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.

Total flavonoids of Astragalus membranaceus protect against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced neurotoxicity in mice by inhibiting ferroptosis through SLC7A11/GPX-4 signaling pathway

Parkinson’s disease(PD)is a common neurodegenerative disorder with no cure.Astragalus membranaceus is used in Chinese culture as a food supplement to boost immunity.The present study aimed to explore the neuroprotective effects of total flavonoids extracted from A.membranaceus(TFA)and their protective mechanisms.TFA offered neuroprotection against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine(MPTP)in the mouse model of Parkinsonism,by improving behavior performance in the gait analysis and pole test,and inhibiting the decline of tyrosine hydroxylase(TH)positive neurons and TH protein expression in substantia nigra of mice.TFA also prevented 1-methyl-4-phenylpyridinium(MPP+)induced neurotoxicity in SHSY5Y cells,by increasing GSH and GSH/GSSG ratio,and reducing reactive oxygen species.In addition,the neuroprotective effects of TFA were associated with its ability to restore MPTP/MPP+induced downregulation of SLC7A11 and glutathione peroxidase 4(GPX-4).In conclusion,we demonstrated that TFA exerted significant neuroprotection against MPTP/MPP+induced neurodegeneration by inhibiting ferroptosis through the regulation of SLC7A11/GPX-4 axis,suggesting the use of TFA as a possible food supplement in the prevention of PD.

Interfacial friction effects on sealing performances of elastomer packer

Elastomer sealing performance is of critical importance for downhole tools application including the use of fracturing(Frac)plugs during multi-stage hydraulic fracking.In practice sealing performances of such plugs are normally evaluated through pressure tests,and in numerical simulation studies,maximum contact stress,average contact stress and contact length data are used to determine sealing quality between a packer and casing.In previous studies,the impact of friction forces on sealing performance is often overlooked.This work aims to fill this knowledge gap in determining the influence of friction forces on elastomer packer sealing performances.We first determined the most appropriate constitutive hyperelastic model for the elastomers used in frac plug.Then we compared analytical calculation results with Finite Element Analysis simulation using a simplified tubular geometry and showed the significant influences on interfacial friction on elastomer packer stress distribution,deformation,and contact stress after setting.With the demonstration of validity of FEA method,we conducted systematic numerical simulation studies to show how the interfacial friction coefficients can affect the maximum contact stress,average contact stress,contact stress distribution,and maximum mises stress for an actual packer used in plug products.In addition,we also demonstrated how the groove in a packer can affect packer deformation and evolvement during setting with the consideration of interfacial stress.This study underscores the critical role that friction forces play in Frac plug performance and provides a new dimension for optimizing packer design by controlling interfacial interactions at the packer contact surfaces.

Quantification of Total Phenols, Total Flavonoids, Total Anthocyanins and Evaluation of Antioxidant and Antiradical Activities of Detarium Senegalense Extracts from Chad

The aim of the present work is to assess the value of Detarium Senegalense by determining the content of total phenols, total flavonoids and total anthocyanins, and by evaluating the free radical scavenging activity of Detarium Senegalense extracts. For this purpose, sequential extraction using solvents of increasing polarity was essential. The various extracts obtained underwent phytochemical and biochemical analyses. Phytochemical screening revealed the presence of flavonoids, alkaloids, tannins, polyphenols, anthocyanins and steroids/terpenes. Quantitative analysis of total polyphenols, total flavonoids and total anthocyanins yielded the following results: total flavonoids (0.803 ± 0029 mg EQ/100g P for acetone extract of roots and 0.871 ± 0.401 mg EQ/100g P for methanol extract of leaves);total polyphenols (23.298 ± 12.68 mg EAG/100g P for acetone extract of roots and 24.69 ± 0.49 401 mg EAG/100g P for methanol extract of leaves);total monomeric anthocyanins (44.697 ± 0.939 mg EC3G/100g P and 16.699 ± 0.193 mg EC3G/100g P respectively for acetone and methanol extracts of stem bark). DPPH free radical scavenging activity was 1.674 ± 0.023 mg/mL for the acetone extract and 0.934 ± 0.24 mg/mL for the methanol extract of roots. .

