METHODS: We retrospectively collected CT scan data from 276 patients with pathologically confirmed primary bone tumors from 4 medical centers in Guangdong Province between January, 2010 and August, 2021. A convolutional neural network (CNN) was employed as the deep learning architecture. The optimal baseline deep learning model (R-Net) was determined through transfer learning, and an optimized model (S-Net) was obtained through algorithmic improvements. Multivariate logistic regression analysis was used to screen the clinical features such as sex, age, mineralization location, and pathological fractures, which were then connected with the imaging features to construct the deep learning fusion model (SC-Net). The diagnostic performance of the SC-Net model and machine learning models were compared with radiologists' diagnoses, and their classification performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score. RESULTS: In the external test set, the fusion model (SC-Net) achieved the best performance with an AUC of 0.901 (95% CI: 0.803-1.00), an accuracy of 83.7% (95% CI: 69.3%-93.2%) and an F1 score of 0.857, and outperformed the S-Net model with an AUC of 0.818 (95% CI: 0.694-0.942), an accuracy of 76.7% (95% CI: 61.4%-88.2%), and an F1 score of 0.828. The overall classification performance of the fusion model (SC-Net) exceeded that of radiologists' diagnoses. CONCLUSIONS The deep learning fusion model based on multi-center CT images and clinical features is capable of accurate classification of osseous and chondroid matrix mineralization and may potentially improve the accuracy of clinical diagnoses of osteogenic versus chondrogenic primary bone tumors.
Humans ; Deep Learning ; Bone Neoplasms/diagnostic imaging* ; Retrospective Studies ; Tomography, X-Ray Computed/methods* ; Neural Networks, Computer ; Male ; Female ; ROC Curve ; Algorithms

Objective To study the effect of storage duration on compressive mechanical properties of rabbit patellar, so as to provide references for in vitro ligament storage.Methods The compressive mechanical properties of rabbit patellar ligament storaged at -20 ℃ at different storage durations (in 36 d) were tested with the universal tensile test machine. The microscopic morphology of collagen fibers was observed under the scanning electron microscopy (SEM). The enthalpy and denaturation temperature of collagen fibers were measured with differential scanning calorimetry (DSC).Results With the increase of storage duration, the compressive stress of the patellar ligament at 40% strain increased from 19 kPa to 112 kPa and then decreased to 57 kPa. SEM observation showed that the cross-linking of collagen fibers was initially strengthened and then weakened. DSC results showed that the enthalpy increased from 59.47 J/g to 67.10 J/g and then decreased to 54.43 J/g. The denaturation temperature increased from 67.62 ℃ to 77.28 ℃ and then decreased to 64.10 ℃.Conclusions When rabbit patellar ligament is stored at -20 ℃, with the increase of storage duration, the compressive stress of rabbit patellar ligament at 40% strain increases at first and then decreases. This change may be due to the variation of cross-linking level of collagen fibers. The stronger the cross-linking of collagen fibers, the stronger the compressive mechanical properties will be.

Objective:To investigate whether knee osteoarthritis has an impact on the patient′s depression and whether it′s progression will affect the patient′s depression, and to provide a reference for clinical work.Methods:Patients diagnosed with osteoarthritis in Dalian Central Hospital from 2016 to 2019 were divided into 4 groups according to Kellgren-Lawrence staging, and the patients were scored on WOMAC scale, AKSS clinical scale, and AKSS. The score of the scale and the score of the HAMD scale were collected and statistically analyzed using SPSS 17.0.Results:χ2 test was used to show that there was no difference in the gender composition of patients in different stages ( P<0.05). The AKSS clinical scale score, AKSS functional scale score, WOMAC scale score and HAMD scale score were statistically analyzed for each stage. The results showed that the average AKSS clinical scores of patients in each stage were as follows: stage Ⅰ: (90.01 ± 8.41) points; stage Ⅱ: (79.98 ± 10.93) points; stage Ⅲ: (71.78 ± 13.64) points; stage Ⅳ: (54.18 ± 12.58) points. The AKSS functional scores were as follows, stage Ⅰ: 100 points; stage Ⅱ: 80 points; stage Ⅲ: 70 points; stage Ⅳ: 45 points; the average WOMAC scale scores of patients in each stage were as follows, stage Ⅰ: (28.69 ± 19.22) points ; stage Ⅱ: (49.43 ± 22.69) points; stage Ⅲ (70.13 ± 24.84) points; stage Ⅳ: (107.79 ± 24.39) points. The average HAMD scale scores of patients in each stage were as follows, stage Ⅰ: (4.89 ± 3.42) points; stage Ⅱ: (7.65 ± 4.20) points; Stage Ⅲ: (9.05 ± 5.03) points; stage Ⅳ: (12.35 ± 5.41) points. The analysis showed that there were significant statistical differences in the scale scores between each period ( P<0.05). There was a correlation between the patient′s depression status and the patient′s age, pain, and joint function, and there were statistical differences ( P<0.05). Conclusions:There is a significant correlation between depression and pain and function in patients with knee osteoarthritis. The progress of the osteoarthritis course will aggravate the patient′s depression state. Conversely, the patient′s depression state can also aggravate the symptoms of osteoarthritis patients and affect the clinical efficacy of the patients.

