High-Capacity and Ultra-Long-Life Mg-Metal Batteries Enabled by Intercalation-Conversion Hybrid Cathode Materials.

The advancement of rechargeable Mg-metal batteries (RMBs) is severely impeded by the lack of suitable cathode materials. Despite the good cyclic stability of intercalation-type compounds, their specific capacity is relatively low. Conversely, the conversion-type cathodes can deliver a higher capacity but often suffer from poor cycling reversibility and stability. Herein, a WSe2/Se intercalation-conversion hybrid material with elemental Se uniformly distributed into WSe2 nanosheets is fabricated via a simple solvothermal method for high-performance RMBs. The uniformly introduced Se confined in WSe2 nanosheets can not only efficiently improve the conductivity of the hybrid cathodes, facilitating the fast electron transport and ion diffusion, but also provide additional specific capacity. Besides, the WSe2 can effectively inhibit the detrimental Se dissolution and polyselenide shuttle, thereby activating the activity of Se and improving its utilization. Consequently, the synergy of intercalation and conversion mechanisms endows WSe2/Se hybrids with superior reversible capacity of 252 mAh g-1 at 0.1 A g-1 and ultra-long cyclability of up to 5000 cycles at 2.0 A g-1 with capacity retention of 78.1%. This work demonstrates the feasibility of the strategy by integrating intercalation and conversion mechanisms for developing high-performance cathode materials for RMBs.

Team-, case-, lecture- and evidence-based learning in medical postgraduates training.

BACKGROUND: The aim of this study was to evaluate the effectiveness of team-, case-, lecture-, and evidence-based learning (TCLEBL) methods in cultivating students' clinical and research abilities, as compared to traditional lecture-based learning (LBL) approaches. METHODS: Forty-one medical postgraduates were divided into two groups, a TCLEBL group and an LBL group. Teaching effectiveness was evaluated through student- and teacher-feedback questionnaires, scores from theoretical examinations and written literature reviews, and student learning burdens. RESULTS: Compared to the LBL approach, both teachers and students were more satisfied with the TCLEBL model (p < 0.001 for both teachers and students). The TCLEBL group performed significantly higher on the theory test compared to the LBL group (p = 0.009). There were significant differences between the LBL and TCLEBL groups, respectively, in terms of literature review and citations (12.683 ± 2.207 vs. 16.302 ± 1.095, p < 0.001), argument and perspective (12.55 ± 1.572 vs. 16.333 ± 1.354, p < 0.001), comprehensiveness of content (13.3 ± 2.268 vs. 16.683 ± 1.344, p < 0.001), and scientific rigor and accuracy (10.317 ± 1.167 vs. 12.746 ± 0.706, p < 0.001). There was no significant difference in the total extracurricular time expended between the two groups (323.75 ± 30.987 min vs. 322.619 ± 24.679 min, respectively for LBL vs. TCLEBL groups, p = 0.898). CONCLUSIONS: TCLEBL is an effective teaching method that cultivates students' clinical and research abilities.

The Top 100 Most-Cited Articles on Arthroscopy: Most Popular Topic Is Rotator Cuff Rather Than Cartilage in the Last 5 Years.

PURPOSE: To highlight the characteristics of the 100 most-cited articles on arthroscopy and provide the variation trend of citation rate among the top 25 articles in the past 9 years. We further analyzed the topics of interest in the past or currently. METHODS: The Thomson ISI Web of Science database was used to identify arthroscopy-related articles that were published from 1950 to March 31, 2020. The 100 most-cited articles were selected for further analysis. In addition, author key words of the articles that published in the recent 5 years were further analyzed. RESULTS: Mean of citations was 433.59 ± 400.73. The publication year ranged from 1980 to 2013. Most articles were focused on cartilage lesions and treatments (26%). A large proportion of articles were published in the 2000s (61%). Arthroscopy-the Journal of Arthroscopic and Related Surgery (23%) was the most popular journal. One half of the articles originated from the United States. The most prolific institution and first author were the Steadman Philippon Research Institute (5%) and Marc J. Philippon (4%), respectively. Most of the articles were Level IV evidence (33%). The citation rate increased by 131% from the previous top 25 articles published in 2011. A growth trend can be seen in the citation density over time. "Shoulder" (occurrences = 535) was the most used joint key word and "rotator cuff" (342) was the most used key word of research objective in the last 5 years, whereas "cartilage" only occurred 262 times. CONCLUSIONS: Based on bibliometric analysis of the 100 most-cited articles on arthroscopy combined with network analysis of the whole articles that published in the recent 5 years, the topic of most interest in the recent 5 years was rotator cuff rather than cartilage. The number of citations among the 25 most-cited articles is growing rapidly and has at least doubled in size on average in the past 9 years. Citation density among the 100 most-cited articles on arthroscopy has seen a growth trend. CLINICAL RELEVANCE: This article clarifies the characteristics of the 100 most-cited papers and provides guidance on the topics of interest in the past or currently as a roadmap for future research on arthroscopy.