Physicochemical and Biochemical Characterization, Total Phenolic and Energy Value from Bulbs of Different Onion (Allium cepa L.) Varieties in Senegal

The purpose of this study is to investigate the physicochemical properties of some local varieties of onion (Allium cepa L.) and compare them with an imported variety, all collected in May 2021. Proteins, reducing sugars, lipids, and polyphenol content were estimated according to the AFNOR standardized methods. The determination of calcium, magnesium, iron, sodium, potassium and phosphorus was performed by atomic absorption spectrophotometer coupled with a CCD detector. The results highlighted an average acidity of 0.377% ± 0.002% lower than the value of the imported variety which is 0.520% ± 0.001%. Local varieties have a pH ranging from 6.35 ± 0.003 to 6.42 ± 0.004, while the variety has a pH of 6.36 ± 0.003. The ash and dry matter contents vary respectively from 4.788% ± 0.004% to 8.253% ± 0.003% and 7.945% ± 0.021% to 11.945% ± 0.007% for the local varieties. Moreover, the imported one has ash and dry matter contents of 5.175% ± 0.007% and 10.035% ± 0.021% respectively. The results show that the protein, reducing sugar and lipid contents in the local onion varieties vary respectively from 2.815 ± 0.000 to 15.634 ± 0.001 g·100 g-1;4.691 ± 0.001 to 12.596 ± 0.002 g·100 g-1 and 0.006 ± 0.001 to 0.050 ± 0.057 g·100 g-1. Furthermore, the imported variety has a protein, reducing sugar and lipid content of 5.649 ± 0.002;8.565 ± 0.002 g·100 g-1 and 0.011 ± 0.010 g·100 g-1 respectively. The maximum levels of total polyphenols are obtained in the imported variety, Bellani and Gandiol, respectively 9.973 ± 0.001, 4.535 ± 0.002, and 3.425 ± 0.006 mg EAG/g of dry matter. The local varieties have a significant calorific intake of between 35.451 ± 0.001 and 112.980 ± 0.003 kcal·100 g-1 compared to the imported one with an energy value of 56.953 ± 0.001 kcal·100 g-1 of dry matter. The bulbs of different onion varieties studied have a fairly high content of mineral elements. The potassium content of local varieties is between 502.16 ± 0.06 mg·100 g-1 and 582.77 ± 0.04 mg·100 g-1 while the imported variety has a content of 536.62 ± 1.30 mg·100 g-1. They note that the local varieties have a better calcium content (249.75 ± 0.07 to 434.20 ± 0.57 mg·100 g-1) and magnesium (142.15 ± 0.07 to 162.60 ± 0.42 mg·100 g-1) than the imported variety (229.58 ± 0.04 mg·100 g-1) except for the varieties White Grano (228.29 ± 0.01 mg·100 g-1) and Rouge Amposta (117.00 ± 0.42 mg·100 g-1) respectively. These results reveal that Gandiol, Dayo and Orient F1 are nutritionally found better due to their higher antioxidant property, proteins, carbohydrates, and reducing sugar and should be included in diets to supplement our daily allowance needed by the body.

Evolution and Application of Sealing Ability of Gypsum Caprocks under Temperature-Pressure Coupling:An Example of the ZS5 Well in the Tazhong Area of the Tarim Basin

Gypsum caprocks'sealing ability is affected by temperature-pressure coupling.Due to the limitations of experimental conditions,there is still a lack of triaxial stress-strain experiments that simultaneously consider changes in temperature and pressure conditions,which limits the accuracy of the comprehensive evaluation of the brittle plastic evolution and sealing ability of gypsum rocks using temperature pressure coupling.Triaxial stress-strain tests were utilized to investigate the differences in the evolution of the confinement capacity of gypsum rocks under coupled temperaturepressure action and isothermal-variable pressure action on the basis of sample feasibility analysis.According to research,the gypsum rock's peak and residual strengths decrease under simultaneous increases in temperature and pressure over isothermal pressurization experimental conditions,and it becomes more ductile.This reduces the amount of time it takes for the rock to transition from brittle to plastic.When temperature is taken into account,both the brittle–plastic transformation's depth limit and the lithological transformation of gypsum rocks become shallower,and the evolution of gypsum rocks under variable temperature and pressure conditions is more complicated than that under isothermal pressurization.The sealing ability under the temperature-pressure coupling is more in line with the actual geological context when the application results of the Well#ZS5 are compared.This provides a theoretical basis for precisely determining the process of hydrocarbon accumulation and explains why the early hydrocarbon were not well preserved.

