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
In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applyin...In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.展开更多
The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoo...The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
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
Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements o...Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.展开更多
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
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
Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patien...Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.展开更多
The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacem...The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacement is to lose body weight,whether patients with obesity,diabetes,fatty liver,infertile or pregnant women can benefit from weight loss.In addition,MRs still exhibit more biomedical potential in preventing and treating diseases,like anti-diabetes,improving fatty liver and kidney disease,preventing cancer,conceiving and reducing pregnancy complications,and improving life quality.Indeed,there are also disadvantages to meal replacement,including causing adverse effects,although most are acceptable and tolerated.To date,various commercially-developed MRs are walking from dining table to sickbed.Therefore,a scientific understanding of the advantages and disadvantages of meal replacements is crucial for their extensive application beyond biomedical potentials.展开更多
Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucid...Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucidate the effects of milk replacer(MR)feeding on growth,lipid metabolism,colonic epithelial gene expression,colonic microbiota composition and systemic metabolism in goat kids compared to breast milk(BM)feeding,addressing a critical knowledge gap in early life nutrition.Methods Ten female goat kids were divided into 2 groups:those fed breast milk(BM group)and those fed a milk replacer(MR group).Over a period of 28 d,body weight was monitored and blood and tissue samples were collected for biochemical,transcriptomic and metabolomic analyses.Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing.Intestinal microbiota transplantation(IMT)experiments in gnotobiotic mice were per-formed to validate causality.Results MR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol(TC)and non-esterified fatty acid(NEFA)concentrations.Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism,concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria.Specifically,genera such as Bifidobacterium and Prevotella were enriched in the MR group,while Clostridium and Fae-calibacterium were depleted.Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic path-ways.IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats,confirming the role of the microbiota in modulating host lipid metabolism.Conclusions Milk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics,result-ing in reduced growth rates and metabolic alterations.These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants.This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.展开更多
The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration an...The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration and pulverization,achieving precise size control,suppression of aggregation,and uniform dispersion of Ag nanoparticles remains challenging.Herein,the metal-organic frameworks(MOF)-assisted pyrolysis-galvanic replacement method was employed to construct ultrafine Ag particles uniformly anchored within a three-dimensional(3D)-ordered porous carbon skeleton composite(3D Ag@NC).By utilizing the potential difference between the elements,spontaneous replacement reactions occur,effectively preventing particle agglomeration usually caused by high-temperature reduction.The in situ constructed 3D porous carbon skeleton not only promotes electron transfer and electrolyte penetration but also mitigates the volume expansion of Ag particles during electrochemical cycling.Consequently,3D Ag@NC demonstrates outstanding dechlorination performance(105.29 mg g^(-1)),high charge efficiency(0.95),and exceptional cycling stability(84.12% after 100 cycles).This galvanic replacement strategy offers valuable insights into the fabrication of other small-sized,highly dispersed metal electrode materials.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
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
BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(TH...BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.展开更多
BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach conce...BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.展开更多
AIM:To analyze the ocular findings of patients who received lifelong leptin therapy due to congenital leptin deficiency(CLD),an extremely rare condition.METHODS:A prospective,cross-sectional comparative study was perf...AIM:To analyze the ocular findings of patients who received lifelong leptin therapy due to congenital leptin deficiency(CLD),an extremely rare condition.METHODS:A prospective,cross-sectional comparative study was performed on six patients with CLD and 13 healthy age-and sex-matched controls.The central corneal thickness(CCT),anterior chamber depth(ACD),axial length(AL),keratometry(K1,K2),optical coherence tomography(OCT),and OCT angiography parameters were compared between the leptin and control groups at the baseline visit.The change in these measurements in leptin patients over a two-year period was analyzed.RESULTS:CLD patients had lower mean AL,ACD,and CCT(P≤0.012 for all).Mean K1,K2(P≤0.047 for both),choroidal thickness(P≤0.001),and central ganglion cell layer(GCL)thickness(P=0.029)were higher in the leptin group.Perifoveal superficial capillary plexus(SCP)density was decreased in all quadrants except the temporal region(P<0.05),and parafoveal deep capillary plexus(DCP)density was decreased in the superior hemisphere,temporal quadrant(P≤0.036 for both)and nasal quadrant(P=0.048)in the leptin group.During the two-year follow-up,no changes in anterior and posterior segment measurements were observed in the leptin patients,except for subfoveal choroidal thickness(P<0.001).CONCLUSION:CLD patients exhibit structural alterations in both the anterior and posterior segments of the eye,including notable changes in retinal and choroidal vasculature.However,there is limited evidence concerning the influence of leptin therapy on the eye.展开更多
