Background: Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system.

Methods: The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex.

Results: The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16-36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30-52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29-62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion.

Conclusion: Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.

Keywords: Anterior talofibular ligament; Calcaneofibular ligament; Miniaturization ligament performance probe; Tension.

Background: Throughout the last decade, tuberculosis (TB) treatment success has not surpassed 90%, the global target. The impact of mobile health interventions (MHIs) on TB treatment outcomes is unknown, especially in low- and middle-income countries (LMICs). MHIs, including interactive voice response technology (IVRT), may enhance adherence and retention in the care of patients with tuberculosis and improve TB treatment outcomes. This study seeks to determine the impact of IVRT-based MHI on TB treatment success (treatment completion and cure rates) in patients with TB receiving care at five public health facilities in Uganda.

Methods: We used a theory-based and human-centered design (HCD) to adapt an already piloted software to design "Call for life-TB" (CFL-TB), an MHI that utilizes IVRT to deliver adherence and appointment reminders and allows remote symptom reporting. This open-label, multicenter, randomized controlled trial (RCT), with nested qualitative and economic evaluation studies, will determine the impact of CFL-TB on TB treatment success in patients with drug-susceptible TB in Uganda. Participants (n = 274) at the five study sites will be randomized (1:1 ratio) to either control (standard of care) or intervention (adherence and appointment reminders, and health tips) arms. Multivariable regression models will be used to compare treatment success, adherence to treatment and clinic appointments, and treatment completion at 6 months post-enrolment. Additionally, we will determine the cost-effectiveness, acceptability, and perceptions of stakeholders. The study received national ethical approval and was conducted in accordance with the international ethical guidelines.

Discussion: This randomized controlled trial aims to evaluate interactive voice response technology in the context of resource-limited settings with a high burden of TB and high illiteracy rates. The software to be evaluated was developed using HCD and the intervention was based on the IMB model. The software is tailored to the local context and is interoperable with the MHI ecosystem. The HCD approach ensures higher usability of the MHI by integrating human factors in the prototype development. This research will contribute towards the understanding of the implementation and impact of the MHI on TB treatment outcomes and the health system, especially in LMICs.

Trial registration: ClinicalTrials.gov NCT04709159 . Registered on January 14, 2021.

Keywords: Africa; Interactive voice response; Low - and middle-income countries; Resource-limited settings; mHealth; tuberculosis.

The pigment composition of isolated reaction centers (RCs) of the green filamentous bacterium Chloroflexus (Cfl.) aurantiacus was changed by chemical exchange of native bacteriopheophytin a (BPheo) molecules with externally added pheophytin a (Pheo) or [3-acetyl]-Pheo upon incubation of RC/pheophytin mixtures at room temperature and 45 °C. The modified RCs were characterized by Vis/NIR absorption spectroscopy, and the effect of pigment exchange on RC photochemical activity was assessed by measuring the photoaccumulation of the reduced pigment at the binding site H_A. It is shown that both pheophytins can be exchanged into the H_A site instead of BPheo by incubation at room temperature. While the newly introduced Pheo molecule is not active in electron transfer, the [3-acetyl]-Pheo molecule is able to replace functionally the photoreducible H_A BPheo molecule with the formation of the [3-acetyl]-Pheo^- radical anion instead of the BPheo^-. After incubation at 45 °C, the majority (~ 90%) of H_A BPheo molecules is replaced by both Pheo and [3-acetyl]-Pheo. Only a partial replacement of inactive BPheo molecules with pheophytins is observed even when the incubation temperature is raised to 50 °C. The results are discussed in terms of (i) differences in the accessibility of BPheo binding sites for extraneous pigments depending on structural constraints and incubation temperature and (ii) the effect of the reduction potential of pigments introduced into the H_A site on the energetics of the charge separation process. The possible implication of Pheo-exchanged preparations for studying early electron-transfer events in Cfl. aurantiacus RCs is considered.

Keywords: Bacteriopheophytins; Chloroflexus aurantiacus; Pigment replacement; Plant-type pheophytins; Reaction centers; Rhodobacter sphaeroides.

