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
Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacem...Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0~0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.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
目的:使用CT联合Mimics软件测量全髋关节置换术(total hip arthroplasty,THA)后股骨偏心距(femoral offset,FO)、旋转中心高度(rotation center height,RCH)与双下肢长度差(lower leg length discrepancy,LLD),并探讨THA后FO、RCH与LLD...目的:使用CT联合Mimics软件测量全髋关节置换术(total hip arthroplasty,THA)后股骨偏心距(femoral offset,FO)、旋转中心高度(rotation center height,RCH)与双下肢长度差(lower leg length discrepancy,LLD),并探讨THA后FO、RCH与LLD的关系。方法:回顾性分析2020年10月至2022年6月符合标准的40例行单侧THA的患者,其中男21例,女19例;年龄30~81(58.90±14.13)岁;身体质量指数(body mass index,BMI)为17.3~31.5(25.3±3.4)kg·m^(-2);左侧18例,右侧22例。诊断为股骨头坏死30例(FicatⅣ期),髋关节骨性关节炎2例(TünnisⅢ期),发育性髋关节脱位合并终末期骨关节炎2例(CroweⅢ期),股骨颈骨折6例(GardenⅣ期)。术前、术后拍摄骨盆CT三维重建,经Mimics软件处理后建立三维重建模型,在模型上对FO、RCH、LLD进行测量。结果:术后双侧FO差值与LLD呈正相关性(r=0.744,P<0.001);将FO重建组与偏心距未重建组进行卡方检验得出:FO重建组下肢等长率高于FO未重建组(χ^(2)=6.320,P=0.012)。术后双侧RCH差值与LLD呈负相关性(r=-0.877,P<0.001);双侧FO差值及双侧RCH差值与术后LLD之间存在线性关系,且满足线性回归方程:术后LLD=0.038x-0.099y+0.257(x为术后双侧FO差值;y为术后双侧RCH差值;单位为cm),F=77.993,R2=0.808,P=0.009。结论:THA术后LLD随着FO的增大而增大,随着RCH增大而减小;重建FO更易获得下肢等长效果。THA术后双侧FO差值及双侧RCH差值与LLD之间存在线性关系,回归方程可为判断LLD提供一种理论参考。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
AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway(SSP) by following total knee arthroplasty(TKA). METHODS The study included primary TKA's perform...AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway(SSP) by following total knee arthroplasty(TKA). METHODS The study included primary TKA's performed in a highvolume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay(LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index(BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies(PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS. RESULTS Eight hundred and six consecutive primary SSP TKA's were included in this study. Patients were discharged at a median of 49 h(post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer(P < 0.001)], female gender [4.3 h longer(P = 0.012)], age [3.5 h longer per ten-year increase in age(P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported(P = 0.005)], later procedure endtimes [0.8 h longer per hour increase in end-time(P = 0.004)] and Black or African American patients [6.1 h longer(P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter(P = 0.011)] and TKA's performed during holiday weeks [9.4 h shorter(P = 0.011)]. Non-significant factors included: BMI, median income, patient's living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery. CONCLUSION The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.展开更多
目的探讨术后加速康复(enhanced recovery after surgery,ERAS)模式在初次全膝关节置换术(total knee arthroplasty,TKA)中应用的效果及安全性,揭示ERAS模式下延长TKA术后住院时间(length of stay,LOS)的危险因素。方法回顾性收集2018年...目的探讨术后加速康复(enhanced recovery after surgery,ERAS)模式在初次全膝关节置换术(total knee arthroplasty,TKA)中应用的效果及安全性,揭示ERAS模式下延长TKA术后住院时间(length of stay,LOS)的危险因素。方法回顾性收集2018年7月至10月在北京积水潭医院回龙观院区矫形骨科病房接受初次TKA的患者共182例,男37例,女145例;年龄22~86岁,平均(65.2±7.7)岁。分析该患者人群术后LOS、术后1个月内并发症及术后1个月内再住院率等指标,分析年龄、性别、身体质量指数(body mass index,BMI)、病因、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、术前白蛋白、术前及术后血色素、术者等因素对TKA术后LOS的影响。结果ERAS模式下初次TKA患者平均术后LOS(2.8±0.9)d,其中术后LOS≤48 h的病例82例(45.1%)。术后1个月内7例(3.8%)出现并发症,包括2例(1.1%)症状性下肢深静脉血栓,2例(1.1%)严重内科并发症(1例胃出血和1例肺炎),3例(1.6%)伤口浅表感染。术后1个月内再住院患者3例(1.6%),其中2例因严重内科并发症,1例因伤口浅表感染。术后LOS>48 h比≤48 h的患者ASA分级更高(P=0.030),类风湿关节炎比骨关节炎的比例低(P=0.030),术者也是术后LOS的影响因素(P=0.040)。结论ERAS诊治模式在初次TKA患者中的应用是安全、有效的。患者术前的内科情况是影响术后LOS的重要影响因素,需要围手术期对内科情况进行优化来促进患者术后的早期康复。展开更多