The differences of clinical characteristics and outcomes between imported and local patients of COVID-19 in Hunan: a two-center retrospective study.

BACKGROUND: The clinical characteristics and outcomes of the 2019 novel coronavirus (COVID-19) pneumonia are different in Hubei compared to other regions in China. But there are few comparative studies on the differences between imported and local patients which may provide information of the different courses of the virus after transmission. METHODS: We investigated 169 cases of COVID-19 pneumonia in two centers in Hunan Province, and divided them into two groups according to epidemiological history, "imported patients" refers to patient with a clear history of travel in Wuhan within 14 days before onset, and " local patients" refers to local resident without a recent history of travel in Wuhan, aiming to analyze the difference in clinical characteristics and outcomes between the two groups. All the epidemiological, clinical, imaging, and laboratory data were analyzed and contrasted. RESULTS: The incidence of fever on admission in imported patients was significantly higher than local patients. There was a significantly higher proportion of abnormal pulmonary signs, hypokalemia, hyponatremia, prolonged PT, elevated D-dimer and elevated blood glucose in imported patients. Compared with local patients, the proportion using antibiotics, glucocorticoids and gamma globulin were significantly higher in imported patients. The moderate type was more common in local patients, and the severe type were more frequent in imported patients. In addition, the median duration of viral clearance was longer in imported patients. CONCLUSIONS: In summary, we found that imported cases were more likely to develop into severe cases, compared with local patients and required more powerful treatments. Trial registration Registered 21st March 2020, and this study has been approved by the Medical Ethics Committee (Approved Number. 2020017).

Oxygen embolism after hydrogen peroxide irrigation during hip arthroscopy: a case report.

BACKGROUND: Hydrogen peroxide has been widely used in Orthopaedics including Orthopaedic oncology, trauma and joint surgeries. However, we encountered an oxygen embolism and myoglobinuria after hydrogen peroxide was used to irrigate a septic hip arthroscopically. CASE PRESENTATION: A 61-year-old male patient with right hip septic arthritis underwent an arthroscopic hip washout and debridement. During the operation, the surgeon used 100 ml of 3% hydrogen peroxide to irrigate the joint cavity. Two minutes after irrigation, there was a transient decrease in oxygen saturation, heart rate and blood pressure, with significant subcutaneous emphysema around the wound. Concentrated urine was drained out 8 h after operation which resolved the following day. Post-operatively, the patient was managed in the intensive care unit for a pulmonary embolism and discharged without further complications. CONCLUSION: Medical staff should be aware of the risk of oxygen embolism and be extremely careful when using hydrogen peroxide in patient care. Oxygen embolism following hydrogen peroxide use is rare, however, once encountered, it may bring serious consequences. Therefore, the use of hydrogen peroxide in closed spaces or arthroscopic procedures should be discontinued.

Twin defects engineered Pd cocatalyst on C3N4 nanosheets for enhanced photocatalytic performance in CO2 reduction reaction.

