Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current ev...Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.展开更多
BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupt...BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.展开更多
This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior...This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.展开更多
The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims ...The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims to develop a hybrid model that combines the Fracture Aquifer Index(FAI)with the conventional GOD(Groundwater occurrence,Overall lithology,Depth to water table)method,to assess groundwater vulnerability in fractured aquifer.To develop the hybrid model,the classical GOD method was integrated with FAI to produce a single composite index.Each parameter within both GOD and FAI was scored,and a final index was calculated to delineate vulnerable areas.The results show that the study area can be classified into four vulnerability levels:Very low,low,moderate,and high,indicating that approximately 8%of the area exhibits very low vulnerability,29%has low vulnerability,25%falls into the moderate category,and 38%is considered highly vulnerable.The FAI-GOD model further incorporates fracture network characteristics.This refinement reduces the classification to three vulnerability classes:Low,medium,and high.The outcomes demonstrate that 46%of the area is highly vulnerable due to a dense concentration of fractures,while 17%represents an intermediate zone characterized by either shallow or deeper fractures.In contrast,37%corresponds to areas with lightly fractured rock,where the impact on vulnerability is minimal.Multivariate statistical analysis was employed using Principal Components Analysis(PCA)and Hierarchical Cluster Analysis(HCA)on 24 samples across six variables.The first three components account for over 76%of the total variance,reinforcing the significance of fracture dynamics in classifying vulnerability levels.The FAI-GOD model removes the very-low-vulnerability class and expands the spatial extent of low-and high-vulnerability zones,reflecting the dominant influence of fracture networks on aquifer sensitivity.While both indices use a five-class system,FAI-GOD redistributes vulnerability by eliminating very-low-vulnerability areas and amplifying low/high categories,highlighting the critical role of fractures.A strong correlation(R2=0.94)between the GOD and FAI-GOD indices,demonstrated through second-order polynomial regression,confirms the robustness of the FAI-GOD model in accurately predicting vulnerability to pollution.This model provides a useful framework for assessing the vulnerability of complex aquifers and serves as a decision-making tool for groundwater managers in similar areas.展开更多
BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges f...BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.展开更多
To analyze the differences in the transport and distribution of different types of proppants and to address issues such as the short effective support of proppant and poor placement in hydraulically intersecting fract...To analyze the differences in the transport and distribution of different types of proppants and to address issues such as the short effective support of proppant and poor placement in hydraulically intersecting fractures,this study considered the combined impact of geological-engineering factors on conductivity.Using reservoir production parameters and the discrete elementmethod,multispherical proppants were constructed.Additionally,a 3D fracture model,based on the specified conditions of the L block,employed coupled(Computational Fluid Dynamics)CFD-DEM(Discrete ElementMethod)for joint simulations to quantitatively analyze the transport and placement patterns of multispherical proppants in intersecting fractures.Results indicate that turbulent kinetic energy is an intrinsic factor affecting proppant transport.Moreover,the efficiency of placement and migration distance of low-sphericity quartz sand constructed by the DEM in the main fracture are significantly reduced compared to spherical ceramic proppants,with a 27.7%decrease in the volume fraction of the fracture surface,subsequently affecting the placement concentration and damaging fracture conductivity.Compared to small-angle fractures,controlling artificial and natural fractures to expand at angles of 45°to 60°increases the effective support length by approximately 20.6%.During hydraulic fracturing of gas wells,ensuring the fracture support area and post-closure conductivity can be achieved by controlling the sphericity of proppants and adjusting the perforation direction to control the direction of artificial fractures.展开更多
Particle-fluid two-phase flows in rock fractures and fracture networks play a pivotal role in determining the efficiency and effectiveness of hydraulic fracturing operations,a vital component in unconventional oil and...Particle-fluid two-phase flows in rock fractures and fracture networks play a pivotal role in determining the efficiency and effectiveness of hydraulic fracturing operations,a vital component in unconventional oil and gas extraction.Central to this phenomenon is the transport of proppants,tiny solid particles injected into the fractures to prevent them from closing once the injection is stopped.However,effective transport and deposition of proppant is critical in keeping fracture pathways open,especially in lowpermeability reservoirs.This review explores,then quantifies,the important role of fluid inertia and turbulent flows in governing proppant transport.While traditional models predominantly assume and then characterise flow as laminar,this may not accurately capture the complexities inherent in realworld hydraulic fracturing and proppant emplacement.Recent investigations highlight the paramount importance of fluid inertia,especially at the high Reynolds numbers typically associated with fracturing operations.Fluid inertia,often overlooked,introduces crucial forces that influence particle settling velocities,particle-particle interactions,and the eventual deposition of proppants within fractures.With their inherent eddies and transient and chaotic nature,turbulent flows introduce additional complexities to proppant transport,crucially altering proppant settling velocities and dispersion patterns.The following comprehensive survey of experimental,numerical,and analytical studies elucidates controls on the intricate dynamics of proppant transport under fluid inertia and turbulence-towards providing a holistic understanding of the current state-of-the-art,guiding future research directions,and optimising hydraulic fracturing practices.展开更多
GH4169 joints manufactured by Linear Friction Welding(LFW)are subjected to tensile test and stair-case method to evaluate the High Cycle Fatigue(HCF)performance at 650℃.The yield and ultimate tensile strengths are 58...GH4169 joints manufactured by Linear Friction Welding(LFW)are subjected to tensile test and stair-case method to evaluate the High Cycle Fatigue(HCF)performance at 650℃.The yield and ultimate tensile strengths are 582 MPa and 820 MPa,respectively.The HCF strength of joint reaches 400 MPa,which is slightly lower than that of Base Metal(BM),indicating reliable quality of this type of joint.The microstructure observation results show that all cracks initiate at the inside of specimens and transfer into deeper region with decrease of external stress,and the crack initiation site is related with microhardness of matrix.The Electron Backscattered Diffraction(EBSD)results of the observed regions with different distances to fracture show that plastic deformation plays a key role in HCF,and the Schmid factor of most grains near fracture exceeds 0.4.In addition,the generation of twins plays a vital role in strain concentration release and coordinating plastic deformation among grains.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks be...Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.展开更多
