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.

Development of 3D bicontinuous metal-intermetallic composites through subsequent alloying process after liquid metal dealloying

This study presents a novel process for the fabrication of metal-intermetallic composites with a 3D bicontinuous structure, achieved through a combination of liquid metal dealloying(LMD) and subsequent alloying. Initially, porous Ti structures are produced using the LMD process, followed by immersion in a molten Mg-3Al(wt%) metal. Due to the higher thermodynamic miscibility of Al with Ti compared to Mg, the concentration of Al in the Ti matrix increases as the immersion time increases. This results in a sequential phase transition within the Ti matrix: α-Ti → Ti_(3)Al → Ti Al. The phase transition considerably affects the hardness and strength of the composite material,with the Mg-Ti_(3)Al-Ti Al composite exhibiting a maximum hardness nearly twice as high as that of the conventional Mg-Ti composite. This innovative process holds potential for the development of various bicontinuous metal-intermetallic composites.

《维也纳条约法公约》第31.3条“Subsequent Practice”研究

从国际法制和相关案例来看,嗣后惯例的效力和构成要素是模糊的。嗣后惯例并非正式的、文本性协定,其解释性价值完全依赖于一致性的行为、所有当事方间达成的协定和作为单一的自主解释之合成解释。嗣后惯例必须是确立了当事方间的协定,当事方在条约履行中明确地实施了本质上相同或一致的行为。嗣后惯例的效力是一个颇有争议的问题,尤其是部分缔约方的惯行对原条约和其他缔约方的效力问题。相互矛盾的嗣后惯例会有不同的效力,这取决于所涉的多边条约机制。该惯例的形成有赖于国家在适用条约时有机会采取某些行动,并不要求每个当事方都必须单独地实施足以被接受为惯例的行为,只需要所有当事方接受,甚至是默示地接受。嗣后惯例与嗣后协定间存在联系与差异。

Comparison of concomitant and subsequent cholangiocarcinomas associated with hepatolithiasis:Clinical implications

AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.

Effects of the Residues of Cuscuta campestris and Mikania micrantha on Subsequent Plant Germination and Early Growth

Cuscuta campestris, a dodder, can parasitize and suppress a scrambling herbaceous to semi-woody perennial vine, Mikania micrantha, one of the most destructive weeds in the world. To assess the effects of the mixed residue of C. campestris and M. micrantha on the subsequent plant community, we conducted a one-year experiment on the germination and seedling growth of subsequent plant community after the application of C. campestris. Seven treatments of varying proportions of C. campestris and M. mierantha residue on 21 subject trees and shrubs, which were commonly found in South China, resulted in a germination rate of 35.3% for all 8 715 seeds from 18 species, ranging from 5.7 to 81.9%; the remaining 3 species failed to germinate. ANOVA analysis showed that the residue did not affect the germination, growth, or mortality of the trees and shrubs. The germinated C. campestris seeds from the residue coiled the seedlings of most of the species, but less than 4% host death caused by C. campestris. In addition, the residue did not affect the germination of the herbaceous seedlings originating from the loam, and the similarity coefficients of the germinated seedlings between the treatments were very high. These results suggested that the residue had no negative impact on the germination and early seedling stages of the tree, shrub and grass species of the subsequent plant community. The use of C. campestris residue had a positive effect on the growth of M. micrantha, but it did not change the trend of M. micrantha being suppressed because re-parasitization occurred soon after the growth restarted. No negative effect was detected on the other species as a result of the parasitization of C. campestris or by the use of the mixed residue. This suggests that C. campestris is likely to be an effective and promising ecologically safe native herbaceous agent for controlling M. micrantha.

Neuroprotective effects of ischemic preconditioning on hippocampal CA1 pyramidal neurons through maintaining calbindin D28k immunoreactivity following subsequent transient cerebral ischemia

Ischemic preconditioning elicited by a non-fatal brief occlusion of blood flow has been applied for an experimental therapeutic strategy against a subsequent fatal ischemic insult. In this study, we investigated the neuroprotective effects of ischemic preconditioning（2-minute transient cerebral ischemia） on calbindin D28k immunoreactivity in the gerbil hippocampal CA1 area following a subsequent fatal transient ischemic insult（5-minute transient cerebral ischemia）. A large number of pyramidal neurons in the hippocampal CA1 area died 4 days after 5-minute transient cerebral ischemia. Ischemic preconditioning reduced the death of pyramidal neurons in the hippocampal CA1 area. Calbindin D28k immunoreactivity was greatly attenuated at 2 days after 5-minute transient cerebral ischemia and it was hardly detected at 5 days post-ischemia. Ischemic preconditioning maintained calbindin D28 k immunoreactivity after transient cerebral ischemia. These findings suggest that ischemic preconditioning can attenuate transient cerebral ischemia-caused damage to the pyramidal neurons in the hippocampal CA1 area through maintaining calbindin D28k immunoreactivity.

