In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applyin...In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.展开更多
The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoo...The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.展开更多
Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microgl...Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microglia play an important role in secondary injury and can be activated in response to traumatic brain injury.In this article,we review the origin and classification of microglia as well as the dynamic changes of microglia in traumatic brain injury.We also clarify the microglial polarization pathways and the therapeutic drugs targeting activated microglia.We found that regulating the signaling pathways involved in pro-inflammatory and anti-inflammatory microglia,such as the Toll-like receptor 4/nuclear factor-kappa B,mitogen-activated protein kinase,Janus kinase/signal transducer and activator of transcription,phosphoinositide 3-kinase/protein kinase B,Notch,and high mobility group box 1 pathways,can alleviate the inflammatory response triggered by microglia in traumatic brain injury,thereby exerting neuroprotective effects.We also reviewed the strategies developed on the basis of these pathways,such as drug and cell replacement therapies.Drugs that modulate inflammatory factors,such as rosuvastatin,have been shown to promote the polarization of antiinflammatory microglia and reduce the inflammatory response caused by traumatic brain injury.Mesenchymal stem cells possess anti-inflammatory properties,and clinical studies have confirmed their significant efficacy and safety in patients with traumatic brain injury.Additionally,advancements in mesenchymal stem cell-delivery methods—such as combinations of novel biomaterials,genetic engineering,and mesenchymal stem cell exosome therapy—have greatly enhanced the efficiency and therapeutic effects of mesenchymal stem cells in animal models.However,numerous challenges in the application of drug and mesenchymal stem cell treatment strategies remain to be addressed.In the future,new technologies,such as single-cell RNA sequencing and transcriptome analysis,can facilitate further experimental studies.Moreover,research involving non-human primates can help translate these treatment strategies to clinical practice.展开更多
Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor...Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor symptoms,including tremors,rigidity,and bradykinesia.Drug treatments,such as levodopa,provide symptomatic relief.However,they do not halt disease progression,and their effectiveness diminishes over time(reviewed in Poewe et al.,2017).展开更多
Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological change...Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.展开更多
BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affectin...BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
This study addressed the critical need for an integrated,personalized approach to perimenopausal mental health,addressing both biological and psychosocial fac-tors.Current research highlighted the influence of hormona...This study addressed the critical need for an integrated,personalized approach to perimenopausal mental health,addressing both biological and psychosocial fac-tors.Current research highlighted the influence of hormonal fluctuations,genetic predispositions,and lifestyle factors in shaping perimenopausal mental health outcomes.This transitional period is marked by significant hormonal fluctuations contributing to heightened anxiety,depression,and sleep disturbances,affecting the women’s quality of life.Traditional pharmacological treatments,including selective serotonin reuptake inhibitors and hormone replacement therapy,have limitations due to variable efficacy and side effects,emphasizing the need for precision medicine.Advancements in pharmacogenomics and metabolomics provide new avenues for individualized treatments,with genetic markers(e.g.,Solute carrier organic anion transporter family member 1B1,estrogen receptor 1/estrogen receptor 2,and tachykinin receptor 3)guiding hormone therapy resp-onses.Emerging digital health technologies,such as artificial intelligence-driven diagnostics,wearable monitoring,and telehealth platforms,offer scalable,real-time mental health support,though regulatory and clinical validation challenges remain.Furthermore,integrative treatment models combining hormone-based therapy with non-pharmacological interventions demonstrate significant efficacy in alleviating perimenopausal symptoms.Future directions should prioritize the clinical validation and ethical implementation of digital health solutions,ensuring safety,efficacy,and user accessibility.A multidisciplinary,patient-centric model,incorporating genetics,endocrinology,digital health,and psychosocial interventions,is essential for optimizing perimenopausal mental health outcomes.展开更多
Testosterone affects several organs in the body and is very important for male well-being.Aging men with late-onset hypogonadism(LOH)experience physiologic,psychiatric,and sexual symptoms related to a decline in the s...Testosterone affects several organs in the body and is very important for male well-being.Aging men with late-onset hypogonadism(LOH)experience physiologic,psychiatric,and sexual symptoms related to a decline in the serum concentration of testosterone with age.However,it is well-known that the extent of the decline in testosterone concentration does not correlate with the severity of LOH-related symptoms.Therefore,it is difficult to diagnose and treat patients with LOH.In addition,the symptoms,response to testosterone replacement therapy(TRT),and medical insurance coverage differ among ethnicities and countries.The evaluation of testosterone is essential for the diagnosis and treatment of LOH.The effects of testosterone are determined not only by the serum testosterone concentration but also by the androgen receptor sensitivity.A low number of glutamine repeats is indicative of high androgenic activity,and the number shows ethnicity-related differences(fewer in African American than in Caucasian people and more in East Asian people).The diagnosis of LOH is typically made using subjective symptoms and the serum testosterone concentration.The Aging Male Symptoms scale is widely used to evaluate the symptoms.The normal range of total testosterone concentration varies around the world;therefore,clinicians should follow the guidelines of their regional academic society.The principal treatment for LOH is TRT.There are many types of TRT and other treatment strategies are also available.Thus,physicians should treat LOH according to each patient’s situation,considering related disorders,such as diabetes,osteoporosis,metabolic syndrome,and depression.展开更多
Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patient...Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to patients.The ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian brain.Because the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March 2024.After screening,76 articles were included in the analysis from which 178 separate transplant studies were identified.From these,graft survival could be assessed in 52 studies and differentiation in 129 studies.Overall,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.展开更多
Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health S...Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health Science Center at Houston,Environmental Health&Safety,6431 Fannin St,CYF G.102,Houston,TX,77030;2.Corresponding author)Abstract:The ability to irradiate cells,tissues,and other biological materials with high-energy photons has been an essential tool in the discovery of numerous biomedical research advancements.展开更多
Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durabl...Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.展开更多
Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with ...Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.展开更多
In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,com...In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.展开更多
Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasin...Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.展开更多
The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacter...The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.展开更多
BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress ...BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.展开更多
Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure...Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.展开更多
Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR...Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.展开更多
基金Natural Science Foundation of China under Grant Nos.50908036&51261120376Natural Science Foundation of Liaoning Province No.201202040
文摘In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.
基金This research was funded by the National Natural Science Foundation of China No.51908291Nanjing Forestry University Youth Science and Technology Innovation Fund No.CX2019002.
文摘The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.
基金supported by the Natural Science Foundation of Yunnan Province,No.202401AS070086(to ZW)the National Key Research and Development Program of China,No.2018YFA0801403(to ZW)+1 种基金Yunnan Science and Technology Talent and Platform Plan,No.202105AC160041(to ZW)the Natural Science Foundation of China,No.31960120(to ZW)。
文摘Traumatic brain injury can be categorized into primary and secondary injuries.Secondary injuries are the main cause of disability following traumatic brain injury,which involves a complex multicellular cascade.Microglia play an important role in secondary injury and can be activated in response to traumatic brain injury.In this article,we review the origin and classification of microglia as well as the dynamic changes of microglia in traumatic brain injury.We also clarify the microglial polarization pathways and the therapeutic drugs targeting activated microglia.We found that regulating the signaling pathways involved in pro-inflammatory and anti-inflammatory microglia,such as the Toll-like receptor 4/nuclear factor-kappa B,mitogen-activated protein kinase,Janus kinase/signal transducer and activator of transcription,phosphoinositide 3-kinase/protein kinase B,Notch,and high mobility group box 1 pathways,can alleviate the inflammatory response triggered by microglia in traumatic brain injury,thereby exerting neuroprotective effects.We also reviewed the strategies developed on the basis of these pathways,such as drug and cell replacement therapies.Drugs that modulate inflammatory factors,such as rosuvastatin,have been shown to promote the polarization of antiinflammatory microglia and reduce the inflammatory response caused by traumatic brain injury.Mesenchymal stem cells possess anti-inflammatory properties,and clinical studies have confirmed their significant efficacy and safety in patients with traumatic brain injury.Additionally,advancements in mesenchymal stem cell-delivery methods—such as combinations of novel biomaterials,genetic engineering,and mesenchymal stem cell exosome therapy—have greatly enhanced the efficiency and therapeutic effects of mesenchymal stem cells in animal models.However,numerous challenges in the application of drug and mesenchymal stem cell treatment strategies remain to be addressed.In the future,new technologies,such as single-cell RNA sequencing and transcriptome analysis,can facilitate further experimental studies.Moreover,research involving non-human primates can help translate these treatment strategies to clinical practice.
基金supported by the DGIST start-up funds from the Ministry of Science and ICT(2024010330)a National Research Foundation of Korea(NRF)grant funded by the Korea Government(MSIT)(No.RS-2024-00351442)(to TWK).