目的探讨接受全髋关节置换术(total hip replacement,THA)患者的一般情况、合并症和围手术期因素,了解这些因素与术后住院时间(length of stay,LOS)的相关性。方法回顾性分析2015年1月至2019年12月于苏州大学附属第二医院接受THA的绝经...目的探讨接受全髋关节置换术(total hip replacement,THA)患者的一般情况、合并症和围手术期因素,了解这些因素与术后住院时间(length of stay,LOS)的相关性。方法回顾性分析2015年1月至2019年12月于苏州大学附属第二医院接受THA的绝经后股骨颈骨折患者病历资料。共纳入患者637例,平均年龄(70.6±6.5)岁,平均体质量指数(body mass index,BMI)为(28.2±5.7)kg/m 2,术后LOS中位数为7(6,8)d,术后LOS长于中位数的有263例(占41.3%)。采用Logistic回归方法分析影响LOS的相关因素。结果①运用单因素分析方法分析了影响THA的LOS因素,其中年龄、BMI、入院时间、ASA(美国麻醉医师协会)分级、合并症、术前等待时间、手术时间、贫血、术后低蛋白血症、术后不良事件这十项指标有统计学意义(P<0.05);②将P<0.1的因素纳入二元Logistic回归模型进行多因素分析,其中年龄>70岁(OR:1.513;95%CI:1.032~2.260;P<0.001)、BMI<18.5 kg/m 2(OR:1.577;95%CI:1.073~2.319;P=0.021)、周五或周六入院(OR:1.558;95%CI:1.154~2.412;P=0.007)、ASAⅢ/Ⅳ级(OR:2.076;95%CI:1.472~2.926;P<0.001)、合并术前贫血(OR:1.665;95%CI:1.338~2.072;P<0.001)、合并术后不良事件(OR:1.814;95%CI:1.174~2.803;P=0.007)这六项指标为LOS延长的独立危险因素。结论术后住院时间(LOS)与老年人术后恢复状况关系密切,绝经后股骨颈骨折患者THA术后LOS延长与部分人口学、合并症、围手术期指标、入院时间等因素相关;其中有六项指标是独立危险因素。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Objective To investigate the methods to maintain leg equalization for patients undergoing primary total hip joint replacement. Methods 40 patients,45 hips with various diseases were treated by total hip joint replacement from Jan 2000 to Sep 2001.Before operation, the perpendicular length from center of femoral head to the summit of great tuberosity and the tip of less tuberosity to the line of bilateral ischial tuberosity were measured; the length from anterior superior iliac spine to medial malleolus were measured at same time.Leg length was decided and corrected according to these lines. Results Before operation, shortening of limbs were presented in 39 hips, 1 to 4 cm, average 2.4 cm.After operation, discrepancy of both legs was 0~0.8 cm.Apparent limps were not observed in all patients. Conclusion This measurement is a useful method to maintain and recover leg length in total hip joint replacement.
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.
文摘目的:使用CT联合Mimics软件测量全髋关节置换术(total hip arthroplasty,THA)后股骨偏心距(femoral offset,FO)、旋转中心高度(rotation center height,RCH)与双下肢长度差(lower leg length discrepancy,LLD),并探讨THA后FO、RCH与LLD的关系。方法:回顾性分析2020年10月至2022年6月符合标准的40例行单侧THA的患者,其中男21例,女19例;年龄30~81(58.90±14.13)岁;身体质量指数(body mass index,BMI)为17.3~31.5(25.3±3.4)kg·m^(-2);左侧18例,右侧22例。诊断为股骨头坏死30例(FicatⅣ期),髋关节骨性关节炎2例(TünnisⅢ期),发育性髋关节脱位合并终末期骨关节炎2例(CroweⅢ期),股骨颈骨折6例(GardenⅣ期)。术前、术后拍摄骨盆CT三维重建,经Mimics软件处理后建立三维重建模型,在模型上对FO、RCH、LLD进行测量。结果:术后双侧FO差值与LLD呈正相关性(r=0.744,P<0.001);将FO重建组与偏心距未重建组进行卡方检验得出:FO重建组下肢等长率高于FO未重建组(χ^(2)=6.320,P=0.012)。术后双侧RCH差值与LLD呈负相关性(r=-0.877,P<0.001);双侧FO差值及双侧RCH差值与术后LLD之间存在线性关系,且满足线性回归方程:术后LLD=0.038x-0.099y+0.257(x为术后双侧FO差值;y为术后双侧RCH差值;单位为cm),F=77.993,R2=0.808,P=0.009。结论:THA术后LLD随着FO的增大而增大,随着RCH增大而减小;重建FO更易获得下肢等长效果。THA术后双侧FO差值及双侧RCH差值与LLD之间存在线性关系,回归方程可为判断LLD提供一种理论参考。
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AIM To determine social, logistical and demographic factors that influence time to discharge in a short stay pathway(SSP) by following total knee arthroplasty(TKA). METHODS The study included primary TKA's performed in a highvolume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay(LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index(BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies(PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS. RESULTS Eight hundred and six consecutive primary SSP TKA's were included in this study. Patients were discharged at a median of 49 h(post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer(P < 0.001)], female gender [4.3 h longer(P = 0.012)], age [3.5 h longer per ten-year increase in age(P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported(P = 0.005)], later procedure endtimes [0.8 h longer per hour increase in end-time(P = 0.004)] and Black or African American patients [6.1 h longer(P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter(P = 0.011)] and TKA's performed during holiday weeks [9.4 h shorter(P = 0.011)]. Non-significant factors included: BMI, median income, patient's living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery. CONCLUSION The cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.
