The atom-bond sum-connectivity(ABS)index,put forward by[J.Math.Chem.,2022,60(10):20812093],exhibits a strong link with the acentric factor of octane isomers.The experimental physico-chemical properties of octane isome...The atom-bond sum-connectivity(ABS)index,put forward by[J.Math.Chem.,2022,60(10):20812093],exhibits a strong link with the acentric factor of octane isomers.The experimental physico-chemical properties of octane isomers,such as boiling point,of formation are found to be better measured by the ABS index than by the Randi,atom-bond connectivity(ABC),and sum-connectivity(SC)indices.One important source of information for researching the molecular structure is the bounds for its topological indices.The extrema of the ABS index of the line,total,and Mycielski graphs are calculated in this work.Moreover,the pertinent extremal graphs were illustrated.展开更多
ADPr-ATP is a natural nucleotide with three sugar rings and five pentavalent phosphorus,and can be produced through TIR-catalyzed ADP-ribosylation reactions for plant immunity.Here,we report the first total synthesis ...ADPr-ATP is a natural nucleotide with three sugar rings and five pentavalent phosphorus,and can be produced through TIR-catalyzed ADP-ribosylation reactions for plant immunity.Here,we report the first total synthesis of ADPr-ATP(1)with a total yield of 6.4%through 14 steps,featuring late-stage P(V)−N activation reaction of pyrophosphate(4)and 5′-phosphoromorpholidate(25).The protected adenosine 5′-phosphoromorpholidate(24)was prepared on the basis of a scalable to adenosine 5′′-monophosphate(2).The construction of P(V)−N bond in phosphoramidate is esteemed as a critical step as they are sufficiently stable in deprotection reactions.The chemical synthesis of ADPr-ATP can offer an appealing alternative to traditional enzymatic synthesis and fractionation methods.Furthermore,the pRib-AMP and its prodrug are also synthesized to evaluate cytotoxicity and anti-influenza activity in vitro.展开更多
Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June ...Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.展开更多
BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different ...BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.展开更多
The micro-riblet structures have been demonstrated effective in controlling the Total Pressure Loss(TPL)of aero-engine blades.However,due to the considerable scale gap between micro-texture and an actual aero-engine b...The micro-riblet structures have been demonstrated effective in controlling the Total Pressure Loss(TPL)of aero-engine blades.However,due to the considerable scale gap between micro-texture and an actual aero-engine blade,wind tunnel tests and numerical simulations with massive grids directly describing the global flow field are costly for aerodynamic evaluation.Furthermore,the fine micro surface structure brings unavoidable manufacturing errors,and the probability prediction contributes to gaining the confidence interval of the results.Therefore,a novel relay-based probabilistic model for multi-fidelity scenarios in the TPL prediction of a compressor cascade with micro-riblet surfaces is proposed to trade off accuracy and efficiency.Combined with the low-fidelity flow data generated by an aerodynamic solution strategy using the boundary surrogate model and the high-fidelity flow data from the experiment,the relay-based modeling has been achieved through knowledge transferring,and the confidence interval can be provided by the Gaussian Process Regression(GPR)model.The TPL of compressor cascades with micro-riblet surfaces under different surface structures at March number Ma=0.64,0.74,0.84 have been evaluated using the Relay-Based Probabilistic(RBP)model.The results illustrate that the RBP model could provide higher accuracy than the Single-Fidelity-Data-Driven(SFDD)prediction model,which show the promising potential of multi-fidelity scenarios data fusion in the aerodynamic evaluation of multi-scale configurations.展开更多
BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is ...BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.展开更多
Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and st...Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and standardized discharge preparation intervention programs in clinical practice.Methods:Following the“5S”evidence model,literature such as guidelines,expert consensuses,evidence summaries and randomized controlled trials related to discharge preparation services for total knee arthroplasty patients were retrieved from relevant websites and databases,both domestic and international,from database inception to August 31,2025.Two researchers independently screened the literature,conducted quality appraisals,and extracted and synthesized the evidence.Results:A total of 15 articles were included,comprising 3 guidelines,4 expert consensuses,3 evidence summaries,3 systematic reviews and 2 randomized controlled trials.Ultimately,23 pieces of evidence were summarized across five aspects.Conclusion:This study synthesizes the evidence on discharge preparation services for patients undergoing total knee arthroplasty.It is recommended that healthcare professionals apply this evidence in clinical practice,considering specific circumstances and patient needs.展开更多
Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse event...Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.展开更多
BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favo...BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.展开更多
BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar k...BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.展开更多
