Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Anisotropic time-dependent behaviors of shale under direct shearing and associated empirical creep models

Understanding the anisotropic creep behaviors of shale under direct shearing is a challenging issue.In this context,we conducted shear-creep and steady-creep tests on shale with five bedding orientations (i.e.0°,30°,45°,60°,and 90°),under multiple levels of direct shearing for the first time.The results show that the anisotropic creep of shale exhibits a significant stress-dependent behavior.Under a low shear stress,the creep compliance of shale increases linearly with the logarithm of time at all bedding orientations,and the increase depends on the bedding orientation and creep time.Under high shear stress conditions,the creep compliance of shale is minimal when the bedding orientation is 0°,and the steady-creep rate of shale increases significantly with increasing bedding orientations of 30°,45°,60°,and 90°.The stress-strain values corresponding to the inception of the accelerated creep stage show an increasing and then decreasing trend with the bedding orientation.A semilogarithmic model that could reflect the stress dependence of the steady-creep rate while considering the hardening and damage process is proposed.The model minimizes the deviation of the calculated steady-state creep rate from the observed value and reveals the behavior of the bedding orientation's influence on the steady-creep rate.The applicability of the five classical empirical creep models is quantitatively evaluated.It shows that the logarithmic model can well explain the experimental creep strain and creep rate,and it can accurately predict long-term shear creep deformation.Based on an improved logarithmic model,the variations in creep parameters with shear stress and bedding orientations are discussed.With abovementioned findings,a mathematical method for constructing an anisotropic shear creep model of shale is proposed,which can characterize the nonlinear dependence of the anisotropic shear creep behavior of shale on the bedding orientation.

Theoretical analysis of hydrogen solubility in direct coal liquefaction solvents

The cyclic hydrogenation technology in a direct coal liquefaction process relies on the dissolved hydrogen of the solvent or oil participating in the hydrogenation reaction.Thus,a theoretical basis for process optimization and reactor design can be established by analyzing the solubility of hydrogen in liquefaction solvents.Experimental studies of hydrogen solubility in liquefaction solvents are challenging due to harsh reaction conditions and complex solvent compositions.In this study,the composition and content of liquefied solvents were analyzed.As model compounds,hexadecane,toluene,naphthalene,tetrahydronaphthalene,and phenanthrene were chosen to represent the liquefied solvents in chain alkanes and monocyclic,bicyclic,and tricyclic aromatic hydrocarbons.The solubility of hydrogen X(mol/mol)in pure solvent components and mixed solvents(alkanes and aromatics mixed in proportion to the chain alkanes+bicyclic aromatic hydrocarbons,bicyclic saturated aromatic hydrocarbons+bicyclic aromatic hydrocarbons,and bicyclic aromatic hydrocarbons+compounds containing het-eroatoms composed of mixed components)are determined using Aspen simulation at temperature and pressure conditions of 373–523 K and 2–10 MPa.The results demonstrated that at high temperatures and pressures,the solubility of hydrogen in the solvent increases with the increase in temperature and pressure,with the pressure having a greater impact.Further-more,the results revealed that hydrogen is more soluble in straight-chain alkanes than in other solvents,and the solubility of eicosanoids reaches a maximum of 0.296.The hydrogen solubility in aromatic ring compounds decreased gradually with an increase in the aromatic ring number.The influence of chain alkanes on the solubility of hydrogen predominates in a mixture of solvents with different mixing ratios of chain alkanes and aromatic hydrocarbons.The solubility of hydrogen in mixed aromatic solvents is less than that in the corresponding single solvents.Hydrogen is less soluble in solvent compounds containing heteroatoms than in compounds without heteroatoms.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

Estimation of the anisotropy of hydraulic conductivity through 3D fracture networks using the directional geological entropy

With an extension of the geological entropy concept in porous media,the approach called directional entrogram is applied to link hydraulic behavior to the anisotropy of the 3D fracture networks.A metric called directional entropic scale is used to measure the anisotropy of spatial order in different directions.Compared with the traditional connectivity indexes based on the statistics of fracture geometry,the directional entropic scale is capable to quantify the anisotropy of connectivity and hydraulic conductivity in heterogeneous 3D fracture networks.According to the numerical analysis of directional entrogram and fluid flow in a number of the 3D fracture networks,the hydraulic conductivities and entropic scales in different directions both increase with spatial order(i.e.,trace length decreasing and spacing increasing)and are independent of the dip angle.As a result,the nonlinear correlation between the hydraulic conductivities and entropic scales from different directions can be unified as quadratic polynomial function,which can shed light on the anisotropic effect of spatial order and global entropy on the heterogeneous hydraulic behaviors.