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction

OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.

CONVERSION OF SURGICALLY VERIFIED UNRESECTABLE TO RESECTABLE HEPATOCELLULAR CARCINOMA(A REPORT OF 26 PATIENTS WITH SUBSEQUENT RESECTION)

During the period 1978-1987, 255 patients with pathologically proven hepatocellular carcinoma (HCC) were determined by laparotomy to be un-resectable, 155 (60.8%) out of them had their tumor mainly confined in right or left lobe and considered to be potentially resectable if remarkable tumor shrinkage appears after treatment. Second look operation was performed in 26 (16.8%) out of the 155 patients after marked reduction of tumor size, resection was done in all of these 26 patients. Triple or quadruple combination treatment with hepatic artery ligation (HAL), hepatic artery infusion (HAI) with chemotherapy, radiotherapy using linear accelerator, and radioimmunotherapy using 131-I antihu-man HCC ferritin antibody yielded the highest conversion rate (29.8%, 14/47) as compared to double combination treatment with HAL+HAI, or cryosur-gery+HAL (16.9%, 12/71) and single treatment with HAL or HAI or HAE (embolization) (0%, 0/37). The median tumor size of these 26 patients was reduced from 9.5 cm to 5.0 cm after combination treatment. The median interval between the first laparotomy and the subsequent resection was 5.0 (2-16) months. The survival rates calculated by life table method were: 1-year 86.5%, 2-year 74.3% and 3-year 74.3%. Nine cases have survival more than 3 years. Thus, multimodality combination treatment with subsequent resection might prolong survival significantly for some patients with unresectable HCC particularly confined in right lobe of a cirrhotic liver.

Subsequent yield loci of 57540 aluminum alloy sheet

Complex loading paths were realized with cruciform specimens and biaxial loading testing machine. Experimental method for determining the subsequent yield locus of sheet metal was established. With this method,the subsequent yield loci of 5754O aluminum alloy sheet were obtained under complex loading paths. Theoretical subsequent yield loci based on Yld2000-2d yield criterion and three kinds of hardening modes were calculated and compared with the experimental results. The results show that the theoretical subsequent yield loci based on mixed hardening mode describe the experimental subsequent yield loci well,whereas isotropic hardening mode,which is widely used in sheet metal forming fields,predicts values larger than the experimental results. Kinematic hardening mode predicts values smaller than the experimental results and its errors are the largest.

Effect of drawbead on forming performance of subsequent sheet

In order to research the plastic performance of sheet going through the drawbead and the simple tensile test of sheet, the influence of drawbead structure parameters on sheet performance and the subsequent performance of the sheet were performed to investigate the residual deformation characteristics of the sheet through different drawbead structures, and also the influences of drawbead structures and geometry parameters on pre-deformation and subsequent forming characters of sheet were analyzed. The results show that the pre-deformation decreases with the increase of the round corner radius, the pre-deformation increase with the increase of the height of drawbead, and the subsequent forming characteristics of sheet going through drawbead are remarkably different from undeformed sheet and these differences heavily depend on the pre-deformation. With the increases of pre-deformation, the yield ratio increases, but the subsequent elongation exponential decreases. These means deformability of the sheet is significantly reduced. As the structure of drawbead changes, the mechanical characteristics of material in different cyclic loading conditions also change. For the BUFDE+Z deep drawing steel sheet, the subsequent performance of the sheet is hardened when the pre-deformation is greater than 0.044. For the DC52D+ZF hot-galvanize steel sheet, the subsequent performance of the sheet begins to harden when the pre-deformation is greater than 0.079, and it presents that the pre-deformation is not bigger than 0.052.