The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of ke...The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of key fracture parameters,such as the fracture height and width,are particularly important to ensure efficient oilfield development and precise fracture diagnosis.This study utilized the optical frequency domain reflectometer(OFDR)technique in physical simulation experiments to monitor fractures during indoor true triaxial hydraulic fracturing experiments.The results indicate that the distributed fiber optic strain monitoring technology can efficiently capture the initiation and expansion of fractures.In horizontal well monitoring,the fiber strain waterfall plot can be used to interpret the fracture width,initiation location,and expansion speed.The fiber response can be divided into three stages:strain contraction convergence,strain band formation,and postshutdown strain rate reversal.When the fracture does not contact the fiber,a dual peak strain phenomenon occurs in the fiber and gradually converges as the fracture approaches.During vertical well monitoring in adjacent wells,within the effective monitoring range of the fiber,the axial strain produced by the fiber can represent the fracture height with an accuracy of 95.6%relative to the actual fracture height.This study provides a new perspective on real-time fracture monitoring.The response patterns of fiber-induced strain due to fractures can help us better understand and assess the dynamic fracture behavior,offering significant value for the optimization of oilfield development and fracture diagnostic techniques.展开更多
To more accurately describe the coal damage and fracture evolution law during liquid nitrogen(LN_(2))fracturing under true triaxial stress,a thermal-hydraulic-mechanical-damage(THMD)coupling model for LN_(2) fracturin...To more accurately describe the coal damage and fracture evolution law during liquid nitrogen(LN_(2))fracturing under true triaxial stress,a thermal-hydraulic-mechanical-damage(THMD)coupling model for LN_(2) fracturing coal was developed,considering the coal heterogeneity and thermophysical parameters of nitrogen.The accuracy and applicability of model were verified by comparing with LN_(2) injection pre-cooling and fracturing experimental data.The effects of different pre-cooling times and horizontal stress ratios on coal damage evolution,permeability,temperature distribution,and fracture characteristics were analyzed.The results show that the permeability and damage of the coal increase exponentially,while the temperature decreases exponentially during the fracturing process.As the pre-cooling time increases,the damage range of the coal expands,and the fracture propagation becomes more pronounced.The initiation pressure and rupture pressure decrease and tend to stabilize with longer precooling times.As the horizontal stress ratio increases,fractures preferentially extend along the direction of maximum horizontal principal stress,leading to a significant decrease in both initiation and rupture pressures.At a horizontal stress ratio of 3,the initiation pressure drops by 48.07%,and the rupture pressure decreases by 41.36%.The results provide a theoretical basis for optimizing LN_(2) fracturing techniques and improving coal seam modification.展开更多
With the increasing demand for energy,traditional oil resources are facing depletion and insufficient supply.Many countries are rapidly turning to the development of unconventional oil and gas resources.Among them,sha...With the increasing demand for energy,traditional oil resources are facing depletion and insufficient supply.Many countries are rapidly turning to the development of unconventional oil and gas resources.Among them,shale oil and gas reservoirs have become the focus of unconventional oil and gas resources exploration and development.Based on the characteristics of shale oil and gas reservoirs,supercritical CO_(2) fracturing is more conducive to improving oil recovery than other fracturing technologies.In this paper,the mechanism of fracture initiation and propagation of supercritical CO_(2) in shale is analyzed,including viscosity effect,surface tension effect,permeation diffusion effect of supercritical CO_(2),and dissolution-adsorption effect between CO_(2) and shale.The effects of natural factors,such as shale properties,bedding plane and natural fractures,and controllable factors,proppant,temperature,pressure,CO_(2) concentration and injection rate on fracture initiation and propagation are clarified.The methods of supercritical CO_(2) fracturing process,thickener and proppant optimization to improve the efficiency of supercritical CO_(2) fracturing are discussed.In addition,some new technologies of supercritical CO_(2) fracturing are introduced.The challenges and prospects in the current research are also summarized.For example,supercritical CO_(2) is prone to filtration when passing through porous media,and it is difficult to form a stable flow state.Therefore,in order to achieve stable fracturing fluid suspension and effectively support fractu res,it is urge nt to explo re new fracturing fluid additives or improve fracturing fluid formulations combined with the research of new proppants.This paper is of great significance for understanding the behavior mechanism of supercritical CO_(2) in shale and optimizing fracturing technology.展开更多
Discrete fracture network(DFN)commonly existing in natural rock masses plays an important role in geological complexity which can influence rock fracturing behaviour during fluid injection.This paper simulated the hyd...Discrete fracture network(DFN)commonly existing in natural rock masses plays an important role in geological complexity which can influence rock fracturing behaviour during fluid injection.This paper simulated the hydraulic fracturing process in lab-scale coal samples with DFNs and the induced seismic activities by the discrete element method(DEM).The effects of DFNs on hydraulic fracturing,induced seismicity and elastic property changes have been concluded.Denser DFNs can comprehensively decrease the peak injection pressure and injection duration.The proportion of strong seismic events increases first and then decreases with increasing DFN density.In addition,the relative modulus of the rock mass is derived innovatively from breakdown pressure,breakdown fracture length and the related initiation time.Increasing DFN densities among large(35–60 degrees)and small(0–30 degrees)fracture dip angles show opposite evolution trends in relative modulus.The transitional point(dip angle)for the opposite trends is also proportionally affected by the friction angle of the rock mass.The modelling results have much practical meaning to infer the density and geometry of pre-existing fractures and the elastic property of rock mass in the field,simply based on the hydraulic fracturing and induced seismicity monitoring data.展开更多