Rat nerve growth factor and total flavonoids from hawthorn leaf contribute to the recovery of neurological function after spinal cord injury,including traumatic,non-traumatic spinal cord injuries.However,it remains ch...Rat nerve growth factor and total flavonoids from hawthorn leaf contribute to the recovery of neurological function after spinal cord injury,including traumatic,non-traumatic spinal cord injuries.However,it remains challenging to efficiently deliver nerve growth factor and total flavonoids from hawthorn leaf to spinal cord injury sites,ensure their sustained release,and minimize further damage.In the present study,we chose a biocompatible and biodegradable gelatin as the substrate,which was crosslinked with the natural biological crosslinker genipin to form a gelatin-genipin hydrogel carrier for the slow release of nerve growth factor and total flavonoids from hawthorn leaf in spinal cord injury sites.The prepared gelatin-genipin hydrogel had good injectable properties and photothermal effects.Furthermore,when the hydrogel with 2%genipin,200 ng/mL nerve growth factor,and 320μg/mL total flavonoids from hawthorn leaf was combined with near infrared irradiation,there was a slow release of total flavonoids from hawthorn leaf and nerve growth factor,reduced oxidative stress,an improved inflammatory microenvironment,and accelerated angiogenesis and axonal regeneration via inhibition of the nuclear factor kappa-B signaling pathway,thereby promoting recovery from spinal cord injury.Collectively,our results indicate that this new hydrogel may improve the prognosis of spinal cord injury,and may represent a new strategy for treating spinal cord injury.展开更多
For the next exploration direction and integrated evaluation and optimization of targets for the northern continental margin of the South China Sea,this paper proposes the concept of the“total natural gas play system...For the next exploration direction and integrated evaluation and optimization of targets for the northern continental margin of the South China Sea,this paper proposes the concept of the“total natural gas play system”based on the principles of systems theory.Integrating over 60 years of exploration achievements in the four major basins,the paper studies the basic geological conditions,hydrocarbon accumulation models and distribution characteristics of the system.With the core principle of“source-heat controlling natural gas and play-stratigraphy controlling accumulation”,it analyzes the distribution law of natural gas reservoirs covering“intra-sag,sag margin,extra-sag”and multi-stratigraphic sequences.The study shows that under the joint control of source and heat,the northern continental margin of the South China Sea can be divided into two major gas areas:the southern area dominated by coal-type gas and the northern area dominated by oil-type gas,with the former as the main body.Based on the distribution location of hydrocarbon kitchen,the total gas plays are classified into three types:intra-sag,sag margin and extra-sag.In the oil-type gas area of the northern coastal zone,the proportion of intra-sag natural gas is relatively high;in the coal-type gas area of the southern offshore zone,the proportions of intra-sag and sag margin natural gas are relatively large;while the scale of gas accumulation in the extra-sag plays is relatively small.Finally,it is clearly pointed out that the southern offshore zone is the main direction for the next natural gas exploration in the northern South China Sea.Specifically,in the offshore zone,the intra-sag play and middle-deep layers of the sag margin play in the Yingzhong sag should be focused for the Yinggehai Basin;the intra-sag play and sag margin play in the central depression are targets for the Qiongdongnan Basin;the middle-deep layers of the intra-sag play are targets for the Baiyun sag of the Pearl River Mouth Basin.Furthermore,in the northern depression zone of the Pearl River Mouth Basin within the coastal zone,the main exploration directions include the middle-deep layers of the intra-sag play in the Huizhou sag and the middle-deep layers of the intra-sag play in the Enping sag;in the Beibu Gulf Basin,the main directions are the middle-deep layers of the intra-sag play in the Weixinan sag and the middle-deep layers of the intra-sag play in the Haizhong sag.展开更多
Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been invest...Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis(OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty(TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improvedlong-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict longterm functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.展开更多
We build an experiment system based on total reflection(TR) method to observe the evolution of real contact area of polymethyl methacrylate(PMMA) in the continual stick-slip movement. The bilateral friction is adopted...We build an experiment system based on total reflection(TR) method to observe the evolution of real contact area of polymethyl methacrylate(PMMA) in the continual stick-slip movement. The bilateral friction is adopted to overcome the bending moment in the lateral friction movement. Besides some classical phenomena of stick-slip movement such as periodical slow increase of frictional force in sticking phase and a sudden drop when slipping, a special phenomenon that the contact area increases with the tangential force is observed, which was called junction growth by Tabor in 1959.Image processing methods are developed to observe the variation of the junction area. The results show that the center of the strongest contact region will keep sticking under the tangential force until the whole slipping, the strongest point undergoes three stages in one cycle, which are named as sticking stage, fretting stage, and cracking stage, respectively. The combined analysis reveals a physical process of stick-slip movement: the tangential force causes the increase of the real contact area, which reduces the pressure between the contact spots and finally leads to the slipping. Once slipping occurs,the real contact area drops to the original level resulting in the pressure increase to the original level, which makes the sticking happen again.展开更多
Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissu...Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissue reactions. This study was conducted to analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion®ceramic-on-ceramic (COC) hip articulation, with special emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise and revision surgery. Material and Methods: 150 consecutive hips were operated for primary cementless Total Hip Replacement (THR) using DeltaMotion®at a tertiary care center in Mumbai, India, between January 2010 and January 2015. Clinico-radiological outcome was assessed using the Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with an average age of 50.87 years. Mean follow-up was 54 months (range: 37 - 86 months). The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction, 25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32 post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications (superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger head size in relatively smaller Indian hips due to factory fitted ceramic lining. At 6-year follow-up, high activity level was observed with excellent clinical-radiological outcomes and component longevity in relatively young Indian population.展开更多
BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vesse...BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.展开更多
BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gast...BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.展开更多
BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually be...BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.展开更多
BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the p...BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.展开更多
Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for thes...Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.展开更多
基金Supported by Ningbo NSF(No.2021J234)Zhejiang Provincial Philosophy and Social Sciences Planning Project(No.24NDJC057YB)。
文摘The atom-bond sum-connectivity(ABS)index,put forward by[J.Math.Chem.,2022,60(10):20812093],exhibits a strong link with the acentric factor of octane isomers.The experimental physico-chemical properties of octane isomers,such as boiling point,of formation are found to be better measured by the ABS index than by the Randi,atom-bond connectivity(ABC),and sum-connectivity(SC)indices.One important source of information for researching the molecular structure is the bounds for its topological indices.The extrema of the ABS index of the line,total,and Mycielski graphs are calculated in this work.Moreover,the pertinent extremal graphs were illustrated.
基金supported by the National Natural Science Foundation of China(Nos.82204209 and 82130103)Natural Science Foundation of Henna Province(No.242300421084).
文摘ADPr-ATP is a natural nucleotide with three sugar rings and five pentavalent phosphorus,and can be produced through TIR-catalyzed ADP-ribosylation reactions for plant immunity.Here,we report the first total synthesis of ADPr-ATP(1)with a total yield of 6.4%through 14 steps,featuring late-stage P(V)−N activation reaction of pyrophosphate(4)and 5′-phosphoromorpholidate(25).The protected adenosine 5′-phosphoromorpholidate(24)was prepared on the basis of a scalable to adenosine 5′′-monophosphate(2).The construction of P(V)−N bond in phosphoramidate is esteemed as a critical step as they are sufficiently stable in deprotection reactions.The chemical synthesis of ADPr-ATP can offer an appealing alternative to traditional enzymatic synthesis and fractionation methods.Furthermore,the pRib-AMP and its prodrug are also synthesized to evaluate cytotoxicity and anti-influenza activity in vitro.
基金supported by the Henan Provincial Medical Science and Technology Research Program,grant funded by the Henan Provincial Health Commission(No.LHGJ 20200888)。
文摘Objective:To investigate the related factors of motility after total hip arthroplasty(THA).Methods:The convenience sampling method was used to include 213 patients receiving THA in our hospital from June 2020 to June 2023.They were divided into 2 groups according to the occurrence of kinesiophobia after THA.The demographic data of the 2 groups were analyzed by single-factor analysis.The factors with statistically significant differences were analyzed by binary logistic regression as independent variables.Finally,Spearman analysis was used to analyze the relationship between risk factors and the degree of kinesiophobia.Results:Among 213 THA patients,38 patients were diagnosed with kinetophobia,and the incidence of kinetophobia was 17.84%.visual analogue scale(VAS)and pain duration before operation were higher in patients with kinetophobia than in patients without kinetophobia.The scores of education level,self-efficacy,and social support were significantly lower than those of the non-phobia group,with statistical significance(P<0.05).Logistic regression analysis showed that VAS was a risk factor for kinetophobia after THA.Education level and self-efficacy were protective factors to reduce the occurrence of kinetophobia after THA(P<0.05).Spearman correlation analysis showed that the degree of pain(r=0.697,P<0.001)was positively correlated with the degree of kinetophobia,while the degree of education(r=-0.647,P<0.001)and self-efficacy(r=-0.756,P<0.001)were negatively correlated with the degree of kinetophobia.Conclusions:The degree of pain is a risk factor of kinesiophobia after THA,and it is positively correlated with the degree.Educational level and self-efficacy were protective factors to reduce the incidence of kinesiophobia and were negatively correlated with the degree of kinesiophobia.