Photocatalytic conversion of CO2 to value-added chemicals, a potential route to addressing the depletion of fossil fuels and anthropogenic climate change, is greatly limited by the low-efficient semiconductor photocatalyst. The integration of cocatalyst with light-harvesting semiconductor is a promising approach to enhancing the photocatalytic performance in CO2 reduction reaction. The enhancement is greatly determined by the catalytic active sites on the surface of cocatalyst. Herein, we demonstrate that the photocatalytic performance in the CO2 reduction reaction is greatly promoted by twin defects engineered Pd cocatalyst. In this work, Pd nanoicosahedrons with twin defects were in situ grown on C3N4 nanosheets, which effectively improve the photocatalytic performance in reduction of CO2 to CO and CH4 in comparison with Pd nanotetrahedrons without twin defects. It is proposed that the twin boundary (TB) terminations on the surface of Pd cocatalysts are highly catalytic active sites for CO2 reduction reaction. Based on the proposed mechanism, the photocatalytic activity and selectivity in CO2 reduction were further advanced through reducing the size of Pd icosahedral cocatalyst resulted from the increased surface density of TB terminations. The defect engineering on the surface of cocatalyst represents a novel route in realizing high-performance photocatalytic applications.

Hydrogen-rich saline attenuates ischemia-reperfusion injury in skeletal muscle.

BACKGROUND: To investigate the potential beneficial effect of hydrogen-rich saline (HRS) in ischemia-reperfusion (IR) injury of skeletal muscle. METHODS: Three experimental groups were established in male Sprague-Dawley rats: (1) sham group, (2) IR with normal saline group, (3) and IR with HRS group. A rat model of skeletal muscle IR injury was induced by 3-h tourniquet occlusion on its left hind limb and 4-h reperfusion. Normal saline and HRS (1.0 mL/100 g) were administered intraperitoneally at 10 min before reperfusion, respectively. Muscle and serum samples were analyzed for detecting the levels of myeloperoxidase (MPO), superoxide dismutase (SOD), malondialdehyde (MDA), and hydroxyl radical (•OH). Muscle samples were assessed by wet/dry rate, hematoxylin and eosin histologic assessment, Bcl2, Bax, cytochrome C, LC3B, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling, and electron microscopy. RESULTS: The wet/dry ratio increased significantly in the IR group (P < 0.01 compared with that in the sham group) and decreased significantly in IR with HRS groups (4.12 ± 0.14 versus 4.12 ± 0.14, P < 0.01 compared with that in the IR group). Muscle tissues and serum of the IR group had significantly increased levels of MPO, MDA, •OH content, and decreased SOD activities compared with the sham group (P < 0.01). The activity of SOD in the IR with HRS group was greatly elevated compared with that in the IR group (295.028 ± 9.288 versus 249.190 ± 5.450 in muscle tissues; 91.627 ± 2.604 versus 73.4045 ± 6.487 in serum; P < 0.01), whereas the levels of MPO, MDA, and •OH content were clearly reduced (MPO: 0.5649 ± 0.0724 versus 1.0984 ± 0.0824 in muscle tissues; 0.7257 ± 0.1232 versus 1.3147 ± 0.0531 in serum. MDA: 4.457 ± 0.650 versus 7.107 ± 0.597 in muscle tissues; 2.531 ± 0.434 versus 4.626 ± 0.237 in serum. •OH: 16.451 ± 0.806 versus 19.871 ± 0.594 in muscle tissues; 500.212 ± 7.387 versus 621.352 ± 7.591 in serum, P < 0.01). The integrated optical density of positive amethyst staining increased significantly in the IR group (P < 0.01 compared with that in the sham group) and decreased significantly in IR with HRS group (928.79 ± 234.537 versus 3005.972 ± 83.567, P < 0.01 compared with that in the IR group). Muscle tissues of the IR group had significantly increased levels of Bax, cytochrome C, LC3B content, and decreased Bcl2 activities compared with those in the sham group (P < 0.01). The activity of Bcl2 in the IR with HRS group was greatly elevated compared with that in the IR group (0.2635 ± 0.0704 versus 0.1242 ± 0.0662; P < 0.01), whereas the levels of Bax, cytochrome C, and LC3B content were clearly reduced (Bax: 0.3103 ± 0.0506 versus 0.5122 ± 0.0148; cytochrome C: 0.4194 ± 0.1116 versus 0.8127 ± 0.0166; LC3B: 0.5884 ± 0.0604 versus 1.3758 ± 0.0319; respectively, P < 0.01). CONCLUSIONS: HRS seems to be effective in attenuating IR injury in skeletal muscle via its antioxidant, anti-apoptosis, and anti-autophagy effect.

Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis.

BACKGROUND: The purpose of this study was to document the clinical and radiographic results of a consecutive series of patients with ankylosing spondylitis (AS) who had undergone bilaterally primary THA using non-cemented components. METHODS: Twenty-six hips of 13 patients with bilateral ankylosis of the hip caused by AS were converted to THA from January 2000 to January 2008. The mean age of the patients was 33.7 years (range, 22-57 years). There were 11 males and 2 females. All the patients had bilateral bony ankylosis with 0° range of motion. The average Harris Hip Scores (HSS) was 22.1 (10-38). RESULTS: At a mean follow-up of 128.4 months, the mean HSS at the latest follow-up examination was 91.7 points (range, 75-98 points). All the patients reported marked relief of painful symptoms. Three (11.5%) of the 26 hips were outside the Lewinnek acetabular cup inclination safe range, and 5 (19.2%) of the 26 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of survival of the prostheses was 100% at 5 years and 92.3% at 10 years, but it dropped sharply to 73.1% at 13 years. CONCLUSION: Cementless THA is a worthwhile treatment for the osseous ankylosed hip joint caused by AS. Newfound mobility, maneuverability, and improved ability to sit comfortably were the outcomes that alleviated the patients' daunted morale. However, the technically demanding nature of the procedure should not be underestimated.

Using Google web search to analyze and evaluate the application of ChatGPT in femoroacetabular impingement syndrome.

Background: Chat Generative Pre-trained Transformer (ChatGPT) is a new machine learning tool that allows patients to access health information online, specifically compared to Google, the most commonly used search engine in the United States. Patients can use ChatGPT to better understand medical issues. This study compared the two search engines based on: (i) frequently asked questions (FAQs) about Femoroacetabular Impingement Syndrome (FAI), (ii) the corresponding answers to these FAQs, and (iii) the most FAQs yielding a numerical response. Purpose: To assess the suitability of ChatGPT as an online health information resource for patients by replicating their internet searches. Study design: Cross-sectional study. Methods: The same keywords were used to search the 10 most common questions about FAI on both Google and ChatGPT. The responses from both search engines were recorded and analyzed. Results: Of the 20 questions, 8 (40%) were similar. Among the 10 questions searched on Google, 7 were provided by a medical practice. For numerical questions, there was a notable difference in answers between Google and ChatGPT for 3 out of the top 5 most common questions (60%). Expert evaluation indicated that 67.5% of experts were satisfied or highly satisfied with the accuracy of ChatGPT's descriptions of both conservative and surgical treatment options for FAI. Additionally, 62.5% of experts were satisfied or highly satisfied with the safety of the information provided. Regarding the etiology of FAI, including cam and pincer impingements, 52.5% of experts expressed satisfaction or high satisfaction with ChatGPT's explanations. Overall, 62.5% of experts affirmed that ChatGPT could serve effectively as a reliable medical resource for initial information retrieval. Conclusion: This study confirms that ChatGPT, despite being a new tool, shows significant potential as a supplementary resource for health information on FAI. Expert evaluations commend its capacity to provide accurate and comprehensive responses, valued by medical professionals for relevance and safety. Nonetheless, continuous improvements in its medical content's depth and precision are recommended for ongoing reliability. While ChatGPT offers a promising alternative to traditional search engines, meticulous validation is imperative before it can be fully embraced as a trusted medical resource.

Size-Dependent Electrochemical Performance Mediated by Stress-Induced Cracking in Zn2SnO4 Electrodes.

Correlating the microscopic structural characteristics with the macroscopic electrochemical performance in electrode materials is critical for developing excellent-performance lithium-ion batteries, which however remains largely unexplored. Here, we show that the Zn2SnO4 (ZTO) nanowires (NWs) with smaller diameters (d < 5 nm) exhibit slower capacity fade rate and better cycling stability, as compared with the NWs with larger diameters ranging from tens to hundreds of nanometers. By applying in situ transmission electron microscopy (TEM), we discover a strong correlation of cracking behavior with the NW diameter. Upon the first lithiation, there exists a critical diameter of ∼80 nm, below which the NWs neither crack nor fracture, and above which the cracks could easily nucleate and propagate along the specific planes, resulting in the deteriorated cycling stability in larger sized electrodes. Further theoretical calculations based on the finite element model and the climbing image nudged elastic band method faithfully predict the size-dependent cracking behaviors, which may result from the synergistic effect of axial stress evolution as well as preferential Li-ion migration directions during the first lithiation. This work provides a real-time tracking of the tempo-spatial structural evolution of a single ZTO NW, which facilitates a fundamental understanding of how the sample size affects the electrochemical behavior and thus offers a reference for future battery design and application strategy.

