CA for improving the extraction of target feature information and detection accuracy. Furthermore, an SPPF features fusion module is inserted into the neck of the network model to improve the detection accuracy of the network. To enhance the performance of supervised learning algorithms, a dataset containing a total of 3800 images is created, more than 600 images for each type of defect samples. The outcome of the experiment manifests that the mean average precision (mAP) of the YOLOv5-C3CA-SPPF algorithm is 97.1%, and the detection speed FPS is 41 f/s. Contrast to the traditional lens surface defects detection algorithms, YOLOv5-C3CA-SPPF can detect the types of optical lens surface and inside defects more accurately and quickly, the experimental results show that the YOLOv5-C3CA-SPPF model for identifying optical lens defects has good generalizability and robustness, which is favorable for on-line quality automatic detection of optical lens defects and provide an important guarantee for the quality consistency of finished products.

Fibrous hamartoma of infancy with bone destruction of the tibia: A case report.

BACKGROUND: Fibrous hamartoma of infancy (FHI) is a rare disease of infancy with unknown etiology. The disease mainly involves soft tissue, has no specific clinical manifestations, and is difficult to diagnose. At present, the diagnosis is mainly confirmed by histopathological examination, and the main treatment is surgical resection of the pathological tissue, which is prone to recurrence. CASE SUMMARY: A five-month-old female patient was admitted to our hospital with swelling in the right calf. Two biopsies were performed in our hospital and another hospital, respectively, confirming the diagnosis as fibrous hamartoma. After exclusion of surgical contraindications, resection was performed with clear margins of 1 cm. Radiographic examination showed tumor recurrence more than four months after the operation, and surgery was performed again to extend the resection margins to 1.5 cm. The patient is recovering well, and after a follow-up of 36 mo, shows no signs of recurrence. CONCLUSION: Our case report demonstrates that FHI should be considered in the differential diagnosis for a lower extremity mass with bone destruction. For FHI with bone destruction and unclear boundaries, excision margins of 1.5 cm could be superior to margins of 1 cm.

Adaptive equalization based on dynamic compressive sensing for single-carrier multiple-input multiple-output underwater acoustic communications.

The sparse property of a direct adaptive equalizer (DAE) for single-carrier underwater acoustic communications is well recognized. It has been used to improve the performance and/or reduce the complexity of a DAE. Extensive investigations have been performed in terms of performance improvement. On the contrary, research on complexity reduction remains preliminary. A fundamental way for reducing the complexity of a DAE is to keep only significant taps while discarding trivial taps, that is, to run a partial-tap DAE. Existing partial-tap DAE designs assume a slowly varying sparse structure and may suffer performance degradation under a severe underwater environment. Motivated by this fact, the dynamic compressed sensing (DCS) technique is resorted to and a partial-tap DAE based on the sparse adaptive orthogonal matching pursuit-affine projection algorithm is proposed. The sparse adaptive orthogonal matching pursuit-affine projection algorithm-direct adaptive equalizer (SpAdOMP-APA-DAE) achieves symbol-wise updating of both positions and values of the significant coefficients. In this paper, a more extensive study on DCS-based DAEs is performed, and an enhanced dynamic compressed sensing-direct adaptive equalizer design enabled by the sparse adaptive subspace pursuit-improved proportionate affine projection algorithm (SpAdOMP-IPAPA) is proposed. The sparse adaptive subspace pursuit-improved proportionate affine projection algorithm-direct adaptive equalizer enjoys lower complexity while better performance than the previous SpAdOMP-APA-DAE. Experimental results corroborated the superiority of the SpAdOMP-IPAPA-DAE.

Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study.

BACKGROUND: Periprosthetic joint infection (PJI) is a catastrophic complication that can occur following total knee arthroplasty (TKA). Currently, the treatment for PJI mainly includes the use of antibiotics alone, prosthetic debridement lavage, primary revision, secondary revision, joint fusion, amputation, etc. AIM: To explore the clinical effect of two-stage revision surgery for the treatment of PJI after TKA. METHODS: The clinical data of 27 patients (3 males and 24 females; age range, 47-80 years; mean age, 66.7 ± 8.0 years; 27 knees) with PJI treated with two-stage revision surgery in our hospital between January 1, 2010 and December 31, 2020 were analyzed retrospectively. The following outcomes were compared for changes between preoperative and last follow-up results: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS) scores, Hospital for Special Surgery (HSS) scores, knee range of motion (ROM), and infection cure rates. RESULTS: All 27 patients were followed up (range, 13-112 mo). The ESR (14.5 ± 6.3 mm/h) and CRP (0.6 ± 0.4 mg/dL) of the patients at the last follow-up were significantly lower than those at admission; the difference was statistically significant (P < 0.001). The postoperative VAS score (1.1 ± 0.7), HSS score (82.3 ± 7.1), and knee ROM (108.0° ± 19.7°) were significantly improved compared with those before the surgery; the difference was statistically significant (P < 0.001). Of the 27 patients, 26 were cured of the infection, whereas 1 case had an infection recurrence; the infection control rate was 96.3%. CONCLUSION: Two-stage revision surgery can effectively relieve pain, control infection, and retain good joint function in the treatment of PJI after TKA.