基金Supported by the National Natural Science Foundation of China,No.82402789Beijing Jishuitan Hospital Youcai Plan,No.KYYC202402+1 种基金Beijing Jishuitan Research Funding,No.HL202402and Beijing Natural Science Foundation,No.L232062,No.L222063.
文摘BACKGROUND Aseptic loosening remains the leading cause of revision in primary total hip arthroplasty(pTHA).However,the literature demonstrates significant variability regarding the relative contributions of different factors.AIM To investigate the key determinants of aseptic loosening,we performed a systematic review and meta-analysis.METHODS A comprehensive search of PubMed,Web of Science,EMBASE,and the Cochrane Library was conducted,encompassing studies from database inception to January 1,2025.Meta-analyses were performed to evaluate factors associated with aseptic loosening following pTHA.Inclusion and exclusion criteria were systematically applied at each stage to ensure methodological transparency and reproducibility.Study quality was assessed using standardized categories.Pooled odds ratio(OR)with corresponding 95%confidence interval were calculated with random-or fixed-effects models to generate reliability estimates,and study heterogeneity was visualized using forest plots.Ten factors,categorized into patient-,surgeon-,and device-related domains,were reviewed and meta-analyzed.Funnel plot analysis demonstrated a relatively symmetrical distribution,suggesting minimal publication bias.RESULTS A meta-analysis of 20 studies(520789 participants)found a pooled prevalence of 1.96%.Significant risk factors for aseptic loosening after pTHA included elevated body mass index(OR=1.116,P<0.001),higher Charlson comorbidity index(OR=1.378,P<0.001),prosthesis-related factors(OR=1.497,P<0.001),and adverse lifestyles(OR=2.198,P=0.037).Protective factors were non-white race(OR=0.445,P<0.001)and favorable genetics(OR=0.723,P<0.001).Male sex increased risk(OR=1.232,P=0.016),while age and anatomy were not significant.Surgical expertise showed a slight protective effect(OR=1.048,P<0.001).A comprehensive understanding of the modifiable and non-modifiable factors contributing to aseptic loosening after pTHA requires consideration of patient-related factors,surgical expertise,and prosthesis characteristics.CONCLUSION The identification of these factors is critical for risk mitigation.High-risk patients should receive targeted counseling regarding individualized profiles.Further studies are warranted to establish clearer causal relationships and identify additional contributing factors.
基金supported by the National Natural Science Foundation of China(No.12301672)the Shanghai Science and Technology Innovation Action Plan(Yangfan Special Project),China(No.23YF1401300)。
文摘The micro-riblet structures have been demonstrated effective in controlling the Total Pressure Loss(TPL)of aero-engine blades.However,due to the considerable scale gap between micro-texture and an actual aero-engine blade,wind tunnel tests and numerical simulations with massive grids directly describing the global flow field are costly for aerodynamic evaluation.Furthermore,the fine micro surface structure brings unavoidable manufacturing errors,and the probability prediction contributes to gaining the confidence interval of the results.Therefore,a novel relay-based probabilistic model for multi-fidelity scenarios in the TPL prediction of a compressor cascade with micro-riblet surfaces is proposed to trade off accuracy and efficiency.Combined with the low-fidelity flow data generated by an aerodynamic solution strategy using the boundary surrogate model and the high-fidelity flow data from the experiment,the relay-based modeling has been achieved through knowledge transferring,and the confidence interval can be provided by the Gaussian Process Regression(GPR)model.The TPL of compressor cascades with micro-riblet surfaces under different surface structures at March number Ma=0.64,0.74,0.84 have been evaluated using the Relay-Based Probabilistic(RBP)model.The results illustrate that the RBP model could provide higher accuracy than the Single-Fidelity-Data-Driven(SFDD)prediction model,which show the promising potential of multi-fidelity scenarios data fusion in the aerodynamic evaluation of multi-scale configurations.
文摘BACKGROUND Salvage of the infected long stem revision total knee arthroplasty is challenging due to the presence of well-fixed ingrown or cemented stems.Reconstructive options are limited.Above knee amputation(AKA)is often recommended.We present a surgical technique that was successfully used on four such patients to convert them to a knee fusion(KF)using a cephalomedullary nail.CASE SUMMARY Four patients with infected long stem revision knee replacements that refused AKA had a single stage removal of their infected revision total knee followed by a KF.They were all treated with a statically locked antegrade cephalomedullary fusion nail,augmented with antibiotic impregnated bone cement.All patients had successful limb salvage and were ambulatory with assistive devices at the time of last follow-up.All were infection free at an average follow-up of 25.5 months(range 16-31).CONCLUSION Single stage cephalomedullary nailing can result in a successful KF in patients with infected long stem revision total knees.
