In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applyin...In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.展开更多
The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoo...The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microgl...Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microglia play an important role in secondary injury and can be activated in response to traumatic brain injury.In this article,we review the origin and classification of microglia as well as the dynamic changes of microglia in traumatic brain injury.We also clarify the microglial polarization pathways and the therapeutic drugs targeting activated microglia.We found that regulating the signaling pathways involved in pro-inflammatory and anti-inflammatory microglia,such as the Toll-like receptor 4/nuclear factor-kappa B,mitogen-activated protein kinase,Janus kinase/signal transducer and activator of transcription,phosphoinositide 3-kinase/protein kinase B,Notch,and high mobility group box 1 pathways,can alleviate the inflammatory response triggered by microglia in traumatic brain injury,thereby exerting neuroprotective effects.We also reviewed the strategies developed on the basis of these pathways,such as drug and cell replacement therapies.Drugs that modulate inflammatory factors,such as rosuvastatin,have been shown to promote the polarization of antiinflammatory microglia and reduce the inflammatory response caused by traumatic brain injury.Mesenchymal stem cells possess anti-inflammatory properties,and clinical studies have confirmed their significant efficacy and safety in patients with traumatic brain injury.Additionally,advancements in mesenchymal stem cell-delivery methods—such as combinations of novel biomaterials,genetic engineering,and mesenchymal stem cell exosome therapy—have greatly enhanced the efficiency and therapeutic effects of mesenchymal stem cells in animal models.However,numerous challenges in the application of drug and mesenchymal stem cell treatment strategies remain to be addressed.In the future,new technologies,such as single-cell RNA sequencing and transcriptome analysis,can facilitate further experimental studies.Moreover,research involving non-human primates can help translate these treatment strategies to clinical practice.展开更多
Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patient...Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to patients.The ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian brain.Because the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March 2024.After screening,76 articles were included in the analysis from which 178 separate transplant studies were identified.From these,graft survival could be assessed in 52 studies and differentiation in 129 studies.Overall,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.展开更多
Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health S...Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health Science Center at Houston,Environmental Health&Safety,6431 Fannin St,CYF G.102,Houston,TX,77030;2.Corresponding author)Abstract:The ability to irradiate cells,tissues,and other biological materials with high-energy photons has been an essential tool in the discovery of numerous biomedical research advancements.展开更多
Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durabl...Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.展开更多
Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with ...Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.展开更多
In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,com...In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.展开更多
Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasin...Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.展开更多
The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacter...The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.展开更多
BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress ...BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.展开更多
Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure...Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.展开更多
Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR...Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.展开更多
Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements o...Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.展开更多
Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patien...Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
The recent success of DeepSeek AI has sparked a heated debate in China about the necessity of learning the Chinese language.With its ability to generate sophisticated content in seconds,AI appears increasingly capable...The recent success of DeepSeek AI has sparked a heated debate in China about the necessity of learning the Chinese language.With its ability to generate sophisticated content in seconds,AI appears increasingly capable of replacing human writers.Does this signal a shift in the value of language mastery,or will human creativity and cultural nuance remain irreplaceable?展开更多
BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(TH...BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.展开更多
基金Natural Science Foundation of China under Grant Nos.50908036&51261120376Natural Science Foundation of Liaoning Province No.201202040
文摘In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.
基金This research was funded by the National Natural Science Foundation of China No.51908291Nanjing Forestry University Youth Science and Technology Innovation Fund No.CX2019002.
文摘The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金supported by the Natural Science Foundation of Yunnan Province,No.202401AS070086(to ZW)the National Key Research and Development Program of China,No.2018YFA0801403(to ZW)+1 种基金Yunnan Science and Technology Talent and Platform Plan,No.202105AC160041(to ZW)the Natural Science Foundation of China,No.31960120(to ZW)。
文摘Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microglia play an important role in secondary injury and can be activated in response to traumatic brain injury.In this article,we review the origin and classification of microglia as well as the dynamic changes of microglia in traumatic brain injury.We also clarify the microglial polarization pathways and the therapeutic drugs targeting activated microglia.We found that regulating the signaling pathways involved in pro-inflammatory and anti-inflammatory microglia,such as the Toll-like receptor 4/nuclear factor-kappa B,mitogen-activated protein kinase,Janus kinase/signal transducer and activator of transcription,phosphoinositide 3-kinase/protein kinase B,Notch,and high mobility group box 1 pathways,can alleviate the inflammatory response triggered by microglia in traumatic brain injury,thereby exerting neuroprotective effects.We also reviewed the strategies developed on the basis of these pathways,such as drug and cell replacement therapies.Drugs that modulate inflammatory factors,such as rosuvastatin,have been shown to promote the polarization of antiinflammatory microglia and reduce the inflammatory response caused by traumatic brain injury.Mesenchymal stem cells possess anti-inflammatory properties,and clinical studies have confirmed their significant efficacy and safety in patients with traumatic brain injury.Additionally,advancements in mesenchymal stem cell-delivery methods—such as combinations of novel biomaterials,genetic engineering,and mesenchymal stem cell exosome therapy—have greatly enhanced the efficiency and therapeutic effects of mesenchymal stem cells in animal models.However,numerous challenges in the application of drug and mesenchymal stem cell treatment strategies remain to be addressed.In the future,new technologies,such as single-cell RNA sequencing and transcriptome analysis,can facilitate further experimental studies.Moreover,research involving non-human primates can help translate these treatment strategies to clinical practice.
基金supported by research grants from the Michael J Fox Foundation for Parkinson’s Research(grant numbers:17244 and 023410)Science Foundation Ireland(Grant Numbers:19/FFP/6554)(to ED)。
文摘Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to patients.The ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian brain.Because the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March 2024.After screening,76 articles were included in the analysis from which 178 separate transplant studies were identified.From these,graft survival could be assessed in 52 studies and differentiation in 129 studies.Overall,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.
文摘Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health Science Center at Houston,Environmental Health&Safety,6431 Fannin St,CYF G.102,Houston,TX,77030;2.Corresponding author)Abstract:The ability to irradiate cells,tissues,and other biological materials with high-energy photons has been an essential tool in the discovery of numerous biomedical research advancements.
文摘Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.
文摘Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.
文摘In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.
文摘Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.
基金the National Natural Science Foundation of China(No.5220031085)the Postdoctoral Research Project in Henan Province(No.HN2022054)+2 种基金the Key Scientific Research Projects of Colleges and Universities in Henan Province(No.23A430009)the State Key Laboratory of Polymer Materials Engineering(No.sklpme2022-4-03)the Key Technologies R&D Program of Henan Province(No.242102230131)。
文摘The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.
文摘BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.
文摘Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.
文摘Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.
文摘Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.
基金supported by grants from the initial funding of National Natural Science Foundation of China(No.8227020480)。
文摘Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
文摘The recent success of DeepSeek AI has sparked a heated debate in China about the necessity of learning the Chinese language.With its ability to generate sophisticated content in seconds,AI appears increasingly capable of replacing human writers.Does this signal a shift in the value of language mastery,or will human creativity and cultural nuance remain irreplaceable?
文摘BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.