Federated learning (FL) is a distributed model for deep learning that integrates client-server architecture, edge computing, and real-time intelligence. FL has the capability of revolutionizing machine learning (ML) but lacks in the practicality of implementation due to technological limitations, communication overhead, non-IID (independent and identically distributed) data, and privacy concerns. Training a ML model over heterogeneous non-IID data highly degrades the convergence rate and performance. The existing traditional and clustered FL algorithms exhibit two main limitations, including inefficient client training and static hyperparameter utilization. To overcome these limitations, we propose a novel hybrid algorithm, namely, genetic clustered FL (Genetic CFL), that clusters edge devices based on the training hyperparameters and genetically modifies the parameters clusterwise. Then, we introduce an algorithm that drastically increases the individual cluster accuracy by integrating the density-based clustering and genetic hyperparameter optimization. The results are bench-marked using MNIST handwritten digit dataset and the CIFAR-10 dataset. The proposed genetic CFL shows significant improvements and works well with realistic cases of non-IID and ambiguous data. An accuracy of 99.79% is observed in the MNIST dataset and 76.88% in CIFAR-10 dataset with only 10 training rounds.

A numerical formulation based on the precise-integration time-domain (PITD) method for simulating periodic media is extended for overcoming the Courant-Friedrich-Levy (CFL) limit on the time-step size in a finite-difference time-domain (FDTD) simulation. In this new method, the periodic boundary conditions are implemented, permitting the simulation of a wide range of periodic optical media, i.e., gratings, or thin-film filters. Furthermore, the complete tensorial derivation for the permittivity also allows simulating anisotropic periodic media. Numerical results demonstrate that PITD is reliable and even considering anisotropic media can be competitive compared to traditional FDTD solutions. Furthermore, the maximum allowable time-step size has been demonstrated to be much larger than that of the CFL limit of the FDTD method, being a valuable tool in cases in which the steady-state requires a large number of time-steps.

Keywords: anisotropic media; computational electromagnetics; diffractive optics; periodic media; precise-integration time-domain (PITD) method.

Explicit electromagnetic particle-in-cell (PIC) codes are typically limited by the Courant-Friedrichs-Lewy (CFL) condition, which implies that the timestep multiplied by the speed of light must be smaller than the smallest cell size. In the case of boosted-frame PIC simulations of plasma-based acceleration, this limitation can be a major hindrance, as the cells are often very elongated along the longitudinal direction and the timestep is thus limited by the small, transverse cell size. This entails many small-timestep PIC iterations and can limit the potential speed-up of the boosted-frame technique. Here, by using a CFL-free analytical spectral solver, and by mitigating additional numerical instabilities that arise at large timestep, we show that it is possible to overcome traditional limitations on the timestep and thereby realize the full potential of the boosted-frame technique over a much wider range of parameters.

Most face recognition methods employ single-bit binary descriptors for face representation. The information from these methods is lost in the process of quantization from real-valued descriptors to binary descriptors, which greatly limits their robustness for face recognition. In this study, we propose a novel weighted feature histogram (WFH) method of multi-scale local patches using multi-bit binary descriptors for face recognition. First, to obtain multi-scale information of the face image, the local patches are extracted using a multi-scale local patch generation (MSLPG) method. Second, with the goal of reducing the quantization information loss of binary descriptors, a novel multi-bit local binary descriptor learning (MBLBDL) method is proposed to extract multi-bit local binary descriptors (MBLBDs). In MBLBDL, a learned mapping matrix and novel multi-bit coding rules are employed to project pixel difference vectors (PDVs) into the MBLBDs in each local patch. Finally, a novel robust weight learning (RWL) method is proposed to learn a set of robust weights for each patch to integrate the MBLBDs into the final face representation. In RWL, a codebook is first constructed by clustering MBLBDs on each local patch to extract a feature histogram. Then, considering that different parts of the face have different degrees of robustness to local changes, a set of weights is learned to concatenate the feature histograms of all local patches into the final representation of a face image. In addition, to further improve the performance for heterogeneous face recognition, a coupled WFH (C-WFH) method is proposed. C-WFH maintains the similarity of the corresponding MBLBDs and feature histograms for a pair of heterogeneous face images by means of a novel coupled feature learning (CFL) method to reduce the modality gap. A series of experiments are conducted on widely used face datasets to analyze the performance of WFH and C-WFH. Extensive experimental results show that WFH and C-WFH outperform state-of-the-art face recognition methods.