文摘Objective:To systematically summarize and evaluate the evidence on discharge preparation services for patients undergoing total knee arthroplasty,providing an evidence-based foundation for developing scientific and standardized discharge preparation intervention programs in clinical practice.Methods:Following the“5S”evidence model,literature such as guidelines,expert consensuses,evidence summaries and randomized controlled trials related to discharge preparation services for total knee arthroplasty patients were retrieved from relevant websites and databases,both domestic and international,from database inception to August 31,2025.Two researchers independently screened the literature,conducted quality appraisals,and extracted and synthesized the evidence.Results:A total of 15 articles were included,comprising 3 guidelines,4 expert consensuses,3 evidence summaries,3 systematic reviews and 2 randomized controlled trials.Ultimately,23 pieces of evidence were summarized across five aspects.Conclusion:This study synthesizes the evidence on discharge preparation services for patients undergoing total knee arthroplasty.It is recommended that healthcare professionals apply this evidence in clinical practice,considering specific circumstances and patient needs.
文摘Leg-length discrepancy(LLD)in individuals experiencing total hip arthroplasty(THA)is related to a substantially higher fall risk,length of post-operative hospital in-patient stay,elevated implant-related adverse events,and earlier revision.Therefore,it is essential to try to avoid LLD when implanting a THA.Several studies focus on this issue,including the following:Accelerometer-based portable navigation system,preoperative digital templating,robot-assisted surgery,the anatomical marker positioning method(shoulder-to-shoulder)and the artificial intelligence-based three-dimensional planning software system.The aforementioned methods should be familiar to surgeons who perform THA procedures,as a fundamental objective of this surgical intervention is to avoid LLD.
文摘BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.
文摘BACKGROUND Medial dished(MD)liner designs for cruciate-retaining(CR)total knee arthroplasty(TKA)are a relatively novel development.MD tibial inserts have a more constraining medial side,which allows for more similar kinematics and function to a native knee.AIM To evaluate the clinical results and patient-reported outcomes after CR TKA procedures utilizing a kinematically designed medial dish system.METHODS A multicenter,retrospective cohort review of 139 primary elective TKAs utilizing a kinematically designed CR Knee System(JOURNEY™II CR MD;Smith and Nephew,Memphis,TN,United States)at three different institutions with a minimum of two years of follow-up.Demographic information,clinical outcomes,and patient-reported outcome measures were collected and analyzed.RESULTS With up to 3.7 years from surgery,overall implant survivorship was 98.6%.There were significant postoperative increases in the average Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores(17.4 at 6 months,26.1 points at two years or more,P<0.001).CONCLUSION The combination of high implant survivorship and substantial improvements in patient-reported outcome measures suggests that the medial dish tibial insert represents a safe and effective option within TKA.Additional investigation is necessary to evaluate the long-term survivorship of this design.
基金Guangxi Science and Technology Base and Talent Special Project,No.GuiKeAD24010037(to SZ)Guangxi Health Commission Self-Funded Research Project,No.Z-A20241029(to YL).
文摘Rat nerve growth factor and total flavonoids from hawthorn leaf contribute to the recovery of neurological function after spinal cord injury,including traumatic,non-traumatic spinal cord injuries.However,it remains challenging to efficiently deliver nerve growth factor and total flavonoids from hawthorn leaf to spinal cord injury sites,ensure their sustained release,and minimize further damage.In the present study,we chose a biocompatible and biodegradable gelatin as the substrate,which was crosslinked with the natural biological crosslinker genipin to form a gelatin-genipin hydrogel carrier for the slow release of nerve growth factor and total flavonoids from hawthorn leaf in spinal cord injury sites.The prepared gelatin-genipin hydrogel had good injectable properties and photothermal effects.Furthermore,when the hydrogel with 2%genipin,200 ng/mL nerve growth factor,and 320μg/mL total flavonoids from hawthorn leaf was combined with near infrared irradiation,there was a slow release of total flavonoids from hawthorn leaf and nerve growth factor,reduced oxidative stress,an improved inflammatory microenvironment,and accelerated angiogenesis and axonal regeneration via inhibition of the nuclear factor kappa-B signaling pathway,thereby promoting recovery from spinal cord injury.Collectively,our results indicate that this new hydrogel may improve the prognosis of spinal cord injury,and may represent a new strategy for treating spinal cord injury.