Study on Key Problems of a New Environmental Dredging Based on Ecological Protection and Subsequent Ecological Restoration

[Objective] The research aimed to study key problems of a new environmental dredging based on ecological protection and subsequent ecological restoration. [Method] People paid more attention to sediment pollutant removal in environmental dredging, without considering coming aquatic eco-restoration work after dredging. Factor affecting aquatic ecosystem existence and growth was screened, and ecological dredging manner was put forward. [Result] On the basis of analyzing dredging objective, effect and influence, started from ecological protection and subsequent ecological restoration, water depth and substrate were screened as priority control factors of the environmental sediment dredging. New manner of combining sediment dredging to reshape underwater terrain was put forward. [Conclusion] The research provided solution for water depth and substrate demands of the subsequent ecological restoration.

Effects of Helium Implantation and Subsequent Electron Irradiation on Microstructures of Fe-11 wt.% Cr Model Alloy

Helium effects on dislocation and cavity formation of Fe-11 wt.% Cr model alloy are investigated. Single-beam(electron) and dual-beam(He^+/e^-) irradiations are performed at 350℃ and 400℃ using an ultra-high voltage electron microscope combined with ion accelerators. In-situ observation shows that the growth rate of dislocation loops is reduced in the helium pre-injected specimen. The mean size of cavities decreased in the helium preinjected specimen. The possible mechanisms are discussed.

Shake-up Processes in the 3d Photoionization of Sr I and the Subsequent Auger Decay

The shake-up processes accompanied by 3d photoionization and subsequent Auger decay are studied using multiconfiguration Dirac-Fock methods.Generalagreement is obtained with the experimental results for both the photoelectron and Auger electron spectra.The energy and relative intensity of the 5s → 6s shake-up accompanied by the 3d photoionization process are identified quantitatively.

The Time-Space Features of Ms≥6.0 Earthquakes Subsequent to Ms≥7.0 Earthquakes in the Mainland of China

In this paper,the time-space features of Ms≥6.0 strong earthquakes that have occurred on the Chinese mainland since the beginning of this century were analyzed; the effect of Ms≥7.0 large shocks in mitigating Ms≥6.0 strong earthquakes subsequent to them vas studied both temporally and spatially; and the accumulative probabilities for the occurrence of Ms≥6.0 strong earthquakes subsequent to Ms≥7.0 large shocks were calculated.The results seem to imply that the effect of Ms≥7.0 large shocks in mitigating subsequent strong events is relatively obvious within certain time-space ranges.This is because the strain energy accumulated over a long time in the region around the source has been mostly released through the fracture produced by the large shock,the possibility for another large fracture to occur again in the same region within a certain period of time has been greatly reduced and therefore the probability for subsequent strong earthquakes to occur in that region is very low.These results can

一种抑制后续换相失败的电流偏差控制参数整定方法

电网换相换流器型高压直流输电(line commutated converter-based high voltage direct current,LCC-HVDC)系统若发生后续换相失败,将严重影响交直流混联电网的安全稳定运行。文中首先针对LCC-HVDC系统故障恢复过程中电流偏差控制作用阶段易再次发生换相失败的问题,对电流偏差控制参数与换相失败之间的关系进行理论分析,发现此阶段系统若不发生换相失败,逆变侧LCC直流电压和交流换相电压须满足一定的约束关系,且该约束关系受电流偏差控制参数的直接影响。然后,基于理论分析结果,提出一种电流偏差控制参数整定方法,可改善系统故障恢复过程中对直流电压恢复速度和程度的控制要求,使系统更易满足直流电压与交流换相电压稳定运行约束关系,以降低后续换相失败概率。最后,利用PSCAD/EMTDC仿真平台CIGRE标准测试模型验证了理论分析的正确性以及参数整定方法的有效性。

奖励式众筹的后续市场效应:基于场景视角的研究

场景化赋予奖励式众筹独特的情感体验与社群价值,使得国内的众筹模式逐渐脱离早期单一的融资属性,向新品推广、品牌孵化、场景营销等多元化功能演变。文章选取小米有品众筹平台数据作为研究样本,基于场景视角探讨了奖励式众筹的场景化运作与价值创造逻辑,通过有序Logistic模型考察了奖励式众筹的后续市场效应,以及场景营销、场景互动的调节作用。研究发现,奖励式众筹绩效对于产品后续市场表现具有显著的正向影响,场景营销能够强化这一关系,而普通用户互动比领先用户互动的调节作用更为显著。异质性分析发现,奖励式众筹的后续市场效应在平台嵌入程度较高的企业中更为显著。进一步研究发现,奖励式众筹具有品牌推广效应,能够显著提升企业的品牌关注度。文章基于场景视角拓展了众筹研究的边界,对奖励式众筹平台及企业的场景化创新具有一定的指导意义。