Background: HU-014, a newly introduced botulinum toxin type A, has not been investigated for its efficacy and safety in crow's feet line (CFL) treatment.

Objective: Here, we compared the efficacy and safety of HU-014 and onabotulinumtoxinA in CFL treatment.

Methods: This was a randomized, double-blind, active drug-controlled, multicenter, 16-week, Phase I/III study designed to determine the noninferiority of HU-014 compared with onabotulinumtoxinA in moderate-to-severe CFL treatment. In the Phase III study, 290 subjects were randomized at a 1:1 ratio to receive a single treatment of HU-014 or onabotulinumtoxinA. The primary endpoint was the proportion of subjects achieving Grade 0 or 1 in the facial wrinkle scale on maximum smile at Week 4.

Results: The primary endpoint was achieved by 72% of the subjects with HU-014 and onabotulinumtoxinA treatments, supporting the noninferiority of HU-014 compared with onabotulinumtoxinA. All secondary efficacy outcomes were achieved by the subjects. The 2 groups showed no significant differences in the safety analysis.

Conclusion: HU-014 has noninferior efficacy and safety compared with onabotulinumtoxinA in the treatment of CFL.

Matsuo, H, Funasaki, K, and Yamada, S. The applicability of the risk score approach to competitive sport: development of a physical success score for the Canadian football league combine. J Strength Cond Res XX(X): 000-000, 2021-In the scouting combine of the Canadian Football League (CFL), players are measured for 6 athletic abilities, including 2 measurements of body size. For coaches and their players who desire to play in the CFL, knowing the players metrics that are important for being drafted and their levels will help coaches plan and evaluate their training. Thus, the purpose of this study was to provide a simple scoring system using the predictors of CFL Combines identified by multivariate analysis and their regression coefficients, and reference values. In this study, authors created a scoring system to classify draft success and failure of CFL Combines based on the measurement results. This scoring system was named as the physical success score (PSS). To do so, a repeated grid-search cross-validation for variable selection algorithm was performed on the players (line: N = 215, big skill [linebacker and running back]: n = 174, skill [defensive back and wide receiver]: n = 229) who participated in the CFL Combines between 2011 and 2019. The final binary logistic regression models and the reference values were used to generate the PSS for each group. As a result, PSS of the line, big skill, and skill were developed. In each group, all possible total scores and the estimated draft success probability were shown. From the results of this study, it was concluded that the PSS approach can provide useful information for coaches in setting training goals.

Background: Manual evaluation is an important method for assessing ankle instability, but it is not quantitative. Capacitance-type sensors can be used to measure the distance on the basis of the capacitance value. We applied the sensor to the noninvasive device for measuring ankle instability and showed its utility.

Methods: First, 5 ankles embalmed by Thiel's method were used in an experiment using a cadaver. The capacitance-type sensor was fixed alongside the anterior talofibular ligament (ATFL) of a specially made brace, and the anterior drawer test was performed. The test had been performed for the intact ankle, with the ATFL transected and with both the ATFL and calcaneofibular ligament (CFL) transected. The anterior drawer distance was calculated by the sensor. Intra- and interinvestigator reliability were also analyzed.Next, as a clinical study, a brace with a sensor was fitted to 22 ankles of 20 patients with a history of ankle sprain. An anterior drawer test at a load of 150 N was conducted using a Telos stress device. The anterior drawer distances measured by the sensor and based on radiographic images were then compared.

Results: The mean anterior drawer distances were 3.7 ± 1.0 mm for the intact cadavers, 6.1 ± 1.6 mm with the ATFL transected (P < .001), and 7.9 ± 1.8 mm with the ATFL and CFL transected (P < .001). The intrainvestigator intraclass correlation coefficients (ICCs) were 0.862 to 0.939, and the interinvestigator ICC was 0.815. In the experiments on patients, the mean anterior drawer distance measured by the sensor was 2.9 ± 0.9 mm, and it was 2.7 ± 0.9 mm for the radiographic images. The correlation coefficient between the sensor and the radiographic images was 0.843.

Conclusion: We quantitatively evaluated anterior drawer laxity using a capacitance-type sensor and found it had high reproducibility and strongly correlated with stress radiography measurements in patients with ankle instability. Capacitance-type sensors can be used for the safe, simple, and accurate evaluation of ankle instability.

