自体股骨头结构植骨重建髋臼辅助THA在改良CROWE Type ⅣB型DDH中的临床疗效分析

目的:分析和总结自体股骨头结构植骨重建髋臼辅助全髋关节置换术(total hip arthroplasty,THA)治疗改良Crowe TypeⅣB型成人髋关节发育不良性脱位(developmental dysplasia of the hip,DDH)患者的临床疗效。方法:按照改良Crowe分型,选取山东大学齐鲁医院德州医院关节外科2015年8月至2023年3月收治的TypeⅣB型DDH患者26例,其中男25例,女1例,采用自体股骨头结构植骨重建髋臼辅助THA,记录患者手术时间、术中失血量、术中术后输血量、术后血红蛋白、手术相关并发症和骨愈合时间等,并行骨盆正位X线片了解假体位置、假体骨长入、假体松动以及骨愈合情况等,采用视觉模拟评分表(visual analogue scale,VAS)评价髋关节的疼痛不适,采用髋关节Harris评分和Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)来评价髋关节功能及临床疗效。结果:所有患者的平均随访时间(9.73±8.35)个月,术中出血平均为(715.38±143.37) mL,术中平均输血(415.38±282.41) mL,手术时间平均为(118.62±18.27) min,术后平均输血为(192.31±236.51) mL。所有患者转子下骨端、自体股骨头和假臼之间均骨愈合良好。髋关节VAS评分从术前6.73±0.45,至术后末次随访时VAS评分1.73±0.53,差异有统计学意义(P=0.000),髋关节活动度均较术前明显改善,髋关节Harris评分从术前24.27±1.66,至术后末次随访时Harris评分74.77±2.89,差异有统计学意义(P=0.000),WOMAC术前术后评分分别为130.08±5.72和67.85±3.23,差异均有统计学意义(P=0.000)。结论:自体股骨头结构植骨重建髋臼辅助THA治疗改良Crowe TypeⅣB型DDH,具有操作相对简单、固定牢固、手术相对安全和疗效确切的优点。

Which approach of total hip arthroplasty is the best efficacy and least complication?

BACKGROUND Total hip arthroplasty is as an effective intervention to relieve pain and improve hip function.Approaches of the hip have been exhaustively explored about pros and cons.The efficacy and the complications of hip approaches remains inconclusive.This study conducted an umbrella review to systematically appraise previous meta-analysis(MAs)including conventional posterior approach(PA),and minimally invasive surgeries as the lateral approach(LA),direct anterior approach(DAA),2-incisions method,mini-lateral approach and the newest technique direct superior approach(DSA)or supercapsular percutaneouslyassisted total hip(SuperPath).AIM To compare the efficacy and complications of hip approaches that have been published in all MAs and randomized controlled trials(RCTs).METHODS MAs were identified from MEDLINE and Scopus from inception until 2023.RCTs were then updated from the latest MA to September 2023.This study included studies which compared hip approaches and reported at least one outcome such as Harris Hip Score(HHS),dislocation,intra-operative fracture,wound compliData were independently selected,extracted and assessed by two reviewers.Network MA and cluster rank and surface under the cumulative ranking curve(SUCRA)were estimated for treatment efficacy and safety.RESULTS Finally,twenty-eight MAs(40 RCTs),and 13 RCTs were retrieved.In total 47 RCTs were included for reanalysis.The results of corrected covered area showed high degree(13.80%).Among 47 RCTs,most of the studies were low risk of bias in part of random process and outcome reporting,while other domains were medium to high risk of bias.DAA significantly provided higher HHS at three months than PA[pooled unstandardized mean difference(USMD):3.49,95%confidence interval(CI):0.98,6.00 with SUCRA:85.9],followed by DSA/SuperPath(USMD:1.57,95%CI:-1.55,4.69 with SUCRA:57.6).All approaches had indifferent dislocation and intraoperative fracture rates.SUCRA comparing early functional outcome and composite complications(dislocation,intra-operative fracture,wound complication,and nerve injury)found DAA was the best approach followed by DSA/SuperPath.CONCLUSION DSA/SuperPath had better earlier functional outcome than PA,but still could not overcome the result of DAA.This technique might be the other preferred option with acceptable complications.

Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients

BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.

Kinematically Aligned Total Knee Arthroplasty for Valgus Osteoarthritis of More than 10°―Is It Still a “Challenging Surgery”?

Mechanically aligned total knee arthroplasty (TKA) for valgus knee is considered a “challenging surgery.” Recently, the kinematic alignment (KA) method has gained attention. This study aimed to present objective clinical data, such as intraoperative balance assessment and radiographic evaluation of postoperative lower extremity alignment after TKA using the KA method for valgus deformity. Twenty-one TKA knees (mean age, 74 years;2 males, 19 females) with KA for severe valgus deformity (hip-knee-ankle-angle ≥ 10°) performed at our department in the past 3 years were included in this study. Intraoperative gap and balance measurements and postoperative radiographic evaluation were performed. A total arc of range of motion was achieved up to 98% of preoperative values at 3 weeks postoperatively. Intraoperative gap and balance were stable throughout the entire range of motion. In addition, there were no statistically significant differences in either balance or gap values at each flexion angle. KA TKA is a “simple surgery” rather than a “challenging surgery” because additional soft tissue procedures are not required, operative time is short, intraoperative and postoperative balance is very stable, and a good alignment is achieved. This procedure may relieve surgeons of the stress of TKA for valgus deformities.

Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.

Total flavonoids of Astragalus membranaceus protect against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced neurotoxicity in mice by inhibiting ferroptosis through SLC7A11/GPX-4 signaling pathway

Parkinson’s disease(PD)is a common neurodegenerative disorder with no cure.Astragalus membranaceus is used in Chinese culture as a food supplement to boost immunity.The present study aimed to explore the neuroprotective effects of total flavonoids extracted from A.membranaceus(TFA)and their protective mechanisms.TFA offered neuroprotection against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)in the mouse model of Parkinsonism,by improving behavior performance in the gait analysis and pole test,and inhibiting the decline of tyrosine hydroxylase(TH)positive neurons and TH protein expression in substantia nigra of mice.TFA also prevented 1-methyl-4-phenylpyridinium(MPP+)induced neurotoxicity in SHSY5Y cells,by increasing GSH and GSH/GSSG ratio,and reducing reactive oxygen species.In addition,the neuroprotective effects of TFA were associated with its ability to restore MPTP/MPP+induced downregulation of SLC7A11 and glutathione peroxidase 4(GPX-4).In conclusion,we demonstrated that TFA exerted significant neuroprotection against MPTP/MPP+induced neurodegeneration by inhibiting ferroptosis through the regulation of SLC7A11/GPX-4 axis,suggesting the use of TFA as a possible food supplement in the prevention of PD.

Research Progress and Prospects of Total Factor Productivity in the Construction Industry

The high-quality development of the construction industry fundamentally stems from the significant improvement of total factor productivity.Therefore,it is of crucial significance for promoting the development of the construction industry to a higher level by scientifically and accurately measuring the total factor productivity of the construction industry and deeply analyzing the influencing factors behind it.Based on a comprehensive consideration of research methods and influencing factors,this paper systematically reviews the existing relevant literature on total factor productivity in the construction industry,aiming to reveal the current research development trend in this field and point out potential problems.This effort aims to provide a solid theoretical foundation and valuable reference for further in-depth research,and jointly promote the continuous progress and development of total factor productivity research in the construction industry.