Supercritical CO_(2)(SC-CO_(2))fracturing stands out a promising waterless stimulation technique in the development of unconventional resources.While numerous studies have delved into the inducedfracture mechanism of ...Supercritical CO_(2)(SC-CO_(2))fracturing stands out a promising waterless stimulation technique in the development of unconventional resources.While numerous studies have delved into the inducedfracture mechanism of SC-CO_(2),the small scale of rock samples and synthetic materials used in many studies have limited a comprehensive understanding of fracture propagation in unconventional formations.In this study,cubic tight sandstone samples with dimensions of 300 mm were employed to conduct SC-CO_(2)fractu ring experiments under true-triaxial stre ss conditions.The spatial morphology and quantitative attributes of fracture induced by water and SC-CO_(2)fracturing were compared,while the impact of in-situ stress on fracture propagation was also investigated.The results indicate that the SCCO_(2)fracturing takes approximately ten times longer than water fracturing.Furthermore,under identical stress condition,the breakdown pressure(BP)for SC-CO_(2)fracturing is nearly 25%lower than that for water fracturing.A quantitative analysis of fracture morphology reveals that water fracturing typically produces relatively simple fracture pattern,with the primary fracture distribution predominantly controlled by bedding planes.In contrast,SC-CO_(2)fracturing results in a more complex fracture morphology.As the differential of horizontal principal stress increases,the BP for SC-CO_(2)fractured rock exhibits a downward trend,and the induced fracture morphology becomes more simplified.Moreover,the presence of abnormal in-situ stress leads to a further increase in the BP for SC-CO_(2)fracturing,simultaneously enhancing the development of a more conductive fracture network.These findings provide critical insights into the efficiency and behavior of SC-CO_(2)fracturing in comparison to traditional water-based fracturing,offering valuable implication for its potential applications in unconventional reservoirs.展开更多
BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appea...BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.展开更多
CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-nu...CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-null mice showed decreased callus bone formation as assessed by microcomputed tomography 10 days post-fracture and increased fibrous volume as determined by histology.To understand the cellular basis for this phenotype,mesenchymal progenitors(MSC)were harvested from bone marrow.CD47-null MSC showed decreased large fibroblast colony formation(CFU-F),significantly less proliferation,and fewer cells in Sphase,although osteoblast differentiation was unaffected.However,consistent with prior research,CD47-null endothelial cells showed increased proliferation relative to WT cells.Similarly,in a murine ischemic fracture model,CD47-null mice showed reduced fracture callus size due to a reduction in bone relative to WT 15 days-post fracture.Consistent with our in vitro results,in vivo EdU labeling showed decreased cell proliferation in the callus of CD47-null mice,while staining for CD31 and endomucin demonstrated increased endothelial cell density.Finally,WT mice with ischemic fracture that were administered a CD47 morpholino,which blocks CD47 protein production,showed a callus phenotype similar to that of ischemic fractures in CD47-null mice,suggesting the phenotype was not due to developmental changes in the knockout mice.Thus,inhibition of CD47 during bone healing reduces both non-ischemic and ischemic fracture healing,in part,by decreasing MSC proliferation.Furthermore,the increase in endothelial cell proliferation and early blood vessel density caused by CD47 disruption is not sufficient to overcome MSC dysfunction.展开更多
The roughness of the fracture surface directly affects the strength,deformation,and permeability of the surrounding rock in deep underground engineering.Understanding the effect of high temperature and thermal cycle o...The roughness of the fracture surface directly affects the strength,deformation,and permeability of the surrounding rock in deep underground engineering.Understanding the effect of high temperature and thermal cycle on the fracture surface roughness plays an important role in estimating the damage degree and stability of deep rock mass.In this paper,the variations of fracture surface roughness of granite after different heating and thermal cycles were investigated using the joint roughness coefficient method(JRC),three-dimensional(3D)roughness parameters,and fractal dimension(D),and the mechanism of damage and deterioration of granite were revealed.The experimental results show an increase in the roughness of the granite fracture surface as temperature and cycle number were incremented.The variations of JRC,height parameter,inclination parameter and area parameter with the temperature conformed to the Boltzmann's functional distribution,while the D decreased linearly as the temperature increased.Besides,the anisotropy index(Ip)of the granite fracture surface increased as the temperature increased,and the larger parameter values of roughness characterization at different temperatures were attained mainly in directions of 20°–40°,60°–100°and 140°–160°.The fracture aperture of granite after fracture followed the Gauss distribution and the average aperture increased with increasing temperature,which increased from 0.665 mm at 25℃to 1.058 mm at 800℃.High temperature caused an uneven thermal expansion,water evaporation,and oxidation of minerals within the granite,which promoted the growth and expansion of microfractures,and reduced interparticle bonding strength.In particular,the damage was exacerbated by the expansion and cracking of the quartz phase transition after T>500℃.Thermal cycles contributed to the accumulation of this damage and further weakened the interparticle bonding forces,resulting in a significant increase in the roughness,anisotropy,and aperture of the fracture surface after five cycles.展开更多
BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outco...BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.展开更多
文摘Complex trimalleolar ankle fractures are a major orthopaedic challenge,with an incidence of 4.22 per 10000 person-years in the United States and an annual cost of 3.4 billion dollars.This review synthesizes current evidence on diagnostic protocols and management strategies,highlighting optimal approaches and emerging trends.Initial care emphasizes soft tissue assessment,often guided by the Tscherne classification,and fracture classification systems.External fixation may be required in open injuries,while early open reduction and internal fixation within six days is linked to improved outcomes.Minimally invasive techniques for the lateral malleolus,including intramedullary nailing and locking plates,are effective,while medial malleolus fractures are commonly managed with screw fixation or tension-band wiring.Posterior malleolus fragments involving more than 25%of the articular surface usually warrant fixation.Alternatives to syndesmotic screws,such as cortical buttons or high-strength sutures,reduce the need for secondary procedures.Arthroscopic-assisted open reduction and internal fixation benefits younger,active patients by enabling concurrent management of intra-articular and ligamentous injuries.Postoperative care prioritizes early weight-bearing and validated functional scores.Despite advances,complications remain common,and further research is needed to refine surgical strategies and improve outcomes.
