An anomalous total dose effect that the long length device is more susceptible to total ionizing dose than the short one is observed with the 0.13？μm partially depleted silicon-on-insulator technology. The measured ...An anomalous total dose effect that the long length device is more susceptible to total ionizing dose than the short one is observed with the 0.13？μm partially depleted silicon-on-insulator technology. The measured results and 3D technology computer aided design simulations demonstrate that the devices with different channel lengths may exhibit an enhanced reverse short channel effect after radiation. It is ascribed to that the halo or pocket implants introduced in processes results in non-uniform channel doping profiles along the device length and trapped charges in the shallow trench isolation regions.展开更多
Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized th...Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.展开更多
BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthro...BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.展开更多
[目的]比较“肩-肩”新型解剖标记定位法与人工智能辅助规划系统(AIHIP系统)规划的全髋关节置换(total hip arthroplasty, THA)中假体置入定位及预防双下肢不等长的准确性。[方法] 2020年8月-2022年12月就诊于本院行初次THA的94例患者,...[目的]比较“肩-肩”新型解剖标记定位法与人工智能辅助规划系统(AIHIP系统)规划的全髋关节置换(total hip arthroplasty, THA)中假体置入定位及预防双下肢不等长的准确性。[方法] 2020年8月-2022年12月就诊于本院行初次THA的94例患者,按照随机数字表法分为两组,47例采用“肩-肩”法(肩-肩组),另外47例采用AIHIP系统规划法(智能组),分别于术前进行规划,比较两组临床和影像结果。[结果]两组患者手术时间、总失血量、术后下地时间的差异均无统计学意义(P>0.05)。影像方面,两组髋臼假体匹配、股骨柄假体匹配、双下肢长度差、联合偏心距的差异均无统计学意义(P>0.05),肩-肩组的尖肩距[(15.9±3.0) mm vs(17.7±3.4) mm, P<0.001]、截骨距[(7.8±2.7) mm vs(9.2±4.1) mm, P=0.003]均显著小于智能组。[结论]“肩-肩”新型解剖标记定位法可以在THA术中准确置入股骨侧假体,并可预防术后双下肢不等长。展开更多
[目的]探讨Mako机器人辅助经改良Harding入路全髋关节置换术(total hip arthroplasty,THA)的治疗效果及安全性。[方法]回顾性分析本院2021年4月—2023年5月行THA的48例患者的资料。根据手术前医患沟通结果,24例采用Mako机器人辅助下THA...[目的]探讨Mako机器人辅助经改良Harding入路全髋关节置换术(total hip arthroplasty,THA)的治疗效果及安全性。[方法]回顾性分析本院2021年4月—2023年5月行THA的48例患者的资料。根据手术前医患沟通结果,24例采用Mako机器人辅助下THA(机器人组),另外24例采用经改良Harding入路常规徒手THA(徒手组)。比较两组患者围手术期、随访结果及影像评估资料。[结果]两组患者均顺利完成改良Harding入路THA,机器人组的手术时间[min,(102.6±15.7)vs(83.7±16.8),P<0.001]和术中出血量[mL,(279.7±35.1)vs(212.5±29.6),P<0.001]均显著大于徒手组,两组患者术后引流量、住院天数的差异无统计学意义(P>0.05)。术后平均随访(20.8±8.5)个月。随时间推移,两组患者VAS评分、Harris评分、最大伸髋和最大屈髋活动度(range of motion,ROM)、最大内收和最大外展ROM均显著改善(P<0.05)。术后1周机器人组的VAS评分[分,M(P25,P75),2.0(2.0,4.0)vs 3.5(3.0,5.0),P<0.001]、最大屈髋[°,(74.5±9.0)vs(66.5±10.4),P=0.006]、最大内收[°,(18.5±6.2)vs(7.0±1.6),P<0.001]显著优于徒手组;术后1周和术后3个月机器人组的Harris评分[分,(75.1±4.9)vs(68.3±5.1),P<0.001;(84.8±4.9)vs(78.3±4.5),P<0.001]、最大伸髋[°,(20.5±5.3)vs(12.5±5.6),P<0.001;(31.0±3.6)vs(24.1±4.5),P<0.001]、最大外展[°,(26.2±3.3)vs(21.5±4.8),P<0.001;(33.4±3.8)vs(27.8±4.3),P<0.001]显著优于徒手组,但是,末次随访时两组间上述指标的差异均已无统计学意义(P>0.05)。影像方面,机器人组的术后双下肢长度差异(leg length discrepancy,LLD)[mm,(4.9±1.0)vs(8.1±1.4),P<0.001]和双侧联合偏心距(combined offset,CO)差值(■CO)的绝对值[mm,(1.5±0.5)vs(3.5±0.6),P<0.001]、髋臼假体外展角[°,(40.3±1.7)vs(45.3±4.1),P<0.001]和前倾角[°,(15.9±1.2)vs(18.8±3.6),P<0.001]均显著小于徒手组。[结论]与常规徒手THA相比,Mako机器人辅助下改良Harding入路THA假体置放更精准,早期治疗效果更优,但机器人技术的手术时间较长且术中失血量更大。展开更多
