Utility of D-dimer in total joint arthroplasty

As the number of patients receiving total joint replacements continues to rise,considerable attention has been directed towards the early detection and prevention of postoperative complications.While D-dimer has long been studied as a diagnostic tool in venous thromboembolism(VTE),this assay has recently received considerable attention in the diagnosis of periprosthetic joint infection(PJI).D-dimer values are substantially elevated in the acute postoperative period after total joint arthroplasty,with levels often exceeding the standard institutional cutoff for VTE(500µg/L).The utility of D-dimer in detecting VTE after total joint replacement is currently limited,and more research to assess its value in the setting of contemporary prophylaxis protocols is warranted.Recent literature supports D-dimer as a good to excellent biomarker for the diagnosis of chronic PJI,especially when using serum sample technique.Providers should exercise caution when interpreting D-dimer levels in patients with inflammatory and hypercoagulability disorders,as the diagnostic value is decreased.The updated 2018 Musculoskeletal Infection Society criteria,which includes D-dimer levels>860µg/L as a minor criterion,may be the most accurate for diagnosing chronic PJI to date.Larger prospective trials with transparent lab testing protocols are needed to establish best assay practices and optimal cutoff values for D-dimer in the diagnosis of PJI.This review summarizes the most current literature on the value of D-dimer in total joint arthroplasty and elucidates areas for future progress.

Artificial intelligence in sleep medicine:Present and future

Artificial intelligence(AI)has impacted many areas of healthcare.AI in healthcare uses machine learning,deep learning,and natural language processing to analyze copious amounts of healthcare data and yield valuable outcomes.In the sleep medicine field,a large amount of physiological data is gathered compared to other branches of medicine.This field is primed for innovations with the help of AI.A good quality of sleep is crucial for optimal health.About one billion people are estimated to have obstructive sleep apnea worldwide,but it is difficult to diagnose and treat all the people with limited resources.Sleep apnea is one of the major contributors to poor health.Most of the sleep apnea patients remain undiagnosed.Those diagnosed with sleep apnea have difficulty getting it optimally treated due to several factors,and AI can help in this situation.AI can also help in the diagnosis and management of other sleep disorders such as insomnia,hypersomnia,parasomnia,narcolepsy,shift work sleep disorders,periodic leg movement disorders,etc.In this manuscript,we aim to address three critical issues about the use of AI in sleep medicine:(1)How can AI help in diagnosing and treating sleep disorders?(2)How can AI fill the gap in the care of sleep disorders?and(3)What are the ethical and legal considerations of using AI in sleep medicine?

X-ray imaging of 30 year old wine grape wood reveals cumulative impacts of rootstocks on scion secondary growth and Ravaz index

Annual rings from 30 year old vines in a California rootstock trial were measured to determine the effects of 15 different rootstocks on Chardonnay and Cabernet Sauvignon scions.Viticultural traits measuring vegetative growth,yield,berry quality,and nutrient uptake were collected at the beginning(1995 to 1999)and end(2017 to 2020)of the lifetime of a vineyard initially planted in 1991 and removed in 2021.X-ray Computed Tomography(CT)was used to measure ring widths in 103 vines.Ring width was modeled as a function of ring number using a negative exponential model.Early and late wood ring widths,cambium width,and scion trunk radius were correlated with 27 traits.Modeling of annual ring width shows that scions alter the width of the first rings but that rootstocks alter the decay of later rings,consistently shortening ring width throughout the lifetime of the vine.Ravaz index,juice pH,photosynthetic assimilation and transpiration rates,and instantaneous water use efficiency are correlated with scion trunk radius.Ultimately,our research indicates that rootstocks modulate secondary growth over years,altering physiology and agronomic traits.Rootstocks act in similar but distinct ways from climate to modulate ring width,which borrowing techniques from dendrochronology,can be used to monitor both genetic and environmental effects in woody perennial crop species.