Review on laser directed energy deposited aluminum alloys

Lightweight aluminum(Al)alloys have been widely used in frontier fields like aerospace and automotive industries,which attracts great interest in additive manufacturing(AM)to process high-value Al parts.As a mainstream AM technique,laser-directed energy deposition(LDED)shows good scalability to meet the requirements for large-format component manufacturing and repair.However,LDED Al alloys are highly challenging due to their inherent poor printability(e.g.low laser absorption,high oxidation sensitivity and cracking tendency).To further promote the development of LDED high-performance Al alloys,this review offers a deep understanding of the challenges and strategies to improve printability in LDED Al alloys.The porosity,cracking,distortion,inclusions,element evaporation and resultant inferior mechanical properties(worse than laser powder bed fusion)are the key challenges in LDED Al alloys.Processing parameter optimizations,in-situ alloy design,reinforcing particle addition and field assistance are the efficient approaches to improving the printability and performance of LDED Al alloys.The underlying correlations between processes,alloy innovation,characteristic microstructures,and achievable performances in LDED Al alloys are discussed.The benchmark mechanical properties and primary strengthening mechanism of LDED Al alloys are summarized.This review aims to provide a critical and in-depth evaluation of current progress in LDED Al alloys.Future opportunities and perspectives in LDED high-performance Al alloys are also outlined.

Post-transcriptional mechanisms controlling neurogenesis and direct neuronal reprogramming

Neurogenesis is a tightly regulated process in time and space both in the developing embryo and in adult neurogenic niches.A drastic change in the transcriptome and proteome of radial glial cells or neural stem cells towards the neuronal state is achieved due to sophisticated mechanisms of epigenetic,transcriptional,and post-transcriptional regulation.Understanding these neurogenic mechanisms is of major importance,not only for shedding light on very complex and crucial developmental processes,but also for the identification of putative reprogramming factors,that harbor hierarchically central regulatory roles in the course of neurogenesis and bare thus the capacity to drive direct reprogramming towards the neuronal fate.The major transcriptional programs that orchestrate the neurogenic process have been the focus of research for many years and key neurogenic transcription factors,as well as repressor complexes,have been identified and employed in direct reprogramming protocols to convert non-neuronal cells,into functional neurons.The post-transcriptional regulation of gene expression during nervous system development has emerged as another important and intricate regulatory layer,strongly contributing to the complexity of the mechanisms controlling neurogenesis and neuronal function.In particular,recent advances are highlighting the importance of specific RNA binding proteins that control major steps of mRNA life cycle during neurogenesis,such as alternative splicing,polyadenylation,stability,and translation.Apart from the RNA binding proteins,microRNAs,a class of small non-coding RNAs that block the translation of their target mRNAs,have also been shown to play crucial roles in all the stages of the neurogenic process,from neural stem/progenitor cell proliferation,neuronal differentiation and migration,to functional maturation.Here,we provide an overview of the most prominent post-transcriptional mechanisms mediated by RNA binding proteins and microRNAs during the neurogenic process,giving particular emphasis on the interplay of specific RNA binding proteins with neurogenic microRNAs.Taking under consideration that the molecular mechanisms of neurogenesis exert high similarity to the ones driving direct neuronal reprogramming,we also discuss the current advances in in vitro and in vivo direct neuronal reprogramming approaches that have employed microRNAs or RNA binding proteins as reprogramming factors,highlighting the so far known mechanisms of their reprogramming action.

Two-photon live imaging of direct glia-to-neuron conversion in the mouse cortex

Over the past decade,a growing number of studies have reported transcription factor-based in situ reprogramming that can directly conve rt endogenous glial cells into functional neurons as an alternative approach for n euro regeneration in the adult mammalian central ne rvous system.Howeve r,many questions remain regarding how a terminally differentiated glial cell can transform into a delicate neuron that forms part of the intricate brain circuitry.In addition,concerns have recently been raised around the absence of astrocyte-to-neuron conversion in astrocytic lineage-tra cing mice.In this study,we employed repetitive two-photon imaging to continuously capture the in situ astrocyte-to-neuron conversion process following ecto pic expression of the neural transcription factor NeuroD1 in both prolife rating reactive astrocytes and lineage-tra ced astrocytes in the mouse cortex.Time-lapse imaging over several wee ks revealed the ste p-by-step transition from a typical astrocyte with numero us short,tapered branches to a typical neuro n with a few long neurites and dynamic growth cones that actively explored the local environment.In addition,these lineage-converting cells were able to migrate ra dially or to ngentially to relocate to suitable positions.Furthermore,two-photon Ca2+imaging and patch-clamp recordings confirmed that the newly generated neuro ns exhibited synchronous calcium signals,repetitive action potentials,and spontaneous synaptic responses,suggesting that they had made functional synaptic connections within local neural circuits.In conclusion,we directly visualized the step-by-step lineage conversion process from astrocytes to functional neurons in vivo and unambiguously demonstrated that adult mammalian brains are highly plastic with respect to their potential for neuro regeneration and neural circuit reconstruction.