文摘Parkinson’s disease(PD)is the second most common neurodegenerative disorder.The progressive degeneration of dopamine(DA)producing neurons in the midbrain is the pathological hallmark,which leads to debilitating motor symptoms,including tremors,rigidity,and bradykinesia.Drug treatments,such as levodopa,provide symptomatic relief.However,they do not halt disease progression,and their effectiveness diminishes over time(reviewed in Poewe et al.,2017).
基金supported by the National Key Research and Development Program of China,No.2019YFA0111200the National Natural Science Foundation of China,Nos.U23A20436,82371047+3 种基金Key Research Project in Shanxi Province,No.202302130501008Shanxi Provincial Science Fund for Distinguished Young Scholars,No.202103021221008Key Research and Development Program in Shanxi Province,No.202204051001023Shanxi Medical University Doctor’s Startup Fund Project,No.SD22028(all to YG)。
文摘Retinal ganglion cells are the bridging neurons between the eye and the central nervous system,transmitting visual signals to the brain.The injury and loss of retinal ganglion cells are the primary pathological changes in several retinal degenerative diseases,including glaucoma,ischemic optic neuropathy,diabetic neuropathy,and optic neuritis.In mammals,injured retinal ganglion cells lack regenerative capacity and undergo apoptotic cell death within a few days of injury.Additionally,these cells exhibit limited regenerative ability,ultimately contributing to vision impairment and potentially leading to blindness.Currently,the only effective clinical treatment for glaucoma is to prevent vision loss by lowering intraocular pressure through medications or surgery;however,this approach cannot halt the effect of retinal ganglion cell loss on visual function.This review comprehensively investigates the mechanisms underlying retinal ganglion cell degeneration in retinal degenerative diseases and further explores the current status and potential of cell replacement therapy for regenerating retinal ganglion cells.As our understanding of the complex processes involved in retinal ganglion cell degeneration deepens,we can explore new treatment strategies,such as cell transplantation,which may offer more effective ways to mitigate the effect of retinal degenerative diseases on vision.
基金approved by Institutional Review Board of Faculty of Medicine in Assiut University,No.04-2024-300470.
文摘BACKGROUND In an era leaning toward a personalized alignment of total knee arthroplasty,coronal plane alignment of the knee(CPAK)phenotypes for each population are studied;furthermore,other possible variables affecting the alignment,such as ankle joint alignment,should be considered.AIM To determine CPAK distribution in the North African(Egyptian)population with knee osteoarthritis and to assess ankle joint line orientation(AJLO)adaptations across different CPAK types.METHODS A cross-sectional study was conducted on patients with primary knee osteoarthritis and normal ankle joints.Radiographic parameters included the mechanical lateral distal femoral angle,medial proximal tibial angle,and the derived calculations of joint line obliquity(JLO)and arithmetic hip-knee-ankle angle(aHKA).The tibial plafond horizontal angle(TPHA)was used for AJLO assessment,where 0°is neutral(type N),<0°is varus(type A),and>0°is valgus(type B).The nine CPAK types were further divided into 27 subtypes after incorporating the three AJLO types.RESULTS A total of 527 patients(1054 knees)were included for CPAK classification,and 435 patients(870 knees and ankles)for AJLO assessment.The mean age was 57.2±7.8 years,with 79.5%females.Most knees(76.4%)demonstrated varus alignment(mean aHKA was-5.51°±4.84°)and apex distal JLO(55.3%)(mean JLO was 176.43°±4.53°).CPAK types I(44.3%),IV(28.6%),and II(10%)were the most common.Regarding AJLO,70.2%of ankles exhibited varus orientation(mean TPHA was-5.21°±6.45°).The most frequent combined subtypes were CPAK type I-A(33.7%),IV-A(21.5%),and I-N(6.9%).A significant positive correlation was found between the TPHA and aHKA(r=0.40,P<0.001).CONCLUSION In this North African cohort,varus knee alignment with apex distal JLO and varus AJLO predominated.CPAK types I,IV,and II were the most common types,while subtypes I-A,IV-A,and I-N were commonly occurring after incorporating AJLO types;furthermore,the AJLO was significantly correlated to aHKA.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金Supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education,No.RS-2023-00237287。
文摘This study addressed the critical need for an integrated,personalized approach to perimenopausal mental health,addressing both biological and psychosocial fac-tors.Current research highlighted the influence of hormonal fluctuations,genetic predispositions,and lifestyle factors in shaping perimenopausal mental health outcomes.This transitional period is marked by significant hormonal fluctuations contributing to heightened anxiety,depression,and sleep disturbances,affecting the women’s quality of life.Traditional pharmacological treatments,including selective serotonin reuptake inhibitors and hormone replacement therapy,have limitations due to variable efficacy and side effects,emphasizing the need for precision medicine.Advancements in pharmacogenomics and metabolomics provide new avenues for individualized treatments,with genetic markers(e.g.,Solute carrier organic anion transporter family member 1B1,estrogen receptor 1/estrogen receptor 2,and tachykinin receptor 3)guiding hormone therapy resp-onses.Emerging digital health technologies,such as artificial intelligence-driven diagnostics,wearable monitoring,and telehealth platforms,offer scalable,real-time mental health support,though regulatory and clinical validation challenges remain.Furthermore,integrative treatment models combining hormone-based therapy with non-pharmacological interventions demonstrate significant efficacy in alleviating perimenopausal symptoms.Future directions should prioritize the clinical validation and ethical implementation of digital health solutions,ensuring safety,efficacy,and user accessibility.A multidisciplinary,patient-centric model,incorporating genetics,endocrinology,digital health,and psychosocial interventions,is essential for optimizing perimenopausal mental health outcomes.