Keywords: ankle instability; anterior drawer test; anterior talofibular ligament; calcaneofibular ligament; capacitance-type strain sensor; quantitative evaluation.

Introduction: Mandibular angle resection is an important procedure in facial feminization surgery. Two different approaches are described: trans-oral and cervico-facial lift (CFL) approaches. The aim of the study was to compare surgical outcomes and patient's satisfaction between the two approaches.

Material and methods: We retrospectively analyzed medical charts of patients who underwent mandibular angle resection in the same center by the same surgeon between 2017 and 2019. Aesthetic and functional results were objectively assessed using serial photographs and subjectively with patient self-assessments. All patients benefited from a medical consultation at least 6 months after the surgery.

Results: Seven patients benefited from trans-oral approach and 14 from CFL approach. The mean age was 42. No major complications occurred. No long-term nerve damage was found. Aesthetic evaluation showed mostly an improved result. All patients answered positively to the quality of life survey.

Discussion: These preliminary results of the study suggest that mandibular angle resection is a much-needed and safe surgical procedure regardless of the surgical approach. Patients who underwent facial feminization surgery frequently present a mixed indication of CFL and mandibular angle resection. The study is limited by the low number of patients included. Moreover, interpretation of results is biased because the patients benefited from other minor facial cosmetic procedures in the same surgery. We reported the first analysis of transgender patient's satisfaction concerning mandibular angle resection. This procedure improves quality of life as well as facial aesthetics for transgender patients.

Keywords: Facial feminization; Inferior third of the face; Mandibular angle resection; Quality of life; Sexual reassignment surgery.

Background: Letibotulinum toxin A (LeBA) was approved by the Ministry of Food and Drug Safety (known as the Korea Food & Drug Administration) for cosmetic indications in 2012. However, the efficacy and safety of this newly introduced LeBA has not been investigated in crow's feet lines (CFL) treatment and standardization before its universal use.

Objective: The aim of this multicenter, double-blind, randomized, parallel, active-controlled Phase III clinical trial with two stages (ClinicalTrials.gov identifier: NCT03408236) was to investigate the non-inferiority of LeBA versus the existing onabotulinum toxin A (OnBA) for the treatment of CFL.

Methods: A total of 240 subjects were randomized to either the test (LeBA) or control (OnBA) group. At the baseline and at weeks 4 while maximum smiling (primary efficacy assessment), 8, 12, and 16, investigator's on-site evaluation, independent evaluator, evaluation by the subjects, subjects' satisfaction assessment, and safety assessment were performed.

Results: At week 4, the response rate of primary efficacy assessment was 69.75% and 68.33% in the test (LeBA) and control (OnBA) groups, respectively, without a significant difference. Other minor secondary evaluation results showed significant differences suggesting that LeBA offered better improvement than OnBA, but the overall results did not show significant differences between the two groups.

Conclusion: This study showed that LeBA was as effective and safe as OnBA for the treatment of CFL at the same doses.

Keywords: Phase III clinical trial with two stages; letibotulinum toxin A; crow’s feet lines; onabotulinum toxin A.

Objective: Non-tuberculous mycobacteria (NTM) represents an important etiology of cervicofacial lymphadenitis (CFL) and skin/soft tissue infections in children. It can also affect the salivary glands, including the parotid gland, which is unique due to the presence of intra-salivary lymph nodes. There are no established guidelines for treatment of NTM CFL. NTM lymphadenitis was historically surgically treated; recently the literature supports initial medical treatment. Treatment decisions have been dependent on the extent of disease, preference of providers, and risk of surgical complications. The goal is to report our experience in surgical outcomes of NTM CFL with involvement of the parotid gland after pre-operative medical management.

Methods: A retrospective case series of patients with NTM affecting the parotid gland at a tertiary care pediatric hospital between 2004 and 2020.