目的基于脑小血管病(cerebral small vessel disease,CSVD)影像学总负荷构建急性脑梗死(acute cerebral infarction,ACI)患者住院时间延长列线图模型,并对其进行验证。方法选取2021年1月至2023年12月湖州学院附属南太湖医院神经内科收治...目的基于脑小血管病(cerebral small vessel disease,CSVD)影像学总负荷构建急性脑梗死(acute cerebral infarction,ACI)患者住院时间延长列线图模型,并对其进行验证。方法选取2021年1月至2023年12月湖州学院附属南太湖医院神经内科收治的462例ACI患者作为研究对象,按照7∶3原则,将患者分为训练组(n=323)和验证组(n=139)。采用Lasso-Logistic回归分析ACI患者住院时间延长危险因素,采用受试者操作特征曲线(receiver operating characteristic curves,ROC曲线)预测效能。结果基于训练组数据,Lasso回归筛选出4个非零系数指标,分别为基线美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)评分、中性粒细胞与淋巴细胞比值(neutroph to lymphocyte ratio,NLR)、CSVD总负荷评分。多因素Logistic回归分析显示,基线NIHSS评分、aCCI评分、NLR、CSVD总负荷评分均是ACI患者住院时间延长的独立危险因素(P<0.05)。基于上述4项指标构建列线图模型,预测训练组、验证组患者住院时间延长的ROC曲线下面积为0.812(95%CI:0.756~0.868)、0.820(95%CI:0.730~0.909)。结论基于CSVD总负荷评分构建的ACI患者住院时间延长列线图模型具有较好的预测效能,可作为筛查ACI患者住院时间延长的评估工具。展开更多
基金Supported by the Weapon Equipment Pre-Research Foundation of China under Grant No 9140A11020114ZK34147the Shanghai Municipal Natural Science Foundation under Grant Nos 15ZR1447100 and 15ZR1447200
文摘An anomalous total dose effect that the long length device is more susceptible to total ionizing dose than the short one is observed with the 0.13？μm partially depleted silicon-on-insulator technology. The measured results and 3D technology computer aided design simulations demonstrate that the devices with different channel lengths may exhibit an enhanced reverse short channel effect after radiation. It is ascribed to that the halo or pocket implants introduced in processes results in non-uniform channel doping profiles along the device length and trapped charges in the shallow trench isolation regions.
文摘Objectives: Hyperglycemia is a well-known marker of poor clinical outcomes in acute myocardial infarction and critical illness;however, its effect in congestive heart failure (CHF) is controversial. We hypothesized that persistent hyperglycemia is associated with increased length of stay (LOS) and increased total cost in patients admitted with CHF. Methods: We studied 203 consecutive patients admitted with a primary diagnosis of CHF. Patient characteristics, admission glucose, mean blood glucose (MBG) during the entire hospital stay, length of stay, total cost, and readmission rates were assessed. Persistent hyperglycemia was defined as a MBG level ≥140 mg/dl. Results:Patients with persistent hyperglycemia had longer mean LOS (8.1 vs 5.2 days, p = 0.001) and higher total hospital costs (median $8940 vs $6892, p = 0.01) independent of diabetes status. Similarly, prolonged hospital stay >7 days (38% vs 21%;p = 0.01) and total cost >$10,000/patient (46% vs 29%;p = 0.01) were seen more commonly in patients with poor glucometrics. Neither admission glucose >140 mg/ dL or diabetes status was predictive of total costs or LOS. In multivariate linear regression, only MBG ≥ 140 mg/dl was associated with increased LOS and total cost. Patients with persistent hyperglycemia also had higher 6 months all-cause readmission rates (51% vs 37%;p = 0.03). Conclusion: Persistent hyperglycemia (MBG > 140 mg/dL), but not admission glucose, was associated with increased LOS, total cost and readmission rates independent of diabetes status. Our study emphasizes the need to further examine the role of glycemic control in patients admitted with CHF.
文摘BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.
