Objective:To evaluate the clinical efficacy of a novel surgical approach of debridement, antibiotics, and implant retention (DAIR) with flap transfer, for treating chronic implant infections in bone tumor patients.Methods:A retrospective review was conducted on nine consecutive patients [6 males, 3 females; median age 35(27, 51) years, range 9-71] who underwent a modified procedure of DAIR plus flap transfer between November 2022 and January 2024. The cohort included six cases of chronic periprosthetic joint infection and three cases of chronic plate and screw infection. Tumor diagnoses included seven primary malignant tumors (osteosarcoma=5, undifferentiated pleomorphic sarcoma of bone=1, synovial sarcoma=1) and two bone metastasis of renal cell carcinoma. The procedure involved wide, radical debridement, meticulous removal of biofilm from implants and surrounding soft tissue, followed by the transfer of a well vascularized musculocutaneous flap to fully envelope the contaminated interface. Pre-operative clinicopathological data, surgical details, postoperative complications and infection recurrence were analyzed.Results:The median interval between initial implantation and debridement was 10.0(3.3, 14.8) months. Median follow-up after debridement was 15.9(15.4, 18.2) months. All nine surgeries were completed as planned: six musculocutaneous flaps, two fasciocutaneous flaps and one muscle-only flap. Implants were preserved in six patients; two required subsequent removal for recurrent infection, and one patient later underwent amputation for tumor recurrence. Infection-free implant survival at 3, 6 and 12 months was 88.9%, 87.5% and 87.5%, respectively. Major complications included one donor-site hematoma, one donor-site sensory deficit and one wound healing delay. All the complications were well management. Both reinfections occurred in proximal tibial prostheses, likely due to limited flap coverage options and local anatomical constraints.Conclusion:Although reinfections happened in two cases DAIR with flap transfer provides promising short-term infection control in patients with chronic implant-associated infections following bone tumor surgery.

OBJECTIVES: We propose a myocardial infarction (MI) detection and localization model for improving the diagnostic accuracy for MI to provide assistance to clinical decision-making. METHODS: The proposed model was constructed based on multi-scale field residual blocks fusion modified channel attention (MSF-RB-MCA). The model utilizes lead II electrocardiogram (ECG) signals to detect and localize MI, and extracts different levels of feature information through the multi-scale field residual block. A modified channel attention for automatic adjustment of the feature weights was introduced to enhance the model's ability to focus on the MI region, thereby improving the accuracy of MI detection and localization. RESULTS: A 5-fold cross-validation test of the model was performed using the publicly available Physikalisch-Technische Bundesanstalt (PTB) dataset. For MI detection, the model achieved an accuracy of 99.96% on the test set with a specificity of 99.84% and a sensitivity of 99.99%. For MI localization, the accuracy, specificity and sensitivity were 99.81%, 99.98% and 99.65%, respectively. The performances of the model for MI detection and localization were superior to those of other comparison models. CONCLUSIONS The proposed MSF-RB-MCA model shows excellent performance in AI detection and localization based on lead II ECG signals, demonstrating its great potential for application in wearable devices.
Myocardial Infarction/diagnosis* ; Humans ; Electrocardiography/methods* ; Signal Processing, Computer-Assisted ; Algorithms ; Sensitivity and Specificity

To address the limitations of the existing automatic electrocardiogram(ECG)diagnosis models in learning long-term dependencies,an automatic 12-lead long-term ECG signal diagnosis model which combines bidirectional selective state space model(bidirectional mamba,BiMamba)with residual multi-scale receptive field block(RMSF)is proposed:(1)designing a multi-scale receptive field module with residual connections to realize more extensive feature extraction and fusion;(2)introducing BiMamba block to enhance the model's temporal modeling capability by employing both forward and backward temporal processing;(3)using the classifier to process features from BiMamba for accomplishing multi-label ECG classification.Five major diagnostic categories from the PTB-XL dataset are extracted and subjected to 5-fold cross-validation experiments.The experimental results from the comparative study show that BiMamba-RMSF achieves an average accuracy of 89.42%,an average AUC of 0.9356,and an average F1 score of 72.85%,outperforming the other 4 automatic ECG diagnosis models.Additionally,ablation study further validates the effectiveness of BiMamba block.It is demonstrated that the proposed model has a high precision in the multi-label classification for 12-lead long-term ECG signals.

Objective:To evaluate the clinical efficacy of a novel surgical approach of debridement, antibiotics, and implant retention (DAIR) with flap transfer, for treating chronic implant infections in bone tumor patients.Methods:A retrospective review was conducted on nine consecutive patients [6 males, 3 females; median age 35(27, 51) years, range 9-71] who underwent a modified procedure of DAIR plus flap transfer between November 2022 and January 2024. The cohort included six cases of chronic periprosthetic joint infection and three cases of chronic plate and screw infection. Tumor diagnoses included seven primary malignant tumors (osteosarcoma=5, undifferentiated pleomorphic sarcoma of bone=1, synovial sarcoma=1) and two bone metastasis of renal cell carcinoma. The procedure involved wide, radical debridement, meticulous removal of biofilm from implants and surrounding soft tissue, followed by the transfer of a well vascularized musculocutaneous flap to fully envelope the contaminated interface. Pre-operative clinicopathological data, surgical details, postoperative complications and infection recurrence were analyzed.Results:The median interval between initial implantation and debridement was 10.0(3.3, 14.8) months. Median follow-up after debridement was 15.9(15.4, 18.2) months. All nine surgeries were completed as planned: six musculocutaneous flaps, two fasciocutaneous flaps and one muscle-only flap. Implants were preserved in six patients; two required subsequent removal for recurrent infection, and one patient later underwent amputation for tumor recurrence. Infection-free implant survival at 3, 6 and 12 months was 88.9%, 87.5% and 87.5%, respectively. Major complications included one donor-site hematoma, one donor-site sensory deficit and one wound healing delay. All the complications were well management. Both reinfections occurred in proximal tibial prostheses, likely due to limited flap coverage options and local anatomical constraints.Conclusion:Although reinfections happened in two cases DAIR with flap transfer provides promising short-term infection control in patients with chronic implant-associated infections following bone tumor surgery.