[Curative effect of arthroscopic suture anchor fixation on shoulder bankart injury].

OBJECTIVE: To determine the curative effect of arthroscopic suture anchor fixation on shoulder bankart injury. METHODS: Sixteen patients with shoulder recurrent dislocation and diagnosed bankart injury were treated with suture anchor fixed by shoulder arthroscopy. Both shoulders of the patients had X-ray, MRI, physical examination before the operation. Suture anchors were used to fix the lesion labrum by shoulder arthroscopy. University of California at Los Angeles (UCLA) score and visual analogue scale (VAS) score were adopted for the final evaluation at the latest follow-up. RESULTS: All patients were followed for a period of 25 (7-68) months. At the latest follow-up, no redislocation and instability occured. The pre- and post-operation UCLA score was (20.8 ± 0.8) vs (32.9 ± 1.5), excellent in 6, good in 10, with no poor score, while the pre- and post-operation VAS score was (3.3 ± 0.8) vs (0.6 ± 0.5). CONCLUSION: Suture anchor fixation guided by arthroscopy is good for bankart injury caused by recurrent shoulder dislocation, which has many advantages, such as mini-invasion, rapid recovery and a satisfactory outcome in function and motion.

A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study.

INTRODUCTION: Few studies have investigated the in-hospital mortality among critically ill patients with hip fracture. This study aimed to develop and validate a model to estimate the risk of in-hospital mortality among critically ill patients with hip fracture. METHODS: For this study, data from the Medical Information Mart for Intensive Care III (MIMIC-III) Database and electronic Intensive Care Unit (eICU) Collaborative Research Database were evaluated. Enrolled patients (n=391) in the MIMIC-III database were divided into a training (2/3, n=260) and a validation (1/3, n=131) group at random. Using machine learning algorithms such as random forest, gradient boosting machine, decision tree, and eXGBoosting machine approach, the training group was utilized to train and optimize models. The validation group was used to internally validate models and the optimal model could be obtained in terms of discrimination (area under the receiver operating characteristic curve, AUROC) and calibration (calibration curve). External validation was done in the eICU Collaborative Research Database (n=165). To encourage practical use of the model, a web-based calculator was developed according to the eXGBoosting machine approach. RESULTS: The in-hospital death rate was 13.81% (54/391) in the MIMIC-III database and 10.91% (18/165) in the eICU Collaborative Research Database. Age, gender, anemia, mechanical ventilation, cardiac arrest, and chronic airway obstruction were the six model parameters which were identified using the Least Absolute Shrinkage and Selection Operator (LASSO) method combined with 10-fold cross-validation. The model established using the eXGBoosting machine approach showed the highest area under curve (AUC) value (0.797, 95% CI: 0.696-0.898) and the best calibrating ability, with a calibration slope of 0.999 and intercept of -0.019. External validation also revealed favorable discrimination (AUC: 0.715, 95% CI: 0.566-0.864; accuracy: 0.788) and calibration (calibration slope: 0.805) in the eICU Collaborative Research Database. The web-based calculator could be available at https://doctorwangsj-webcalculator-main-yw69yd.streamlitapp.com/. CONCLUSION: The model has the potential to be a pragmatic risk prediction tool that is able to identify hip fracture patients who are at a high risk of in-hospital mortality in ICU settings, guide patient risk counseling, and simplify prognosis bench-marking by controlling for baseline risk.

Unexpected Two-Dimensional Polarons Induced by Oxygen Vacancies in Layered Structure MoO3-x.