Results: Seventy-two patients were referred for surgical evaluation of possible parotid NTM. Thirty-three patients underwent surgical excision. Fifteen patients were identified with presumed NTM infection involving the parotid gland. There were twelve females and three males with a mean age of 2.0 years (SD 1.55; range 1-6 days) at the time of surgery. All underwent surgical excision with parotidectomy. The most common pre-operative antimycobacterial therapy used was a combination of clarithromycin and rifampin. All 15 patients had pathological findings consistent with NTM infection (granulomatous lymphadenitis). Forty percent (n = 6) of patients had positive stains with acid-fast bacilli (AFB), with Mycobacterium avium as the most common species (n = 5). The majority of patients, 86.67% (n = 13), had complete resolution of infection after surgery. Clarithromycin and rifampin were the most common post-operative antimycobacterial treatment (mean 81.5 days, SD 110.14, range 2-411 days). The most common complication experienced was acute (<3 months) lower facial nerve paresis (40%, n = 6), but no patient had permanent facial paralysis.

Conclusion and relevance: Parotidectomy is a safe and efficacious treatment in patients with NTM CFL affecting the parotid gland after incomplete resolution with antimycobacterial therapy. Further investigation to optimize duration of antimycobacterial treatment is necessary. We highlight the experience of a high-volume tertiary care pediatric hospital with surgical management of this disease.

Keywords: Lymphadenitis; Non-tuberculous mycobacteria; Parotidectomy.

Background & objectives: Phototherapy (PT) has become the standard of care for treating neonatal jaundice. This study was aimed to find out if intermittent PT (IPT) results in comparable rate of fall of bilirubin level to continuous PT (CPT) and results in lesser side effects and better acceptance.

Methods: In this non-inferiority trial, 174 neonates ≥35 wk gestation and >2000 g with jaundice requiring PT were randomized to receive either IPT (one hour on and two hours off) or CPT (with minimum interruptions for feeding) after device stratification [light-emitting diode (LED) or compact fluorescent light (CFL)]. Bilirubin was checked 12^th hourly, and calcium, vitamin D and nitric oxide (NO) levels were analyzed along with the clinical side effects and nursing and maternal satisfaction scores (CTRI Registration No. CTRI/2018/01/011072).

Results: The rate of fall of bilirubin was similar in both the CPT and IPT groups [0.16 (0.10, 0.22) vs. 0.13 (0.09, 0.20) mg/dl/h, P=0.22]. The median difference with 95 per cent confidence interval of 0.03 (0.03, 0.03) mg/dl was also within the pre-defined inferiority limits. There was no significant change in the duration of PT and side effects such as fall in calcium levels, rise in vitamin D and NO levels or the clinical side effects. Maternal satisfaction favoured the IPT group, but the nurses opined that IPT was difficult to implement. Subgroup analysis for PT devices used showed that efficacy of both CFL and LED devices was equivalent.

Interpretation & conclusions: IPT was non-inferior to CPT in reducing bilirubin levels in ≥35 wk neonates, irrespective of device used, and also mothers reported better satisfaction with IPT. Although IPT appears promising, CPT does not increase clinical and biochemical side effects compared to IPT.

Keywords: Compact fluorescent light; continuous phototherapy; intermittent phototherapy; jaundice; light-emitting diode; neonate.

One mechanism of ciprofloxacin resistance is attributed to chromosomal DNA-encoded efflux pumps such as the MepA and NorB proteins. The goal of this research is to find a way to bypass Staphylococcus aureus' efflux pumps. Because of its high membrane permeability and low association with NorB and MepA efflux proteins, a liposome-encapsulating antibiotic is one of the promising, cost-effective drug carriers and coating mechanisms for overcoming active transport of methicillin-resistant S. aureus (MRSA) multidrug-resistant efflux protein . The calculated "Log Perm RRCK" membrane permeability values of 1,2-distearoyl-sn-glycerol-3-phosphocholine (DSPC) ciprofloxacin liposome-encapsulated (CFL) showed a lower negative value of - 4,652 cm/s and greater membrane permeability than ciprofloxacin free (CPF). The results of RT-qPCR showed that cationic liposomes containing ciprofloxacin in liposome-encapsulated form (CFL) improved CPF antibacterial activity and affinity for negatively charged bacterial cell surface membrane in comparison to free drug and liposome, as it overcame several resistance mechanisms and reduced the expression of efflux pumps. Ciprofloxacin liposome-encapsulated (CFL) is therefore more effective than ciprofloxacin alone. Liposomes can be combined with a variety of drugs that interact with bacterial cell efflux pumps to maintain high sustained levels of antibiotics in bacterial cells.

Keywords: Ciprofloxacin; Efflux protein; Liposomes; Membrane permeability.