氧化锆在THA和TKA治疗中的应用

阐述人工关节技术,氧化锆因其卓越的耐腐蚀性能、低弹性模量以及优良的生物相容性,已经成为生物医学领域尤其关节置换手术领域不可或缺的金属材料;综合分析氧化锆假体在骨缺损治疗中的相关临床研究,从假体结构、临床应用背景及临床疗效等角度进行系统性综述;总结氧化锆假体在关节置换治疗中的应用现状;分析氧化锆假体的优势与劣势,指明未来的骨科材料研究的方向。

Effects of Ethanol Condensation Reflux Extraction and Ultrasound-assisted Extraction on the Content of Total Flavonoids of Pueraria edulis

With Pueraria edulis from different habitats in Yunnan Province,Guangdong Province and Guangxi Zhuang autonomous region as materials,the medicinal materials of P.edulis were extracted by ethanol condensation reflux extraction and ultrasound-assisted extraction,and the effects of different extraction methods the contents of total flavonoids in P.edulis from different areas were compared.The results showed that the best extraction time for P.edulis in Yunnan Province was 20 min,and that for Guangdong and Guangxi Zhuang Autonomous Region was 30 min.The yield of total flavonoids from P.edulis extracted by the condensation reflux extraction method was relatively better.The content of total flavonoids in P.edulis in Yunnan was the highest with an average content of 0.2557%,while the average content of total flavonoids in P.edulis in Guangdong was the lowest with an average content of 0.2108%.

FNS与THA在老年股骨颈骨折治疗中的疗效比较

目的:比较股骨颈动力交叉钉系统(FNS)与全髋关节置换治疗老年股骨颈骨折的临床疗效。方法:回顾性分析自2022-01至2023-06期间采用FNS内固定与全髋关节置换(THA)治疗的42例老年股骨颈骨折,根据手术方式不同分为FNS组和THA组。比较两组手术时间、术中出血量、住院时间、术后Harris髋关节功能评分(HHS)及术后并发症发生情况。结果:FNS组的THA组的手术时间、住院时间、术后Harris髋关节功能评分差异无统计学意义(P > 0.05),FNS组术中出血量少于THA组,差异有统计学意义(P 0.05)。结论:FNS系统与全髋关节置换治疗老年股骨颈骨折在手术时长、术后髋关节功能恢复及并发症等方面无明显差异,FNS内固定术中出血量较少,是一种可行的治疗老年股骨颈骨折的方式。

Quantification of Total Phenols, Total Flavonoids, Total Anthocyanins and Evaluation of Antioxidant and Antiradical Activities of Detarium Senegalense Extracts from Chad

The aim of the present work is to assess the value of Detarium Senegalense by determining the content of total phenols, total flavonoids and total anthocyanins, and by evaluating the free radical scavenging activity of Detarium Senegalense extracts. For this purpose, sequential extraction using solvents of increasing polarity was essential. The various extracts obtained underwent phytochemical and biochemical analyses. Phytochemical screening revealed the presence of flavonoids, alkaloids, tannins, polyphenols, anthocyanins and steroids/terpenes. Quantitative analysis of total polyphenols, total flavonoids and total anthocyanins yielded the following results: total flavonoids (0.803 ± 0029 mg EQ/100g P for acetone extract of roots and 0.871 ± 0.401 mg EQ/100g P for methanol extract of leaves);total polyphenols (23.298 ± 12.68 mg EAG/100g P for acetone extract of roots and 24.69 ± 0.49 401 mg EAG/100g P for methanol extract of leaves);total monomeric anthocyanins (44.697 ± 0.939 mg EC3G/100g P and 16.699 ± 0.193 mg EC3G/100g P respectively for acetone and methanol extracts of stem bark). DPPH free radical scavenging activity was 1.674 ± 0.023 mg/mL for the acetone extract and 0.934 ± 0.24 mg/mL for the methanol extract of roots. .

利伐沙班与低分子肝素对THA患者术后DVT预防研究

评估利伐沙班(缩略:RIV)以及低分子肝素(缩略:LMWH)对于人工全髋关节置换术(缩略:THA)术后下肢深静脉血栓(缩略:DVT)的预防效用。选择近1年院内收入的120例THA术后患者,经摸球界定,第一组利用RIV预防DVT;第二组利用LMWH预防DVT,较比预防效果。结果 组间的DVT发生率较比后,P<0.05。组间的临床指标、不良反应率相较比,显示P>0.05。且治疗后的凝血功能、血栓弹力图(缩略:TEG)参数、血红蛋白(缩略:Hb)以及血小板计数(缩略:PLT)相较比,显示为P<0.05。结论 RIV对于THA术后DVT的预防效果优于LMWH,且能调节凝血功能,不会升高出血风险。但两种药物在临床指标与用药安全性方面,并无差异。