Tensile strength and failure behavior of rock-mortar interfaces: Direct and indirect measurements

The tensile strength at the rock-concrete interface is one of the crucial factors controlling the failure mechanisms of structures,such as concrete gravity dams.Despite the critical importance of the failure mechanism and tensile strength of rock-concrete interfaces,understanding of these factors remains very limited.This study investigated the tensile strength and fracturing processes at rock-mortar interfaces subjected to direct and indirect tensile loadings.Digital image correlation(DIC)and acoustic emission(AE)techniques were used to monitor the failure mechanisms of specimens subjected to direct tension and indirect loading(Brazilian tests).The results indicated that the direct tensile strength of the rock-mortar specimens was lower than their indirect tensile strength,with a direct/indirect tensile strength ratio of 65%.DIC strain field data and moment tensor inversions(MTI)of AE events indicated that a significant number of shear microcracks occurred in the specimens subjected to the Brazilian test.The presence of these shear microcracks,which require more energy to break,resulted in a higher tensile strength during the Brazilian tests.In contrast,microcracks were predominantly tensile in specimens subjected to direct tension,leading to a lower tensile strength.Spatiotemporal monitoring of the cracking processes in the rock-mortar interfaces revealed that they show AE precursors before failure under the Brazilian test,whereas they show a minimal number of AE events before failure under direct tension.Due to different microcracking mechanisms,specimens tested under Brazilian tests showed lower roughness with flatter fracture surfaces than those tested under direct tension with jagged and rough fracture surfaces.The results of this study shed light on better understanding the micromechanics of damage in the rock-concrete interfaces for a safer design of engineering structures.

Preventing brain aging by the artificial enforcement of the unfolded protein response:future directions

As the life expectancy of the world’s population increases,age-related diseases are emerging as one of the greatest problems facing modern society.The onset of dementia and neurodegenerative diseases is strictly dependent on aging as a major risk factor and has a profound impact on various aspects of the lives of individuals and their families.

Ascertaining the influences of auxiliary qubits on the Einstein–Podolsky–Rosen steering and its directions

Einstein–Podolsky–Rosen(EPR) steering is an example of nontrivial quantum nonlocality and characteristic in the non-classical world.The directivity(or asymmetry) is a fascinating trait of EPR steering,and it is different from other quantum nonlocalities.Here,we consider the strategy in which two atoms compose a two-qubit X state,and the two atoms are owned by Alice and Bob,respectively.The atom of Alice suffers from a reservoir,and the atom of Bob couples with a bit flip channel.The influences of auxiliary qubits on EPR steering and its directions are revealed by means of the entropy uncertainty relation.The results indicate that EPR steering declines with growing time t when adding fewer auxiliary qubits.The EPR steering behaves as damped oscillation when introducing more auxiliary qubits in the strong coupling regime.In the weak coupling regime,the EPR steering monotonously decreases as t increases when coupling auxiliary qubits.The increases in auxiliary qubits are responsible for the fact that the steerability from Alice to Bob(or from Bob to Alice) can be more effectively revealed.Notably,the introductions of more auxiliary qubits can change the situation that steerability from Alice to Bob is certain to a situation in which steerability from Bob to Alice is certain.

Printability disparities in heterogeneous material combinations via laser directed energy deposition:a comparative study

Additive manufacturing provides achievability for the fabrication of bimetallic and multi-material structures;however,the material compatibility and bondability directly affect the parts’formability and final quality.It is essential to understand the underlying printability of different material combinations based on an adapted process.Here,the printability disparities of two common and attractive material combinations(nickel-and iron-based alloys)are evaluated at the macro and micro levels via laser directed energy deposition(DED).The deposition processes were captured using in situ high-speed imaging,and the dissimilarities in melt pool features and track morphology were quantitatively investigated within specific process windows.Moreover,the microstructure diversity of the tracks and blocks processed with varied material pairs was comparatively elaborated and,complemented with the informative multi-physics modeling,the presented non-uniformity in mechanical properties(microhardness)among the heterogeneous material pairs was rationalized.The differences in melt flow induced by the unlike thermophysical properties of the material pairs and the resulting element intermixing and localized re-alloying during solidification dominate the presented dissimilarity in printability among the material combinations.This work provides an in-depth understanding of the phenomenological differences in the deposition of dissimilar materials and aims to guide more reliable DED forming of bimetallic parts.

