Exploring Aqueous Solution-Processed Pseudohalide Rare-Earth Double Perovskite Ferroelectrics toward X-ray Detection with High Sensitivity.

Three-dimensional (3D) pseudohalide rare-earth double perovskites (PREDPs) have garnered significant attention for their versatile physical properties, including ferroelectricity, ferroelasticity, large piezoelectric responses, and circularly polarized luminescence. However, their potential for X-ray detection remains unexplored, and the low Curie temperature (TC) limits the performance window for PREDP ferroelectrics. Here, by applying the chemical regulation strategies involving halogen substitution on the organic cation and Rb/Cs substitution to the PREDP [(R)-M3HQ]2RbEu(NO3)6 [(R)-M3HQ = (R)-N-methyl-3-hydroxylquinuclidinium] with a low TC of 285 K, a novel 3D PREDP ferroelectric [(R)-CM3HQ]2CsEu(NO3)6 [(R)-CM3HQ = (R)-N-chloromethyl-3-hydroxylquinuclidinium] are successfully synthesized, for which the TC reaches 344 K. More importantly, such a strategy endowed [(R)-CM3HQ]2CsEu(NO3)6 with notable X-ray detection capabilities. Centimeter-sized [(R)-CM3HQ]2CsEu(NO3)6 single crystals fabricated from aqueous solutions demonstrated a sensitivity of 1307 µC Gyair-1 cm-2 and a low detectable dose rate of 152 nGyair s-1, the highest sensitivity reported for hybrid double perovskite ferroelectric detectors. This work positions PREDPs as promising candidates for the next generation of eco-friendly optoelectronic materials and also offers substantial insights into the interaction between structure, composition, and functionality in ferroelectric materials.

Distinct phenotypic clusters of sleep-disordered breathing and their association with medical care-seeking behaviour and sleep habits: the Guangdong Sleep Health Study.

Sleep-disordered breathing (SDB) is highly prevalent, but its rates of diagnosis and treatment are low. As a heterogeneous condition, it is associated with delayed diagnosis and/or suboptimal treatment. We aimed to determine distinct SDB clusters and examine their association with medical care-seeking behaviour and sleep habits in a community-dwelling population in South China. Participants were enrolled in the 'Guangdong Sleep Health Study'. Five distinct community sites were investigated. Participant information was collected, and overnight sleep monitoring was performed. Latent class analysis was performed to classify patients with SDB based on patterns of SDB-related symptoms and signs. Overall, 1,524 patients with SDB were evaluated. Four distinct clusters were identified: 'minimally symptomatic' (Cluster 2), which was the most dominant subtype (41.6%), followed by 'pure insomnia/fewer daytime symptoms' (Cluster 4; 24.7%), 'insomnia/multiple daytime symptoms' (Cluster 3; 17.8%), and 'upper airway symptoms with sleepiness' (Cluster 1; 15.9%). The overall medical care-seeking rate attributable to sleep and breathing disorders was only 3.3%: 10.3% in Cluster 3, 2.5% in Cluster 1, 2.1% in Cluster 4, and 1.3% in Cluster 2, in which Cluster 3 was the highest and Cluster 2 was the lowest (adjusted p < 0.05). Regarding the sleep habit of going to bed and waking up at a consistent time, Cluster 3 exhibited the worst performance and Cluster 2 the best. In conclusion, distinct phenotypic subtypes were identified in community-dwelling patients with SDB. Tailored strategies to encourage medical care-seeking, early identification, and optimisation of treatment are necessary considering the different subtypes.

The association of nocturnal hypoxemia with dyslipidemia in sleep-disordered breathing population of Chinese community: a cross-sectional study.