基于生态补偿的南水北调后续工程水价研究

制定科学合理的跨流域调水工程水价是开展水源区生态补偿的重要途径之一。在现有水价的基础上,新增生态补偿作为水价的重要组成部分,运用机会成本法测算南水北调东线工程水源区生态补偿标准,并引入社会发展阶段系数和政府支付能力系数对其进行修正,构建计入生态补偿的南水北调后续工程水价定价模型。以南水北调东线一期工程胶东干线为例,得到2016、2020年水源区的理论生态补偿标准分别为116.121、199.992亿元,在现行价格基础上水价需分别提高0.93、4.51元/m^(3)。结果表明,生态补偿会耗费大量资金,只有当工程调水能力达到规划设计规模时,持续性调水才能逐步降低供水成本,否则水价会超出受水区的承受范围,工程效益也难以发挥。

担保型以物抵债协议真要识契——对《<民法典>合同编通则部分司法解释》第28条的再思考

《合同编通则司法解释》否定担保型以物抵债协议的独立地位,协调了《担保制度司法解释》第68条与《民间借贷司法解释》第23条的关系,其采取的“完成财产权利所有权变动公示的属于让与担保、未完成财产权利所有权变动公示的仅能就其受偿”做法虽大体合理,但却忽视了履约期满前签订的以物抵债协议中“为清偿而给付”情形的剔除以及存在多个未完成财产权利所有权变动公示的担保型以物抵债法律关系时各个债权人的受偿规则建构。出于尊重真实意思表示、细化操作规则的考虑,有必要重新厘定担保型以物抵债协议的概念范围、完善未完成财产权利所有权变动公示的担保型以物抵债协议中的受偿规则。

股权众筹企业后续融资绩效的影响因素研究

股权众筹是一种新型的融资模式,具有门槛低、效率高、成本低等优势,为中小企业拓展了融资渠道,吸收了大众闲散资金。但这种新兴的融资模式也存在诸多问题,如法律环境、信用体系、知识产权保护和社会认知等,可能影响企业高质量发展,让投资者的决策面临风险。本文基于信号理论,利用股权众筹平台Seedrs和Crunchbase的相关数据,从项目特征、众筹绩效、获得的广告效应三个方面,对完成股权众筹的初创企业的后续融资绩效影响因素进行了研究。研究发现,项目特征中的项目估值、目标金额、出让股权份额、政策优惠程度,以及众筹绩效中的先前的融资经历、获得的广告效应中的投资者数量,均会显著正向影响后续融资绩效(是否获得后续融资、后续融资所需时间或后续融资金额)。除此之外,项目视频介绍长度、所在城市等级、公司经营对象、数字化程度、融资完成时间、公司年龄对于后续融资也有一定影响。本文研究结论可为投资者、创业者和平台提供有效的决策参考。

基于故障安全域的混合级联直流输电系统后续换相失败抑制策略

混合级联直流输电系统兼顾了电网换相换流器(LCC)和模块化多电平换流器(MMC)的优势,具有良好的工程应用前景,但系统逆变侧LCC与MMC间复杂的交直流耦合特性增加了后续换相失败的抑制难度。为此,该文提出了一种应对混合级联系统后续换相失败的协调控制策略。首先,分析了控制器交互期间电气量波动和LCC无功需求对系统恢复产生的不利影响,并在考虑控制器作用和MMC动态无功支撑的基础上建立了多电气量耦合作用下的故障安全域;其次,通过对混合级联系统和基于电网换相换流器的高压直流输电故障安全域对比分析,提出了一种基于MMC和低压限流环节(VDCOL)的协调控制策略,以实现系统后续换相失败抑制和功率快速平稳恢复相协调;最后,基于PSCAD/EMTDC分别在不同严重程度交流故障、不同短路比和不同故障持续时间下进行仿真对比分析,验证了所提协调控制策略的有效性。