文摘[目的]比较“肩-肩”新型解剖标记定位法与人工智能辅助规划系统(AIHIP系统)规划的全髋关节置换(total hip arthroplasty, THA)中假体置入定位及预防双下肢不等长的准确性。[方法] 2020年8月-2022年12月就诊于本院行初次THA的94例患者,按照随机数字表法分为两组,47例采用“肩-肩”法(肩-肩组),另外47例采用AIHIP系统规划法(智能组),分别于术前进行规划,比较两组临床和影像结果。[结果]两组患者手术时间、总失血量、术后下地时间的差异均无统计学意义(P>0.05)。影像方面,两组髋臼假体匹配、股骨柄假体匹配、双下肢长度差、联合偏心距的差异均无统计学意义(P>0.05),肩-肩组的尖肩距[(15.9±3.0) mm vs(17.7±3.4) mm, P<0.001]、截骨距[(7.8±2.7) mm vs(9.2±4.1) mm, P=0.003]均显著小于智能组。[结论]“肩-肩”新型解剖标记定位法可以在THA术中准确置入股骨侧假体,并可预防术后双下肢不等长。
文摘[目的]探讨Mako机器人辅助经改良Harding入路全髋关节置换术(total hip arthroplasty,THA)的治疗效果及安全性。[方法]回顾性分析本院2021年4月—2023年5月行THA的48例患者的资料。根据手术前医患沟通结果,24例采用Mako机器人辅助下THA(机器人组),另外24例采用经改良Harding入路常规徒手THA(徒手组)。比较两组患者围手术期、随访结果及影像评估资料。[结果]两组患者均顺利完成改良Harding入路THA,机器人组的手术时间[min,(102.6±15.7)vs(83.7±16.8),P<0.001]和术中出血量[mL,(279.7±35.1)vs(212.5±29.6),P<0.001]均显著大于徒手组,两组患者术后引流量、住院天数的差异无统计学意义(P>0.05)。术后平均随访(20.8±8.5)个月。随时间推移,两组患者VAS评分、Harris评分、最大伸髋和最大屈髋活动度(range of motion,ROM)、最大内收和最大外展ROM均显著改善(P<0.05)。术后1周机器人组的VAS评分[分,M(P25,P75),2.0(2.0,4.0)vs 3.5(3.0,5.0),P<0.001]、最大屈髋[°,(74.5±9.0)vs(66.5±10.4),P=0.006]、最大内收[°,(18.5±6.2)vs(7.0±1.6),P<0.001]显著优于徒手组;术后1周和术后3个月机器人组的Harris评分[分,(75.1±4.9)vs(68.3±5.1),P<0.001;(84.8±4.9)vs(78.3±4.5),P<0.001]、最大伸髋[°,(20.5±5.3)vs(12.5±5.6),P<0.001;(31.0±3.6)vs(24.1±4.5),P<0.001]、最大外展[°,(26.2±3.3)vs(21.5±4.8),P<0.001;(33.4±3.8)vs(27.8±4.3),P<0.001]显著优于徒手组,但是,末次随访时两组间上述指标的差异均已无统计学意义(P>0.05)。影像方面,机器人组的术后双下肢长度差异(leg length discrepancy,LLD)[mm,(4.9±1.0)vs(8.1±1.4),P<0.001]和双侧联合偏心距(combined offset,CO)差值(■CO)的绝对值[mm,(1.5±0.5)vs(3.5±0.6),P<0.001]、髋臼假体外展角[°,(40.3±1.7)vs(45.3±4.1),P<0.001]和前倾角[°,(15.9±1.2)vs(18.8±3.6),P<0.001]均显著小于徒手组。[结论]与常规徒手THA相比,Mako机器人辅助下改良Harding入路THA假体置放更精准,早期治疗效果更优,但机器人技术的手术时间较长且术中失血量更大。
文摘目的基于脑小血管病(cerebral small vessel disease,CSVD)影像学总负荷构建急性脑梗死(acute cerebral infarction,ACI)患者住院时间延长列线图模型,并对其进行验证。方法选取2021年1月至2023年12月湖州学院附属南太湖医院神经内科收治的462例ACI患者作为研究对象,按照7∶3原则,将患者分为训练组(n=323)和验证组(n=139)。采用Lasso-Logistic回归分析ACI患者住院时间延长危险因素,采用受试者操作特征曲线(receiver operating characteristic curves,ROC曲线)预测效能。结果基于训练组数据,Lasso回归筛选出4个非零系数指标,分别为基线美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分、年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index,aCCI)评分、中性粒细胞与淋巴细胞比值(neutroph to lymphocyte ratio,NLR)、CSVD总负荷评分。多因素Logistic回归分析显示,基线NIHSS评分、aCCI评分、NLR、CSVD总负荷评分均是ACI患者住院时间延长的独立危险因素(P<0.05)。基于上述4项指标构建列线图模型,预测训练组、验证组患者住院时间延长的ROC曲线下面积为0.812(95%CI:0.756~0.868)、0.820(95%CI:0.730~0.909)。结论基于CSVD总负荷评分构建的ACI患者住院时间延长列线图模型具有较好的预测效能,可作为筛查ACI患者住院时间延长的评估工具。