BACKGROUND: Currently, there is limited and controversial clinical research on the correlation between sleep-disordered breathing (SDB) and dyslipidemia. This discrepancy in findings may be because studies that primarily focused on hospital-based populations may not be applicable to community-based populations. Therefore, the primary objective of this research endeavor is to scrutinize the correlation between nocturnal hypoxemia and blood lipid concentrations among adult individuals residing in the community who exhibit symptoms of SDB. Additionally, this study aimed to identify the nocturnal hypoxia parameters having the strongest correlation with this relationship. METHODS: This cross-sectional study collected data from The Guangdong Sleep Health Study, which included 3829 participants. Type IV sleep monitoring was employed to measure hypoxemia parameters, and lipoproteins were evaluated using fasting blood samples. To understand the association between dyslipidemia and hypoxemia parameters, a multivariable logistic regression model was used. Subgroup analyses were conducted to stratify data according to age, sex, waist circumference, and chronic diseases. RESULTS: The age of the individuals involved in the study spanned from 20 to 90 years. The average age of the participants was 56.15 ± 13.11 years. Of the total sample size, 55.7% were male. In the fully adjusted model, the meanSpO2 was negatively associated with hyperlipidemia (0.9303 [95% confidence interval 0.8719, 0.9925]). Upon conducting a nonlinearity test, the relationship between the meanSpO2 and hyperlipidemia was nonlinear. The inflection points were determined to be 95. When meanSpO2 ≥ 95%, a difference of 1 in the meanSpO2 corresponded to a 0.07 difference in the risk of hyperlipidemia. CONCLUSIONS: This study revealed that higher meanSpO2 is significantly and negatively associated with hyperlipidemia in adult community residents with SDB, particularly when the meanSpO2 exceeds 95. This finding emphasizes the importance of close monitoring for dyslipidemia, which is considered an early indicator of atherosclerosis in patients with SDB who experience nocturnal hypoxia.

Comparative study of a wearable intelligent sleep monitor and polysomnography monitor for the diagnosis of obstructive sleep apnea.

PURPOSE: Due to the lack of an objective population-based screening tool for obstructive sleep apnea (OSA), a large number of patients with potential OSA have not been identified in the general population. Our study compared an objective wearable sleep monitoring device with polysomnography (PSG) to provide a reference for OSA screening in a large population. METHODS: Using a self-control method, patients admitted to our sleep center from July 2020 to March 2021 were selected for overnight PSG and wearable intelligent sleep monitor (WISM) at the same time. The sensitivity and specificity of the device for the diagnosis of OSA were evaluated. RESULTS: A total of 196 participants (mean age: 45.1 ± 12.3 years [18-80 years]; 168 men [86%]) completed both PSG and WISM monitoring. Using an apnea-hypopnea index (AHI) ≥ 5 events/h as the diagnostic criterion, the sensitivity, specificity, kappa value, and area under the receiver operating characteristic curve of the WISM for OSA diagnosis were 93%, 77%, 0.6, and 0.95, respectively. Using an AHI ≥ 15 events/h as the diagnostic criterion for moderate-to-severe OSA, these values were 92%, 89%, 0.8, and 0.95, respectively. The mean difference in the AHI between PSG and the artificial intelligence oxygen desaturation index from the WISM was 6.8 events/h (95% confidence interval: - 13.1 to 26.7). CONCLUSION: Compared with the PSG, WISM exhibits good sensitivity and specificity for the diagnosis of OSA. This small, simple, and easy-to-use device is more suitable for OSA screening in a large population because of its single-step application procedure.

Effects of cyclic fluid stress at different frequencies on behaviors of cells incubated on titanium alloy.

The orthopedic external fixation is always in dynamic mechanical environment with the somatic movement. We used a self-designed mini oscillator to simulate this condition by providing the reciprocating cyclic fluid stress, and observed the behavioral responses of fibroblasts implanted on titanium alloy plane to the stress at different frequencies, including 0.2 Hz, 0.6 Hz, and 1.0 Hz. We found that the cell angle, shape index and expression of vinculin were mostly biphasic-dependent with the increase of frequency, with peaks at 0.6 Hz. Whereas the cell area, expression of Col-I and α-SMA were mainly affected by the 1.0 Hz stress. Interestingly, 1.0 Hz stress also promoted Col-I expression of bone marrow mesenchymal stem cells (BMSCs), although it did not increase α-SMA. These results reveal that 0.6 Hz stress improves the alignment, polarity and adherence of fibroblasts on titanium alloy substrates, thus improving the sealing of implants; the 1.0 Hz force activates the differentiation of fibroblasts into myofibroblasts and increases collagen produced by stem cells, which probably cause the formation of fibrous capsules around implants.

Lower expression of Bax predicts poor clinical outcome in patients with glioma after curative resection and radiotherapy/chemotherapy.

