目的总结老年髋部骨折患者术前预康复的最佳证据,为进一步规范临床实践提供循证依据。方法根据“6S”证据金字塔模型,采用计算机检索医脉通,BMJ Best Practice,UpToDate,世界卫生组织(World Health Organization,WHO),国际指南协作网(gu...目的总结老年髋部骨折患者术前预康复的最佳证据,为进一步规范临床实践提供循证依据。方法根据“6S”证据金字塔模型,采用计算机检索医脉通,BMJ Best Practice,UpToDate,世界卫生组织(World Health Organization,WHO),国际指南协作网(guidelines international network,GIN),英国国家卫生与临床优化研究所(national institute for health and care excellence,NICE),美国国立指南库(national guideline clearinghouse,NGC),加拿大临床指南网站(Canadian Medical Association:Clinical Practice Guidelines Infobase,CMA),苏格兰院际间指南网(Scottish intercollegiate guidelines network,SIGN),加拿大安大略注册护士学会网站(registered Nurses’Association of Ontario,RNAO),美国运动医学会(American College of Sports Medicine,ACSM)网站,美国骨科医师协会(American Academy of Orthopaedic Surgeons,AAOS)网站,欧洲临床营养与代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站,美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)网站、快速康复协会(Enhanced Recovery After Surgery Society,ERASS)网站,Cochrane Library,乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库,PubMed,CINAHL,Web of Science,Embase,Scopus,Science Direct,CNKI,万方,维普,SinoMed中关于老年髋部骨折患者预康复的证据,检索的文献类型包括临床决策,指南,证据总结,最佳实践,专家共识,系统评价和随机对照试验。检索时限为建库至2023年12月31日。由2名经过循证护理系统培训的研究者对纳入文献进行质量评价,并提取、汇总证据。结果共纳入14篇文献,包括2篇临床决策、4篇指南、1篇最佳实践、4篇专家共识、3篇系统评价。汇总了包括多学科管理、术前评估、术前健康教育、多模式镇痛、营养管理、运动干预、并发症风险评估与预防7个类别共25条证据。结论本研究总结的最佳证据为老年髋部骨折患者术前预康复提供了依据,临床护理人员在转化证据时应结合临床情境,进一步规范老年髋部骨折患者术前预康复流程,以改善老年髋部骨折患者的临床结局。展开更多
Iron-based superconductors(IBSs)are compelling candidates for high-field magnet applications due to their excellent intrinsic properties.The hot isostatic pressing(HIP)effectively enhances their critical current densi...Iron-based superconductors(IBSs)are compelling candidates for high-field magnet applications due to their excellent intrinsic properties.The hot isostatic pressing(HIP)effectively enhances their critical current density by increasing core density.However,IBS tapes are highly stress-sensitive after heat treatment.This necessitates fabricating magnets prior to the HIP process.Consequently,the requirement for large-volume HIP furnaces for full-scale magnets presents significant technological and cost barriers.To circumvent this manufacturing bottleneck,this paper introduces a novel“pre-HIP”two-step annealing process.The principle involves an initial,low-temperature HIP(pre-HIP)heat treatment on IBS tapes to achieve densification.Subsequently,the tapes are wound into the desired magnet or conductor geometry,followed by a final heat treatment at atmospheric pressure(AP).This strategy allows large-scale magnets to be treated in conventional,cost-effective furnaces.We systematically evaluated the effect of the pre-HIP temperature(370-450℃at 50 MPa)on the transport properties and bend performance of 7-filamentary Ba_(1-x)K_(x)Fe_(2)As_(2)(Ba-122)tapes.Results show that pre-HIP significantly enhances the critical current.However,a critical trade-off was identified:higher pre-HIP temperatures yield superior critical performance but induce local grain growth,causing severe degradation during bending.Samples pre-HIP at 370℃retained 78%of their initial performance after bending to 10 mm diameter,whereas the 450℃samples degraded significantly.This study confirms that pre-HIP is a cost-effective method to improve IBS magnet performance when the optimal temperature is selected.展开更多
背景:精确的术前计划是全髋关节置换术(total hip arthroplasty,THA)获得成功的重要基础。目的:对基于三维数据的术前计划指导THA髋臼假体植入的准确性进行分析。方法:纳入20例拟行THA的患者。所有患者均行髋部CT薄层扫描。术前以Mimics...背景:精确的术前计划是全髋关节置换术(total hip arthroplasty,THA)获得成功的重要基础。目的:对基于三维数据的术前计划指导THA髋臼假体植入的准确性进行分析。方法:纳入20例拟行THA的患者。所有患者均行髋部CT薄层扫描。术前以Mimics 17.0软件对所有髋部CT扫描数据进行处理,生成髋部三维模型;利用Rhinoceros 4.0软件生成180°半球型三维CAD髋臼杯模型,在三维模型上进行模拟髋臼假体安放,预测臼杯大小、臼杯外展角、旋转中心位置,预测结果与术后实际结果进行比较。结果:应用三维软件进行术前计划,85%(17/20)的臼杯预测型号与实际型号一致,15%(3/20)相差一个型号。术前预测的臼杯外展角39.40°±4.18°、髋臼旋转中心位置的水平距离(82.89±5.17)mm和垂直距离(47.38±6.95)mm,与术后实际外展角39.77°±4.76°、水平距离(82.14±5.80)mm和垂直距离(48.32±8.40)mm比较无统计学差异(P>0.05)。结论:基于三维数据的THA术前计划,能提高臼杯型号选择和植入位置的准确性。展开更多