含有加州杏仁粉和烘焙酶制剂的面团体系的流变学特性研究

本文主要应用动态流变仪测定了美国加州杏仁粉(全脂和脱脂)百分含量分别为0%、12.5%、25%、37.5%和50%的面团的粘弹性模量(G″和G′)在频率和温度变化过程中所呈现出的变化趋势;以及在频率和温度相同的情况下,杏仁粉含量的变化对面团的G″和G′大小的影响;并进一步探索了淀粉酶处理对面团流变学特性的影响。结果表明:(1)在频率扫描过程中杏仁粉对面团的G″和G′都有明显的影响,含有全脂杏仁粉的面团的G″大于含有相同比例脱脂杏仁粉面团的G″,而含有全脂杏仁粉的面团的弹性模量G′却比含有相同比例脱脂杏仁粉的小,从而推断杏仁粉中的油脂对面团的流变学特性具有显著的影响;(2)在相同的频率时小麦粉面团的G″和G′比分别含有12.5%和25%的杏仁粉(全脂和脱脂)的面团的大,而分别含有37.5%和50%的杏仁粉的面团的G″和G′更大,这可能是由于杏仁蛋白质与小麦蛋白质发生了某种相互作用所致;(3)在升温过程中,添加全脂和脱脂杏仁粉都会使面团的G″和G′减小;在降温过程中,加入杏仁粉(全脂和脱脂)使面团的G′减小,但含有脱脂杏仁粉面团的G′大于含有全脂杏仁粉面团的G′,而加入杏仁粉对面团的G″在降温过程中的变化影响不显著;(4)在频率变化、升温和降温过程中,加入淀粉酶都会使面团的G″和G′减小。

Changes in efficiency and resource utilization after increasing experience with double balloon enteroscopy

AIM:To investigate changes in efficiency and resource utilization as a single endoscopist's experience increased with each subsequent 100 double balloon enteroscopy(DBE) procedures.METHODS:We reviewed consecutive DBE procedures performed by a single endoscopist at our center over 4 years.DBE was employed when the clinician deemed the procedure was needed for disease management.The approach(oral,anal or both) was chosen based on suspected location of the target lesion.All DBE was performed in a standard endoscopy room with a portable fluoroscopy unit.Fluoroscopy was used to aid in shortening the small intestine and reducing bowel loops.For oral DBE,measurements were taken from the incisors.For anal DBE,measurements were taken from the anal verge.Enteroscopy continued until the target lesion was reached,until the entire small intestine was examined,or until no further progress was deemed possible.The length of small intestine examined(cm),procedure duration(min),and fluoroscopy time(s) were analyzed for sequential groups of 100 DBE.Sub-groups of diagnostic and therapeutic procedures were analyzed using multivariable linear regression.RESULTS:802 consecutive DBE procedures were analyzed.For oral DBE,median [interquartile range(IQR)] length of small bowel examined was 230.8 cm(range:210-248 cm) and for anal DBE was 143.5 cm(range:100-180 cm).No significant increase in length examined was noted for either the oral or anal approach with advancing position in series.In terms of duration of procedure,the median(IQR) for oral DBE was 86 min(range:71-105 min) and for anal DBE was 81.3 min(range:67-105 min).When comparing by the position in series,there was a significant(P value < 0.001) decrease in procedure duration for both upper and lower procedures with increasing experience.Median(IQR) time of exposure to fluoroscopy for oral DBE was 190 s(114-275) compared to anal DBE which was 196.4 s(312-128).This represented a significant(P value < 0.001) decrease in the amount of fluoroscopy used with increasing position in series.For both oral and anal DBE,fluoroscopy time was reduced by greater than 50% over the course of 802 total procedures performed.Sub-group analysis was conducted on therapeutic and diagnostic groups.Out of 802 procedures,a total of 434 were considered therapeutic.Argon plasma coagulation was by far the most common therapeutic intervention performed.There was no evidence of a difference in length examined or fluoroscopy exposure among oral DBE for diagnostic and therapeutic procedures,P = 0.91 and P = 0.32 respectively.The median(IQR) for length was 235 cm(range:178-280 cm) for diagnostic vs 230 cm(range:180-275 cm) for therapeutic procedures;additionally,fluoroscopy time median(IQR) was 180 s(range:110-295 s) and 162 s(range:102-263 s) for no intervention and intervention.However,there was a significant difference in procedure duration among oral DBE(P < 0.001).The median(IQR) was 80 min(range:60-97 min) and 94 min(range:77-110 min) for diagnostic and therapeutic interventions respectively.CONCLUSION:For a single endoscopist,increased DBE experience with number of performed procedures is associated with increased efficiency and decreased resource utilization.