How do individuals adjust their savings and consumption behaviors in response to the combined effects of increased life expectancy and declining pension replacement rates?This study constructs a life-cycle model,using...How do individuals adjust their savings and consumption behaviors in response to the combined effects of increased life expectancy and declining pension replacement rates?This study constructs a life-cycle model,using changes in conditional survival probabilities as a proxy for shifts in individual life expectancy,to examine consumption behavior under the dual backdrop of prolonged longevity and a gradual decline in pension replacement rates.The results suggest that changes in life expectancy and pension replacement rates together explain 8.9%to 10.2%of the observed decline in consumption in recent years,with both variables playing equally significant explanatory roles.Furthermore,we find that,to fully offset the negative impact of increased life expectancy on consumption,the pension replacement rate must reach at least 82%.These findings offer theoretical and policy implications for improving the quality of life in later years among enterprise employees in the context of population aging.展开更多
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Natural Science Foundation of China under Grant Nos.50908036&51261120376Natural Science Foundation of Liaoning Province No.201202040
文摘In this study,a method for control of reticulated shells is proposed and its practicality is demonstrated.The control is implemented by replacing selected bars of the shell with passive viscoelastic dampers.By applying the eigenvalue perturbation technique and the earthquake spectrum concept,the sensitivities of various topologies of the shell are analyzed,and the optimal topology is determined by taking their symmetries into consideration.The results of this research show that common damper topologies are not effective for all types of responses and recorded earthquakes.The optimal topology identifi ed requires a minimal number of dampers for each type of earthquake record.The displacement control effect of the dynamic responses of the optimal topology is 10% – 20%; the acceleration control effect is also about 10% – 20%; and the axial force control effect is as much as 30% – 45%.Furthermore,the incremental dynamic analysis(IDA) method is used to investigate the stability of the controlled shell.The results show that the dynamic stability of the controlled shell is well preserved when it is vibrated under vibration and is better than the uncontrolled shell.The ultimate load increased by 10% and the elements entered into the plastic stage when the peak acceleration reached 580 Gal,which is 200 Gal larger than the uncontrolled shell.
基金This research was funded by the National Natural Science Foundation of China No.51908291Nanjing Forestry University Youth Science and Technology Innovation Fund No.CX2019002.
文摘The mortise-tenon joint is an important hub transmitting and distributing external loads for load-bearing components(beams,columns et al.)in the ancient-timber frame structure system.However,the conventional steel hoop reinforcement methods often insert wood screws into the timber components.When the reinforced joint rotates greatly,the anchoring failure of the screws will cause damage to the timber joint.To solve this problem,this study proposes a detachable and replaceable non-destructive flat-steel jacket reinforcement method in which horizontal flat steel is placed in the center of the joint,and the bolt is extended to the outside of the timber beam.Nine 1:3.52 scaled straight-tenon joint specimens were subjected to monotonic loading of beam ends,including three unreinforced reference joints,three joints with flat-steel jacket and three carbon fiber-reinforced plastic(CFRP)reinforced joints.The mechanical behaviors of the novel joints with flat-steel jacket were experimentally studied by comparing with those of the joints without strengthening and retrofitted with CFRP,based on the failure modes,the initial stiffness,the ultimate bearing capacity,and the moment-rotation relationship curves.Results indicated that the mortise-tenon joints reinforced with flat-steel jackets maintain the original semi-rigid properties of the unreinforced mortise-tenon joints and can effectively prevent the tenon from pulling out.The initial stiffness and ultimate bearing capacity were improved markedly.The column and beam of the reinforced joints remain intact providing the reference for the practical application of joints reinforcement.The mortisetenon joints reinforced with CFRP lose the semi-rigid properties of the unreinforced tenon-mortise joints.The joints reinforced with CFRP have the largest initial stiffness,while the unreinforced joints have the lowest stiffness.The initial stiffness of the proposed joint is in between the joints reinforced with CFRP and unreinforced joints.The ultimate bearing capacity of the joints reinforced with flat-steel jacket is larger than the other two joints,whereas the unreinforced joints have the lowest ultimate bearing capacity.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
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Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.