文摘BACKGROUND Ankle fractures are well-documented in snow sports,but concomitant Achilles tendon and peroneal tendon ruptures are rare.This case report presents a previously unreported combination of Achilles tendon rupture,peroneal tendon rupture,and fibular fracture in a snowboarder,highlighting the complex nature of diagnosis,management,and rehabilitation.CASE SUMMARY A 50-year-old male snowboarder presented with severe right ankle pain following a high speed tumbling crash.Initial evaluation revealed an Achilles tendon rupture and a non-displaced distal lateral malleolus fracture.Subsequent magnetic resonance imaging confirmed complete tears of the Achilles tendon and both peroneus longus and brevis tendons,along with a Weber A lateral malleolus fracture.Surgical intervention included a 4-suture core Kraków repair of the Achilles tendon with calcaneal docking,open reduction and internal fixation of the distal fibula fracture,and primary repair of both peroneal tendons.Postoperatively,a modified Achilles repair protocol was implemented.At 16 weeks post-surgery,radiographs showed a well-healed fibular fracture,and physical examination confirmed intact Achilles and peroneal tendon repairs.By 6 months,the patient had regained full daily and work activities,including recreational pursuits.CONCLUSION This case underscores the importance of maintaining a high index of suspicion for concomitant injuries in high-energy ankle trauma during snow sports.Timely advanced imaging and a comprehensive surgical approach are crucial for optimal outcomes in such complex cases.
文摘This paper prepared a novel as-cast W-Zr-Ti metallic ESM using high-frequency vacuum induction melting technique.The above ESM performs a typical elastic-brittle material feature and strain rate strengthening behavior.The specimens exhibit violent chemical reaction during the fracture process under the impact loading,and the size distribution of their residual debris follows Rosin-Rammler model.The dynamic fracture toughness is obtained by the fitting of debris length scale,approximately 1.87 MPa·m~(1/2).Microstructure observation on residual debris indicates that the failure process is determined by primary crack propagation under quasi-static compression,while it is affected by multiple cracks propagation in both particle and matrix in the case of dynamic impact.Impact test demonstrates that the novel energetic fragment performs brilliant penetration and combustion effect behind the front target,leading to the effective ignition of fuel tank.For the brittleness of as-cast W-ZrTi ESM,further study conducted bond-based peridynamic(BB-PD)C++computational code to simulate its fracture behavior during penetration.The BB-PD method successfully captured the fracture process and debris cloud formation of the energetic fragment.This paper explores a novel as-cast metallic ESM,and provides an available numerical avenue to the simulation of brittle energetic fragment.
文摘The Gabes aquifer system,located in southeastern Tunisia,is a crucial resource for supporting local socio-economic activities.Due to its dual porosity structure,is particularly vulnerable to pollution.This study aims to develop a hybrid model that combines the Fracture Aquifer Index(FAI)with the conventional GOD(Groundwater occurrence,Overall lithology,Depth to water table)method,to assess groundwater vulnerability in fractured aquifer.To develop the hybrid model,the classical GOD method was integrated with FAI to produce a single composite index.Each parameter within both GOD and FAI was scored,and a final index was calculated to delineate vulnerable areas.The results show that the study area can be classified into four vulnerability levels:Very low,low,moderate,and high,indicating that approximately 8%of the area exhibits very low vulnerability,29%has low vulnerability,25%falls into the moderate category,and 38%is considered highly vulnerable.The FAI-GOD model further incorporates fracture network characteristics.This refinement reduces the classification to three vulnerability classes:Low,medium,and high.The outcomes demonstrate that 46%of the area is highly vulnerable due to a dense concentration of fractures,while 17%represents an intermediate zone characterized by either shallow or deeper fractures.In contrast,37%corresponds to areas with lightly fractured rock,where the impact on vulnerability is minimal.Multivariate statistical analysis was employed using Principal Components Analysis(PCA)and Hierarchical Cluster Analysis(HCA)on 24 samples across six variables.The first three components account for over 76%of the total variance,reinforcing the significance of fracture dynamics in classifying vulnerability levels.The FAI-GOD model removes the very-low-vulnerability class and expands the spatial extent of low-and high-vulnerability zones,reflecting the dominant influence of fracture networks on aquifer sensitivity.While both indices use a five-class system,FAI-GOD redistributes vulnerability by eliminating very-low-vulnerability areas and amplifying low/high categories,highlighting the critical role of fractures.A strong correlation(R2=0.94)between the GOD and FAI-GOD indices,demonstrated through second-order polynomial regression,confirms the robustness of the FAI-GOD model in accurately predicting vulnerability to pollution.This model provides a useful framework for assessing the vulnerability of complex aquifers and serves as a decision-making tool for groundwater managers in similar areas.
基金approved by King Abdullah International Medical Research Center Ethics Committee(approval No.0000074524).