Objective To compare the clinical efficacy of different treatments for injuries of medial collateral ligament (MCL) Ⅲgrade and anterior cruciate ligament (ACL). Methods Forty-six patients with MCLⅢgrade and ACL injuries admitted to Dalian Central Hospital from June 2013 to April 2017 were retrospectively analyzed, including 28 males and 18 females. Sixteen patients underwent arthroscopic reconstruction of the ACL, and medial collateral ligament was repaired with two anchors simultaneously in 2 weeks (group A); 15 patients were treated with reconstruction of the ACL in 2 weeks, and 4 times extracorporeal shock wave therapies were performed 2 weeks after surgery (group B); 15 patients were treated with reconstruction of the ACL in 2 weeks, and fixed with external fixation (group C). Patients were assessed in 3 months, 6 months and 12 months after surgery, and the Lysholm knee function score, the international knee documentation committee knee evaluation form (IKDC) score and the knee joint range of motion (ROM) were recorded. Results Three months after operation, the levels of Lysholm scores, IKDC scores and ROM in three groups were significantly improved compared with those before operation (P < 0.05). The IKDC scores and Lysholm scores in both group A and group B [IKDC score: (51.8 ± 3.1), (49.7 ± 3.9) scores; Lysholm score: (70.3 ± 3.7), (69.5 ± 3.4) scores] were better than those in group C [(44.5 ± 3.4), (59.3 ± 4.7) scores], and there were significant differences (P<0.05). Six months and 12 months after operation, the IKDC score, Lysholm score and the knee joint ROM in group A were better than those in group B and group C (P<0.05). Conclusions For knee joint MCLⅢgrade combined with ACL injuries, surgical treatment will obtain better functional scores and activity, and the effect of conservative treatment of MCL injury with extracorporeal shock wave therapy is not good.

AIM: To investigate the effect oferythropoietin (EPO) on the rats with heart failure (HF) in hypothermia and to explore its underlying mechanism.METHODS: The Sprague-Dawley rats (n=80) were randomly divided into five groups: control group (CON group), HF in low-temperature group (HFLT group), HF in normal temperature group (HFNT group), HF with EPO in low temperature group (HFLT+EPO group), and HF with EPO and LY2940002 in low temperature group (HFLT+EPO+LY group).All rats were housed in artifitial climate chamber.The animals in CON, HFLT, HFLT+EPO and HFLT+EPO+LY groups were under the low-temperature environment, while those in HFNT group were under normal temperature.The heart function was evaluated by echocardiography.The rats were then executed and the hearts were harvested.The apoptosis of myocytes was assessed by TUNEL method.The mRNA expression of Fas and PI3K was detected by fluorescence quantitative PCR (qPCR) and the protein levels of HSP70, Akt and p-Akt in the myocardial tissues were determined by Western blot.RESULTS: The rat cardiac functions in HFLT group were significantly deteriorated compared with HFNT group.The cardiac functions in HFLT+EPO group were improved compared with HFLT group.The cardiac functions in HFLT+EPO+LY group were significantly pejorated compared with HFLT+EPO group.The apoptotic index of the myocardium in HFLT group and HFNT group was significantly higher than that in CON group (P<0.01).The apoptotic index of the myocardium in HFLT group was significantly higher than that in HFNT group (P<0.05).The apoptotic index of the myocardium in HFLT+EPO group was significantly lower than that in HFLT group (P<0.01).The mRNA expression of Fas in HFLT group was significantly higher than that in HFNT group, and no obvious difference of the mRNA expression level of PI3K between HFLT group and HFNT group was observed.The mRNA expression of PI3K in HFLT+EPO group was significantly lower than that in HFLT group and HFLT+EPO+LY group (P<0.05), and that in HFLT+EPO group was significantly higher than that in HFLT group and HFLT+EPO+LY group (P<0.05).The protein levels of p-Akt and HSP70 in HFLT+EPO group was also higher than those in HFLT group and HFLT+EPO+LY group (P<0.05), and no obvious difference of the protein levels of p-Akt and HSP70 in CON, HFLT and HFNT groups was found.The protein level of Akt had no significant difference in each group.CONCLUSION: The pathway of PI3K/Akt may be one of the cardioprotective ways of EPO.EPO activates the PI3K/Akt pathway, upregulates the experssion of HSP70 (an endogenous protective factor) and inhibits the apoptosis, thus protecting the cardiac functions in the rats with HF in hypothermia.