文摘目的总结老年髋部骨折患者术前预康复的最佳证据,为进一步规范临床实践提供循证依据。方法根据“6S”证据金字塔模型,采用计算机检索医脉通,BMJ Best Practice,UpToDate,世界卫生组织(World Health Organization,WHO),国际指南协作网(guidelines international network,GIN),英国国家卫生与临床优化研究所(national institute for health and care excellence,NICE),美国国立指南库(national guideline clearinghouse,NGC),加拿大临床指南网站(Canadian Medical Association:Clinical Practice Guidelines Infobase,CMA),苏格兰院际间指南网(Scottish intercollegiate guidelines network,SIGN),加拿大安大略注册护士学会网站(registered Nurses’Association of Ontario,RNAO),美国运动医学会(American College of Sports Medicine,ACSM)网站,美国骨科医师协会(American Academy of Orthopaedic Surgeons,AAOS)网站,欧洲临床营养与代谢学会(European Society for Clinical Nutrition and Metabolism,ESPEN)网站,美国肠外肠内营养学会(American Society for Parenteral and Enteral Nutrition,ASPEN)网站、快速康复协会(Enhanced Recovery After Surgery Society,ERASS)网站,Cochrane Library,乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健中心数据库,PubMed,CINAHL,Web of Science,Embase,Scopus,Science Direct,CNKI,万方,维普,SinoMed中关于老年髋部骨折患者预康复的证据,检索的文献类型包括临床决策,指南,证据总结,最佳实践,专家共识,系统评价和随机对照试验。检索时限为建库至2023年12月31日。由2名经过循证护理系统培训的研究者对纳入文献进行质量评价,并提取、汇总证据。结果共纳入14篇文献,包括2篇临床决策、4篇指南、1篇最佳实践、4篇专家共识、3篇系统评价。汇总了包括多学科管理、术前评估、术前健康教育、多模式镇痛、营养管理、运动干预、并发症风险评估与预防7个类别共25条证据。结论本研究总结的最佳证据为老年髋部骨折患者术前预康复提供了依据,临床护理人员在转化证据时应结合临床情境,进一步规范老年髋部骨折患者术前预康复流程,以改善老年髋部骨折患者的临床结局。
基金supported by the National Natural Science Foundation of China(Grant No.52307035 and 12275063the Beijing Municipal Natural Science Foundation(Grant No.3222061).
文摘Iron-based superconductors(IBSs)are compelling candidates for high-field magnet applications due to their excellent intrinsic properties.The hot isostatic pressing(HIP)effectively enhances their critical current density by increasing core density.However,IBS tapes are highly stress-sensitive after heat treatment.This necessitates fabricating magnets prior to the HIP process.Consequently,the requirement for large-volume HIP furnaces for full-scale magnets presents significant technological and cost barriers.To circumvent this manufacturing bottleneck,this paper introduces a novel“pre-HIP”two-step annealing process.The principle involves an initial,low-temperature HIP(pre-HIP)heat treatment on IBS tapes to achieve densification.Subsequently,the tapes are wound into the desired magnet or conductor geometry,followed by a final heat treatment at atmospheric pressure(AP).This strategy allows large-scale magnets to be treated in conventional,cost-effective furnaces.We systematically evaluated the effect of the pre-HIP temperature(370-450℃at 50 MPa)on the transport properties and bend performance of 7-filamentary Ba_(1-x)K_(x)Fe_(2)As_(2)(Ba-122)tapes.Results show that pre-HIP significantly enhances the critical current.However,a critical trade-off was identified:higher pre-HIP temperatures yield superior critical performance but induce local grain growth,causing severe degradation during bending.Samples pre-HIP at 370℃retained 78%of their initial performance after bending to 10 mm diameter,whereas the 450℃samples degraded significantly.This study confirms that pre-HIP is a cost-effective method to improve IBS magnet performance when the optimal temperature is selected.
文摘背景:精确的术前计划是全髋关节置换术(total hip arthroplasty,THA)获得成功的重要基础。目的:对基于三维数据的术前计划指导THA髋臼假体植入的准确性进行分析。方法:纳入20例拟行THA的患者。所有患者均行髋部CT薄层扫描。术前以Mimics 17.0软件对所有髋部CT扫描数据进行处理,生成髋部三维模型;利用Rhinoceros 4.0软件生成180°半球型三维CAD髋臼杯模型,在三维模型上进行模拟髋臼假体安放,预测臼杯大小、臼杯外展角、旋转中心位置,预测结果与术后实际结果进行比较。结果:应用三维软件进行术前计划,85%(17/20)的臼杯预测型号与实际型号一致,15%(3/20)相差一个型号。术前预测的臼杯外展角39.40°±4.18°、髋臼旋转中心位置的水平距离(82.89±5.17)mm和垂直距离(47.38±6.95)mm,与术后实际外展角39.77°±4.76°、水平距离(82.14±5.80)mm和垂直距离(48.32±8.40)mm比较无统计学差异(P>0.05)。结论:基于三维数据的THA术前计划,能提高臼杯型号选择和植入位置的准确性。