基金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supported by grants from the initial funding of National Natural Science Foundation of China(No.8227020480)。
文摘Background Previous studies have shown a relationship between elevated blood urea nitrogen(BUN)level and poor outcomes in several diseases,but data on the prognostic significance of postoperative BUN in elderly patients undergoing valve replacement surgery(VRS)remained sparse.Methods BUN was measured immediately after VRS.A total of 3118 elderly patients were enrolled and divided into four groups according to the quartiles of postoperative BUN:Q1,<5.6 mmol/L;Q2,5.6-6.8 mmol/L;Q3,6.8-8.4 mmol/L and Q4,≥8.4 mmol/L.The associations of postoperative BUN with in-hospital and 1-year mortality were evaluated.Results The incidence of inhospital death(1.0%vs.3.3%vs.3.3%vs.8.4%,P<0.001)and major adverse clinical events(5.1%vs.7.8%vs.9.9%vs.19.1%,P<0.001)was significantly higher in patients with a high BUN level.BUN was independently associated with all-cause in-hospital mortality[odds ratio(OR):1.11,95%confidential interval(CI):1.07-1.16,P<0.001].The receiver operating characteristic(ROC)curve showed that BUN>9 mmol/L had a sensitivity of 48.4%and specificity of 81.8% for predicting in-hospital death[area under curve(AUC):0.705,95%CI:0.658-0.753,P<0.001].Kaplan-Meier survival curves showed that patients with BUN>9 mmol/L had a higher one-year mortality than those without(log-rank test:91.7,P<0.001).Multivariate analysis showed that BUN>9 mmol/L was an independent predictor for one-year mortality[hazard ratio(HR):1.67,95%CI:1.23-2.28,P=0.001].Conclusions This study provided strong evidence that increased postoperative BUN level was associated with poor prognosis in elderly patients undergoing VRS.
基金funded by the National Natural Science Foundation of China(82070877)the CAMS Innovation Fund for Medical Sciences(CIFMS)(2021-I2M-1-028,2021-I2M-1-005)the International Cooperation Project of Qinghai Province(2020-HZ-803)。
文摘The emergence of meal replacement(MR)originates from physical exercise or fitness as a substitute for one or all meals and later expands to the field of weight loss.Indeed,the main application of current meal replacement is to lose body weight,whether patients with obesity,diabetes,fatty liver,infertile or pregnant women can benefit from weight loss.In addition,MRs still exhibit more biomedical potential in preventing and treating diseases,like anti-diabetes,improving fatty liver and kidney disease,preventing cancer,conceiving and reducing pregnancy complications,and improving life quality.Indeed,there are also disadvantages to meal replacement,including causing adverse effects,although most are acceptable and tolerated.To date,various commercially-developed MRs are walking from dining table to sickbed.Therefore,a scientific understanding of the advantages and disadvantages of meal replacements is crucial for their extensive application beyond biomedical potentials.
基金financially supported by National Natural Science Foundation of China (32160801)China Agriculture Research System (CARS-39-12)+1 种基金Young Talent Fund of Association for Science and Technology in Shaanxi, China (2023-6-2-1)“Double-chain” project on livestock breeding (2022GDTSLD-46)
文摘Background Dysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention,especially in the context of alternative feeding strategies.This study aims to elucidate the effects of milk replacer(MR)feeding on growth,lipid metabolism,colonic epithelial gene expression,colonic microbiota composition and systemic metabolism in goat kids compared to breast milk(BM)feeding,addressing a critical knowledge gap in early life nutrition.Methods Ten female goat kids were divided into 2 groups:those fed breast milk(BM group)and those fed a milk replacer(MR group).Over a period of 28 d,body weight was monitored and blood and tissue samples were collected for biochemical,transcriptomic and metabolomic analyses.Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing.Intestinal microbiota transplantation(IMT)experiments in gnotobiotic mice were per-formed to validate causality.Results MR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol(TC)and non-esterified fatty acid(NEFA)concentrations.Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism,concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria.Specifically,genera such as Bifidobacterium and Prevotella were enriched in the MR group,while Clostridium and Fae-calibacterium were depleted.Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic path-ways.IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats,confirming the role of the microbiota in modulating host lipid metabolism.Conclusions Milk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics,result-ing in reduced growth rates and metabolic alterations.These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants.This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.