BACKGROUND: The prognosis in patients with gliomas after surgical resection followed by radiotherapy and/or chemotherapy is still very poor. The pro-apoptotic protein Bax, a short-lived protein in cancers, plays important roles in the sensitivity of glioma cells to spontaneous and therapy-induced apoptosis but and its prognostic value in gliomas is unknown. METHODS: By an immunohistochemical method, we determined Bax protein expression from 96 patients with gliomas after curative resection. Two statistical analyses were performed to evaluate the prognostic significance of Bax protein: an independent continuous and a multivariate categorical analysis, with test/validation set-defined cut points, and Kaplan-Meier estimated outcome measures of overall survival (OS) and relapse-free survival (RFS). RESULTS: Bax protein levels in glioblastoma were significantly decreased compared with grade II gliomas. Lower levels of Bax expression confer worse OS (continuous P = 0.025; categorical P = 0.003) and RFS (continuous P = 0.014; categorical P < 0.0001) and negatively correlate with the grades of gliomas. Patients underwent radiotherapy followed by surgical resection showed significantly increased OS (median = 45 vs. 17 months) and RFS (median = 39 vs. 16 months). Patients with higher levels of Bax and radiotherapy showed greatly increased survival rates (median OS = 66 months and median RFS = 105 months). Lower expression of Bax also confers inferior clinical outcome for gliomas patients after chemotherapy with temozolomide (OS and RFS P < 0.0001). CONCLUSION: Decreased expression of Bax correlates with poor clinical outcome in patients with gliomas. We propose that Bax protein levels can be used as a reliable prognostic marker for risk-stratify patients with gliomas after curative resection and radiotherapy and/or chemotherapy.

RIPK4 promotes bladder urothelial carcinoma cell aggressiveness by upregulating VEGF-A through the NF-κB pathway.

BACKGROUND: Constitutively activated nuclear factor kappa B (NF-κB) signalling plays vital roles in bladder urothelial carcinoma (BC) progression. We investigate the effect of receptor-interacting protein kinase 4 (RIPK4) on NF-κB activation and BC progression. METHODS: The expression of RIPK4 was examined in 25 cryopreserved paired bladder samples and 112 paraffin BC specimens. In vivo and in vitro assays were performed to validate effect of RIPK4 on NF-κB pathway-mediated BC progression. RESULTS: High expression of RIPK4 was observed in BC tissues and was an independent predictor for poor overall survival. Up or downregulating the expression of RIPK4 enhanced or inhibited, respectively, the migration and invasion of BC cells in vitro and in vivo. Mechanistically, RIPK4 promoted K63-linked polyubiquitination of tumour necrosis factor receptor-associated factor 2 (TRAF2), receptor-interacting protein (RIP) and NF-κB essential modulator (NEMO). RIPK4 also promoted nuclear localisation of NF-κB-p65, and maintained activation of NF-κB substantially, leading to upregulation of VEGF-A, ultimately promoting BC cell aggressiveness. CONCLUSIONS: Our data highlighted the molecular aetiology and clinical significance of RIPK4 in BC: upregulation of RIPK4 contributes to NF-κB activation, and upregulates VEGF-A, and BC progression. Targeting RIPK4 might represent a new therapeutic strategy to improve survival for patients with BC.

MicroRNA-26b Enhances the Radiosensitivity of Hepatocellular Carcinoma Cells by Targeting EphA2.