基金Supported by the NSFC-Industry Joint Fund for Innovative Development(U24B2016)China National Science and Technology Major Project(2025ZD1402700)。
文摘For the next exploration direction and integrated evaluation and optimization of targets for the northern continental margin of the South China Sea,this paper proposes the concept of the“total natural gas play system”based on the principles of systems theory.Integrating over 60 years of exploration achievements in the four major basins,the paper studies the basic geological conditions,hydrocarbon accumulation models and distribution characteristics of the system.With the core principle of“source-heat controlling natural gas and play-stratigraphy controlling accumulation”,it analyzes the distribution law of natural gas reservoirs covering“intra-sag,sag margin,extra-sag”and multi-stratigraphic sequences.The study shows that under the joint control of source and heat,the northern continental margin of the South China Sea can be divided into two major gas areas:the southern area dominated by coal-type gas and the northern area dominated by oil-type gas,with the former as the main body.Based on the distribution location of hydrocarbon kitchen,the total gas plays are classified into three types:intra-sag,sag margin and extra-sag.In the oil-type gas area of the northern coastal zone,the proportion of intra-sag natural gas is relatively high;in the coal-type gas area of the southern offshore zone,the proportions of intra-sag and sag margin natural gas are relatively large;while the scale of gas accumulation in the extra-sag plays is relatively small.Finally,it is clearly pointed out that the southern offshore zone is the main direction for the next natural gas exploration in the northern South China Sea.Specifically,in the offshore zone,the intra-sag play and middle-deep layers of the sag margin play in the Yingzhong sag should be focused for the Yinggehai Basin;the intra-sag play and sag margin play in the central depression are targets for the Qiongdongnan Basin;the middle-deep layers of the intra-sag play are targets for the Baiyun sag of the Pearl River Mouth Basin.Furthermore,in the northern depression zone of the Pearl River Mouth Basin within the coastal zone,the main exploration directions include the middle-deep layers of the intra-sag play in the Huizhou sag and the middle-deep layers of the intra-sag play in the Enping sag;in the Beibu Gulf Basin,the main directions are the middle-deep layers of the intra-sag play in the Weixinan sag and the middle-deep layers of the intra-sag play in the Haizhong sag.
文摘Variability in muscle force output and movement variability are important aspects of identifying individuals with mobility deficits, central nervous system impairments, and future risk of falling. This has been investigated in elderly healthy and impaired adults, as well as in adults with osteoarthritis(OA), but the question of whether the same correlations also apply to those who have undergone a surgical intervention such as total knee arthroplasty(TKA) is still being investigated. While there is a growing body of literature identifying potential rehabilitation targets for individuals who have undergone TKA, it is important to first understand the underlying post-operative impairments to more efficiently target functional deficits that may lead to improvedlong-term outcomes. The purpose of this article is to review the potential role of muscle force output and movement variability in TKA recipients. The narrative review relies on existing literature in elderly healthy and impaired individuals, as well as in those with OA before and following TKA. The variables that may predict longterm functional abilities and deficits are discussed in the context of existing literature in healthy older adults and older adults with OA and following TKA, as well as the role future research in this field may play in providing evidence-based data for improved rehabilitation targets.
基金Project supported by the National Natural Science Foundation of China(Grant No.11872033)the Beijing Natural Science Foundation,China(Grant No.3172017)
文摘We build an experiment system based on total reflection(TR) method to observe the evolution of real contact area of polymethyl methacrylate(PMMA) in the continual stick-slip movement. The bilateral friction is adopted to overcome the bending moment in the lateral friction movement. Besides some classical phenomena of stick-slip movement such as periodical slow increase of frictional force in sticking phase and a sudden drop when slipping, a special phenomenon that the contact area increases with the tangential force is observed, which was called junction growth by Tabor in 1959.Image processing methods are developed to observe the variation of the junction area. The results show that the center of the strongest contact region will keep sticking under the tangential force until the whole slipping, the strongest point undergoes three stages in one cycle, which are named as sticking stage, fretting stage, and cracking stage, respectively. The combined analysis reveals a physical process of stick-slip movement: the tangential force causes the increase of the real contact area, which reduces the pressure between the contact spots and finally leads to the slipping. Once slipping occurs,the real contact area drops to the original level resulting in the pressure increase to the original level, which makes the sticking happen again.