This paper pushes the envelope on decomposing camouflaged regions in an image into meaningful components, namely, camouflaged instances. To promote the new task of camouflaged instance segmentation of in-the-wild images, we introduce a dataset, dubbed CAMO++, that extends our preliminary CAMO dataset (camouflaged object segmentation) in terms of quantity and diversity. The new dataset substantially increases the number of images with hierarchical pixel-wise ground truths. We also provide a benchmark suite for the task of camouflaged instance segmentation. In particular, we present an extensive evaluation of state-of-the-art instance segmentation methods on our newly constructed CAMO++ dataset in various scenarios. We also present a camouflage fusion learning (CFL) framework for camouflaged instance segmentation to further improve the performance of state-of-the-art methods. The dataset, model, evaluation suite, and benchmark will be made publicly available on our project page.

When the input colors of the left and right eyes are different from one another, binocular rivalry may occur. According to Hering theory, opponent colors would have the most significant tendency for rivalry. However, binocular color fusion still occurs under the condition that each eye's opponent chromatic responses do not exceed a specific chromatic fusion limit (CFL). This paper detects the binocular chromatic fusion limit for opposite colors within a conventional 3D display color gamut. We conducted a psychophysical experiment to quantitatively measure the binocular chromatic fusion limit on four opposite color directions in the CIELAB color space. Due to color inconsistency between eyes may affect the binocular color fusion, the experiment was divided into two sessions by swapping stimulation colors of left and right eyes. There were 5 subjects and they each experienced 320 trials. By analyzing the results, we used ellipses to quantify the chromatic fusion limits for opposing colors. The average semi-major axis of the ellipses is 27.55 Δ E a b∗, and the average semi-minor axis is 16.98 Δ E a b∗. We observed that the chromatic fusion limit varies with the opposite color direction: the CFL on RedBlue-GreenYellow direction is greater than that on Red-Green direction, the latter being greater than that on Yellow-Blue direction and the CFL on RedYellow-GreenBlue direction is smallest. Furthermore, we suggested that the chromatic fusion limit is independent of the distribution of cells, and there is no significant change in the fusion ellipse boundaries after swapping left and right eye colors.

Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) contribute greatly to the overall stability of the ankle joint; however, ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of the lateral collateral ligament with grafts has been proposed for patients with poor tissue quality or inadequate local tissue. Anatomic reconstruction of the lateral ankle ligaments requires a good understanding of their anatomic location.

Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and qualitatively and explore the relationship of some morphological parameters.

Study design: Descriptive laboratory study.

Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin, length, width, thickness, and angle between the ATFL and CFL, and 73 adult ankle specimens were used for measuring the origin of the CFL. The coefficient of variation was used to describe and compare the respective variability of angle, length, width, and thickness. The origin of the ATFL was labeled as point A, and the leading edge of the CFL intersection with the articular surface of the calcaneus was considered point B.

Results: The ATFL had a variable number of bands. A high degree of variability (coefficient of variation >0.2) was seen for most morphological measurements of the ATFL. In addition, the length of distance AB also varied. The CFL originated at the tip of the fibula in only 9% of specimens. It was found more commonly at the anterior border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle between the ATFL and CFL was consistent at 100° to 105º.

Conclusion: A fair amount of variability of ATFL length, width, and thickness were found in our study, with less variability in the ATFL-CFL angle. Most CFLs attached anterior to the tip of the fibula.

Clinical relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring proper surgical treatment of ankle joint injuries.

Keywords: anatomy; anterior talofibular ligament (ATFL); calcaneofibular ligament (CFL); lateral ankle collateral ligament; variability.

Drag-reducing polymers (DRPs) can significantly improve blood circulation when added to blood at a nanomolar concentration, manifesting great potential for application in the biomedical field. In this work, hyaluronic acid (HA) was selected as a natural DRP, and its effects on blood microcirculation at different concentrations, flow rates, and channel geometry were studied in microchannels. The experimental results show that adding a small dose of HA can increase the velocity and shorten the thickness of the cell-free layer (CFL or cell depletion layer (CDL)) near the wall. After considering efficiency, our experiments determined 50 ppm addition of HA to be the most suitable amount for improving blood circulation. Our results demonstrate that HA has high efficiency in improving the circulation of blood flow and shed light on unveiling the mechanism of using natural DRPs to cure some cardiovascular diseases.