Sensitizing hepatocellular carcinoma (HCC) cells to irradiation is important to achieve satisfactory therapeutic effect with low-dose radiotherapy. Erythropoietin-producing hepatocellular carcinoma A2 (EphA2) is a member of the Eph receptor family that constitutes the largest family of tyrosine kinase receptors. EphA2 overexpression is one of the poor prognostic factors in many progressive cancers. Importantly, EphA2 is a potential target of microRNA-26b (miR-26b), and miR-26b expression is down-regulated in several types of cancer. In this study, we measured the expression levels of miR-26b and EphA2 protein in seven human HCC cell lines by quantitative PCR and western blot analysis, respectively. Overall, lower miR-26b expression levels tended to be associated with higher EphA2 levels in HCC cell lines. Among the cell lines examined, 97H HCC cells expressed the lowest level of miR-26b and highest level of EphA2 protein. Thus, using 97H HCC cells, EphA2 mRNA was verified as the target of miR-26b by the luciferase reporter assay. Accordingly, a synthetic miR-26b, miR-26b mimics, was used to mimic the function of endogenous miR-26b. In 97H HCC cells transfected with miR-26b mimics or short-hairpin RNA targeting EphA2 mRNA, expression of EphA2 protein was reduced, which was associated with significantly lower proliferation rate and invasion ability and with higher apoptosis rate in response to low-dose irradiation, compared to control cells. In contrast, 97H HCC cells over-expressing EphA2 showed higher proliferation rate and invasion ability and lower apoptosis rate upon irradiation. These data suggest that miR-26b enhances the radiosensitivity of 97H HCC cells by targeting EphA2 protein.

Determination of Component Contents of Blend Oil Based on Characteristics Peak Value Integration.

Edible blend oil market is confused at present. It has some problems such as confusing concepts, randomly named, shoddy and especially the fuzzy standard of compositions and ratios in blend oil. The national standard fails to come on time after eight years. The basic reason is the lack of qualitative and quantitative detection of vegetable oils in blend oil. Edible blend oil is mixed by different vegetable oils according to a certain proportion. Its nutrition is rich. Blend oil is eaten frequently in daily life. Different vegetable oil contains a certain components. The mixed vegetable oil can make full use of their nutrients and make the nutrients more balanced in blend oil. It is conducive to people's health. It is an effectively way to monitor blend oil market by the accurate determination of single vegetable oil content in blend oil. The types of blend oil are known, so we only need for accurate determination of its content. Three dimensional fluorescence spectra are used for the contents in blend oil. A new method of data processing is proposed with calculation of characteristics peak value integration in chosen characteristic area based on Quasi-Monte Carlo method, combined with Neural network method to solve nonlinear equations to obtain single vegetable oil content in blend oil. Peanut oil, soybean oil and sunflower oil are used as research object to reconcile into edible blend oil, with single oil regarded whole, not considered each oil's components. Recovery rates of 10 configurations of edible harmonic oil is measured to verify the validity of the method of characteristics peak value integration. An effective method is provided to detect components content of complex mixture in high sensitivity. Accuracy of recovery rats is increased, compared the common method of solution of linear equations used to detect components content of mixture. It can be used in the testing of kinds and content of edible vegetable oil in blend oil for the food quality detection, and provide an effective reference for the creation of national standards.

[Research on Spectroscopy Spectrum De-Noising of Mineral Oil Based on Lifting Scheme Wavelet Transform].

The use of the mineral oil is an important cause of air pollution such as fog. The effectiveness and rapidity of the de-noising processing in mineral oil fluorescence spectroscopy detection system is a hot issue of the online real-time monitoring system. The de-noising method of the lifting wavelet transform (LWT) in the application of mineral oil fluorescence spectrum is proposed. Compared with traditional discrete wavelet transform (DWT), this wavelet transform method decomposes the existing wavelet filter module into the basic construction modules and steps to complete the transform with simplicity and a fast speed. There are characteristics of low computational complexity, in situ operation and the easy implement in the denoising process of mineral oil fluorescence spectra. The LWT can effectively solve the problems in these respects. The three methods of LWT, DWT and EMD are applied to the fluorescence spectra of 0# diesel oil, 97# gasoline and kerosene. The indicators evaluating de-noising effect such as the Signal-to-Noise Ratio (SNR), Mean Squared Error (MSE) and Normalied Correlation Coefficient (NCC) of the three kinds of mineral oil in the fluorescence spectra denoising prove the effectiveness of the lifting scheme wavelet transform in the application of mineral oil fluorescence spectrum. Meanwhile, the lifting scheme transform can improve the flexibility of structure and operation simplicity that makes the de-noising time reduced by 62%, validating the speediness of the de-noising method of the LWT in the application of mineral oil fluorescence spectrum and it is suitable for mineral oil fast de-noising processing system in real time.

[Clinical Application of Cardiac Magnetic Resonance Imaging in a Tertiary Referral Hospital in China].