Unveiling the effects of oxygen vacancies on the structural stability of layered α-MoO3 is critical for optimizing its physical and chemical properties. Herein, we present experimental evidence regarding the phase stability of α-MoO3 with ∼2% oxygen vacancy concentrations. Interestingly, we report a previously ignored oxygen-deficient orthorhombic MoO3-x phase in space group Cmcm. Further density functional theory calculations reveal a detailed phase transition mechanism from α-MoO3 to MoO3-x. More importantly, we demonstrate that two-dimensional (2D) large polarons must exist to stabilize the MoO3-x crystal structure. 2D large polarons are suspected to exist in numerous quasi-2D systems but have never been found in layered α-MoO3 or other molybdenum oxides. Our work contributes to a basic understanding of the polaronic behavior in MoO3-x and may broaden the application realm of molybdenum oxides.

Electronic structure engineering on NiSe2 micro-octahedra via nitrogen doping enabling long cycle life magnesium ion batteries.

Multivalent ion batteries have attracted great attention because of their abundant reserves, low cost and high safety. Among them, magnesium ion batteries (MIBs) have been regarded as a promising alternative for large-scale energy storage device owing to its high volumetric capacities and unfavorable dendrite formation. However, the strong interaction between Mg2+ and electrolyte as well as cathode material results in very slow insertion and diffusion kinetics. Therefore, it is highly necessary to develop high-performance cathode materials compatible with electrolyte for MIBs. Herein, the electronic structure of NiSe2 micro-octahedra was modulated by nitrogen doping (N-NiSe2) through hydrothermal method followed by a pyrolysis process and this N-NiSe2 micro-octahedra was used as cathode materials for MIBs. It is worth noting that N-NiSe2 micro-octahedra shows more redox active sites and faster Mg2+ diffusion kinetics compared with NiSe2 micro-octahedra without nitrogen doping. Moreover, the density functional theory (DFT) calculations indicated that the doping of nitrogen could improve the conductivity of active materials on the one hand, facilitating Mg2+ ion diffusion kinetics, and on the other hand, nitrogen dopant sites could provide more Mg2+ adsorption sites. As a result, the N-NiSe2 micro-octahedra cathode exhibits a high reversible discharge capacity of 169 mAh g-1 at the current density of 50 mA g-1, and a good cycling stability over 500 cycles with a maintained discharge capacity of 158.5 mAh g-1. This work provides a new idea to improve the electrochemical performance of cathode materials for MIBs by the introduction of heteroatom dopant.

Interlayer Engineering of VS2 Nanosheets via In Situ Aniline Intercalative Polymerization toward Long-Cycling Magnesium-Ion Batteries.

Rechargeable magnesium batteries (RMBs) show great potential in large-scale energy storage systems, due to Mg2+ with high polarity leading to strong interactions within the cathode lattice, and the limited discovery of functional cathode materials with rapid kinetics of Mg2+ diffusion and desirable cyclability retards their development. Herein, we innovatively report the confined synthesis of VS2/polyaniline (VS2/PANI) hybrid nanosheets. The VS2/PANI hybrids with expanded interlayer spacing are successfully prepared through the exfoliation of VS2 and in situ polymerization between VS2 nanosheets and aniline. The intercalated PANI increases the interlayer spacing of VS2 from 0.57 to 0.95 nm and improves its electronic conductivity, leading to rapid Mg-ion diffusivity of 10-10-10-12 cm2 s-1. Besides, the PANI sandwiched between layers of VS2 is conducive to maintaining the structural integrity of electrode materials. Benefiting from the above advantages, the VS2/PANI-1 hybrids present remarkable performance for Mg2+ storage, showing high reversible discharge capacity (245 mA h g-1 at 100 mA g-1) and impressive long lifespan (91 mA h g-1 after 2000 cycles at 500 mA g-1). This work provides new perspectives for designing high-performance cathode materials based on layered materials for RMBs.

Traditional Chinese Exercise for Neurodegenerative Diseases: A Bibliometric and Visualized Analysis With Future Directions.