文摘Testosterone affects several organs in the body and is very important for male well-being.Aging men with late-onset hypogonadism(LOH)experience physiologic,psychiatric,and sexual symptoms related to a decline in the serum concentration of testosterone with age.However,it is well-known that the extent of the decline in testosterone concentration does not correlate with the severity of LOH-related symptoms.Therefore,it is difficult to diagnose and treat patients with LOH.In addition,the symptoms,response to testosterone replacement therapy(TRT),and medical insurance coverage differ among ethnicities and countries.The evaluation of testosterone is essential for the diagnosis and treatment of LOH.The effects of testosterone are determined not only by the serum testosterone concentration but also by the androgen receptor sensitivity.A low number of glutamine repeats is indicative of high androgenic activity,and the number shows ethnicity-related differences(fewer in African American than in Caucasian people and more in East Asian people).The diagnosis of LOH is typically made using subjective symptoms and the serum testosterone concentration.The Aging Male Symptoms scale is widely used to evaluate the symptoms.The normal range of total testosterone concentration varies around the world;therefore,clinicians should follow the guidelines of their regional academic society.The principal treatment for LOH is TRT.There are many types of TRT and other treatment strategies are also available.Thus,physicians should treat LOH according to each patient’s situation,considering related disorders,such as diabetes,osteoporosis,metabolic syndrome,and depression.
基金supported by research grants from the Michael J Fox Foundation for Parkinson’s Research(grant numbers:17244 and 023410)Science Foundation Ireland(Grant Numbers:19/FFP/6554)(to ED)。
文摘Stem cell-based brain repair is a promising emergent therapy for Parkinson's disease based on years of foundational research using human fetal donors as a cell source.Unlike current therapeutic options for patients,this approach has the potential to provide longterm stem cell–derived reconstruction and restoration of the dopaminergic input to denervated regions of the brain allowing for restoration of certain functions to patients.The ultimate clinical success of stem cell–derived brain repair will depend on both the safety and efficacy of the approach and the latter is dependent on the ability of the transplanted cells to survive and differentiate into functional dopaminergic neurons in the Parkinsonian brain.Because the pre-clinical literature suggests that there is considerable variability in survival and differentiation between studies,the aim of this systematic review was to assess these parameters in human stem cell-derived dopaminergic progenitor transplant studies in animal models of Parkinson's disease.A defined systematic search of the PubMed database was completed to identify relevant studies published up to March 2024.After screening,76 articles were included in the analysis from which 178 separate transplant studies were identified.From these,graft survival could be assessed in 52 studies and differentiation in 129 studies.Overall,we found that graft survival ranged from<1% to 500% of cells transplanted,with a median of 51%of transplanted cells surviving in the brain;while dopaminergic differentiation of the cells ranged from 0% to 46% of cells transplanted with a median of 3%.This systematic review suggests that there is considerable scope for improvement in the differentiation of stem cell-derived dopaminergic progenitors to maximize the therapeutic potential of this approach for patients.
文摘Establishing Consensus with Users of Research Irradiator Devices to Facilitate Source Type Replacement Danette R.Fennesy1,Janet M.Gutiérrez1,2,Scott J.Patlovich1,Robert J.Emery1(1.The University of Texas Health Science Center at Houston,Environmental Health&Safety,6431 Fannin St,CYF G.102,Houston,TX,77030;2.Corresponding author)Abstract:The ability to irradiate cells,tissues,and other biological materials with high-energy photons has been an essential tool in the discovery of numerous biomedical research advancements.