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.

Fracture sealing performance of granular lost circulation materials at elevated temperature:A theoretical and coupled CFD-DEM simulation study

Lost circulation is a common downhole problem of drilling in geothermal and high-temperature,high-pressure(HTHP)formations.Lost circulation material(LCM)is a regular preventive and remedial measure for lost circulation.However,conventional LCMs seem ineffective in high-temperature formations.This may be due to the changes in the mechanical properties of LCMs and their sealing performance under high-temperature conditions.To understand how high temperature affects the fracture sealing performance of LCMs,we developed a coupled computational fluid dynamics-discrete element method(CFD-DEM)model to simulate the behavior of granular LCMs in fractures.We summarized the literature on the effects of high temperature on the mechanical properties of LCMs and the rheological properties of drilling fluid.We conducted sensitivity analyses to investigate how changing LCM slurry properties affected the fracture sealing efficiency at increasing temperatures.The results show that high temperature reduces the size,strength,and friction coefficient of LCMs as well as the drilling fluid viscosity.Smaller,softer,and less frictional LCM particles have lower bridging probability and slower bridging initiation.Smaller particles tend to form dual-particle bridges rather than single-particle bridges.These result in a deeper,tighter,but unstable sealing zone.Reduced drilling fluid viscosity leads to faster and shallower sealing zones.

Dynamic evaluation on sealing capacity of caprocks of the Meso-Neoproterozoic reservoirs in Ordos Basin,China

The Meso-Neoproterozoic is a new play in the Ordos Basin.A deeper understanding about the dynamic relationship between the caprocks and the source rocks is needed.Based on the comprehensive analysis of hydrocarbon source development characteristics of the Meso-Neoproterozoic and its overlying strata,as well as the formation contact relationships,lithology characteristics and exploratory drilling data,it is recognized that the Meso-Neoproterozoic contains two types of petroleum accumulation assemblage,that is,the“self-sourced indigenous”and“upper source rock-lower reservoir”assemblages.The former is mainly controlled by the development and distribution of source rocks of the Changcheng System,with the Lower Cambrian shale sequence as its caprock.The later is controlled by the superposition between the Meso-Neoproterozoic and its overlying source rocks and this assemblage is mainly distributed in Hangjinqi and Pingliang areas with the Carboniferous-Permian shale sequence as its caprock.The dynamic evaluation on the displacement pressure serves to reconstruct the displacement pressure history of the caprock.The results show that the shale sequence of the Cambrian Maozhuang Formation in well XY 1 in the southern Ordos Basin has possibly acquired the ability of sealing natural gas since the early of Late Triassic.Its displacement pressure increased rapidly up to 20 MPa during the Late Triassic-Jurassic and keeps at 9.2 MPa at present,indicating fair sealing ability.The Carboniferous-Permian caprocks in Hangjinqi area could have acquired the ability to seal natural gas in the Late Jurassic-Early Cretaceous,and the present-day displacement pressure is 9e12 MPa,indicating good sealing ability.The upper Paleozoic caprock in Pingliang area has been able to seal natural gas since the Early Jurassic,with a maximum displacement pressure of 23 MPa during the Cretaceous period and a current value of 17 e20 MPa,indicative of strong ability to seal natural gas.The sealing ability of caprocks of both the“selfsourced indigenous”and“upper source rock-lower reservoir”assemblages has come into being earlier than or at least no later than the peak gas generation of the source rocks and therefore the caprocks are dynamically effective in geohistory.The Meso-Neoproterozoic reservoirs in the Ordos Basin are well preserved and probabally of better potential for exploration in terms of the caprock-source rock combination.