To address the limitations of the existing automatic electrocardiogram(ECG)diagnosis models in learning long-term dependencies,an automatic 12-lead long-term ECG signal diagnosis model which combines bidirectional selective state space model(bidirectional mamba,BiMamba)with residual multi-scale receptive field block(RMSF)is proposed:(1)designing a multi-scale receptive field module with residual connections to realize more extensive feature extraction and fusion;(2)introducing BiMamba block to enhance the model's temporal modeling capability by employing both forward and backward temporal processing;(3)using the classifier to process features from BiMamba for accomplishing multi-label ECG classification.Five major diagnostic categories from the PTB-XL dataset are extracted and subjected to 5-fold cross-validation experiments.The experimental results from the comparative study show that BiMamba-RMSF achieves an average accuracy of 89.42%,an average AUC of 0.9356,and an average F1 score of 72.85%,outperforming the other 4 automatic ECG diagnosis models.Additionally,ablation study further validates the effectiveness of BiMamba block.It is demonstrated that the proposed model has a high precision in the multi-label classification for 12-lead long-term ECG signals.

Objective·To investigate the effect of early postoperative administration of zoledronic acid on fracture healing and functional recovery in elderly patients with osteoporotic femoral intertrochanteric fracture treated with proximal femoral nail antirotation(PFNA)surgery,and explore other potential prognostic factors.Methods·A total of 174 patients with femoral intertrochanteric fractures of 80 years old or above who underwent PFNA treatment in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine from January,2016 to February,2022,were divided into experimental group(n=26)and control group(n=148)according to whether they received zoledronic acid early after surgery.All patients were followed up twice at 6 weeks and 12 weeks after surgery.The patients in the experimental group were matched with the control group by propensity score matching(PSM)at a ratio of 1:3(the matching factors included age,gender,fracture type,and body mass index).General characteristics,as well as fracture healing and functional recovery at the two follow-up visits were compared between the two groups after matching.Subsequently,Logistic regression was used to explore the potential prognostic factors on fracture healing at 12 weeks after surgery.Results·PSM resulted in 25 patients in the experimental group and 65 patients in the control group,and there were no statistically significant differences in baseline characteristics between the two groups.The fracture healing rates at 6 weeks and 12 weeks after surgery in the experimental group(16.0%and 96.0%,respectively)were higher than those in the control group(1.5%and 73.8%),and the differences were statistically significant(P<0.05).Harris hip function score in the experimental group at 12 weeks was significantly higher than that of the control group(P=0.019).The results of Logistic regression analysis showed that good surgical reduction(OR=12.52,95%CI 2.67?58.74,P=0.001),early postoperative administration of zoledronic acid(OR=10.14,95%CI 1.01?102.09,P=0.049),and higher serum albumin level(OR=1.15,95%CI 1.02?1.29,P=0.025)were the favorable factors of early fracture healing,while unstable fracture(OR=0.10,95%CI 0.03?0.31,P=0.000)was the unfavorable factor.Conclusion·For elderly patients with osteoporotic intertrochanteric femoral fractures treated with PFNA surgery,early postoperative administration of zoledronic acid can promote fracture healing and lead to better functional recovery;in addition,good surgical reduction and higher serum albumin levels are favorable factors for fracture healing,whereas unstable fracture presents as a hindrance to the healing process.

The hydroponic culture test method was used to study the physiological and biochemical responses of Paulownia fortunei seedlings under Zn stress, Cd stress, and combined Zn and Cd stress as well as changes in the enrichment and transfer characteristics of heavy metals. Under single and combined heavy metal stress, the biomass, plant height, and peroxidase (POD) activity of P. fortunei decreased as the treatment concentration increased. Combined Zn and Cd affected adversely plant height and biomass. As the concentration of Zn increased when applied alone, the chlorophyll content and catalase (CAT) activity of P. fortunei first increased and then decreased, the superoxide dismutase (SOD) activity increased, and the aboveground malondialdehyde (MDA) content first decreased and then increased. As the concentration of Cd increased when applied alone, chlorophyll content and CAT activity increased, and SOD activity and aboveground MDA content first increased and then decreased. Under both Cd and Zn, the physiological response was more complex. Cd in the seedlings of P. fortunei was concentrated in the root. In contrast, Zn was concentrated in the upper part of the ground, and its transfer coefficient was greater than 1.00. Thus, the addition of Zn promotes the transfer of heavy metals to the above-ground portions of plants. Generally, P. fortunei can effectively promote ecological restoration under complex forms of heavy metal pollution.
Cadmium ; Chlorophyll ; Metals, Heavy ; Plant Roots/chemistry* ; Seedlings ; Soil Pollutants ; Stress, Physiological ; Superoxide Dismutase ; Zinc