Keywords: Cell-free layer; Hyaluronic acid; Microcirculation; Red blood cell; Velocity.

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex.

Case report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months.

Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes.

Keywords: Tarsal navicular bone; anterior talofibular ligament; calcaneofibular ligament; computed tomography scan; fracture; magnetic resonance imaging scan.

The present study compared the motivations to teach Chinese between native and nonnative pre-service teachers of Chinese as a second/foreign language (CSL/CFL). The participants included 325 native and 325 non-native Chinese-speaking pre-service CSL/CFL teachers registered in the Masters in Teaching Chinese to Speakers of Other Languages (MTCSOL) programs; the teachers were asked to complete a 24-item questionnaire. Two major findings emerged. First, a similar six-factor teacher motivation was observed for both the native and non-native teachers. Second, the two groups showed non-significant differences in their ratings of the importance of cross-cultural value, intrinsic value, altruistic value, and fallback career choice as types of motivation but differed significantly in their ratings of extrinsic value and social influence. These results highlight the differences and similarities in the motivation of the second language teacher and offer insights into the variables at different levels that might influence the motivation of the second language teacher. Teacher motivation is advised to be taken into account in the training and administration of CSL/CFL teachers to alleviate the problems of teacher shortage outside China.

Keywords: Chinese as a second/foreign language; Chinese language teacher; language teacher motivation; native speaker teacher; non-native speaker teacher.

Chronic ankle instability (CAI) leads to the ankle osteoarthritis (OA), and ligament repair is performed to restore ankle stability. However, anterior talofibular ligament (ATFL) repair alone is not sufficient to stabilize the ankle in some cases, which additionally require calcaneofibular ligament (CFL) repair. This study aimed to explore characteristics of CAI that necessitated the repair of both ATFL and CFL. Forty-three patients (44 ankles) with CAI treated operatively were retrospectively reviewed. After ATFL repair, patients with residual ankle instability revealed by the varus stress under fluoroscopy additionally underwent CFL repair. Preoperative condition and intraoperative findings of the combined ATFL and CFL repair (AC) (n = 24) and only ATFL repair (A) (n = 20) groups were compared. The ankle activity score of group AC was significantly higher (p < .05) than that of group A. OA changes at the medial gutter were observed in 62.5% (15/24) in the group AC and 20% (4/20) in group A. Chondral/osteochondral lesions were seen in 66.7% (16/24) in the group AC and 20% (4/20) in group A. The remnant quality in group AC was inferior to that of group A. CAI that necessitated both ATFL and CFL repair exhibited characteristic findings such as high ankle activity score, high rate of chondral/osteochondral lesions and/or OA changes, and poor quality of ATFL remnants compared to those in CAI that required only ATFL repair. The repair of both ATFL and CFL should be considered in CAI which exhibit these characteristics to ensure complete correction of the instability.

Keywords: ankle activity score; anterior talofibular ligament; arthroscopy; calcaneofibular ligament; chronic ankle instability.

Background: In sub-Saharan Africa, 3 community-facility linkage (CFL) models-Expert Clients, Community Health Workers (CHWs), and Mentor Mothers-have been widely implemented to support pregnant and breastfeeding women (PBFW) living with HIV and their infants to access and sustain care for prevention of mother-to-child transmission of HIV (PMTCT), yet their comparative impact under real-world conditions is poorly understood.