OBJECTIVES: To review clinical application of cardiac magnetic resonace (CMR) imaging in a tertiary hospital. METHODS: A total of 344 medical records were reviewed in relation to the use of CMR imaging over one year period in a tertiary hospital in China. Data regarding indications for CMR imaging, cardiac structure and function, late gadolinium enhancement (LGE), and diagnoses made from CMR imaging were extracted and examined. RESULTS: Detection of heart failure and cardiomyopathies was the most common reason for CMR imaging requests [164 (47.7%) of requests], which was followed by diagnoses of coronary artery disease [79 (23.0%) of requests] and ventricular arrhythmia [65 (18.9%) of requests]. Quantitative analyses were made in 319 (92.7%) cases, with 208 (65.2%) patients being identified with ventricular dilatation and 46 (14.4%) patients being identified with right ventricular dilatation. Apart from 74 (21.5%) cases for which a confirmed diagnosis could not be obtained, CMR imaging assessment corrected 21.2% (73 patients) and confirmed 57.3% (197 patients) of initial referral diagnoses. CONCLUSIONS: CMR imaging is mainly used for structural and functional assessments of hearts, which can help identify abnormalities that are not detected by other imaging modalities. It can provide incremental diagnostic, therapeutic, and prognostic information.

[Research on Analysis of Oil in Water Based on the Joint Optimization of Savitzky-Golay Smoothing and IBPLS Models].

Rapidly and accurately detection of the type and content of mineral oil in water pollution has important significance for the timely screening and control of pollution sources. The use of infrared spectral analysisi technology to detect mineral oil has advantanges of efficient, fast and pollution-free. Infrared spectrum technology is very for the detection of mineral oil in the water. In order to obtain a more reliable results, Fourier transforms attenuated total reflection infrared spectrometry (FITR-ATR) technology is used to get the spectral information of the mineral oil sample, and SPXY method is used to divide the sample set. The paper not only analyzed partial least squares (PLS) and iterative Bagging partial least squares (IBPLS) the two different methods to build regression model, also compared the difference of using the method of the combination of Savitzky-Golay (SG) smoothing and the method of a single iterative Bagging partial least squares (IBPLS) regression model. Based on the comparison of the predictive regression curve, we can get that the SG smooth has a better reflection on the results. And when the method of the combination of Savitzky-Golay (SG) smoothing and the method of a single iterative Bagging partial least squares (IBPLS) is used to build the regression model, the gasoline model parameters RMSEP is 0.001 125 g x mL(-1), R is 0.992 5; diesel model parameters RMSEP is 0.001 384 g x mL(-1), R is 0.989 3.

[A De-Noising Algorithm for Fluorescence Detection Signal of Mineral Oil in Water by SWT].

Fluorescence analysis is an important means of detecting mineral oil in water pollutants because of high sensitivity, selectivity, ease of design, etc. Noise generated from Photo detector will affect the sensitivity of fluorescence detection system, so the elimination of fluorescence signal noise has been a hot issue. For the fluorescence signal, due to the length increase of the branch set, it produces some boundary issues. The dbN wavelet family can flexibly balance the border issues, retain the useful signals and get. rid of noise, the de-noising effects of dbN families are compared, the db7 wavelet is chosen as the optimal wavelet. The noisy fluorescence signal is statically decomposed into 5 levels via db7 wavelet, and the thresholds are chosen adaptively based on the wavelet entropy theory. The pure fluorescence signal is obtained after the approximation coefficients and detail coefficients quantified by thresholds reconstructed. Compared with the DWT, the signal de-noised via SWT has the advantage of information integrity and time translation invariance.

[Determination of the Sodium Methylparaben Content Based on Spectrum Fluorescence Spectral Technology and GA-BP Neural Network].