Objective To compare the therapeutic effect between Kirschner wire- loop plating and clavicular hook plate in the treatment of distal clavicle fractures. Methods Forty- two patients with type Neer Ⅱ distal clavicle fracture were selected, among whom 23 patients were treated with Kirschner wire- loop plating (group A), and 19 patients were treated with clavicular hook plate (group B). The operative time, fluoroscopy time, length of incision, intra- operative bleeding volume and hospitalization time etc were recorded. The patients were followed up at 6 weeks, 3 months, 6 months and 12 months after operation. The American shoulder and elbow society (ASES) score was evaluated, and the therapeutic effect was evaluated by Karlsson standard. Results The operative time and fluoroscopy time in group B were significantly lower than those in group A: (63.5 ± 12.4) min vs. (71.5 ± 11.1) min and (3.6 ± 1.9) s vs. (4.8 ± 1.5) s, but the intra- operative bleeding volume, length of incision and cases of postoperative shoulder pain in group A were significantly lower than those in group B:(91.5 ± 18.5) ml vs. (108.7 ± 32.5) ml, (6.6 ± 0.7) cm vs. (11.3 ± 0.9) cm and 2 cases vs. 14 cases, and there were statistical differences (P<0.05 or <0.01). There was no statistical difference in hospitalization time between 2 groups (P>0.05). There was no statistical difference in ASES score at 6 weeks and 3 months after operation between 2 groups (P>0.05); but the ASES score at 6 and 12 months in group A was significantly higher than that in group B: (89.9 ± 12.6) scores vs. (79.7 ± 12.6) scores and (96.1 ± 4.8) scores vs. (86.1 ± 12.4) scores, and there was statistical difference (P<0.05 or <0.01). There was no statistical difference in the cases of good and excellent at 6 weeks, 3 months and 6 months after operation (P>0.05);but the cases of good and excellent at 12 months in group A was significantly more than that in group B:23 cases vs. 13 cases, and there was statistical difference (P<0.05). Conclusions Kirschner wire- loop plating provides a new treatment option for type Neer Ⅱ distal clavicle fractures. It is conducive to decrease the incidence of shoulder pain and improve the range of motion of should joint. Besides, this technology has advantage of small incision, relatively simple operation steps and small damage to the surrounding soft tissues of the acromioclavicular joint. It may be superior to the clavicular hook plate.

Objective:To investigate the effects of ursolic acid (UA) on the proliferation and differentiation of osteoclasts (OC), and to explore its role in orthodontic force-induced root resorption and its relationship with OC.Methods:The mononuclear / macrophage cells RAW264.7 were induced to the OC.Tacrolimus acid phosphatase (TRAP) staining and bone resorption lacunae observation were used to identify the induction.CCK-8 method was used to select the appropriate concentration of UA for RAW264.7 cell-free biotoxicity and to observe its effect on the proliferation and differentiation of RAW264.7.In experimental groups, UA with gradient concentrations (1.0,2.5,5.0,10.0,20.0and 40.0 μmol·L-1)were added.UA was not added in control group.Results:The TRAP staining and bone resorption lacunae observation showed that after the RAW264.7 cells were induced for 5 d, the TRAP staining positive cells were found;the resorption lacunae were rounded,and oval, etc,the bottom wall was coarser,and the boundary was clear,which indicated that the RAW264.7 cells were successfully differentiated into the osteoclasts.The CCK-8 detection results showed that high concentration of UA (> 10.0 μmol·L-1) significantly inhibited the proliferation of OC;the appropriate concentration of UA (5.0 μmol·L-1) was in the biological safety concentration range and could inhibit the OC proliferation;low concentration of UA (<2.5 μmol·L-1) had no effect.Conclusion:RANKL can induce the differentiation and maturation of RAW264.7 cells.UA is correlated with the proliferation and differentiation of OC;UA has inhibitory effect on OC at the appropriate concentration (5.0 μmol·L-1) in a time-dependent manner.