大数据下中国动漫产业国际化发展路径创新

随着近年大数据的发展,网络技术革新速度加快,随即也开启了中国动漫产业崭新的跃进阶段。我国现如今已经成为了世界第一动画生产大国,动漫的发展也蒸蒸日上。文章依据时代发展的态势和潮流,讨论了在大数据下,运用"互联网+创新"模式,关注原创,注重中国文化深厚底蕴的运用。正确合理地发挥网络技术手段,助力动漫产业结构调整、产业融合、创新发展和转型升级,从而树立中国自信,文化自信,让中国动漫产业走向国际化发展。

Transcriptome analyses of the Dof-like gene family in grapevine reveal its involvement in berry, flower and seed development

The Dof(DNA-binding with one finger)protein family spans a group of plant transcription factors involved in the regulation of several functions,such as plant responses to stress,hormones and light,phytochrome signaling and seed germination.Here we describe the Dof-like gene family in grapevine(Vitis vinifera L.),which consists of 25 genes coding for Dof.An extensive in silico characterization of the VviDofL gene family was performed.Additionally,the expression of the entire gene family was assessed in 54 grapevine tissues and organs using an integrated approach with microarray(cv Corvina)and real-time PCR(cv Pinot Noir)analyses.The phylogenetic analysis comparing grapevine sequences with those of Arabidopsis,tomato,poplar and already described Dof genes in other species allowed us to identify several duplicated genes.The diversification of grapevine DofL genes during evolution likely resulted in a broader range of biological roles.Furthermore,distinct expression patterns were identified between samples analyzed,corroborating such hypothesis.Our expression results indicate that several VviDofL genes perform their functional roles mainly during flower,berry and seed development,highlighting their importance for grapevine growth and production.The identification of similar expression profiles between both approaches strongly suggests that these genes have important regulatory roles that are evolutionally conserved between grapevine cvs Corvina and Pinot Noir.

A key‘foxy’aroma gene is regulated by homologyinduced promoter indels in the iconic juice grape‘Concord’

‘Concord’,the most well-known juice grape with a parentage of the North American grape species Vitis labrusca L.,possesses a special‘foxy’aroma predominantly resulted from the accumulation of methyl anthranilate(MA)in berries.This aroma,however,is often perceived as an undesirable attribute by wine consumers and rarely noticeable in the common table and wine grape species V.vinifera.Here we discovered homology-induced promoter indels as a major genetic mechanism for species-specific regulation of a key‘foxy’aroma gene,anthraniloyl-CoA:methanol acyltransferase(AMAT),that is responsible for MA biosynthesis.We found the absence of a 426-bp and/or a 42-bp sequence in AMAT promoters highly associated with high levels of AMAT expression and MA accumulation in‘Concord’and other V.labrusca-derived grapes.These promoter variants,all with direct and inverted repeats,were further confirmed in more than 1,300 Vitis germplasm.Moreover,functional impact of these indels was validated in transgenic Arabidopsis.Superimposed on the promoter regulation,large structural changes including exonic insertion of a retrotransposon were present at the AMAT locus in some V.vinifera grapes.Elucidation of the AMAT genetic regulation advances our understanding of the‘foxy’aroma trait and makes it genetically trackable and amenable in grapevine breeding.

Maxillary Distraction Osteogenesis

Background: Distraction Osteogenesis is popular for long bones. And nowadays it has found its role in facial bone deficiency treatments. Purpose: We used our special designed Distractor for advancement of Maxillary deficiencies in cleft lip and palate patients. The purpose of this paper is to compare the treatment of hypoplastic, posteriorly retruded maxillary of cleft palate patients using distraction osteogenesis vs. Le fort I orthognathic surgery for length of advancement, stability and relapse, growth after distraction and soft tissue expansion and soft tissue profile changes. Meterial & Methods: In group A only Le fort I and surgical maxillary advancement sometimes with bone graft were done. In group B we used our special Distractor for Distraction Osteogenesis and advancement of the Maxillary bone. Demographic data, length of retrusion of maxilla, time length of treatment, length of advancement and relapse, SNA and SNB angles were measured and included in the study. The results were compared in each group before and after advancement and between both groups. The rate of distraction was 0.5 mm twice per day to achieve normal occlusion with 2 mm overcorrection more than calculated measures. The devices removed after 10 weeks as latency period. Results: The SNA increased at the end of distraction (p < 0.001), with no significant relapse indicating stability at 1 year after treatment. The total length of advancement in group A was 17 ± 4 mm and in group B was 20 ± 3 mm. The difference between before and after measurements in each group was significant (p = 0.002, p = 0.003 respectively). The mean length of relapse in group A was 3 ± 1 mm and in group B was 1 mm. Discussion: For the deformities and retrusions less than 7 - 8 mm, the Orthognatic surgery is the treatment of choice, however for more retrusions (>10 mm) we recommend Distraction Osteogenesis, and it preferred to start it soon in younger ages.