Methods and findings: We sought to estimate the effects of CFL models on a primary outcome of maternal loss to follow-up (LTFU), and secondary outcomes of maternal longitudinal viral suppression and infant "poor outcome" (encompassing documented HIV-positive test result, LTFU, or death), in Malawi's PMTCT/ART program. We sampled 30 of 42 high-volume health facilities ("sites") in 5 Malawi districts for study inclusion. At each site, we reviewed medical records for all newly HIV-diagnosed PBFW entering the PMTCT program between July 1, 2016 and June 30, 2017, and, for pregnancies resulting in live births, their HIV-exposed infants, yielding 2,589 potentially eligible mother-infant pairs. Of these, 2,049 (79.1%) had an available HIV treatment record and formed the study cohort. A randomly selected subset of 817 (40.0%) cohort members underwent a field survey, consisting of a questionnaire and HIV biomarker assessment. Survey responses and biomarker results were used to impute CFL model exposure, maternal viral load, and early infant diagnosis (EID) outcomes for those missing these measures to enrich data in the larger cohort. We applied sampling weights in all statistical analyses to account for the differing proportions of facilities sampled by district. Of the 2,049 mother-infant pairs analyzed, 62.2% enrolled in PMTCT at a primary health center, at which time 43.7% of PBFW were ≤24 years old, and 778 (38.0%) received the Expert Client model, 640 (31.2%) the CHW model, 345 (16.8%) the Mentor Mother model, 192 (9.4%) ≥2 models, and 94 (4.6%) no model. Maternal LTFU varied by model, with LTFU being more likely among Mentor Mother model recipients (adjusted hazard ratio [aHR]: 1.45; 95% confidence interval [CI]: 1.14, 1.84; p = 0.003) than Expert Client recipients. Over 2 years from HIV diagnosis, PBFW supported by CHWs spent 14.3% (95% CI: 2.6%, 26.1%; p = 0.02) more days in an optimal state of antiretroviral therapy (ART) retention with viral suppression than women supported by Expert Clients. Infants receiving the Mentor Mother model (aHR: 1.24, 95% CI: 1.01, 1.52; p = 0.04) and ≥2 models (aHR: 1.44, 95% CI: 1.20, 1.74; p < 0.001) were more likely to undergo EID testing by age 6 months than infants supported by Expert Clients. Infants receiving the CHW and Mentor Mother models were 1.15 (95% CI: 0.80, 1.67; p = 0.44) and 0.84 (95% CI: 0.50, 1.42; p = 0.51) times as likely, respectively, to experience a poor outcome by 1 year than those supported by Expert Clients, but not significantly so. Study limitations include possible residual confounding, which may lead to inaccurate conclusions about the impacts of CFL models, uncertain generalizability of findings to other settings, and missing infant medical record data that limited the precision of infant outcome measurement.

Conclusions: In this descriptive study, we observed widespread reach of CFL models in Malawi, with favorable maternal outcomes in the CHW model and greater infant EID testing uptake in the Mentor Mother model. Our findings point to important differences in maternal and infant HIV outcomes by CFL model along the PMTCT continuum and suggest future opportunities to identify key features of CFL models driving these outcome differences.

Objective: To measure anatomical data of calcaneofibular ligament (CFL), relevant data of CFL attachment to provide an anatomical basis for CFL reconstruction.

Methods: Twenty-seven adult ankle specimens were selected, including 11 males and 16 females, aged from 22 to 71 years old with an average of (41.6±17.2) years old;9 cases on the left side and 18 cases on the right side. The specimens reserved at least 20 cm above ankle joint and a complete foot, and exclude deformities, fractures, incomplete development and degenerative lesions. CFL was performed detailed anatomical observation, morphological parameters of CFL was measured, and coordinates of fibula side and calcaneal side of CFL in the coordinate axis were measured. The distance between fibula insertion of CFL and fibula tip, distance between calcaneal insertion of CFL and lateral calcaneal nodule, and Angle between CFL and long axis of fibula were also measured.

Results: In these 27 specimens, CFL cases were all single bundles and the length of CFL was (32.83 ± 8.19) mm. The center point of fibula attachment in CFL was(2.87± 1.21) mm proximal with a coefficient of variation of 42.16% and (2.08±1.34) mm anteriorly with a coefficient of variation of 64.42%. The center point of calcaneal attachment region of CFL was located on coordinate axis on the distal end (15.32±5.33) mm, with a coefficient of variation of 34.79%, and the posterior part (6.38±2.15) mm, with a coefficient of variation of 33.86%. The distance between center point of fibula attachment and fibula tip was (4.81±0.82) mm. The distance between center point of calcaneal attachment area of CFL and lateral calcaneal nodules was(17.25±3.12) mm. Angle between CFL and fibula axis is (43 ±18)° .

Conclusion: According to anatomical studies, we could locate the fibula and calcaneal attachment of CFL by anatomical markers around ankle joint. However, the location of CFL attachment has a large variation, and the anatomical characteristics need to be considered in anatomical reconstruction.

Keywords: Anatomy; Ankle joint; Ligaments.