基金financially supported by the Innovative Research Groups of the National Natural Science Foundation of China(No.52121004)the National Natural Science Foundation of China(52374423)+1 种基金the Major Science and Technology Programs of Yunnan Province(202302AB080016)the Hunan Provincial Natural Science Youth Fund(2024JJ6726)。
文摘The capacitive deionization(CDI)performance of silver(Ag)electrodes is limited by electrochemical failure induced by volumetric expansion.While carbon encapsulation and Ag size control mitigate stress concentration and pulverization,achieving precise size control,suppression of aggregation,and uniform dispersion of Ag nanoparticles remains challenging.Herein,the metal-organic frameworks(MOF)-assisted pyrolysis-galvanic replacement method was employed to construct ultrafine Ag particles uniformly anchored within a three-dimensional(3D)-ordered porous carbon skeleton composite(3D Ag@NC).By utilizing the potential difference between the elements,spontaneous replacement reactions occur,effectively preventing particle agglomeration usually caused by high-temperature reduction.The in situ constructed 3D porous carbon skeleton not only promotes electron transfer and electrolyte penetration but also mitigates the volume expansion of Ag particles during electrochemical cycling.Consequently,3D Ag@NC demonstrates outstanding dechlorination performance(105.29 mg g^(-1)),high charge efficiency(0.95),and exceptional cycling stability(84.12% after 100 cycles).This galvanic replacement strategy offers valuable insights into the fabrication of other small-sized,highly dispersed metal electrode materials.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
文摘Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.
文摘BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.
文摘BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.
文摘AIM:To analyze the ocular findings of patients who received lifelong leptin therapy due to congenital leptin deficiency(CLD),an extremely rare condition.METHODS:A prospective,cross-sectional comparative study was performed on six patients with CLD and 13 healthy age-and sex-matched controls.The central corneal thickness(CCT),anterior chamber depth(ACD),axial length(AL),keratometry(K1,K2),optical coherence tomography(OCT),and OCT angiography parameters were compared between the leptin and control groups at the baseline visit.The change in these measurements in leptin patients over a two-year period was analyzed.RESULTS:CLD patients had lower mean AL,ACD,and CCT(P≤0.012 for all).Mean K1,K2(P≤0.047 for both),choroidal thickness(P≤0.001),and central ganglion cell layer(GCL)thickness(P=0.029)were higher in the leptin group.Perifoveal superficial capillary plexus(SCP)density was decreased in all quadrants except the temporal region(P<0.05),and parafoveal deep capillary plexus(DCP)density was decreased in the superior hemisphere,temporal quadrant(P≤0.036 for both)and nasal quadrant(P=0.048)in the leptin group.During the two-year follow-up,no changes in anterior and posterior segment measurements were observed in the leptin patients,except for subfoveal choroidal thickness(P<0.001).CONCLUSION:CLD patients exhibit structural alterations in both the anterior and posterior segments of the eye,including notable changes in retinal and choroidal vasculature.However,there is limited evidence concerning the influence of leptin therapy on the eye.
文摘How do individuals adjust their savings and consumption behaviors in response to the combined effects of increased life expectancy and declining pension replacement rates?This study constructs a life-cycle model,using changes in conditional survival probabilities as a proxy for shifts in individual life expectancy,to examine consumption behavior under the dual backdrop of prolonged longevity and a gradual decline in pension replacement rates.The results suggest that changes in life expectancy and pension replacement rates together explain 8.9%to 10.2%of the observed decline in consumption in recent years,with both variables playing equally significant explanatory roles.Furthermore,we find that,to fully offset the negative impact of increased life expectancy on consumption,the pension replacement rate must reach at least 82%.These findings offer theoretical and policy implications for improving the quality of life in later years among enterprise employees in the context of population aging.