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

BACKGROUND The totally preperitoneal(TPP)approach is a new concept that was recently introduced.Although the TPP approach combined with single-incision laparoscopic hernia repair has its own advantages,there is little evidence reflecting the characteristics and feasibility of either approach.AIM To analyze the potential applications of single-incision laparoscopic TPP(SILTPP)inguinal hernia hernioplasty for the treatment of inguinal hernias.METHODS A total of 152 SIL-TPP surgeries were performed at the First Affiliated Hospital of Ningbo University from February 2019 to November 2022.A single-port,named Iconport,and standard laparoscopic instruments were used during the operation.Demographic data,intraoperative parameters and short-term postoperative outcomes were collected and retrospectively analyzed.RESULTS The demographic data of 152 patients underwent SIL-TPP were shown in Table 1.The average age was 49.5 years(range from 21 to 81 years).The average body mass index was 27.7 kg/m^(2)(range from 17.7 kg/m^(2) to 35.6 kg/m^(2)).SIL-TPP were conducted successfully in 147 patients.Three patients were converted to the SILtransabdominal preperitoneal laparoscopic herniorrhaphy at the initial stage of the study due to a lack of experience.In 2 patients with incisional hernias,an auxiliary operation hole was added during the SIL-TPP procedure,as required for surgery.The mean operative time was 64.5 minutes(range:36.0-110.0 minutes)for unilateral direct and femoral hernias and 81.6 minutes for indirect hernias(range:40.0-150.0 minutes).The mean postoperative hospital stay was 3.4 days.CONCLUSION SIL-TPP is feasible and has advantages for inguinal hernia repair.SIL-TPP has potential benefits for patients with various abdominal wall hernias.Consequently,doctors should be encouraged to actively apply the TPP approach combined with a single incision in their daily work.

Mortality rate after total knee arthroplasty or total hip arthroplasty in patients with a history of liver transplant

In this editorial I comment on the article by Ahmed et al published in a recent issue of the World J Orthop 2023;14:784-790.It is well known that patients who have undergone a liver transplant(LT)may need to have a total hip arthroplasty(THA)or total knee arthroplasty(TKA)implanted.Ahmed et al stated that the mortality rate in these patients was similar to the one of the general population.However,there are three articles previously published that found higher mortality in LT patients who experienced THA/TKA than in the general population(individuals without LT).Therefore,in this Editorial I would like to point out that there is controversy in the literature regarding whether LT patients undergoing THA/TKA have higher mortality than the general population.Therefore,future research should attempt to resolve this controversy.

Comparison efficacy and safety of total laparoscopic gastrectomy and laparoscopically assisted total gastrectomy in treatment of gastric cancer

BACKGROUND The development of laparoscopic technology has provided a new choice for surgery of gastric cancer(GC),but the advantages and disadvantages of laparoscopic total gastrectomy(LTG)and laparoscopic-assisted total gastrectomy(LATG)in treatment effect and safety are still controversial.The purpose of this study is to compare the efficacy and safety of the two methods in the treatment of GC,and to provide a basis for clinical decision-making.AIM To compare the efficacy of totally LTG(TLTG)and LATG in the context of radical gastrectomy for GC.Additionally,we investigated the safety and feasibility of the total laparoscopic esophagojejunostomy technique.METHODS Literature on comparative studies of the above two surgical methods for GC(TLTG group and LATG group)published before September 2022 were searched in the PubMed,Web of Science,Wanfang Database,CNKI,and other Chinese and English databases.In addition,the following search keywords were used:Gastric cancer,total gastrectomy,total laparoscopy,laparoscopy-assisted,esophagojejunal anastomosis,gastric/stomach cancer,total gastrectomy,totally/completely laparoscopic,laparoscopic assisted/laparoscopy assisted/laparoscopically assisted,and esophagojejunostomy/esophagojejunal anastomosis.Review Manager 5.3 software was used for the meta-analysis after two researchers independently screened the literature,extracted the data,and evaluated the risk of bias in the included studies.RESULTS After layer-by-layer screening,258 pieces of literature were recovered,and 11 of those pieces were eventually included.This resulted in a sample size of 2421 instances,with 1115 cases falling into the TLTG group and 1306 cases into the LATG group.Age or sex differences between the two groups were not statistically significant,according to the meta-analysis,however the average body mass index of the TLTG group was considerably higher than that of the LATG group(P=0.01).Compared with those in the LATG group,the incision length in the TLTG group was significantly shorter(P<0.001),the amount of intraoperative blood loss was significantly lower(P=0.003),the number of lymph nodes removed was significantly greater(P=0.04),and the time of first postoperative feeding and postoperative hospitalization were also significantly shorter(P=0.03 and 0.02,respectively).There were no significant differences in tumor size,length of proximal incisal margin,total operation time,anastomotic time,postoperative pain score,postoperative anal exhaust time,postoperative anastomosis-related complications(including anastomotic fistula,anastomotic stenosis,and anastomotic hemorrhage),or overall postoperative complication rate(P>0.05).CONCLUSION TLTG and esophagojejunostomy are safe and feasible.Compared with LATG,TLTG has the advantages of less trauma,less bleeding,easier access to lymph nodes,and faster postoperative recovery,and TLTG is also suitable for obese patients.

Longitudinal dependence of the forecast accuracy of the ionospheric total electron content in the equatorial zone

The longitudinal dependence of the behavior of ionospheric parameters has been the subject of a number of works where significant variations are discovered.This also applies to the prediction of the ionospheric total electron content(TEC),which neural network methods have recently been widely used.However,the results are mainly presented for a limited set of meridians.This paper examines the longitudinal dependence of the TEC forecast accuracy in the equatorial zone.In this case,the methods are used that provided the best accuracy on three meridians:European(30°E),Southeastern(110°E)and American(75°W).Results for the stations considered are analyzed as a function of longitude using the Jet Propulsion Laboratory Global Ionosphere Map(JPL GIM)for 2015.These results are for 2 h ahead and 24 h ahead forecast.It was found that in this case,based on the metric values,three groups of architectures can be distinguished.The first group included long short-term memory(LSTM),gated recurrent unit(GRU),and temporal convolutional networks(TCN)models as a part of unidirectional deep learning models;the second group is based on the recurrent models from the first group,which were supplemented with a bidirectional algorithm,increasing the TEC forecasting accuracy by 2-3 times.The third group,which includes the bidirectional TCN architecture(BiTCN),provided the highest accuracy.For this architecture,according to data obtained for 9 equatorial stations,practical independence of the TEC prediction accuracy from longitude was observed under the following metrics(Mean Absolute Error MAE,Root Mean Square Error RMSE,Mean Absolute Percentage Error MAPE):MAE(2 h)is 0.2 TECU approximately;MAE(24 h)is 0.4 TECU approximately;RMSE(2 h)is less than 0.5 TECU except Niue station(RMSE(2 h)is 1 TECU approximately);RMSE(24 h)is in the range of 1.0-1.7 TECU;MAPE(2 h)<1%except Darwin station,MAPE(24 h)<2%.This result was confirmed by data from additional 5 stations that formed latitudinal chains in the equatorial part of the three meridians.The complete correspondence of the observational and predicted TEC values is illustrated using several stations for disturbed conditions on December 19-22,2015,which included the strongest magnetic storm in the second half of the year(min Dst=-155 nT).

The Increase in Total Knee Replacement Surgery in China: A 10-Year Real-World Study

Total knee arthroplasty (TKR) is the most common and costly surgical procedure performed, and it is considered one of the most successful clinical interventions for patients suffering from severe knee osteoarthritis (OA). The incidence of TKR, including demographics, incidence rates, lengths of hospital stay, and costs, was estimated from 2010 to 2019 by analyzing data extracted from the Joint Surgery Department in our hospital, which included a total of 6770 patients. We calculated the TKR risk ratios to compare the rate of TKR between different covariables such as gender, age group, and primary diagnoses. The annual volume of TKR increased by fivefold (5.14%), with a higher incidence observed in the 60 to 69 age group constituting approximately 36% of cases. There has also been an increase in incidence among young people (<50), which now stands at 6.2%. The rate ratio (RR) per female vs. male was found to be 3.0 and the RR of OA vs. RA was 0.09. The mean average length of stay (ALOS) in the hospital decreased from 15 to just 5 days during this period. Additionally, the adjusted mean cost per patient increased significantly from ¥ 38261 ± 3630.63 to ¥ 53115.17 ± 2831.35. The majority of TKR recipients were over 60 years old with osteoarthritis being identified as the main causative agent. It is worth noting that women are more susceptible to knee arthritis and there is a concerning shift toward younger individuals being affected by this disease. Our results indicate a rise in in-hospital costs alongside a significant decline in hospital ALOS for TKR procedures. We predict an unprecedented rise in TKR incidence in the coming years due to population aging and improving economic conditions in China.

Primary Total Hip Arthroplasty on Complex Hips Conditions in a Low-Resource Setting

Introduction: Total hip arthroplasty of complex morphology is a challenge for the orthopaedic surgeon. Careful analysis of the hip’s anatomy helps to unravel the difficulties and anticipate the procedures to be performed and the implants to be planned. The aim was to identify the types of hip that make first-line THR difficult, specify the technical procedures to be used on these sites, and assess the functional results of the series. Material and Methods: This was a retrospective study that concerned patients operated on for total hip arthroplasty between January 2015 and December 2022 at the medical center “La Grâce” in Bobo-Dioulasso, Burkina Faso. Patients with coxarthrosis (on hip dysplasia, acetabular protrusio, acetabular malunion or neurological hip) and those with ankylosis of the hip, osteonecrosis secondary to neglected dislocation of the hip or hemoglobinopathy were included. Results: A total of 31 total hip replacements were performed in 30 patients. The mean age of patients at the surgery time was 36.2 years with extremes of 17 and 61 years. The male-to-female sex ratio was 1. The main indications for THA were the dysplasic hip osteoarthritis (11 cases) and the neglected hip dislocations (7 cases). In situ femoral neck osteotomy before hip dislocation was performed in seven cases. The acetabulum reconstruction techniques varied from the structural iliac bone graft (n = 3) and cancellous bone graft (n = 4) to the Kerboull plate (n = 1). After 45 months of mean follow-up, all hips were evaluated. The mean PMA score increased from 7.1 [4 - 8] before the surgery to 13.2 [13 - 17]. Conclusion: The large spectrum of challenges in complex hip management requires effective preoperative planning. Preoperative planning minimizes complications and ensures a better outcome.

Offset restoration in total hip arthroplasty:Important:A current review

Normal vertical and horizontal offset is essential for hip biomechanics,muscle functioning and gait pattern.Total hip arthroplasty(THA)should aim to restore normal offset with implantation of femoral and acetabular components.This would be possible with proper preoperative planning,templating and ensuring implant options are available for offset restoration.Templating is essential for understanding the vertical and horizontal offset change,especially in hip arthritis presenting late with significant limb length discrepancy at THA.Planning should include appropriate soft tissue releases and the use of ideal implants to achieve restoration of horizontal and vertical offset.Under correction of horizontal offset at THA for fracture neck of femur could result in abductor fatigue,limp and increased wear.Restoration of horizontal offset is imperative at THA for a fractured neck of the femur to achieve optimal abductor function.Horizontal offset is necessary for optimal abductor muscle tension and function.Revision THA for acetabular bone loss would require hip center restoration with the acetabular and femoral offset correction to achieve limb length correction and abductor length.The inability to achieve vertical and horizontal offset correction could lead to dislocation or signs of abductor fatigue.Careful vertical and horizontal femur offset restoration is required for normal hip biomechanics,decreased wear and increased longevity.

Dual-Fields Rotational Total Skin Electron Therapy: Investigation and Implementation

Purpose: To present a protocol of a dual-field rotational (DFR) total skin electron therapy (TSET) and to provide an assessment of clinical implementation, dosimetry properties, and skin dose evaluation. Methods and Materials: The DFR-TSET combined the Stanford 6-field and McGill rotational methods. Dual 6 MeV electron beams in high dose total skin electron mode were used for DFR-TSET on a commercial linac. Beam profiles and dosimetric properties were measured using solid phantoms. The dose rate at expanded source-to-surface distance (SSD) was a combination of static rate and rotational rate. In vivo dosimetry of patient skin was performed on patients’ skin using film, metal oxide semiconductor field-effect transistors (MOSFET), and optically stimulated luminescent dosimeters (OSLD). Results: Dual field rotational total skin electron therapy exhibited good (≤±10%) uniformity in the beam profiles in the vertical direction at an extended SSD of 332 cm with a gantry angulation of ±20˚ deviated from the horizontal direction. In-vivo measurements confirmed acceptable uniformity of the patients’ total body surfaces and revealed anatomically self-blocked or shielded areas where underdosing occurred. Conclusions: The clinical implementation of DFR-TSET effectively utilizes the special mode on a linac. This technique provides short beam-on times, uniform dose distribution, large treatment field, and reduced dose of x-ray contamination to the patients. In-vivo measurements indicate satisfactory delivery and dose uniformity of the prescribed dose. Electron boost fields are recommended at normal SSDs to address underdosed areas.