A transcriptome analysis of two grapevine populations segregating for tendril phyllotaxy

The shoot structure of cultivated grapevine Vitis vinifera L.typically exhibits a three-node modular repetitive pattern,two sequential leaf-opposed tendrils followed by a tendril-free node.In this study,we investigated the molecular basis of this pattern by characterizing differentially expressed genes in 10 bulk samples of young tendril tissue from two grapevine populations showing segregation of mutant or wild-type shoot/tendril phyllotaxy.One population was the selfed progeny and the other one,an outcrossed progeny of a Vitis hybrid,‘Roger’s Red’.We analyzed 13375 expressed genes and carried out in-depth analyses of 324 of them,which were differentially expressed with a minimum of 1.5-fold changes between the mutant and wild-type bulk samples in both selfed and cross populations.A significant portion of these genes were direct cis-binding targets of 14 transcription factor families that were themselves differentially expressed.Network-based dependency analysis further revealed that most of the significantly rewired connections among the 10 most connected hub genes involved at least one transcription factor.TCP3 and MYB12,which were known important for plant-form development,were among these transcription factors.More importantly,TCP3 and MYB12 were found in this study to be involved in regulating the lignin gene PRX52,which is important to plant-form development.A further support evidence for the roles of TCP3-MYB12-PRX52 in contributing to tendril phyllotaxy was the findings of two other lignin-related genes uniquely expressed in the mutant phyllotaxy background.

Antithrombotic therapy in patients with COVID-19:indications,pharmacotherapy and controversy

Hypercoagulability associated with COVID-19 infection increases risks for either venous or arterial thrombotic events(ATEs)or both.1 For hospitalised patients with COVID-19,the incidence of venous thromboembolism(VTE)was 4.5%2;the rate among patients with crit-ical illness was 27.9%as compared with those not critically ill(7.1%).The exact mechanism of COVID-19-related thrombotic events is unclear.However,it may partially be related to Virchow triad:alternation of blood flow(stasis),vascular endothelial injury by SARS-CoV 2 virus and alteration of the constituents of the blood including inherited or acquired hypercoagulable state.Therefore,it is a challenge to evaluate the thromboembolic risk,select an appropriate antithrombotic agent and decide on the doses and duration of therapy in these patients.Several international and American societies have published clinical guidelines that reviewed evaluation of coagulation abnormalities in patients with COVID-19.3-6 To balance the risk of bleeding and preventing or treating thromboembolic events,a simplified practical summarisation is needed.

Utilization of almond residues

Almond production generates millions of tons of residues in addition to almond nuts.Almond residues,including shells,hulls,pruning,leaves,skin and inedible kernel disposition,are good feedstocks for production of bioenergy and other valuable compounds.In this article,research on the utilization of almond residues as energy and non-energy feedstocks is reviewed.Technical options for converting almond residues to energy and other valuable products are discussed.Several commercial conversion technologies are examined.Needs for further research and development are recommended.

Three-dimensional organ modeling based on deformable surfaces applied to radio-oncology

This paper describes a method based on an energy minimizing deformable model applied to the 3D biomechanical modeling of a set of organs considered as regions of interest (ROI) for radiotherapy. The initial model consists of a quadratic surface that is deformed to the exact contour of the ROI by means of the physical properties of a mass-spring system. The exact contour of each ROI is first obtained using a geodesic active contour model. The ROI is then parameterized by the vibration modes resulting from the deformation process. Once each structure has been defined, the method provides a 3D global model including the whole set of ROIs. This model allows one to describe statistically the most significant variations among its structures. Statistical ROI variations among a set of patients or through time can be analyzed. Experimental results are presented using the pelvic zone to simulate anatomical variations among structures and its application in radiotherapy treatment planning.