BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with min...BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.展开更多
The design provisions of current seismic codes are generally not very accurate for assessing effects of near-fault ground motions on reinforced concrete （r.c.） spatial frames, because only far-fault ground motions a...The design provisions of current seismic codes are generally not very accurate for assessing effects of near-fault ground motions on reinforced concrete （r.c.） spatial frames, because only far-fault ground motions are considered in the seismic codes. Strong near-fault earth- quakes are characterized by long-duration （horizontal） pulses and high values of the ratio ~PGA of the peak value of the vertical acceleration, PGAv, to the analogous value of the horizontal acceleration, PGAH, which can become critical for girders and columns. In this work, six- and twelve-storey r.c. spatial frames are designed according to the provisions of the Italian seismic code, considering the horizontal seismic loads acting （besides the gravity loads） alone or in combination with the vertical ones. The non- linear seismic analysis of the test structures is performed using a step-by-step procedure based on a two-parameter implicit integration scheme and an initial stress-like itera- tive procedure. A lumped plasticity model based on the Haar-K^n~m principle is adopted to model the inelastic behaviour of the frame members. For the numerical investigation, five near-fault ground motions with high values of the acceleration ratio C^p6A are considered. Moreover, following recent seismological studies, which allow the extraction of the largest （horizontal） pulse from a near-fault ground motion, five pulse-type （horizontal） ground motions are selected by comparing the original ground motion with the residual motion after the pulse has been extracted. The results of the nonlinear dynamic analysis carried out on the test structures highlighted thathorizontal and vertical components of near-fault ground motions may require additional consideration in the seis- mic codes.展开更多
Space deixis is concerned with the specification of location in space relative to that of the participants at coding time in a speech event. Cross-linguistically, it is commonly expressed by the use of (i) demonstrati...Space deixis is concerned with the specification of location in space relative to that of the participants at coding time in a speech event. Cross-linguistically, it is commonly expressed by the use of (i) demonstratives including both demonstrative pronouns and demonstrative adjectives, (ii) deictic adverbs of space, (iii) deictically marked third-person pronouns, and (iv) deictic directionals including both motion affixes, morphemes and particles, and motion verbs. In this article, I shall provide a descriptive analysis of the grammaticalization and lexicalization of space deixis. Data is drawn from a wide variety of genetically unrelated and structurally distinct languages to show the diversity and richness of spatial deictic systems in the world’s languages.展开更多
文摘BACKGROUND Severe open tibia fractures are challenging to treat with a lack of published clear management strategies.Our aim was to provide an overview of the largest singlecenter experience in the literature,with minimum 1-year follow-up,of adult type 3 open tibial shaft fractures at Cambridge University Hospitals(a United Kingdom major trauma center).We sought to define patient characteristics and our main outcome measures were infection,union and re-fracture.AIM To retrospectively define patient and injury characteristics,present our surgical methods and analyze our outcomes–namely infection,union and re-fracture rates.METHODS Consecutive series of 74 patients with 75 open tibial fractures treated between 2014 and 2020(26 classified as Gustilo-Anderson 3A,47 were 3B and two were 3C).Nine patients underwent intramedullary nailing(IMN),61 underwent Taylor spatial frame(TSF)fixation and 5 were treated with Masquelet technique(IMN and subsequent bone grafting).RESULTS Mean follow-up was 16 mo(IMN)and 25 mo(TSF).We had an infection rate of 6.7%(5),non-union rate of 4%(3)and re-fracture rate of 2.7%(2).Average time to union was 22 wk for IMN and 38.6 wk for TSF.Thirty-three cases had a bone defect with a mean of 5.4 cm(2-11).Patient age,sex,diabetes,smoking status or injury severity did not have a significant effect on union time with either fixation method.Our limb salvage rate was 98.7%.CONCLUSION Grade 1 to 3A injuries can effectively be treated with reamed or unreamed IMN.Grade 3B/C injuries are best treated by circular external fixators as they provide good,reproducible outcomes and allow large bone defects to be addressed via distraction osteogenesis.
文摘The design provisions of current seismic codes are generally not very accurate for assessing effects of near-fault ground motions on reinforced concrete （r.c.） spatial frames, because only far-fault ground motions are considered in the seismic codes. Strong near-fault earth- quakes are characterized by long-duration （horizontal） pulses and high values of the ratio ~PGA of the peak value of the vertical acceleration, PGAv, to the analogous value of the horizontal acceleration, PGAH, which can become critical for girders and columns. In this work, six- and twelve-storey r.c. spatial frames are designed according to the provisions of the Italian seismic code, considering the horizontal seismic loads acting （besides the gravity loads） alone or in combination with the vertical ones. The non- linear seismic analysis of the test structures is performed using a step-by-step procedure based on a two-parameter implicit integration scheme and an initial stress-like itera- tive procedure. A lumped plasticity model based on the Haar-K^n~m principle is adopted to model the inelastic behaviour of the frame members. For the numerical investigation, five near-fault ground motions with high values of the acceleration ratio C^p6A are considered. Moreover, following recent seismological studies, which allow the extraction of the largest （horizontal） pulse from a near-fault ground motion, five pulse-type （horizontal） ground motions are selected by comparing the original ground motion with the residual motion after the pulse has been extracted. The results of the nonlinear dynamic analysis carried out on the test structures highlighted thathorizontal and vertical components of near-fault ground motions may require additional consideration in the seis- mic codes.
基金This article is based on, and a radically revised, expanded and updated version of section523 of my forthcoming book Prag-matics(Oxford University Press,2006)
文摘Space deixis is concerned with the specification of location in space relative to that of the participants at coding time in a speech event. Cross-linguistically, it is commonly expressed by the use of (i) demonstratives including both demonstrative pronouns and demonstrative adjectives, (ii) deictic adverbs of space, (iii) deictically marked third-person pronouns, and (iv) deictic directionals including both motion affixes, morphemes and particles, and motion verbs. In this article, I shall provide a descriptive analysis of the grammaticalization and lexicalization of space deixis. Data is drawn from a wide variety of genetically unrelated and structurally distinct languages to show the diversity and richness of spatial deictic systems in the world’s languages.
