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.

Virtual source approach for maximizing resolution in high-penetration gamma-ray imaging

High-energy gamma-ray radiography has exceptional penetration ability and has become an indispensable nondestructive testing(NDT)tool in various fields.For high-energy photons,point projection radiography is almost the only feasible imaging method,and its spatial resolution is primarily constrained by the size of the gamma-ray source.In conventional industrial applications,gamma-ray sources are commonly based on electron beams driven by accelerators,utilizing the process of bremsstrahlung radiation.The size of the gamma-ray source is dependent on the dimensional characteristics of the electron beam.Extensive research has been conducted on various advanced accelerator technologies that have the potential to greatly improve spatial resolution in NDT.In our investigation of laser-driven gamma-ray sources,a spatial resolution of about 90μm is achieved when the areal density of the penetrated object is 120 g/cm^(2).A virtual source approach is proposed to optimize the size of the gamma-ray source used for imaging,with the aim of maximizing spatial resolution.In this virtual source approach,the gamma ray can be considered as being emitted from a virtual source within the convertor,where the equivalent gamma-ray source size in imaging is much smaller than the actual emission area.On the basis of Monte Carlo simulations,we derive a set of evaluation formulas for virtual source scale and gamma-ray emission angle.Under optimal conditions,the virtual source size can be as small as 15μm,which can significantly improve the spatial resolution of high-penetration imaging to less than 50μm.

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.

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

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

Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

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.

Probabilistic Analysis of Slope Using Finite Element Approach and Limit Equilibrium Approach around Amalpata Landslide of West Central, Nepal

The stability study of the ongoing and recurring Amalpata landslide in Baglung in Nepal’s Gandaki Province is presented in this research. The impacted slope is around 200 meters high, with two terraces that have different slope inclinations. The lower bench, located above the basement, consistently fails and sets others up for failure. The fluctuating water level of the slope, which travels down the slope masses, exacerbates the slide problem. The majority of these rocks are Amalpata landslide area experiences several structural disruptions. The area’s stability must be evaluated in order to prevent and control more harm from occurring to the nearby agricultural land and people living along the slope. The slopes’ failures increase the damages of house existing in nearby area and the erosion of the slope. Two modeling techniques the finite element approach and the limit equilibrium method were used to simulate the slope. The findings show that, in every case, the terrace above the basement is where the majority of the stress is concentrated, with a safety factor of near unity. Using probabilistic slope stability analysis, the failure probability was predicted to be between 98.90% and 100%.

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.

Carbamazepine in osteoarthritis treatment:A novel approach targeting Nav1.7 channels

Osteoarthritis(OA)presents a growing health concern,with substantial societal and healthcare burdens.Current management focuses on symptom relief,lacking disease-modifying options.Emerging research suggests the sodium channel Nav1.7 as a pivotal target in OA treatment.Preclinical studies demonstrate carbamazepine's efficacy in Nav1.7 blockade,offering significant joint protection in animal models.However,human trials are needed to validate these findings.Carbamazepine's repurposing holds promise for OA management,potentially revolutionizing treatment paradigms.Further research is essential to bridge the gap between preclinical evidence and clinical application,offering hope for improved OA management and enhanced patient quality of life.

Relaxed Stability Criteria for Time-Delay Systems:A Novel Quadratic Function Convex Approximation Approach

This paper develops a quadratic function convex approximation approach to deal with the negative definite problem of the quadratic function induced by stability analysis of linear systems with time-varying delays.By introducing two adjustable parameters and two free variables,a novel convex function greater than or equal to the quadratic function is constructed,regardless of the sign of the coefficient in the quadratic term.The developed lemma can also be degenerated into the existing quadratic function negative-determination(QFND)lemma and relaxed QFND lemma respectively,by setting two adjustable parameters and two free variables as some particular values.Moreover,for a linear system with time-varying delays,a relaxed stability criterion is established via our developed lemma,together with the quivalent reciprocal combination technique and the Bessel-Legendre inequality.As a result,the conservatism can be reduced via the proposed approach in the context of constructing Lyapunov-Krasovskii functionals for the stability analysis of linear time-varying delay systems.Finally,the superiority of our results is illustrated through three numerical examples.

Bipolar hip arthroplasty using conjoined tendon preserving posterior lateral approach in treatment of displaced femoral neck fractures

BACKGROUND Hip fractures account for 23.8%of all fractures in patients over the age of 75 years.More than half of these patients are older than 80 years.Bipolar hemiarthroplasty(BHA)was established as an effective management option for these patients.Various approaches can be used for the BHA procedure.However,there is a high risk of postoperative dislocation.The conjoined tendon-preserving posterior(CPP)lateral approach was introduced to reduce postoperative dislocation rates.AIM To evaluate the effectiveness and safety of the CPP lateral approach for BHA in elderly patients.METHODS We retrospectively analyzed medical data from 80 patients with displaced femoral neck fractures who underwent BHA.The patients were followed up for at least 1 year.Among the 80 patients,57(71.3%)were female.The time to operation averaged 2.3 d(range:1-5 d).The mean age was 80.5 years(range:67-90 years),and the mean body mass index was 24.9 kg/m^(2)(range:17-36 kg/m^(2)).According to the Garden classification,42.5%of patients were typeⅢand 57.5%of patients were typeⅣ.Uncemented bipolar hip prostheses were used for all patients.Torn conjoined tendons,dislocations,and adverse complications during and after surgery were recorded.RESULTS The mean postoperative follow-up time was 15.3 months(range:12-18 months).The average surgery time was 52 min(range:40-70 min)with an average blood loss of 120 mL(range:80-320 mL).The transfusion rate was 10%(8 of 80 patients).The gemellus inferior was torn in 4 patients(5%),while it was difficult to identify in 2 patients(2.5%)during surgery.The posterior capsule was punctured by the fractured femoral neck in 3 patients,but the conjoined tendon and the piriformis tendon remained intact.No patients had stem varus greater than 3 degrees or femoral fracture.There were no patients with stem subsidence more than 5 mm at the last follow-up.No postoperative dislocations were observed throughout the follow-up period.No significance was found between preoperative and postoperative mean Health Service System scores(87.30±2.98 vs 86.10±6.10,t=1.89,P=0.063).CONCLUSION The CPP lateral approach can effectively reduce the incidence of postoperative dislocation without increasing perioperative complications.For surgeons familiar with the posterior lateral approach,there is no need for additional surgical instruments,and it does not increase surgical difficulty.

Optimal Cooperative Secondary Control for Islanded DC Microgrids via a Fully Actuated Approach

DC-DC converter-based multi-bus DC microgrids(MGs) in series have received much attention, where the conflict between voltage recovery and current balancing has been a hot topic. The lack of models that accurately portray the electrical characteristics of actual MGs while is controller design-friendly has kept the issue active. To this end, this paper establishes a large-signal model containing the comprehensive dynamical behavior of the DC MGs based on the theory of high-order fully actuated systems, and proposes distributed optimal control based on this. The proposed secondary control method can achieve the two goals of voltage recovery and current sharing for multi-bus DC MGs. Additionally, the simple structure of the proposed approach is similar to one based on droop control, which allows this control technique to be easily implemented in a variety of modern microgrids with different configurations. In contrast to existing studies, the process of controller design in this paper is closely tied to the actual dynamics of the MGs. It is a prominent feature that enables engineers to customize the performance metrics of the system. In addition, the analysis of the stability of the closed-loop DC microgrid system, as well as the optimality and consensus of current sharing are given. Finally, a scaled-down solar and battery-based microgrid prototype with maximum power point tracking controller is developed in the laboratory to experimentally test the efficacy of the proposed control method.

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.

Accelerated Primal-Dual Projection Neurodynamic Approach With Time Scaling for Linear and Set Constrained Convex Optimization Problems

The Nesterov accelerated dynamical approach serves as an essential tool for addressing convex optimization problems with accelerated convergence rates.Most previous studies in this field have primarily concentrated on unconstrained smooth con-vex optimization problems.In this paper,on the basis of primal-dual dynamical approach,Nesterov accelerated dynamical approach,projection operator and directional gradient,we present two accelerated primal-dual projection neurodynamic approaches with time scaling to address convex optimization problems with smooth and nonsmooth objective functions subject to linear and set constraints,which consist of a second-order ODE(ordinary differential equation)or differential conclusion system for the primal variables and a first-order ODE for the dual vari-ables.By satisfying specific conditions for time scaling,we demonstrate that the proposed approaches have a faster conver-gence rate.This only requires assuming convexity of the objective function.We validate the effectiveness of our proposed two accel-erated primal-dual projection neurodynamic approaches through numerical experiments.