Background: Traditional Chinese Exercise (TCE) has expanded out of China into the world and is frequently used in the prevention and treatment of many diseases. Although many studies have explored the ability of TCE as an intervention for neurodegenerative diseases, there are limited articles summarizing the research. The aim of this study was to investigate current research trends around TCE for neurodegenerative diseases and predict future directions for such research. Materials and Methods: Data was collected from the Web of Science Core Collection (WoSCC). All articles and reviews on TCE in relation to neurodegenerative diseases were retrieved. The data analysis was performed using the CiteSpace (5.8R3) software, and the results were displayed in network maps. Results: The search identified 220 publications between 1999 and 2021. The United States was the most productive country (n = 89), followed by China (n = 68). The United States had the greatest centrality, indicating its tremendous global influence and close collaborations with other countries. Fuzhong Li from the Oregon Research Institute, United States, was not only the most prolific author (n = 5), but also the most co-cited author (n = 120). The Shanghai University of Sport contributed to the most publications (n = 12). PLOS ONE was the most published journal, while Movement Disorders was the most cited journal. Tai Chi, Parkinson's disease, quality of life, balance, and older adult were the most high-frequency keywords, while Alzheimer's disease had the highest centrality. Conclusion: The number of publications on TCE related to neurodegenerative diseases has shown major growth in the past decade. However, there is a need for research institutions to strengthen cooperation between countries and institutions. Tai Chi, Parkinson's disease (PD), Alzheimer's disease, older adults and falls reduction have been the recent research focus. It is anticipated that in the future, PD will continue to be a central focus with the effects of Baduanjin, Wuqinxi, and Yijinjing requiring further research.

Biological signatures and prediction of an immunosuppressive status-persistent critical illness-among orthopedic trauma patients using machine learning techniques.

Background: Persistent critical illness (PerCI) is an immunosuppressive status. The underlying pathophysiology driving PerCI remains incompletely understood. The objectives of the study were to identify the biological signature of PerCI development, and to construct a reliable prediction model for patients who had suffered orthopedic trauma using machine learning techniques. Methods: This study enrolled 1257 patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Lymphocytes were tracked from ICU admission to more than 20 days following admission to examine the dynamic changes over time. Over 40 possible variables were gathered for investigation. Patients were split 80:20 at random into a training cohort (n=1035) and an internal validation cohort (n=222). Four machine learning algorithms, including random forest, gradient boosting machine, decision tree, and support vector machine, and a logistic regression technique were utilized to train and optimize models using data from the training cohort. Patients in the internal validation cohort were used to validate models, and the optimal one was chosen. Patients from two large teaching hospitals were used for external validation (n=113). The key metrics that used to assess the prediction performance of models mainly included discrimination, calibration, and clinical usefulness. To encourage clinical application based on the optimal machine learning-based model, a web-based calculator was developed. Results: 16.0% (201/1257) of all patients had PerCI in the MIMIC-III database. The means of lymphocytes (%) were consistently below the normal reference range across the time among PerCI patients (around 10.0%), whereas in patients without PerCI, the number of lymphocytes continued to increase and began to be in normal range on day 10 following ICU admission. Subgroup analysis demonstrated that patients with PerCI were in a more serious health condition at admission since those patients had worse nutritional status, more electrolyte imbalance and infection-related comorbidities, and more severe illness scores. Eight variables, including albumin, serum calcium, red cell volume distributing width (RDW), blood pH, heart rate, respiratory failure, pneumonia, and the Sepsis-related Organ Failure Assessment (SOFA) score, were significantly associated with PerCI, according to the least absolute shrinkage and selection operator (LASSO) logistic regression model combined with the 10-fold cross-validation. These variables were all included in the modelling. In comparison to other algorithms, the random forest had the optimal prediction ability with the highest area under receiver operating characteristic (AUROC) (0.823, 95% CI: 0.757-0.889), highest Youden index (1.571), and lowest Brier score (0.107). The AUROC in the external validation cohort was also up to 0.800 (95% CI: 0.688-0.912). Based on the risk stratification system, patients in the high-risk group had a 10.0-time greater chance of developing PerCI than those in the low-risk group. A web-based calculator was available at https://starxueshu-perci-prediction-main-9k8eof.streamlitapp.com/. Conclusions: Patients with PerCI typically remain in an immunosuppressive status, but those without PerCI gradually regain normal immunity. The dynamic changes of lymphocytes can be a reliable biomarker for PerCI. This work developed a reliable model that may be helpful in improving early diagnosis and targeted intervention of PerCI. Beneficial interventions, such as improving nutritional status and immunity, maintaining electrolyte and acid-base balance, curbing infection, and promoting respiratory recovery, are early warranted to prevent the onset of PerCI, especially among patients in the high-risk group and those with a continuously low level of lymphocytes.