文摘Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.
文摘Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.
文摘In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.
文摘Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.
基金the National Natural Science Foundation of China(No.5220031085)the Postdoctoral Research Project in Henan Province(No.HN2022054)+2 种基金the Key Scientific Research Projects of Colleges and Universities in Henan Province(No.23A430009)the State Key Laboratory of Polymer Materials Engineering(No.sklpme2022-4-03)the Key Technologies R&D Program of Henan Province(No.242102230131)。
文摘The considerable hazard posed by periprosthetic joint infections underlines the urgent need for the rapid advancement of in-situ drug delivery systems within joint materials.However,the pursuit of sustained antibacterial efficacy remains a formidable challenge.In this context,we proposed a novel strategy that leverages swelling and erosion mechanisms to facilitate drug release of drug-loaded ultrahigh molecular weight polyethylene(UHMWPE),thereby ensuring its long-lasting antibacterial performance.Polyethylene oxide(PEO),a hydrophilic polymer with fast hydrating ability and high swelling capacity,was incorporated in UHMWPE alongside the antibacterial tea polyphenol(epigallocatechin gallate,EGCG as representative).The swelling of PEO enhanced water infiltration into the matrix,while the erosion of PEO balanced the release of the encapsulated EGCG,resulting in a steady release.The behavior was supported by the EGCG release profiles and the corresponding fitted release kinetic models.As demonstrated by segmented antibacterial assessments,the antibacterial efficiency was enhanced 2to 3 times in the PEO/EGCG/UHMWPE composite compared to that of EGCG/UHMWPE.Additionally,the PEO/EGCG/UHMWPE composite exhibited favorable biocompatibility and mechanical performance,making it a potential candidate for the development of drug-releasing joint implants to combat prosthetic bacterial infections.
文摘BACKGROUND Total hip arthroplasty(THA)has increased along with an increasing demand for improved quality of life.Combined with prolonged life expectancy,the number of revision surgeries is expected to increase.Stress shielding is a significant issue with traditional femoral stems used in THA,making revision surgeries particularly challenging in younger patients.This has sparked renewed interest in studying safety and functional outcomes of short metaphyseal femoral stems,which have the potential to alleviate these challenges and simplify revision surgeries.AIM To evaluate the long-term outcomes of short-stem THA.METHODS A total of 124 hips that underwent THA using the short femoral stem(TRILOCK®Depuy)between May 2006 and November 2008 were included in this study.Patients were followed for a period of 15 years.Outcomes were assessed in terms of pain relief,hip joint range of motion,improvement in mobility,and functional outcomes using the modified Harris Hip Score,Oxford hip score,and Western Ontario and McMaster Universities Osteoarthritis index score.RESULTS A total of 124 hips in 98 patients were evaluated.Significant improvements in functional outcomes were observed over the 15-year follow-up period,with no cases of subsidence,implant loosening,or complications necessitating revision surgery.The only complication reported was heterotopic ossification in 1 patient.CONCLUSION Short metaphyseal stems provide better functional outcomes with early mobilization,and its long-term follow-up without subsidence,implant loosening,or proximal femoral bone loss simplifies revision surgery in younger patients.
文摘Aortic stenosis(AS)is one of the most common types of valvular heart disease in older adults,with age being significantly associated with the development of AS.The transcatheter aortic valve replacement(TAVR)procedure,since it was first performed in 2002,has emerged as a preferred treatment option for patients who are at intermediate to high surgical risk due to advanced age or medical comorbidities.Older adults with severe AS may present with acute decompensated heart failure leading to cardiogenic shock(CS).Among patients 65 years and older with AS presenting for TAVR,4.1%were reportedly in acute CS.Regardless of etiology,mortality from CS itself is high(30%−50%)and increases with advancing age.TAVR for these patients could provide a definite treatment for both AS and CS.There is still limited evidence regarding the safety and efficacy of TAVR in this population,but recent studies are promising,with successful procedural results and a good recovery rate after the procedure.However,particularly for older adults,there are other factors that clinicians should consider during pre-and post-procedural status,such as patient’s goals,frailty,polypharmacy,dementia,or delirium.In this article,we reviewed current studies regarding TAVR for older adults with AS and CS,the reason for comprehensive geriatric assessment,and the introduction of appropriate geriatric assessment tools based on the Age-Friendly 4Ms framework that cardiologists can adopt in real-world practice.
文摘Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.