文摘Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissue reactions. This study was conducted to analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion®ceramic-on-ceramic (COC) hip articulation, with special emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise and revision surgery. Material and Methods: 150 consecutive hips were operated for primary cementless Total Hip Replacement (THR) using DeltaMotion®at a tertiary care center in Mumbai, India, between January 2010 and January 2015. Clinico-radiological outcome was assessed using the Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with an average age of 50.87 years. Mean follow-up was 54 months (range: 37 - 86 months). The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction, 25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32 post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications (superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger head size in relatively smaller Indian hips due to factory fitted ceramic lining. At 6-year follow-up, high activity level was observed with excellent clinical-radiological outcomes and component longevity in relatively young Indian population.
基金supported by the CAMS Innovation Fund for Medical Sciences(No.2021-I2M-1-008)the National High Level Hospital Clinical Research Funding(No.2023-GSP-GG-2&No.2023-GSP-QN-34&No.2023-GSPRC-05).
文摘BACKGROUND The clinical impact of post-percutaneous coronary intervention (PCI) quantitative flow ratio (QFR) in patients treated with PCI for chronic total occlusion (CTO) was still undetermined.METHODS All CTO vessels treated with successful anatomical PCI in patients from PANDA Ⅲ trial were retrospectively measured for postPCI QFR.The primary outcome was 2-year vessel-oriented composite endpoints (VOCEs,composite of target vessel-related cardiac death,target vessel-related myocardial infarction,and ischemia-driven target vessel revascularization).Receiver operator characteristic curve analysis was conducted to identify optimal cutoff value of post-PCI QFR for predicting the 2-year VOCEs,and all vessels were stratified by this optimal cutoff value.Cox proportional hazards models were employed to calculate the hazard ratio (HR) with 95% CI.RESULTS Among 428 CTO vessels treated with PCI,353 vessels (82.5%) were analyzable for post-PCI QFR.31 VOCEs (8.7%) occurred at 2 years.Mean value of post-PCI QFR was 0.92±0.13.Receiver operator characteristic curve analysis shown the optimal cutoff value of post-PCI QFR for predicting 2-year VOCEs was 0.91.The incidence of 2-year VOCEs in the vessel with post-PCI QFR<0.91 (n=91) was significantly higher compared with the vessels with post-PCI QFR≥0.91 (n=262)(22.0%vs.4.2%,HR=4.98,95%CI:2.32–10.70).CONCLUSIONS Higher post-PCI QFR values were associated with improved prognosis in the PCI practice for coronary CTO.Achieving functionally optimal PCI results (post-PCI QFR value≥0.91) tends to get better prognosis for patients with CTO lesions.
文摘BACKGROUND Gastric cancer is the most common malignancy of the digestive system and surgical resection is the primary treatment.Advances in surgical technology have reduced the risk of complications after radical gastrectomy;however,post-surgical pancreatic fistula remain a serious issue.These fistulas can lead to abdominal infections,anastomotic leakage,increased costs,and pain;thus,early diagnosis and prevention are crucial for a better prognosis.Currently,C-reactive protein(CRP),procalcitonin(PCT),and total bilirubin(TBil)levels are used to predict post-operative infections and anastomotic leakage.However,their predictive value for pancreatic fistula after radical gastrectomy for gastric cancer remains unclear.The present study was conducted to determine their predictive value.AIM To determine the predictive value of CRP,PCT,and TBil levels for pancreatic fistula after gastric cancer surgery.METHODS In total,158 patients who underwent radical gastrectomy for gastric cancer at our hospital between January 2019 and January 2023 were included.The patients were assigned to a pancreatic fistula group or a non-pancreatic fistula group.Multivariate logistic analysis was conducted to assess the factors influencing development of a fistula.Receiver operating characteristic(ROC)curves were used to determine the predictive value of serum CRP,PCT,and TBil levels on day 1 postsurgery.RESULTS On day 1 post-surgery,the CRP,PCT,and TBil levels were significantly higher in the pancreatic fistula group than in the non-pancreatic fistula group(P<0.05).A higher fistula grade was associated with higher levels of the indices.Univariate analysis revealed significant differences in the presence of diabetes,hyperlipidemia,pancreatic injury,splenectomy,and the biomarker levels(P<0.05).Logistic multivariate analysis identified diabetes,hyperlipidemia,pancreatic injury,CRP level,and PCT level as independent risk factors.ROC curves yielded predictive values for CRP,PCT,and TBil levels,with the PCT level having the highest area under the curve(AUC)of 0.80[95%confidence interval(CI):0.72-0.90].Combined indicators improved the predictive value,with an AUC of 0.86(95%CI:0.78-0.93).CONCLUSION Elevated CRP,PCT,and TBil levels predict risk of pancreatic fistula post-gastrectomy for gastric cancer.