Role of craniofacial surgery in oral and maxillofacial tumors involving the skull base: A retrospective analysis of 126 patients.

OBJECTIVES: Oral and maxillofacial tumors involving the skull base (SB) are rare and complex, making treatment difficult and controversial. The purpose of the present study was to evaluate the treatment efficacy of craniofacial surgery (CFS). STUDY DESIGN: Patients who underwent CFS for these tumors between May 2000 and November 2017 were retrospectively analyzed. Clinicopathologic and treatment modality data were collected and follow-up was recorded. Kaplan-Meier and log-rank tests and Cox-regression model were used for survival analysis. RESULTS: In total, 126 patients were enrolled (70 males and 56 females; 97 malignant tumors). Squamous cell carcinoma accounted for the majority of tumors. The lip-submandibular-neck approach was most frequently applied. Through-and-through SB bone or partial dura resection was performed in 42 cases. A pathologic positive margin was found in 18 cases. Of the included patients, 80 underwent simultaneous craniofacial reconstruction. The postoperative complications rate was 11.1%. Estimated 1-year, 3-year, and 5-year overall survival rates were 78.8%, 68.2%, and 54.4% respectively; and the 1-year, 3-year, and 5-year recurrence-free survival rates were 77.4%, 66.8%, and 63.8%, respectively. Multivariate analysis indicated postoperative complications, radiotherapy, recurrence, and metastasis status had a negative impact on survival (P < .05). CONCLUSIONS: Although tumors involving the SB had various clinicopathologic characteristics, with interdisciplinary cooperation, CFS is an optimal option.

CA9 transcriptional expression determines prognosis and tumour grade in tongue squamous cell carcinoma patients.

CA9 is a member of the carbonic anhydrases' family, that is often expressed in cancer cells under hypoxic condition. However, the role of CA9 in the molecular mechanisms of tongue squamous cell carcinoma (TSCC) pathogenesis remains unclear. CA9 expression was analysed using the TCGA database, and its influence on survival was performed using Kaplan-Meier, LASSO and COX regression analyses. The correlation between CA9 and immune infiltration was investigated by CIBERSORT and ESTIMATE. Moreover, the relationship between CA9 expression and downstream molecular regulation pathways was analysed by GSEA, GO and WGCNA. CA9 expression correlated with clinical prognosis and tumour grade in TSCC. Moreover, CA9 expression potentially contributes to the regulation of cancer cell differentiation and mediates tumour-associated genes and signalling pathways, including apoptosis, hypoxia, G2M checkpoint, PI3K/AKR/mTOR signalling and TGF-beta signalling pathways. However, the follicular helper T cells, regulatory T cells, immune and stromal scores showed no significance between high and low CA9 expression groups. These findings suggested that CA9 plays a critical role of TSCC prognosis and tumour grade. CA9 expression significantly correlated with the regulation of cell differentiation, various oncogenes and cancer-associated pathways.

[Periprosthetic joint infection after artificial joint replacement and preoperative anemia].

Periprosthetic joint infection is the most serious complication after artificial joint arthroplasty. Epidemiological investigation has indicated that perioperative anemia is an independent risk factor for periprosthetic joint infection, which could play an important role by suppressing cellular mechanisms and autoimmune functions. Many domestic and overseas scholars have studied the relationship between periprosthetic joint infection and postoperative anemia, but the relationship between preoperative anemia and periprosthetic joint infection is relatively rare. However, preoperative anemia can reduce the C3b receptor on surface of red blood cells, decrease immune function of the body, increase blood-borne infection, prolong postoperative rehabilitation time, and lead to periprosthetic joint infection. For patients with preoperative anemia, prophylactic antibiotics could be used to prevent. And complement chalybeate used before operation, correct anemia by hemopoietin, treat chronic complications influence by hemoglobin production and improve patient's own immune status, blood transfusion treatment for patients with blood transfusion indications are performed. It could be better prevent occurrence of periprosthetic joint infection after total joint arthroplasty, and reducing chance of secondary or multiple renovations.