Physicochemical and Biochemical Characterization, Total Phenolic and Energy Value from Bulbs of Different Onion (Allium cepa L.) Varieties in Senegal

The purpose of this study is to investigate the physicochemical properties of some local varieties of onion (Allium cepa L.) and compare them with an imported variety, all collected in May 2021. Proteins, reducing sugars, lipids, and polyphenol content were estimated according to the AFNOR standardized methods. The determination of calcium, magnesium, iron, sodium, potassium and phosphorus was performed by atomic absorption spectrophotometer coupled with a CCD detector. The results highlighted an average acidity of 0.377% ± 0.002% lower than the value of the imported variety which is 0.520% ± 0.001%. Local varieties have a pH ranging from 6.35 ± 0.003 to 6.42 ± 0.004, while the variety has a pH of 6.36 ± 0.003. The ash and dry matter contents vary respectively from 4.788% ± 0.004% to 8.253% ± 0.003% and 7.945% ± 0.021% to 11.945% ± 0.007% for the local varieties. Moreover, the imported one has ash and dry matter contents of 5.175% ± 0.007% and 10.035% ± 0.021% respectively. The results show that the protein, reducing sugar and lipid contents in the local onion varieties vary respectively from 2.815 ± 0.000 to 15.634 ± 0.001 g·100 g-1;4.691 ± 0.001 to 12.596 ± 0.002 g·100 g-1 and 0.006 ± 0.001 to 0.050 ± 0.057 g·100 g-1. Furthermore, the imported variety has a protein, reducing sugar and lipid content of 5.649 ± 0.002;8.565 ± 0.002 g·100 g-1 and 0.011 ± 0.010 g·100 g-1 respectively. The maximum levels of total polyphenols are obtained in the imported variety, Bellani and Gandiol, respectively 9.973 ± 0.001, 4.535 ± 0.002, and 3.425 ± 0.006 mg EAG/g of dry matter. The local varieties have a significant calorific intake of between 35.451 ± 0.001 and 112.980 ± 0.003 kcal·100 g-1 compared to the imported one with an energy value of 56.953 ± 0.001 kcal·100 g-1 of dry matter. The bulbs of different onion varieties studied have a fairly high content of mineral elements. The potassium content of local varieties is between 502.16 ± 0.06 mg·100 g-1 and 582.77 ± 0.04 mg·100 g-1 while the imported variety has a content of 536.62 ± 1.30 mg·100 g-1. They note that the local varieties have a better calcium content (249.75 ± 0.07 to 434.20 ± 0.57 mg·100 g-1) and magnesium (142.15 ± 0.07 to 162.60 ± 0.42 mg·100 g-1) than the imported variety (229.58 ± 0.04 mg·100 g-1) except for the varieties White Grano (228.29 ± 0.01 mg·100 g-1) and Rouge Amposta (117.00 ± 0.42 mg·100 g-1) respectively. These results reveal that Gandiol, Dayo and Orient F1 are nutritionally found better due to their higher antioxidant property, proteins, carbohydrates, and reducing sugar and should be included in diets to supplement our daily allowance needed by the body.

Subsequent total joint arthroplasty: Are we learning from the first stage?

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

Comparison efficacy and safety of total laparoscopic gastrectomy and laparoscopically assisted total gastrectomy in treatment of gastric cancer