基金Supported by Health Research Project of Hunan Provincial Health Commission,No.D202315018915.
文摘BACKGROUND With the continuous development of laparoscopic techniques in recent years,laparoscopic total mesorectal excision(LapTME)and laparoscopic-assisted transanal total mesorectal excision(TaTME)have gradually become important surgical techniques for treating low-lying rectal cancer(LRC).However,there is still controversy over the efficacy and safety of these two surgical modalities in LRC treatment.AIM To compare the efficacy of LapTME vs TaTME in patients with LRC.METHODS Ninety-four patients with LRC who visited and were treated at the Affiliated Hengyang Hospital of Hunan Normal University&Hengyang Central Hospital between December 2022 and March 2024 were selected and divided into the LapTME(n=44)and TaTME(n=50)groups.Clinical operation indexes,postoperative recovery indicators,and postoperative complications were recorded.The anal resting pressure(ARP),anal maximum systolic pressure(MSP),and maximum tolerated volume(MTV)of the anal canal were also measured.The intestinal function of patients was evaluated by the Memorial Sloan Kettering Cancer Center(MSKCC)bowel function questionnaire.Serum norepinephrine(NE),adrenaline(AD),and cortisol(Cor)levels were measured.The Quality of Life Questionnaire Core 30(QLQC30)was used for quality of life assessment.RESULTS Compared with the LapTME group,the surgery time in the TaTME group was longer;intraoperative blood loss was low;time of anal exhaust,first postoperative ambulation,intestinal recovery,and hospital stay were shorter;and the distal incisal margin and specimen lengths were longer.The TaTME group also showed higher ARP,MSP,and MTV values and higher MSKCC and QLQ-C30 scores than the LapTME group 3 months postoperatively.Cor,AD,and NE levels were lower in the TaTME group than those in the LapTME group during recovery.CONCLUSION We demonstrated that TaTME better improved anal function,reduced postoperative stress,and accelerated postoperative recovery and,hence,was safer for patients with LRC.
文摘BACKGROUND At present,the concept of surgical treatment of gastric cancer(GC)has changed from“radical treatment”to“care for patients”to a certain extent.The reconstruction method is the most likely to affect the postoperative life of the patient.Currently,the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC.However,more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure,with more reconstruction steps and longer reconstruction time,and the incidence of postoperative complications such as adhesive intestinal obstruction,internal abdominal hernia and volvulus is high.Moreover,the incidence of Roux stasis syndrome is 10%-30%after traditional Roux-en-Y reconstruction.Thus,we modified the traditional Roux-en-Y alimentary tract reconstruction,and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.AIM To evaluate the clinical advantages,feasibility,and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.METHODS Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy(total gastrectomy)for GC were divided into two groups:fifty-four in the conventional Roux-en-Y reconstruction group(Orr group)and forty-three in the modified Roux-en-Y reconstruction group(the modified group).Perioperative and short-term outcomes were analyzed,including complications,postoperative weight loss,hemoglobin levels,and nutritional status.RESULTS The Orr group and the modified group showed no statistically significant differences in baseline characteristics.Compared with the Orr group,the modified group had shorter digestive tract reconstruction and operation times,less intraoperative bleeding,and shorter postoperative hospital stays compared to the Orr group.Although both groups had similar amounts of intraoperative blood loss,postoperative recovery times,and hospital expenses,the Orr group experienced longer operation times and digestive tract reconstruction times.Furthermore,the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications,with a reduced incidence of reflux esophagitis and improved nutritional status.CONCLUSION The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety,simplicity,and a reduction in bile reflux.This method shortens operation times and minimizes postoperative complications,aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival.This method warrants further clinical application and promotion.
文摘Total hip arthroplasty for adults with sequelae from childhood hip disorders poses significant challenges due to altered anatomy.The paper published by Oommen et al reviews the essential management strategies for these complex cases.This article explores the integration of finite element analysis(FEA)to enhance surgical precision and outcomes.FEA provides detailed biomechanical insights,aiding in preoperative planning,implant design,and surgical technique optimization.By simulating implant configurations and assessing bone quality,FEA helps in customizing implants and evaluating surgical techniques like subtrochanteric shortening osteotomy.Advanced imaging techniques,such as 3D printing,virtual reality,and augmented reality,further enhance total hip arthroplasty precision.Future research should focus on validating FEA models,developing patient-specific simulations,and promoting multidisciplinary collaboration.Integrating FEA and advanced technologies in total hip arthroplasty can improve functional outcomes,reduce complications,and enhance quality of life for patients with childhood hip disorder sequelae.