BACKGROUND: Knee arthroplasty can correct the joint deformity, alleviate the pain and improve the joint function,thereby improving the patients' quality of life. Early rehabilitative training is the key to the functional recovery of the joint.OBJECTIVE: To observe the clinical effectiveness of early gait training on the rehabilitation of patients after knee arthroplasty.METHODS: Eighty-six cases undergoing unilateral knee arthroplasty in the Department of Sports Medicine were selected and randomly divided into experimental and control groups (n=43 per group). The experimental group wasgiven rehabilitation instruction before operation, and the gait training was carried out just after the operation. The patients in the control group only received the basic rehabilitation training. The Visual Analogue Scale and the Hospital for Special Surgery scores were evaluated at baseline and 2, 4, and 8 weeks, and 6 months postoperatively, and the clinical effectiveness was compared between two groups.RESULTS AND CONCLUSION: (1) The range of motion of the knee in the experimental group was significantly higher than that in the control group at 4 and 8 weeks, and 6 months postoperatively (P < 0.05). (2) At 8 weeks and 6 months postoperatively, the Visual Analogue Scale scores in the two groups both were significantly decreased (P < 0.05). (3) At 2 weeks postoperatively, the Hospital for Special Surgery scores in both groups were significantly increased (P < 0.05);the scores at 8 weeks postoperatively in the experimental group were higher than those in the control group (P > 0.05);the scores at 6 months postoperatively in the experimental group were significantly higher than those in the control group (P < 0.05). (4) These findings suggest that compared with conventional training, early gaiting training can significantly improve the range of motion and pain of the knee, as well as enhance the functional recovery of the knee joint, which exhibits remarkable curative efficacy in the rehabilitation following knee arthroplasty.

Objective: To evaluate the efficacy and safety of ivabradine for the treatment of Chinese patients with chronic heart failure based on the Chinese subgroup data of the systolic heart failure treatment with the I_f inhibitor ivabradine trial (SHIFT). Method: A total of 6 558 stable outpatients who presented symptoms of heart failure, with a left ventricular ejection fraction (LVEF) ≤35%, sinus rhythms with a heart rate ≥70 bpm participated in the randomized, double-blind, placebo-controlled, international multicenter clinical study.The subset of Chinese patients with heart rate ≥75 bpm was enrolled in the post-hoc subgroup analyses.Patients were randomly allocated by computer-generated assignment through a telephone interactive voice response system to ivabradine group (starting dose 5 mg bid, which was then uptitrated to the maximum 7.5 mg bid) or matched placebo group.The clinical baseline characteristics of participants were obtained and analyzed.The primary outcome endpoint was a composite endpoint of cardiovascular death or hospitalization resulting from worsening HF.The primary safety endpoint included total incidence of adverse events during the study, bradycardia, and adverse visual reaction (phosphenes). Results: A total of 49 Chinese centers enrolled a total of 225 patients with chronic heart failure, of whom, 106 patients were randomized to the ivabradine group and the other 119 patients to the placebo group, and the mean follow-up time was (15.6±5.1) months.By the end of the study, mean heart rate (71.0 bpm vs. 80.3 bpm, P<0.05) and incidence of the primary endpoint events (18.9% (20/106) vs. 31.9%(38/119), HR=0.56, 95%CI 0.33-0.97, P=0.039) were significantly lower, while the percentage of patients with improvement in heart functional class NYHA (53.8% (56/106) vs. 34.5% (41/119), P=0.006 1) was significantly higher in the ivabradine group than in the placebo group.The total number of adverse events (129 events, 49.6% PY) in the ivabradine group was lower than that in the placebo group (203 events, 50.8% PY). In the ivabradine group and the placebo group, there were respectively 2 patients (1.9%) and 0 patients experienced bradycardia, 3 patients (2.9%) and 1 patient (0.8%) experienced adverse visual reaction (phosphenes). Conclusions: Ivabradine significantly reduced heart rate and improved the clinical outcomes and NYHA function class in Chinese patients with chronic heart failure, these beneficial effects are achieved without inducing remarkable adverse reactions.The results of Chinese subgroup analysis were thus consistent with the overall results of the SHIFT study. Clinical Trial Registry International standard randomized controlled trials registry, ISRCTN 70429960.

Objective To analyze the status of biobanks in public hospitals in Shanghai.Methods A questionnaire survey on biobanks was conducted in 9 representative public hospitals in Shanghai.Results The management system of hospital biobanks in Shanghai was basically shaped,but the human resources and financial inputs were in shortage,and some management and regulations were not in place yet.Conclusions The biobanks of public hospitals need more inputs,improvement,and standardized management.