BACKGROUND The development of laparoscopic technology has provided a new choice for surgery of gastric cancer(GC),but the advantages and disadvantages of laparoscopic total gastrectomy(LTG)and laparoscopic-assisted total gastrectomy(LATG)in treatment effect and safety are still controversial.The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC,and to provide a basis for clinical decision-making.AIM To compare the efficacy of totally LTG(TLTG)and LATG in the context of radical gastrectomy for GC.Additionally,we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique.METHODS Literature on comparative studies of the above two surgical methods for GC(TLTG group and LATG group)published before September 2022 were searched in the PubMed,Web of Science,Wanfang Database,CNKI,and other Chinese and English databases.In addition,the following search keywords were used:Gastric cancer,total gastrectomy,total laparoscopy,laparoscopy-assisted,esophagojejunal anastomosis,gastric/stomach cancer,total gastrectomy,totally/completely laparoscopic,laparoscopic assisted/laparoscopy assisted/laparoscopically assisted,and esophagojejunostomy/esophagojejunal anastomosis.Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.RESULTS After layer-by-layer screening,258 pieces of literature were recovered,and 11 of those pieces were eventually included.This resulted in a sample size of 2421 instances,with 1115 cases falling into the TLTG group and 1306 cases into the LATG group.Age or sex differences between the two groups were not statistically significant,according to the meta-analysis,however the average body mass index of the TLTG group was considerably higher than that of the LATG group(P=0.01).Compared with those in the LATG group,the incision length in the TLTG group was significantly shorter(P<0.001),the amount of intraoperative blood loss was significantly lower(P=0.003),the number of lymph nodes removed was significantly greater(P=0.04),and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter(P=0.03 and 0.02,respectively).There were no significant differences in tumor size,length of proximal incisal margin,total operation time,anastomotic time,postoperative pain score,postoperative anal exhaust time,postoperative anastomosis-related complications(including anastomotic fistula,anastomotic stenosis,and anastomotic hemorrhage),or overall postoperative complication rate(P>0.05).CONCLUSION TLTG and esophagojejunostomy are safe and feasible.Compared with LATG,TLTG has the advantages of less trauma,less bleeding,easier access to lymph nodes,and faster postoperative recovery,and TLTG is also suitable for obese patients.

Longitudinal dependence of the forecast accuracy of the ionospheric total electron content in the equatorial zone

The longitudinal dependence of the behavior of ionospheric parameters has been the subject of a number of works where significant variations are discovered.This also applies to the prediction of the ionospheric total electron content(TEC),which neural network methods have recently been widely used.However,the results are mainly presented for a limited set of meridians.This paper examines the longitudinal dependence of the TEC forecast accuracy in the equatorial zone.In this case,the methods are used that provided the best accuracy on three meridians:European(30°E),Southeastern(110°E)and American(75°W).Results for the stations considered are analyzed as a function of longitude using the Jet Propulsion Laboratory Global Ionosphere Map(JPL GIM)for 2015.These results are for 2 h ahead and 24 h ahead forecast.It was found that in this case,based on the metric values,three groups of architectures can be distinguished.The first group included long short-term memory(LSTM),gated recurrent unit(GRU),and temporal convolutional networks(TCN)models as a part of unidirectional deep learning models;the second group is based on the recurrent models from the first group,which were supplemented with a bidirectional algorithm,increasing the TEC forecasting accuracy by 2-3 times.The third group,which includes the bidirectional TCN architecture(BiTCN),provided the highest accuracy.For this architecture,according to data obtained for 9 equatorial stations,practical independence of the TEC prediction accuracy from longitude was observed under the following metrics(Mean Absolute Error MAE,Root Mean Square Error RMSE,Mean Absolute Percentage Error MAPE):MAE(2 h)is 0.2 TECU approximately;MAE(24 h)is 0.4 TECU approximately;RMSE(2 h)is less than 0.5 TECU except Niue station(RMSE(2 h)is 1 TECU approximately);RMSE(24 h)is in the range of 1.0-1.7 TECU;MAPE(2 h)<1%except Darwin station,MAPE(24 h)<2%.This result was confirmed by data from additional 5 stations that formed latitudinal chains in the equatorial part of the three meridians.The complete correspondence of the observational and predicted TEC values is illustrated using several stations for disturbed conditions on December 19-22,2015,which included the strongest magnetic storm in the second half of the year(min Dst=-155 nT).

The Increase in Total Knee Replacement Surgery in China: A 10-Year Real-World Study

Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.

Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting

Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome.