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.

Is there sufficient evidence to support the use of antibiotic holiday just before the second stage of an infected total hip or knee arthroplasty revision surgery?

The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 2018 on Musculoskeletal Infection.A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review(2023)on diagnosing,managing,and treating periprosthetic knee infections.However,a significant lack of literature exists concerning the optimal duration for the antibiotic holiday,calling for more research before establishing any clinical guidelines.

Present and future of new systemic therapies for early and intermediate stages of hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic liver.The therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at diagnosis.Notwithstanding the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical challenge.Emergent systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of HCC.This review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative intent.We also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative intent.Finally,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.

Debate on direct-anterior vs posterior approach for hip hemiarthroplasty:The authors’insights

We read and discussed the study entitled“Complication rates after direct anterior vs posterior approach for Hip Hemiarthroplasty in elderly individuals with femoral neck fractures”with great interest.The authors have done justice to the topic of comparison of anterior and posterior surgical approaches for bipolar hemiarthroplasty which has been an everlasting debate in the existing literature.However,there are certain aspects of this study that need clarification from the authors.

A FLEXIBLE OBJECTIVE-CONSTRAINT APPROACH AND A NEW ALGORITHM FOR CONSTRUCTING THE PARETO FRONT OF MULTIOBJECTIVE OPTIMIZATION PROBLEMS

In this article, a novel scalarization technique, called the improved objective-constraint approach, is introduced to find efficient solutions of a given multiobjective programming problem. The presented scalarized problem extends the objective-constraint problem. It is demonstrated that how adding variables to the scalarized problem, can lead to find conditions for (weakly, properly) Pareto optimal solutions. Applying the obtained necessary and sufficient conditions, two algorithms for generating the Pareto front approximation of bi-objective and three-objective programming problems are designed. These algorithms are easy to implement and can achieve an even approximation of (weakly, properly) Pareto optimal solutions. These algorithms can be generalized for optimization problems with more than three criterion functions, too. The effectiveness and capability of the algorithms are demonstrated in test problems.

Single-cell profiling of the pig cecum at various developmental stages

The gastrointestinal tract is essential for food digestion,nutrient absorption,waste elimination,and microbial defense.Single-cell transcriptome profiling of the intestinal tract has greatly enriched our understanding of cellular diversity,functional heterogeneity,and their importance in intestinal tract development and disease.Although such profiling has been extensively conducted in humans and mice,the single-cell gene expression landscape of the pig cecum remains unexplored.Here,single-cell RNA sequencing was performed on 45572 cells obtained from seven cecal samples in pigs at four different developmental stages(days(D)30,42,150,and 730).Analysis revealed 12 major cell types and 38 subtypes,as well as their distinctive genes,transcription factors,and regulons,many of which were conserved in humans.An increase in the relative proportions of CD8^(+)T and Granzyme A(low expression)natural killer T cells(GZMA^(low)NKT)cells and a decrease in the relative proportions of epithelial stem cells,Tregs,RHEX^(+)T cells,and plasmacytoid dendritic cells(pDCs)were noted across the developmental stages.Moreover,the post-weaning period exhibited an up-regulation in mitochondrial genes,COX2 and ND2,as well as genes involved in immune activation in multiple cell types.Cell-cell crosstalk analysis indicated that IBP6^(+)fibroblasts were the main signal senders at D30,whereas IBP6^(−)fibroblasts assumed this role at the other stages.NKT cells established interactions with epithelial cells and IBP6^(+)fibroblasts in the D730 cecum through mediation of GZMA-F2RL1/F2RL2 pairs.This study provides valuable insights into cellular heterogeneity and function in the pig cecum at different development stages.

Novel method for identifying the stages of discharge underwater based on impedance change characteristic

It is difficult to determine the discharge stages in a fixed time of repetitive discharge underwater due to the arc formation process being susceptible to external environmental influences. This paper proposes a novel underwater discharge stage identification method based on the Strong Tracking Filter(STF) and impedance change characteristics. The time-varying equivalent circuit model of the discharge underwater is established based on the plasma theory analysis of the impedance change characteristics and mechanism of the discharge process. The STF is used to reduce the randomness of the impedance of repeated discharges underwater, and then the universal identification resistance data is obtained. Based on the resistance variation characteristics of the discriminating resistance of the pre-breakdown, main, and oscillatory discharge stages, the threshold values for determining the discharge stage are obtained. These include the threshold values for the resistance variation rate(K) and the moment(t).Experimental and error analysis results demonstrate the efficacy of this innovative method in discharge stage determination, with a maximum mean square deviation of Scrless than 1.761.

Experimental and numerical analyses of the effect of fibre content on the close-in blast performance of a UHPFRC beam

Limited research has been conducted on the influences of fiber content on close-in blasting characteristics for ultrahigh-performance fiber-reinforced concrete(UHPFRC)beams.This paper aims to address this knowledge gap through experimental and mesoscale numerical methods.Experiments were conducted on ten UHPFRC beams built with varying steel fiber volumetric fractions subjected to close-in explosive conditions.Additionally,this study considered other parameters,such as the longitudinal reinforcement type and ratio.In the case of UHPFRC beams featuring normal-strength longitudinal reinforcement of diametersΦ12,Φ16,andΦ20,a reduction in maximum displacement by magnitudes of19.6%,19.5%,and 17.4%was observed,respectively,as the volumetric fractions of fiber increased from1.0%to 2.5%.In addition,increasing the longitudinal reinforcement ratio and using high-strength steel longitudinal reinforcement both significantly reduced the deformation characteristics and increase the blasting resistances of UHPFRC beams.However,the effects on the local crushing and spalling damage were not significant.A mesoscale finite element model,which considers the impacts of fiber parameters on UHPFRC beam behaviors,was also established and well correlated with the test findings.Nevertheless,parametric analyses were further conducted to examine the impacts of the steel fiber content and length and the hybrid effects of various types of microfibers and steel fibers on the blasting performance of UHPFRC beams.

Correlation of tumor-associated macrophage density and proportion of M2 subtypes with the pathological stage of colorectal cancer

BACKGROUND Colorectal cancer(CRC)is a prevalent global malignancy with complex prognostic factors.Tumor-associated macrophages(TAMs)have shown paradoxical associations with CRC survival,particularly concerning the M2 subset.AIM We aimed to establish a simplified protocol for quantifying M2-like TAMs and explore their correlation with clinicopathological factors.METHODS A cross-sectional study included histopathological assessment of paraffinembedded tissue blocks obtained from 43 CRC patients.Using CD68 and CD163 immunohistochemistry,we quantified TAMs in tumor stroma and front,focusing on M2 proportion.Demographic,histopathological,and clinical parameters were collected.RESULTS TAM density was significantly higher at the tumor front,with the M2 proportion three times greater in both zones.The tumor front had a higher M2 proportion,which correlated significantly with advanced tumor stage(P=0.04),pathological nodal involvement(P=0.04),and lymphovascular invasion(LVI,P=0.01).However,no significant association was found between the M2 proportion in the tumor stroma and clinicopathological factors.CONCLUSION Our study introduces a simplified protocol for quantifying M2-like TAMs in CRC tissue samples.We demonstrated a significant correlation between an increased M2 proportion at the tumor front and advanced tumor stage,nodal involvement,and LVI.This suggests that M2-like TAMs might serve as potential indicators of disease progression in CRC,warranting further investigation and potential clinical application.

Indication and surgical approach for reconstruction with endoprosthesis in bone-associated soft tissue sarcomas:Appropriate case management is vital

It is important for surgeons performing sarcoma surgery to know that bone resection and tumor prosthesis applications in soft tissue sarcomas(STS)have unique features in terms of indication,surgical approach and follow-up,in terms of the management of these cases.Some STS are associated with bone and major neurovascular structures.Bone-associated STS are generally relatively large and relatively deep-seated.Additionally,the tendency for metastasis is high.In some cases,the decision about which structures to resect is difficult.These cases are often accompanied by poor oncological and surgical outcomes.Management of cases should be done by a multidisciplinary team in advanced centers specialized in this field.The surgical team must have sufficient knowledge and experience in the field of limb-sparing surgery.Preoperative evaluation and especially good planning of bone and soft tissue reconstruction are vital.

Regional Brand and High-quality Development of Fruits in Ethnic Areas of the Yangtze River Economic Belt under the Greater Food Approach

Establishing the Greater Food Approach and promoting the Yangtze River Economic Belt s national major regional development strategy can better support and serve the agricultural power and Chinese-style modernization.This paper introduces the characteristics of fruit industry in 16 autonomous prefectures and 47 autonomous counties under the jurisdiction of the Yangtze River Economic Belt.It studies the intellectual property resources of brand marks from the aspects of geographical indications,collective trademarks,certification trademarks,well-known trademarks in China and national design patents,and analyzes the main problems of brand and high-quality development of fruit industry in these ethnic autonomous areas.Finally,it puts forward some strategies,such as improving the protection of intellectual property rights of geographical indications,using intellectual property rights of brand signs,building modern seed industry upgrading project,drawing lessons from the experience of thousand villages demonstration project,ensuring that large-scale poverty does not occur,and building a diversified food supply system.

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.

Mirror Stage Theory Analysis of Bravery in Zootopia(2016)and Nezha(2019)

American Hollywood animated films have conquered the world.In recent years,many successful works have appeared in domestic animated films,bringing new vitality to the Chinese animated film industry.Based on Lacan’s Mirror Stage Theory,this study attempts to start from the bravery of Judy and Nezha,the protagonists of Zootopia(2016)and Nezha(2019).It analyzes and compares their embodiment,formation,influence and reflection with real society to solve the problems of the two brave characters’formation causes,characteristic differences and social influences,including racial discrimination,individualism in American society and family problems in Chinese society.This study sheds light on the transmission of intercultural values in animated films.

Application Effect of Staged Health Education in the Nursing Care of Patients with Upper Gastrointestinal Bleeding

Objective:To investigate the application effect of staged health education in the care of patients with upper gastrointestinal bleeding.Methods:This study takes health education in the care of patients with upper gastrointestinal bleeding as the main direction.160 patients with upper gastrointestinal bleeding who received treatment in our hospital were selected as samples,and the grouping software was used to divide them into the reference group and the study group,with 80 patients each.The reference group and the study group used routine health education and staged health education respectively.Relevant research data were recorded during the nursing process,analyzed,and used as research indicators.Results:The compliance behavior of the study group was higher than that of the reference group after the staged nursing care,and at the same time,the nursing care satisfaction of the study group was higher than that of the reference group(P<0.05).Conclusion:The use of staged health education for the care of patients with upper gastrointestinal bleeding not only enhances the degree of patient awareness and compliance but also improves nursing satisfaction,which is worthy of promotion and application.

The Discourse-Historical Approach of Identity Construction in Corporate Promotional Videos for External Publicity Image

Corporate identity construction of external publicity image is an important part of the development of enterprises.Based on Wodak’s discourse-historical approach,this study takes the text of COFCO’s English promotional video as the research object,analyzes the corporate brand image,media image,organizational image,and environmental image constructed by the enterprises from three steps:linguistic expression,discourse strategy,and theme to provide references for Chinese enterprises to enhance their international influence.

Evaluation of the Effect and Efficiency of Ear Tip Bloodletting Combined with Xianfang Huoming Yin in the Treatment of Early-Stage Wheals

Objective:To evaluate the effect and efficiency of ear tip bloodletting combined with Xianfang Huoming Yin(XFH)in the treatment of early-stage wheals.Methods:70 patients with early-stage wheals admitted from September 2020 to September 2022 were divided into two groups by randomized numerical table method,with 35 cases/group.Both groups received conventional treatment,the control group combined with XFH,and the observation group combined with ear tip bloodletting therapy and XFH.Conscious symptom scores,ocular indexes,therapeutic effects,and sleep quality between the two groups were compared.Results:After the treatment,the patients in the observation group had lower self-awareness symptom scores and sleep quality scores as compared to those in the control group;the diameter of the mass in the observation group was smaller than that of the control group after treatment;the average tear film rupture time and the time taken for the first non-contact tear film to rupture were longer in the observation group than those in the control group;the total effective rate of the treatment in the observation group was higher than that of the control group(P<0.05).Conclusion:Ear tip bloodletting combined with XFH was ideal for the treatment of early-stage wheals and has a high effective rate.

Salvia Polyphenolates Combined with Doxophylline in the Treatment of Patients with Chronic Pulmonary Heart Disease in the Compensated Stage

Objective:To statistically determine the effect of salvia polyphenolates combined with doxophylline treatment in patients with chronic pulmonary heart disease in the compensated stage.Methods:From January 2023 to January 2024,76 patients with chronic pulmonary heart disease in the compensated stage were selected as research subjects.The patients were divided into a research group and a reference group using a randomized numerical table method.The research group was treated with salvia polyphenolates combined with doxophylline,while the reference group received conventional therapy.The treatment effects of the two groups were compared.Results:The patients in the research group,treated with salvia polyphenolates combined with doxophylline,showed maximal ventilation of 73.26±4.83 L/min,left ventricular ejection fraction of 56.14±1.98%,and total effective treatment rate of 94.74%.These results were better than those of the reference group.The differences between the data of the research group and the reference group were statistically significant(P<0.05).Conclusion:For patients with chronic pulmonary heart disease in the compensated stage,treatment with salvia polyphenolates combined with doxophylline significantly improves maximum ventilation and left ventricular ejection fraction,and also results in a higher total effective treatment rate.

The Immediate Analgesic Effect and Impact on Gait Function of Transcutaneous Electrical Nerve Stimulation in Late-Stage Elderly Individuals with Knee Pain: Examination of Gait Function Using an IoT-Based Gait Analysis Device

Purpose: This study verified the effects of transcutaneous electrical nerve stimulation (TENS), which can be worn during walking and exercise, in elderly individuals with late-stage knee pain who exercise regularly. Methods: Thirty-two late-stage elderly individuals were evaluated for knee pain during rest, walking, and program exercises, with and without TENS. Gait analysis was performed using an IoT-based gait analysis device to examine the effects of TENS-induced analgesia on gait. Results: TENS significantly reduced knee pain during rest, walking, and programmed exercises, with the greatest analgesic effect observed during walking. The greater the knee pain without TENS, the more significant the analgesic effect of TENS. A comparison of gait parameters revealed a significant difference only in the gait cycle time, with a trend towards faster walking with TENS;however, the effect was limited. Conclusion: TENS effectively relieves knee pain in late-stage elderly individuals and can be safely applied during exercise. Pain management using TENS provides important insights into the implementation of exercise therapy in this age group.

Stiffness and Shear Stress Distribution of Glulam Beams in Elastic-Plastic Stage:Theory,Experiments and Numerical Modelling

Traditional methods focus on the ultimate bending moment of glulam beams and the fracture failure of materials with defects,which usually depends on empirical parameters.There is no systematic theoretical method to predict the stiffness and shear distribution of glulam beams in elastic-plastic stage,and consequently,the failure of such glulam beams cannot be predicted effectively.To address these issues,an analytical method considering material nonlinearity was proposed for glulam beams,and the calculating equations of deflection and shear stress distribution for different failure modes were established.The proposed method was verified by experiments and numerical models under the corresponding conditions.Results showed that the theoretical calculations were in good agreement with experimental and numerical results,indicating that the equations proposed in this paper were reliable and accurate for such glulam beams with wood material in the elastic-plastic stage ignoring the influence of mechanic properties in radial and tangential directions of wood.Furthermore,the experimental results reported by the previous studies indicated that the method was applicable and could be used as a theoretical reference for predicting the failure of glulam beams.

Analysis of the Energy and Environmental Sustainability of a Built Space System: The Case of Patte d’Oie University Campus in Ouagadougou

The aim of this study was to carry out a dynamic simulation of the energy and environmental performance of a built space system, with a view to assessing its energy and environmental class. The use of a simulation and modeling tool, supported by various methodological references, formed the basis of our approach. Adopting a systemic perspective, we described the structural and functional aspects of the systems making up built spaces, as well as the associated energy flows. Our approach was also based on a typology, taking into account typical days, structural and functional configurations at different scales and angles of observation. The analysis tool we developed in Java was applied to the built space system of the Patte d’Oie university campus in Ouagadougou. Annual electricity consumption was measured at 124387.34 kWh, closely aligned with the average annual electricity bill (125224.31 kWh), with a maximum relative deviation of 1%, followed by a carbon emission balance of 58337.66 kg eq CO2 per year. This validation confirmed the effectiveness of our tool. In addition, following the analysis of electricity consumption using our tool, the university campus was classified in energy class B and environmental class C. These results will be based on the emission factors of the energy mix of the West African Economic and Monetary Union (WAEMU) territory, with particular emphasis on Burkina Faso.