Sodium methylparaben as one kind of preservatives is widely used in our life, but it will do harm to health if it is eaten too much. So there are strict rules on the dosage of sodium methylparaben in every country. The fluorescence spectral properties of sodium methylparaben in aqueous solution and orange juice solution are analyzed with FS920 fluorescence spectrometer. The research result shows that the fluorescence characteristic peak of sodium methylparaben solution is in λ(ex)/λ(em) = 380/5 10 nm, while sodium methylparaben orange juice solution has two fluorescence characteristic peaks which are in λ(ex)/λ(em) = 440/520 nm and 470/530 nm, and its best excitation wavelength is 440 nm. So it can be concluded from the result that there is a significant change between the characteristic peaks of sodium methylparaben in the two solution. Compared with the fluorescence characteristic peak of sodium methylparaben solution, thoses of sodium methylparaben orange juice solution are changed significantly, which are caused by the interference of orange juice fluorescence characteristics. In order to determine the content of sodium methylparaben in the fresh orange juice, a detection model of sodium methylparaben content in orange juice is built based on GA-BP neural network, according to the relationship between fluorescence intensity in λ(ex) = 440 nm and the content of sodium methylparaben orange juice solution. When the accuracy of the mean square error in the process of network training reaches 10(-3), the correlation coefficient of network output and that of the expected is 0.996. At the same time, a better prediction result can be obtained that the average recovery of the forecast samples is 98.67% and the average relative standard deviation is 0.86%. When the concentration ranges from 0.02 to 1.0 g x L(-1), the results testify that detection method based on fluorescence spectroscopy and GA-BP neural network can accurately determine the content of sodium methylparaben in orange juice. This method has the features of novelty and simplicity and it is expected to be applied to the determination of sodium methylparaben in other kinds of drink.

Salvianolic acid B attenuates spinal cord ischemia-reperfusion-induced neuronal injury and oxidative stress by activating the extracellular signal-regulated kinase pathway in rats.

BACKGROUND: Salvianolic acid B (SalB), the main bioactive compound isolated from the traditional Chinese medicinal herb broad Radix Salviae Miltiorrhizae exerts a spectrum of pharmacologic activities. We investigated the effects of SalB treatment in a rat model of spinal cord ischemia and reperfusion (I/R) injury and the underlying mechanism. MATERIALS AND METHODS: SalB was administered at 1, 10, or 50 mg/kg after spinal cord ischemia. The potential protective effects on spinal cord injury were determined by spinal cord edema, infarct volume, and motor function assessment of the hind limbs. RESULTS: SalB treatment significantly decreased spinal cord edema and infarct volume and preserved motor function of the hind limbs in a dose-dependent manner. SalB administration ameliorated the generation of oxidative products and preserved antioxidant defense activities in the injured spinal cord at both 4 and 24 h after I/R injury. Moreover, SalB prolonged the I/R injury-induced activation of extracellular signal-regulated kinase (ERK), and blocking ERK activation with PD98059 partially prevented the neuroprotective effects of SalB. CONCLUSIONS: These findings demonstrate the neuroprotective effects of SalB in a spinal cord I/R injury model and suggest that SalB-induced neuroprotection was mediated by ERK activation.

Isocitrate lyase is required for urediniospore germination of Puccinia striiformis f. sp. tritici.

The PstICL1 gene, which encodes isocitrate lyase, a key enzyme in the glyoxylate cycle, was cloned and characterized in the biotrophic wheat pathogen Puccinia striiformis f. sp. tritici (Pst). Expression analyses of PstICL1 exhibited high levels of transcripts in ungerminated urediniospores, which showed low isocitrate lyase enzyme activity. In planta, PstICL1 expression was continuously down-regulated upon germination. During the later stages of the infection of wheat, the level of PstICL1 expression was extremely low. The function of PstICL1 was identified via mutant complementation. The expression of PstICL1 in Saccharomyces cerevisiae can complement the defects of the △ICL mutant. Using 3-nitropropionate, we observed that inactivation of isocitrate lyase greatly reduced the germination rate of urediniospores, indicating that PstICL1 plays a key role during Pst germination. Furthermore, analysis of lipid bodies revealed that lipid components continuously enter the germ tube from the urediniospore cell during germ tube elongation. Moreover, during this period, the lipid contents continuously decreased, and the total carbohydrates markedly increased, demonstrating that the lipids are being converted into carbohydrates. These results suggest that PstICL1 is required for Pst germination.

Curative use of forequarter amputation for recurrent breast cancer over an axillary area: a case report and literature review.