Bioinspired directional structures for inhibiting wetting on super-melt-philic surfaces above 1200°C

Over the past two decades,superhydrophobic surfaces that are easily created have aroused considerable attention for their superior performances in various applications at room temperature.Nowadays,there is a growing demand in special fields for the development of surfaces that can resist wetting by high-temperature molten droplets(>1200°C)using facile design and fabrication strategies.Herein,bioinspired directional structures(BDSs)were prepared on Y2O3-stabilized ZrO2(YSZ)surfaces using femtosecond laser ablation.Benefiting from the anisotropic energy barriers,the BDSs featured with no additional modifiers showed a remarkable increase from 9.2°to 60°in the contact angle of CaO–MgO–Al2O3–SiO2(CMAS)melt and a 70.1%reduction in the spreading area of CMAS at 1250°C,compared with polished super-CMAS-melt-philic YSZ surfaces.Moreover,the BDSs demonstrated exceptional wetting inhibition even at 1400°C,with an increase from 3.3°to 31.3°in contact angle and a 67.9%decrease in spreading area.This work provides valuable insight and a facile preparation strategy for effectively inhibiting the wetting of molten droplets on super-melt-philic surfaces at extremely high temperatures.

Neonatal Direct Rigid Laryngoscopy and Bronchoscopy: A Near Miss

Airway management is a skill necessary for healthcare providers who manage patients. Intubation is a skill that both anesthesiologists and intensivists use daily. We present a case of a neonate that developed significant worsening stridor after a successful intubation for a hernia repair. After 4 intubation attempts, with easy visualization of the vocal cords and unsuccessful placement of the endotracheal tube, the patient was emergently brought to the operating room for evaluation.

Cracking on a nickel-based superalloy fabricated by direct energy deposition

Cracks have consistently been a significant challenge limiting the development of additive manufactured nickel-based superalloys.It is essential to investigate the location of cracks and their forming mechanism.This study extensively examines the impact of solidification process,microstructural evolution,and stress concentration on crack initiation during direct energy deposition(DED).The results emphasize that the crack formation is significantly related to large-angle grain boundaries,rapid cooling rates.Cracks caused by large-angle grain boundaries and a fast-cooling rate predominantly appear near the edge of the deposited samples.Liquation cracks are more likely to form near the top of the deposited sample,due to the presence ofγ/γ'eutectics.The secondary dendritic arm and the carbides in the interdendritic regions can obstruct liquid flow during the final stage of solidification,which results in the formation of solidification cracks and voids.This work paves the way to avoid cracks in nickel-based superalloys fabricated by DED,thereby enhancing the performance of superalloys.

A Fast and Memory-Efficient Direct Rendering Method for Polynomial-Based Implicit Surfaces

Three-dimensional surfaces are typically modeled as implicit surfaces.However,direct rendering of implicit surfaces is not simple,especially when such surfaces contain finely detailed shapes.One approach is ray-casting,where the field of the implicit surface is assumed to be piecewise polynomials defined on the grid of a rectangular domain.A critical issue for direct rendering based on ray-casting is the computational cost of finding intersections between surfaces and rays.In particular,ray-casting requires many function evaluations along each ray,severely slowing the rendering speed.In this paper,a method is proposed to achieve direct rendering of polynomial-based implicit surfaces in real-time by strategically narrowing the search range and designing the shader to exploit the structure of piecewise polynomials.In experiments,the proposed method achieved a high framerate performance for different test cases,with a speed-up factor ranging from 1.1 to 218.2.In addition,the proposed method demonstrated better efficiency with high cell resolution.In terms of memory consumption,the proposed method saved between 90.94%and 99.64%in different test cases.Generally,the proposed method became more memoryefficient as the cell resolution increased.

Study of the pressure transient behavior of directional wells considering the effect of non-uniform flux distribution