文摘BACKGROUND Humeral shaft fractures are common and vary by age,with high-energy trauma observed in younger adults and low-impact injuries in older adults.Radial nerve palsy is a frequent complication.Treatment ranges from nonoperative methods to surgical interventions such as intramedullary K-wires,which promote faster rehabilitation and improved elbow mobility.AIM To evaluate the outcomes of managing humeral shaft fractures using closed reduction and internal fixation with flexible intramedullary K-wires.METHODS This was a retrospective cohort study analyzing the medical records of patients with humeral shaft fractures managed with flexible intramedullary K-wires at King Abdulaziz Medical City,using non-random sampling and descriptive analysis for outcome evaluation.RESULTS This study assessed the clinical outcomes of 20 patients treated for humeral shaft fractures with intramedullary K-wires.Patients were predominantly male(n=16,80%),had an average age of 39.2 years,and a mean body mass index of 29.5 kg/m^(2).The fractures most frequently occurred in the middle third of the humerus(n=14,70%),with oblique fractures being the most common type(n=7,35%).All surgeries used general anesthesia and a posterior approach,with no intraoperative complications reported.Postoperatively,all patients achieved clinical and radiological union(n=20,100%),and the majority(n=13,65%)reached an elbow range of motion from 0 to 150 degrees.CONCLUSION These results suggest that intramedullary K-wire fixation may be an effective option for treating humeral shaft fractures,with favorable outcomes in range of motion recovery,fracture union,and a low rate of intraoperative complications.
基金funded by the project of the Major Scientific and Technological Projects of CNOOC in the 14th Five-Year Plan(No.KJGG2022-0701)the CNOOC Research Institute(No.2020PFS-03).
文摘To analyze the differences in the transport and distribution of different types of proppants and to address issues such as the short effective support of proppant and poor placement in hydraulically intersecting fractures,this study considered the combined impact of geological-engineering factors on conductivity.Using reservoir production parameters and the discrete elementmethod,multispherical proppants were constructed.Additionally,a 3D fracture model,based on the specified conditions of the L block,employed coupled(Computational Fluid Dynamics)CFD-DEM(Discrete ElementMethod)for joint simulations to quantitatively analyze the transport and placement patterns of multispherical proppants in intersecting fractures.Results indicate that turbulent kinetic energy is an intrinsic factor affecting proppant transport.Moreover,the efficiency of placement and migration distance of low-sphericity quartz sand constructed by the DEM in the main fracture are significantly reduced compared to spherical ceramic proppants,with a 27.7%decrease in the volume fraction of the fracture surface,subsequently affecting the placement concentration and damaging fracture conductivity.Compared to small-angle fractures,controlling artificial and natural fractures to expand at angles of 45°to 60°increases the effective support length by approximately 20.6%.During hydraulic fracturing of gas wells,ensuring the fracture support area and post-closure conductivity can be achieved by controlling the sphericity of proppants and adjusting the perforation direction to control the direction of artificial fractures.
基金the Australian Research Council Discovery Project(ARC DP 220100851)scheme and would acknowledge that.
文摘Particle-fluid two-phase flows in rock fractures and fracture networks play a pivotal role in determining the efficiency and effectiveness of hydraulic fracturing operations,a vital component in unconventional oil and gas extraction.Central to this phenomenon is the transport of proppants,tiny solid particles injected into the fractures to prevent them from closing once the injection is stopped.However,effective transport and deposition of proppant is critical in keeping fracture pathways open,especially in lowpermeability reservoirs.This review explores,then quantifies,the important role of fluid inertia and turbulent flows in governing proppant transport.While traditional models predominantly assume and then characterise flow as laminar,this may not accurately capture the complexities inherent in realworld hydraulic fracturing and proppant emplacement.Recent investigations highlight the paramount importance of fluid inertia,especially at the high Reynolds numbers typically associated with fracturing operations.Fluid inertia,often overlooked,introduces crucial forces that influence particle settling velocities,particle-particle interactions,and the eventual deposition of proppants within fractures.With their inherent eddies and transient and chaotic nature,turbulent flows introduce additional complexities to proppant transport,crucially altering proppant settling velocities and dispersion patterns.The following comprehensive survey of experimental,numerical,and analytical studies elucidates controls on the intricate dynamics of proppant transport under fluid inertia and turbulence-towards providing a holistic understanding of the current state-of-the-art,guiding future research directions,and optimising hydraulic fracturing practices.
基金supported by the National Natural Science Foundation of China(Nos.52074228,52305420,and 51875470)the China Postdoctoral Science Foundation(No.2023M742830)。
文摘GH4169 joints manufactured by Linear Friction Welding(LFW)are subjected to tensile test and stair-case method to evaluate the High Cycle Fatigue(HCF)performance at 650℃.The yield and ultimate tensile strengths are 582 MPa and 820 MPa,respectively.The HCF strength of joint reaches 400 MPa,which is slightly lower than that of Base Metal(BM),indicating reliable quality of this type of joint.The microstructure observation results show that all cracks initiate at the inside of specimens and transfer into deeper region with decrease of external stress,and the crack initiation site is related with microhardness of matrix.The Electron Backscattered Diffraction(EBSD)results of the observed regions with different distances to fracture show that plastic deformation plays a key role in HCF,and the Schmid factor of most grains near fracture exceeds 0.4.In addition,the generation of twins plays a vital role in strain concentration release and coordinating plastic deformation among grains.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
基金financially supported by,the Fundamental Research Funds for the Central Universities(Grant No.2023QN1064)the China Postdoctoral Science Foundation(Grant No.2023M733772)Jiangsu Funding Program for Excellent Postdoctoral Talent(Grant No.2023ZB847)。
文摘Prepulse combined hydraulic fracturing facilitates the development of fracture networks by integrating prepulse hydraulic loading with conventional hydraulic fracturing.The formation mechanisms of fracture networks between hydraulic and pre-existing fractures under different prepulse loading parameters remain unclear.This research investigates the impact of prepulse loading parameters,including the prepulse loading number ratio(C),prepulse loading stress ratio(S),and prepulse loading frequency(f),on the formation of fracture networks between hydraulic and pre-existing fractures,using both experimental and numerical methods.The results suggest that low prepulse loading stress ratios and high prepulse loading number ratios are advantageous loading modes.Multiple hydraulic fractures are generated in the specimen under the advantageous loading modes,facilitating the development of a complex fracture network.Fatigue damage occurs in the specimen at the prepulse loading stage.The high water pressure at the secondary conventional hydraulic fracturing promotes the growth of hydraulic fractures along the damage zones.This allows the hydraulic fractures to propagate deeply and interact with pre-existing fractures.Under advantageous loading conditions,multiple hydraulic fractures can extend to pre-existing fractures,and these hydraulic fractures penetrate or propagate along pre-existing fractures.Especially when the approach angle is large,the damage range in the specimen during the prepulse loading stage increases,resulting in the formation of more hydraulic fractures.