Axillary recurrence of breast cancer that involves the brachial neurovascular bundle is uncommon. However, for many patients with such recurrence, forequarter amputation can play a palliative role in relieving excruciating pain and paralysis of the upper limb. Further, for those patients who do not have distant metastasis or other local-regional recurrence, forequarter amputation provides a chance for a cure. Only a few case reports of curative amputations for recurrent breast cancer are present in the literature. Here, we report a case of forequarter amputation for curative treatment of axillary recurrent breast cancer, together with a literature review. To date, we have followed the patient for three years after amputation, during which there has been no evidence of recurrence or metastasis. Although radical resection is feasible, it can be accompanied by surgical wound complications and psychosocial stress. Therefore, an organized multidisciplinary approach is needed to ensure the success of radical resection.

Precise resection and biological reconstruction under navigation guidance for young patients with juxta-articular bone sarcoma in lower extremity: preliminary report.

BACKGROUND: It is a challenge to perform a joint-preserving resection for young patients with juxta-articular bone sarcomas. We determined whether osteotomy under image-guided navigation make joint-saving resection possible for juxta-articular lesions while adhering oncological principles. METHODS: Between June 2008 and July 2010, joint-preserving limb salvage surgeries were performed on 9 patients with juxta-articular bone sarcomas under navigation guidance. Computed tomography/magnetic resonance imaging fusion images were used for real-time navigation. Eight lesions located around the knee and 1 in hip. Six tumors extend to and 3 beyond the epiphyseal line. Planned osteotomy under image-guided navigation was employed for achieving clear surgical margin while maximizing host tissue preservation. All tumors were en bloc removed and intercalary defect were reconstructed by combination of allograft with vascularized fibula graft. All specimens were examined for resection margin. Patients were followed up for an average of 25.2 months for evaluating of functional and oncology outcomes. RESULTS: Entire joint were preserved in 6 patients and part of joint were saved in another 3 patients. The mean registration error for navigation was 0.40 mm (range, 0.31 to 0.62 mm). Clear surgical margin was obtained in all specimens. The average closest distance between the osteotomy line and tumor edge was 9.6 mm (range, 6 to 14 mm). Entire joint cartilage was preserved in 6 patients and portion of joint were saved in 3 patients (2 in proximal tibia, 1 in distal femur). No patient experienced local recurrence. Two patients developed lung metastasis. One died of disease and the other underwent metastasectomy and had no evidence of disease at the most recent follow-up. All reconstruction was in situ with the Musculoskeletal Tumor Society average score of 26.7 at final follow-up. CONCLUSIONS: With careful patient selection, image navigation-assisted surgery made it possible to resect the bone exactly as planned in length and orientation in the magnetic resonance imaging image, yielding a clear margin and preserving the entire or part of the articular cartilage in joint-sparing limb salvage procedures for treating skeletally immature patients with juxta-articular bone sarcomas. LEVEL OF EVIDENCE: Level IV--therapeutic study.

Use of patient-specific templates in hip resurfacing arthroplasty: experience from sixteen cases.

PURPOSE: Hip resurfacing arthroplasty (HRA) is a technically demanding operation, requiring both accuracy and precision in placement of the acetabular and femoral components. Malalignment of the component can lead to notching and possible femoral neck fractures. We used specific templates created using a rapid prototyping machine based on the patients' anatomy, to aid in accurate intraoperative pin placement. METHODS: A 3D model of the hip was reconstructed using spiral computed tomography (CT) data by Amira 3.1 software in 16 patients in whom HRA was planned for hip osteoarthritis (OA). All of the patients in the study had normal contralateral hips. The rotational centre of femoral head on the normal side was superimposed using Imageware12.0 software to determine the centre of the femoral head on the contralateral side. The data was then used to produce patient-specific templates using a rapid prototyping technique. These templates were designed according to the anatomical features of femoral head surface, the rotation centre and the planned prosthesis shaft angle. The orientation of the prosthesis was determined by matching the model to the femoral head surface during the operation. In addition, a control group of 18 patients with OA was operated upon by the conventional method. RESULTS: The mean prosthesis stem shaft angle (SSA), as determined from postoperative imaging, was 138.68 ± 8.85° for the locating template group, and (118.9 ± 12.8) for the conventional group. CONCLUSIONS: The locating template designed and constructed preoperatively can provide precise and dependable location for hip resurfacing femoral components during arthroplasty and ensure the valgus stem placement necessary for optimal outcomes.