During the production,the fluid in the vicinity of the directional well enters the wellbore with different rates,leading to non-uniform flux distribution along the directional well.However,in all existing studies,it is oversimplified to a uniform flux distribution,which can result in inaccurate results for field applications.Therefore,this paper proposes a semi-analytical model of a directional well based on the assumption of non-uniform flux distribution.Specifically,the direction well is discretized into a carefully chosen series of linear sources,such that the complex well trajectory can be captured and the nonuniform flux distribution along the wellbore can be considered to model the three-dimensional flow behavior.By using the finite difference method,we can obtain the numerical solutions of the transient flow within the wellbore.With the aid of Green's function method,we can obtain the analytical solutions of the transient flow from the matrix to the wellbore.The complete flow behavior of a directional well is perfectly represented by coupling the above two types of transient flow.Subsequently,on the basis of the proposed model,we conduct a comprehensive analysis of the pressure transient behavior of a directional well.The computation results show that the flux variation along the direction well has a significant effect on pressure responses.In addition,the directional well in an infinite reservoir may exhibit the following flow regimes:wellbore afterflow,transition flow,inclined radial flow,elliptical flow,horizontal linear flow,and horizontal radial flow.The horizontal linear flow can be observed only if the formation thickness is much smaller than the well length.Furthermore,a dip region that appears on the pressure derivative curve indicates the three-dimensional flow behavior near the wellbore.

Spontaneous Recovery in Directed Dynamical Networks

Complex networked systems,which range from biological systems in the natural world to infrastructure systems in the human-made world,can exhibit spontaneous recovery after a failure;for example,a brain may spontaneously return to normal after a seizure,and traffic flow can become smooth again after a jam.Previous studies on the spontaneous recovery of dynamical networks have been limited to undirected networks.However,most real-world networks are directed.To fill this gap,we build a model in which nodes may alternately fail and recover,and we develop a theoretical tool to analyze the recovery properties of directed dynamical networks.We find that the tool can accurately predict the final fraction of active nodes,and the prediction accuracy decreases as the fraction of bidirectional links in the network increases,which emphasizes the importance of directionality in network dynamics.Due to different initial states,directed dynamical networks may show alternative stable states under the same control parameter,exhibiting hysteresis behavior.In addition,for networks with finite sizes,the fraction of active nodes may jump back and forth between high and low states,mimicking repetitive failure-recovery processes.These findings could help clarify the system recovery mechanism and enable better design of networked systems with high resilience.

Advances and challenges in direct additive manufacturing of dense ceramic oxides

Ceramic oxides,renowned for their exceptional combination of mechanical,thermal,and chemical properties,are indispensable in numerous crucial applications across diverse engineering fields.However,conventional manufacturing methods frequently grapple with limitations,such as challenges in shaping intricate geometries,extended processing durations,elevated porosity,and substantial shrinkage deformations.Direct additive manufacturing(dAM)technology stands out as a state-of-the-art solution for ceramic oxides production.It facilitates the one-step fabrication of high-performance,intricately designed components characterized by dense structures.Importantly,dAM eliminates the necessity for post-heat treatments,streamlining the manufacturing process and enhancing overall efficiency.This study undertakes a comprehensive review of recent developments in dAM for ceramic oxides,with a specific emphasis on the laser powder bed fusion and laser directed energy deposition techniques.A thorough investigation is conducted into the shaping quality,microstructure,and properties of diverse ceramic oxides produced through dAM.Critical examination is given to key aspects including feedstock preparation,laser-material coupling,formation and control of defects,in-situ monitoring and simulation.This paper concludes by outlining future trends and potential breakthrough directions,taking into account current gaps in this rapidly evolving field.

MSD-Net: Pneumonia Classification Model Based on Multi-Scale Directional Feature Enhancement

Computer-aided diagnosis of pneumonia based on deep learning is a research hotspot.However,there are some problems that the features of different sizes and different directions are not sufficient when extracting the features in lung X-ray images.A pneumonia classification model based on multi-scale directional feature enhancement MSD-Net is proposed in this paper.The main innovations are as follows:Firstly,the Multi-scale Residual Feature Extraction Module(MRFEM)is designed to effectively extract multi-scale features.The MRFEM uses dilated convolutions with different expansion rates to increase the receptive field and extract multi-scale features effectively.Secondly,the Multi-scale Directional Feature Perception Module(MDFPM)is designed,which uses a three-branch structure of different sizes convolution to transmit direction feature layer by layer,and focuses on the target region to enhance the feature information.Thirdly,the Axial Compression Former Module(ACFM)is designed to perform global calculations to enhance the perception ability of global features in different directions.To verify the effectiveness of the MSD-Net,comparative experiments and ablation experiments are carried out.In the COVID-19 RADIOGRAPHY DATABASE,the Accuracy,Recall,Precision,F1 Score,and Specificity of MSD-Net are 97.76%,95.57%,95.52%,95.52%,and 98.51%,respectively.In the chest X-ray dataset,the Accuracy,Recall,Precision,F1 Score and Specificity of MSD-Net are 97.78%,95.22%,96.49%,95.58%,and 98.11%,respectively.This model improves the accuracy of lung image recognition effectively and provides an important clinical reference to pneumonia Computer-Aided Diagnosis.