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)techniques.The indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of LH.While laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its outcomes.important anatomical markers,surgical skills,and ICG staining methods.METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed.The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH.The surgical methods,as well as intra-and post-surgical data,were recorded and analyzed.Our hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,respectively.The overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were reported.CONCLUSION LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

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.

Multi-disciplinary Pathways to Computing:A Scalable and Col aborative Approach to Capitalize on the Demand for Computer Science Education

The number of students demanding computer science(CS)education is rapidly rising,and while faculty sizes are also growing,the traditional pipeline consisting of a CS major,a CS master’s,and then a move to industry or a Ph.D.program is simply not scalable.To address this problem,the Department of Computing at the University of Illinois has introduced a multidisciplinary approach to computing,which is a scalable and collaborative approach to capitalize on the tremendous demand for computer science education.The key component of the approach is the blended major,also referred to as“CS+X”,where CS denotes computer science and X denotes a non-computing field.These CS+X blended degrees enable win-win partnerships among multiple subject areas,distributing the educational responsibilities while growing the entire university.To meet the demand from non-CS majors,another pathway that is offered is a graduate certificate program in addition to the traditional minor program.To accommodate the large number of students,scalable teaching tools,such as automatic graders,have also been developed.

Optimizing a Transportation System Using Metaheuristics Approaches (EGD/GA/ACO): A Forest Vehicle Routing Case Study

The large-scale optimization problem requires some optimization techniques, and the Metaheuristics approach is highly useful for solving difficult optimization problems in practice. The purpose of the research is to optimize the transportation system with the help of this approach. We selected forest vehicle routing data as the case study to minimize the total cost and the distance of the forest transportation system. Matlab software helps us find the best solution for this case by applying three algorithms of Metaheuristics: Genetic Algorithm (GA), Ant Colony Optimization (ACO), and Extended Great Deluge (EGD). The results show that GA, compared to ACO and EGD, provides the best solution for the cost and the length of our case study. EGD is the second preferred approach, and ACO offers the last solution.

Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs

In the evolving landscape of cardiac rehabilitation(CR),adopting digital technologies,including synchronous/real-time digital interventions and smart applications,has emerged as a transformative approach.These technologies offer realtime health data access,continuous vital sign monitoring,and personalized educational enhanced patient self-management and engagement.Despite their potential benefits,challenges and limitations exist,necessitating careful consideration.Synchronous/real-time digital CR involves remote,two-way audiovisual communication,addressing issues of accessibility and promoting home-based interventions.Smart applications extend beyond traditional healthcare,providing real-time health data and fostering patient empowerment.Wearable devices and mobile apps enable continuous monitoring,tracking of rehabilitation outcomes,and facilitate lifestyle modifications crucial for cardiac health maintenance.As digital CR progresses,ensuring patient access,equitable implementation,and addressing the digital divide becomes paramount.Artificial intelligence holds promise in the early detection of cardiac events and tailoring patient-specific CR programs.However,challenges such as digital literacy,data privacy,and security must be addressed to ensure inclusive implementation.Moreover,the shift toward digital CR raises concerns about cost,safety,and potential depersonalization of therapeutic relationships.A transformative shift towards technologically enabled CR necessitates further research,focusing not only on technological advancements but also on customization to meet diverse patient needs.Overcoming challenges related to cost,safety,data security,and potential depersonalization is crucial for the widespread adoption of digital CR.Future studies should explore integrating moral values into digital therapeutic relationships and ensure that digital CR is accessible,equitable,and seamlessly integrated into routine cardiac care.Theoretical frameworks that accommodate the dynamic quality of real-time monitoring and feedback feature of digital CR interventions should be considered to guide intervention development.

Solving Neumann Boundary Problem with Kernel-Regularized Learning Approach

We provide a kernel-regularized method to give theory solutions for Neumann boundary value problem on the unit ball. We define the reproducing kernel Hilbert space with the spherical harmonics associated with an inner product defined on both the unit ball and the unit sphere, construct the kernel-regularized learning algorithm from the view of semi-supervised learning and bound the upper bounds for the learning rates. The theory analysis shows that the learning algorithm has better uniform convergence according to the number of samples. The research can be regarded as an application of kernel-regularized semi-supervised learning.