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three-Year MRI Follow-Up.

OBJECTIVE: To describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short- and medium-term outcomes, and assess magnetic resonance imaging (MRI) for follow-up imaging evaluations. METHODS: A total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6-34 years. All patients underwent a complete physical examination, X-ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow-up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing. RESULTS: Preoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow-up periods were 37.5 (19-60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus. CONCLUSIONS: Arthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.

Impaction Bone Grafting with Low Dose Irradiated Freeze-Dried Allograft Bone for Acetabular Reconstruction.

OBJECTIVE: Reconstruction of acetabular defects has been extremely challenging in both primary and revision total hip arthroplasty (THA). Impaction bone grafting (IBG) can restore the acetabulum bone mass and anatomically reconstruct the acetabulum. Our study aimed to report the short and medium-term clinical and radiographic outcomes of IBG for acetabular reconstruction in the cemented THA in the Chinese population. METHODS: This was a single-center retrospective review enrolling 57 patients between May 2013 and July 2019. The patients with acetabular defects were treated with IBG, using low dose irradiated freeze-dried allograft bone with or without autograft bone, in the cemented THA performed by one senior surgeon. Harris hip score (HHS), standard pelvis anterior-posterior radiograph and lateral hip radiograph were obtained before operation and at 1 week, 3 months, 12 months, and yearly. Graft osteointegration was evaluated by Oswestry's criteria, and complication was documented at the last follow-up. Independent sample ANOVA test and Pearson chi-square tests are used for statistical analysis. RESULTS: There were 61 hips in 57 patients. The average follow-up time was 35.59 months (5-77 months). According to AAOS classification, a total of 18 hips were identified as segmental bone deficiency (type I), with 21 and 22 hips for cavitary bone deficiency (type II) and the combined bone deficiency (type III), respectively. The average HHS was improved from 44.49 (range: 32-58) preoperatively to 86.98 (range: 78-93) postoperatively. Graft osteointegration was satisfactory (Oswestry score ≥2) in all patients. No dislocation occurred in the 57 patients (61 hips) during follow-up. Although one cup migrated, no revision, re-revision, radiographic loosening, graft bone lysis, or postoperative complications were detected at the final follow-up. CONCLUSIONS: IBG with low-dose irradiated freeze-dried allograft bone in acetabular bone defect reconstruction is a reliable technique for restoring acetabular bone defects in THA.

New insight into the current study of high tibial osteotomy: A bibliometric analysis.

BACKGROUND: To analyze global trends in focus and funding of research related to high tibial osteotomy (HTO) and to identify the 100 most cited articles in this field. METHODS: A Web of Science search was used to identify HTO publications in English-language scientific journals from January 1967 till February 3th, 2021. Results were filtered to the 100 most cited articles by reading the abstract or full-text paper. Information of these articles was recorded for further analysis. The 10 top-cited articles during the last 5 years and the 10 top-cited articles about HTO ranked by average citations per year were selected to predict research trends. RESULTS: In all, 48 out of the 100 top-cited articles were published between 2000 and 2010. The United States of America was the primary contributor (n = 29) followed by Germany (n = 17) and Japan (n = 11). The total number of citations per article ranged from 65 to 563, median 108, mean 135 (standard deviation = 84). The American Journal of Bone and Joint Surgery accounted for 23 out of the 100 top-cited articles. Koshino T was the most cited author (603 citations). The most frequently highlighted study theme was prognostic research. Patient-based clinical research was the dominant study design (85%). The majority of articles (48 out of 100) were level IV evidence with a mean of 141 (standard deviation = 97) citations. Top-cited articles in the last 5 years focused on open wedge osteotomy. CONCLUSION: Technical optimization of open wedge osteotomy has emerged as the main area of research in HTO. More specifically, recent publications focus on the surgical technology, cartilage repair and new fixation devices. Besides, papers with a high level of evidence are needed for the development of HTO.