文摘目的探讨术后加速康复(enhanced recovery after surgery,ERAS)模式在初次全膝关节置换术(total knee arthroplasty,TKA)中应用的效果及安全性,揭示ERAS模式下延长TKA术后住院时间(length of stay,LOS)的危险因素。方法回顾性收集2018年7月至10月在北京积水潭医院回龙观院区矫形骨科病房接受初次TKA的患者共182例,男37例,女145例;年龄22~86岁,平均(65.2±7.7)岁。分析该患者人群术后LOS、术后1个月内并发症及术后1个月内再住院率等指标,分析年龄、性别、身体质量指数(body mass index,BMI)、病因、美国麻醉医师协会(American society of anesthesiologists,ASA)分级、术前白蛋白、术前及术后血色素、术者等因素对TKA术后LOS的影响。结果ERAS模式下初次TKA患者平均术后LOS(2.8±0.9)d,其中术后LOS≤48 h的病例82例(45.1%)。术后1个月内7例(3.8%)出现并发症,包括2例(1.1%)症状性下肢深静脉血栓,2例(1.1%)严重内科并发症(1例胃出血和1例肺炎),3例(1.6%)伤口浅表感染。术后1个月内再住院患者3例(1.6%),其中2例因严重内科并发症,1例因伤口浅表感染。术后LOS>48 h比≤48 h的患者ASA分级更高(P=0.030),类风湿关节炎比骨关节炎的比例低(P=0.030),术者也是术后LOS的影响因素(P=0.040)。结论ERAS诊治模式在初次TKA患者中的应用是安全、有效的。患者术前的内科情况是影响术后LOS的重要影响因素,需要围手术期对内科情况进行优化来促进患者术后的早期康复。
文摘目的探讨接受全髋关节置换术(total hip replacement,THA)患者的一般情况、合并症和围手术期因素,了解这些因素与术后住院时间(length of stay,LOS)的相关性。方法回顾性分析2015年1月至2019年12月于苏州大学附属第二医院接受THA的绝经后股骨颈骨折患者病历资料。共纳入患者637例,平均年龄(70.6±6.5)岁,平均体质量指数(body mass index,BMI)为(28.2±5.7)kg/m 2,术后LOS中位数为7(6,8)d,术后LOS长于中位数的有263例(占41.3%)。采用Logistic回归方法分析影响LOS的相关因素。结果①运用单因素分析方法分析了影响THA的LOS因素,其中年龄、BMI、入院时间、ASA(美国麻醉医师协会)分级、合并症、术前等待时间、手术时间、贫血、术后低蛋白血症、术后不良事件这十项指标有统计学意义(P<0.05);②将P<0.1的因素纳入二元Logistic回归模型进行多因素分析,其中年龄>70岁(OR:1.513;95%CI:1.032~2.260;P<0.001)、BMI<18.5 kg/m 2(OR:1.577;95%CI:1.073~2.319;P=0.021)、周五或周六入院(OR:1.558;95%CI:1.154~2.412;P=0.007)、ASAⅢ/Ⅳ级(OR:2.076;95%CI:1.472~2.926;P<0.001)、合并术前贫血(OR:1.665;95%CI:1.338~2.072;P<0.001)、合并术后不良事件(OR:1.814;95%CI:1.174~2.803;P=0.007)这六项指标为LOS延长的独立危险因素。结论术后住院时间(LOS)与老年人术后恢复状况关系密切,绝经后股骨颈骨折患者THA术后LOS延长与部分人口学、合并症、围手术期指标、入院时间等因素相关;其中有六项指标是独立危险因素。