基金supported by the National Natural Science Foundation of China(Grant No.52104060)the Natural Science Foundation of Shandong Province,China(Grant No.ZR2021QE015).
文摘The real-time monitoring of fracture propagation during hydraulic fracturing is crucial for obtaining a deeper understanding of fracture morphology and optimizing hydraulic fracture designs.Accurate measurements of key fracture parameters,such as the fracture height and width,are particularly important to ensure efficient oilfield development and precise fracture diagnosis.This study utilized the optical frequency domain reflectometer(OFDR)technique in physical simulation experiments to monitor fractures during indoor true triaxial hydraulic fracturing experiments.The results indicate that the distributed fiber optic strain monitoring technology can efficiently capture the initiation and expansion of fractures.In horizontal well monitoring,the fiber strain waterfall plot can be used to interpret the fracture width,initiation location,and expansion speed.The fiber response can be divided into three stages:strain contraction convergence,strain band formation,and postshutdown strain rate reversal.When the fracture does not contact the fiber,a dual peak strain phenomenon occurs in the fiber and gradually converges as the fracture approaches.During vertical well monitoring in adjacent wells,within the effective monitoring range of the fiber,the axial strain produced by the fiber can represent the fracture height with an accuracy of 95.6%relative to the actual fracture height.This study provides a new perspective on real-time fracture monitoring.The response patterns of fiber-induced strain due to fractures can help us better understand and assess the dynamic fracture behavior,offering significant value for the optimization of oilfield development and fracture diagnostic techniques.
基金financially supported by the National Natural Science Foundation of China(Nos.51874236 and 52174207)Shaanxi Science and Technology Innovation Team(No.2022TD02)Henan University of Science and Technology PhD Funded Projects(No.B2025-9)。
文摘To more accurately describe the coal damage and fracture evolution law during liquid nitrogen(LN_(2))fracturing under true triaxial stress,a thermal-hydraulic-mechanical-damage(THMD)coupling model for LN_(2) fracturing coal was developed,considering the coal heterogeneity and thermophysical parameters of nitrogen.The accuracy and applicability of model were verified by comparing with LN_(2) injection pre-cooling and fracturing experimental data.The effects of different pre-cooling times and horizontal stress ratios on coal damage evolution,permeability,temperature distribution,and fracture characteristics were analyzed.The results show that the permeability and damage of the coal increase exponentially,while the temperature decreases exponentially during the fracturing process.As the pre-cooling time increases,the damage range of the coal expands,and the fracture propagation becomes more pronounced.The initiation pressure and rupture pressure decrease and tend to stabilize with longer precooling times.As the horizontal stress ratio increases,fractures preferentially extend along the direction of maximum horizontal principal stress,leading to a significant decrease in both initiation and rupture pressures.At a horizontal stress ratio of 3,the initiation pressure drops by 48.07%,and the rupture pressure decreases by 41.36%.The results provide a theoretical basis for optimizing LN_(2) fracturing techniques and improving coal seam modification.
文摘With the increasing demand for energy,traditional oil resources are facing depletion and insufficient supply.Many countries are rapidly turning to the development of unconventional oil and gas resources.Among them,shale oil and gas reservoirs have become the focus of unconventional oil and gas resources exploration and development.Based on the characteristics of shale oil and gas reservoirs,supercritical CO_(2) fracturing is more conducive to improving oil recovery than other fracturing technologies.In this paper,the mechanism of fracture initiation and propagation of supercritical CO_(2) in shale is analyzed,including viscosity effect,surface tension effect,permeation diffusion effect of supercritical CO_(2),and dissolution-adsorption effect between CO_(2) and shale.The effects of natural factors,such as shale properties,bedding plane and natural fractures,and controllable factors,proppant,temperature,pressure,CO_(2) concentration and injection rate on fracture initiation and propagation are clarified.The methods of supercritical CO_(2) fracturing process,thickener and proppant optimization to improve the efficiency of supercritical CO_(2) fracturing are discussed.In addition,some new technologies of supercritical CO_(2) fracturing are introduced.The challenges and prospects in the current research are also summarized.For example,supercritical CO_(2) is prone to filtration when passing through porous media,and it is difficult to form a stable flow state.Therefore,in order to achieve stable fracturing fluid suspension and effectively support fractu res,it is urge nt to explo re new fracturing fluid additives or improve fracturing fluid formulations combined with the research of new proppants.This paper is of great significance for understanding the behavior mechanism of supercritical CO_(2) in shale and optimizing fracturing technology.