Algorithms and statistical analysis for linear structured weighted total least squares problem

Weighted total least squares(WTLS)have been regarded as the standard tool for the errors-in-variables(EIV)model in which all the elements in the observation vector and the coefficient matrix are contaminated with random errors.However,in many geodetic applications,some elements are error-free and some random observations appear repeatedly in different positions in the augmented coefficient matrix.It is called the linear structured EIV(LSEIV)model.Two kinds of methods are proposed for the LSEIV model from functional and stochastic modifications.On the one hand,the functional part of the LSEIV model is modified into the errors-in-observations(EIO)model.On the other hand,the stochastic model is modified by applying the Moore-Penrose inverse of the cofactor matrix.The algorithms are derived through the Lagrange multipliers method and linear approximation.The estimation principles and iterative formula of the parameters are proven to be consistent.The first-order approximate variance-covariance matrix(VCM)of the parameters is also derived.A numerical example is given to compare the performances of our proposed three algorithms with the STLS approach.Afterwards,the least squares(LS),total least squares(TLS)and linear structured weighted total least squares(LSWTLS)solutions are compared and the accuracy evaluation formula is proven to be feasible and effective.Finally,the LSWTLS is applied to the field of deformation analysis,which yields a better result than the traditional LS and TLS estimations.

Total ionizing dose effect modeling method for CMOS digital-integrated circuit

Simulating the total ionizing dose(TID)of an electrical system using transistor-level models can be difficult and expensive,particularly for digital-integrated circuits(ICs).In this study,a method for modeling TID effects in complementary metaloxide semiconductor(CMOS)digital ICs based on the input/output buffer information specification(IBIS)was proposed.The digital IC was first divided into three parts based on its internal structure:the input buffer,output buffer,and functional area.Each of these three parts was separately modeled.Using the IBIS model,the transistor V-I characteristic curves of the buffers were processed,and the physical parameters were extracted and modeled using VHDL-AMS.In the functional area,logic functions were modeled in VHDL according to the data sheet.A golden digital IC model was developed by combining the input buffer,output buffer,and functional area models.Furthermore,the golden ratio was reconstructed based on TID experimental data,enabling the assessment of TID effects on the threshold voltage,carrier mobility,and time series of the digital IC.TID experiments were conducted using a CMOS non-inverting multiplexer,NC7SZ157,and the results were compared with the simulation results,which showed that the relative errors were less than 2%at each dose point.This confirms the practicality and accuracy of the proposed modeling method.The TID effect model for digital ICs developed using this modeling technique includes both the logical function of the IC and changes in electrical properties and functional degradation impacted by TID,which has potential applications in the design of radiation-hardening tolerance in digital ICs.

Blood metal concentrations and cardiac structure and function in total joint arthroplasty patients

BACKGROUND There is concern regarding potential long-term cardiotoxicity with systemic distribution of metals in total joint arthroplasty(TJA)patients.AIM To determine the association of commonly used implant metals with echocardiographic measures in TJA patients.METHODS The study comprised 110 TJA patients who had a recent history of high chromium,cobalt or titanium concentrations.Patients underwent two-dimensional,three-dimensional,Doppler and speckle-strain transthoracic echocardiography and a blood draw to measure metal concentrations.Age and sex-adjusted linear and logistic regression models were used to examine the association of metal concentrations(exposure)with echocardiographic measures(outcome).RESULTS Higher cobalt concentrations were associated with increased left ventricular end-diastolic volume(estimate 5.09;95%CI:0.02-10.17)as well as left atrial and right ventricular dilation,particularly in men but no changes in cardiac function.Higher titanium concentrations were associated with a reduction in left ventricle global longitudinal strain(estimate 0.38;95%CI:0.70 to 0.06)and cardiac index(estimate 0.08;95%CI,-0.15 to-0.01).CONCLUSION Elevated cobalt and titanium concentrations may be associated with structural and functional cardiac changes in some patients.Longitudinal studies are warranted to better understand the systemic effects of metals in TJA patients.