基金Australian Research Council Linkage Program(LP200301404)for sponsoring this researchthe financial support provided by the State Key Laboratory of Geohazard Prevention and Geoenvironment Protection(Chengdu University of Technology,SKLGP2021K002)National Natural Science Foundation of China(52374101,32111530138).
文摘Discrete fracture network(DFN)commonly existing in natural rock masses plays an important role in geological complexity which can influence rock fracturing behaviour during fluid injection.This paper simulated the hydraulic fracturing process in lab-scale coal samples with DFNs and the induced seismic activities by the discrete element method(DEM).The effects of DFNs on hydraulic fracturing,induced seismicity and elastic property changes have been concluded.Denser DFNs can comprehensively decrease the peak injection pressure and injection duration.The proportion of strong seismic events increases first and then decreases with increasing DFN density.In addition,the relative modulus of the rock mass is derived innovatively from breakdown pressure,breakdown fracture length and the related initiation time.Increasing DFN densities among large(35–60 degrees)and small(0–30 degrees)fracture dip angles show opposite evolution trends in relative modulus.The transitional point(dip angle)for the opposite trends is also proportionally affected by the friction angle of the rock mass.The modelling results have much practical meaning to infer the density and geometry of pre-existing fractures and the elastic property of rock mass in the field,simply based on the hydraulic fracturing and induced seismicity monitoring data.
基金funded by the National Natural Scientific Foundation of China(Nos.52304008,52404038,52474043)the China Postdoctoral Science Foundation(No.2023MD734223)+1 种基金the Key Laboratory of Well Stability and Fluid&Rock Mechanics in Oil and Gas Reservoir of Shaanxi Province(No.23JS047)the Youth Talent Lifting Program of Xi'an Science and Technology Association(No.959202413078)。
文摘Supercritical CO_(2)(SC-CO_(2))fracturing stands out a promising waterless stimulation technique in the development of unconventional resources.While numerous studies have delved into the inducedfracture mechanism of SC-CO_(2),the small scale of rock samples and synthetic materials used in many studies have limited a comprehensive understanding of fracture propagation in unconventional formations.In this study,cubic tight sandstone samples with dimensions of 300 mm were employed to conduct SC-CO_(2)fractu ring experiments under true-triaxial stre ss conditions.The spatial morphology and quantitative attributes of fracture induced by water and SC-CO_(2)fracturing were compared,while the impact of in-situ stress on fracture propagation was also investigated.The results indicate that the SCCO_(2)fracturing takes approximately ten times longer than water fracturing.Furthermore,under identical stress condition,the breakdown pressure(BP)for SC-CO_(2)fracturing is nearly 25%lower than that for water fracturing.A quantitative analysis of fracture morphology reveals that water fracturing typically produces relatively simple fracture pattern,with the primary fracture distribution predominantly controlled by bedding planes.In contrast,SC-CO_(2)fracturing results in a more complex fracture morphology.As the differential of horizontal principal stress increases,the BP for SC-CO_(2)fractured rock exhibits a downward trend,and the induced fracture morphology becomes more simplified.Moreover,the presence of abnormal in-situ stress leads to a further increase in the BP for SC-CO_(2)fracturing,simultaneously enhancing the development of a more conductive fracture network.These findings provide critical insights into the efficiency and behavior of SC-CO_(2)fracturing in comparison to traditional water-based fracturing,offering valuable implication for its potential applications in unconventional reservoirs.
文摘BACKGROUND In pediatric age group patients(<18 years old)treated operatively for distal radius/both bone fractures extending imaging beyond the initial postoperative period-particularly in uncomplicated cases-appears to provide limited additional benefit.AIM To determine the necessary number of follow-up X-rays to use resources efficiently.METHODS Participants included in this study are pediatric age group patients who were treated operatively for distal radius/both bone fractures and were identified from a prospected collected data from the operating room database between the years 2009 and 2017.The data in the study included patients who had distal radius fractures and underwent fixation surgery(n=88).RESULTS When assessing the difference in the odds of conducting 1 or less X-ray compared to 2 or more X-rays in regard to the type of fixation,the only significant difference is the closed reduction fixation method.Patients who underwent closed reduction method procedure have significantly lower odds of having 2 more X-rays compared to those who didn’t have closed reduction method.Open reduction,internal fixation,and other fixation methods(close reduction and internal fixation,debridement,or epiphysiodesis)have higher odds of having two or more X-rays compared to patients who did not receive these methods;however,these odds are not statistically significant.CONCLUSION The findings of this study reveal notable absence of a statistically significant association between the frequency of postoperative X-rays and the outcome of children with distal radius fractures.
基金supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases(NIAMS)of the National Institutes of Health(NIH)under award numbers F30AR071201(R.L.Z.)and R01 AR066028(K.D.H.)Additional research support is provided by the NIH under a training award T32TR004371(C.A.C.).
文摘CD47 is a ubiquitous and pleiotropic cell-surface receptor.Disrupting CD47 enhances injury repair in various tissues but the role of CD47 has not been studied in bone injuries.In a murine closed-fracture model,CD47-null mice showed decreased callus bone formation as assessed by microcomputed tomography 10 days post-fracture and increased fibrous volume as determined by histology.To understand the cellular basis for this phenotype,mesenchymal progenitors(MSC)were harvested from bone marrow.CD47-null MSC showed decreased large fibroblast colony formation(CFU-F),significantly less proliferation,and fewer cells in Sphase,although osteoblast differentiation was unaffected.However,consistent with prior research,CD47-null endothelial cells showed increased proliferation relative to WT cells.Similarly,in a murine ischemic fracture model,CD47-null mice showed reduced fracture callus size due to a reduction in bone relative to WT 15 days-post fracture.Consistent with our in vitro results,in vivo EdU labeling showed decreased cell proliferation in the callus of CD47-null mice,while staining for CD31 and endomucin demonstrated increased endothelial cell density.Finally,WT mice with ischemic fracture that were administered a CD47 morpholino,which blocks CD47 protein production,showed a callus phenotype similar to that of ischemic fractures in CD47-null mice,suggesting the phenotype was not due to developmental changes in the knockout mice.Thus,inhibition of CD47 during bone healing reduces both non-ischemic and ischemic fracture healing,in part,by decreasing MSC proliferation.Furthermore,the increase in endothelial cell proliferation and early blood vessel density caused by CD47 disruption is not sufficient to overcome MSC dysfunction.
基金funding support from the National Natural Science Foundation of China(Grant No.52274082)the Program of Qingjiang Excellent Young Talents,Jiangxi University of Science and Technology(Grant No.JXUSTQJBJ2020003)the Innovation Fund Designated for Graduate Students of Jiangxi Province(Grant No.YC2023-B215).
文摘The roughness of the fracture surface directly affects the strength,deformation,and permeability of the surrounding rock in deep underground engineering.Understanding the effect of high temperature and thermal cycle on the fracture surface roughness plays an important role in estimating the damage degree and stability of deep rock mass.In this paper,the variations of fracture surface roughness of granite after different heating and thermal cycles were investigated using the joint roughness coefficient method(JRC),three-dimensional(3D)roughness parameters,and fractal dimension(D),and the mechanism of damage and deterioration of granite were revealed.The experimental results show an increase in the roughness of the granite fracture surface as temperature and cycle number were incremented.The variations of JRC,height parameter,inclination parameter and area parameter with the temperature conformed to the Boltzmann's functional distribution,while the D decreased linearly as the temperature increased.Besides,the anisotropy index(Ip)of the granite fracture surface increased as the temperature increased,and the larger parameter values of roughness characterization at different temperatures were attained mainly in directions of 20°–40°,60°–100°and 140°–160°.The fracture aperture of granite after fracture followed the Gauss distribution and the average aperture increased with increasing temperature,which increased from 0.665 mm at 25℃to 1.058 mm at 800℃.High temperature caused an uneven thermal expansion,water evaporation,and oxidation of minerals within the granite,which promoted the growth and expansion of microfractures,and reduced interparticle bonding strength.In particular,the damage was exacerbated by the expansion and cracking of the quartz phase transition after T>500℃.Thermal cycles contributed to the accumulation of this damage and further weakened the interparticle bonding forces,resulting in a significant increase in the roughness,anisotropy,and aperture of the fracture surface after five cycles.
基金Supported by Wang Zhengguo Foundation for Traumatic Medicine“Sequential Medical Research Special Foundation”,No 2024-XGM05.
文摘BACKGROUND Postoperative delirium(POD)is a prevalent complication,particularly in elderly patients with hip fractures(HFs).It significantly affects recovery,length of hospital stay,healthcare costs,and long-term outcomes.Existing studies have investigated risk factors for POD,but most are limited by single-factor analyses or small sample sizes.This study systematically determines independent risk factors using large-scale data and machine learning techniques and develops a validated nomogram model to support early prediction and management of POD.AIM To investigate POD incidence in elderly patients with HF and the independent risk factors,according to which a nomogram prediction model was developed and validated.METHODS This retrospective study included elderly patients with HF who were surgically treated in Dongying People’sHospital from April 2018 to April 2022. The endpoint event includes POD. They were categorized into themodeling and validation cohorts in a 7:3 ratio by randomization. Both cohorts were further classified into thedelirium and normal (non-delirium) groups according to the presence or absence of the endpoint event. Theincidence of POD was calculated, and logistic multivariate analysis was conducted to determine the independentrisk factors. The calibration curve and the Hosmer-Lemeshow test as well as the net benefit threshold probabilityinterval by the decision curve were utilized to statistically validate the accuracy of the nomogram predictionmodel, developed according to each factor’s influence intensity.RESULTSThis study included 532 elderly patients with HF, with an overall POD incidence of 14.85%. The comparison ofbaseline data with perioperative indicators revealed statistical differences in age (P < 0.001), number of comorbidities(P = 0.042), American Society of Anesthesiologists grading (P = 0.004), preoperative red blood cell(RBC) count (P < 0.001), preoperative albumin (P < 0.001), preoperative hemoglobin (P < 0.001), preoperativeplatelet count (P < 0.001), intraoperative blood loss (P < 0.001), RBC transfusion of ≥ 2 units (P = 0.001), andpostoperative intensive care unit care (P < 0.001) between the delirium and non-delirium groups. The participantswere randomized to a training group (n = 372) and a validation group (n = 160). A score-risk nomogram predictionmodel was developed after screening key POD features using Lasso regression, support vector machine, and therandom forest method. The nomogram showed excellent discriminatory capacity with area under the curve of0.833 [95% confidence interval (CI) interval: 0.774-0.888] in the training group and 0.850 (95%CI: 0.718-0.982) in thevalidation group. Calibration curves demonstrated good agreement between predicted and actual probabilities,and decision curve analysis confirmed clinical net benefits within risk thresholds of 0%-30% and 0%-36%, respectively.The model has strong accuracy and clinical utility for predicting the risk of POD.CONCLUSIONThis study reveals cognitive impairment history, American Society of Anesthesiologists grade of > 2, RBCtransfusion of ≥ 2 units, postoperative intensive care unit care, and preoperative hemoglobin level as independentrisk factors for POD in elderly patients with HF. The developed nomogram model demonstrates excellent accuracyand stability in predicting the risk of POD, which is recommended to be applied in clinical practice to optimizepostoperative management and reduce delirium incidence.
