Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis

BACKGROUND Ankylosing spondylitis at total hip arthroplasty(THA)has significant hip stiffness with flexion deformity,restricted mobility,and function.Range of movement(ROM)improvement with good functional outcome is seen following THA in these hips.The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo.All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day.Modified Harris hip score and ROM were assessed during follow-up.Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at followup.SPSS 22.0 was used for statistical analysis.The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range.The mean flexion in 69 hips improved from 29.35±31.38 degrees to 102.17±10.48 degrees.The mean difference of 72.82 with a P value<0.0001 was significant.In total,45 out of 69 hips had flexion deformity,with 13 hips having a deformity above 30 degrees.The flexion during the follow-up was below 90 degrees in 3 hips.Eleven hips had flexion of 90 degrees at follow-up,while the remaining 55 hips had flexion above 100 degrees.Modified Harris hip score improved from 17.03±6.02 to 90.66±7.23(P value<0.0001).The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11,very good in 20,good in 5,fair in 3,and poor in 1.The mean mental health score was 84.10±11.58.Pain relief was good in all 69 hips.Altogether,28/40 patients(70%)had no pain,9 patients(22%)had occasional pain,and 3 patients(8%)had mild to moderate pain with unusual activity.Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM,Harris hip score,and quality of life indicated by the 36-item and 12-item short form health surveys.

THE APPLICATIONS OF A MODIFIED NORMAL FORM APPROACH

The modified normal form approach presented by ZHANG Wei-yi, K Huseyin and CHEN Yu-shu is further extended and a different procedure is introduced which lends itself readily to symbolic calculations, like MAPLE. This provides a number of significant advantages over the previous approach, and facilitates the associated calculations. To illustrate the new approach, three examples are presented.

Three-dimensional pseudo-dynamic reliability analysis of seismic shield tunnel faces combined with sparse polynomial chaos expansion

To address the seismic face stability challenges encountered in urban and subsea tunnel construction,an efficient probabilistic analysis framework for shield tunnel faces under seismic conditions is proposed.Based on the upper-bound theory of limit analysis,an improved three-dimensional discrete deterministic mechanism,accounting for the heterogeneous nature of soil media,is formulated to evaluate seismic face stability.The metamodel of failure probabilistic assessments for seismic tunnel faces is constructed by integrating the sparse polynomial chaos expansion method(SPCE)with the modified pseudo-dynamic approach(MPD).The improved deterministic model is validated by comparing with published literature and numerical simulations results,and the SPCE-MPD metamodel is examined with the traditional MCS method.Based on the SPCE-MPD metamodels,the seismic effects on face failure probability and reliability index are presented and the global sensitivity analysis(GSA)is involved to reflect the influence order of seismic action parameters.Finally,the proposed approach is tested to be effective by a engineering case of the Chengdu outer ring tunnel.The results show that higher uncertainty of seismic response on face stability should be noticed in areas with intense earthquakes and variation of seismic wave velocity has the most profound influence on tunnel face stability.

Two-Dimensional Aerodynamic Models of Insect Flight for Robotic Flapping Wing Mechanisms of Maximum Efficiency

In the ＂modified quasi-steady＂ approach, two-dimensional （2D） aerodynamic models of flapping wing motions are analyzed with focus on different types of wing rotation and different positions of rotation axis to explain the force peak at the end of each half stroke. In this model, an additional velocity of the mid chord position due to rotation is superimposed on the translational relative velocity of air with respect to the wing. This modification produces augmented forces around the end of each stroke. For each case of the flapping wing motions with various combination of controlled translational and rotational velocities of the wing along inclined stroke planes with thin figure-of-eight trajectory, discussions focus on lift-drag evolution during one stroke cycle and efficiency of types of wing rotation. This ＂modified quasi-steady＂ approach provides a systematic analysis of various parameters and their effects on efficiency of flapping wing mechanism. Flapping mechanism with delayed rotation around quarter-chord axis is an efficient one and can be made simple by a passive rotation mechanism so that it can be useful for robotic application.

Analysis of the efficacy of a modified posteromedial approach for Klammer III posterior Pilon fractures

Purpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019.Before the surgery,the patients were fully relieved of swelling and pain,and a comprehensive examination was carried out.The posteromedial approach exposed the posterior and medial fracture block of the distal tibia.According to the fracture of external malleolus,it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor,and then perform a fracture reduction and internal fixation.Postoperatively,the patients were treated with analgesia,detumescence,anticoagulation and rehabilitation exercise.The American orthopaedic foot and ankle society(AOFAS)score and visual analogue score were recorded at regular follow-up after surgery.A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female(n=20)included in the study,aged 22 to 88 years(average age 54.2 years).The injury mechanisms were falling from a height(n=7),traffic accident(n=6),walking injury(n=2)and heavy injury(n=5).The postoperative follow-up duration was 12—24 months(mean 16.95 months).The AOFAS score of the 20 patients before and after surgery were compared.The preoperative AOFAS score was 38.90±3.91,and the final AOFAS score was 80.55±4.20,(p<0.001).The mean final visual analogue scores at rest,active and weight-bearing walking were 0.30,0.85 and 1.70,respectively.One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures,the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus,achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves,and have a better prognosis.

Process of Patients Telling Children about Newly Diagnosed Breast Cancer

Objective: This study aims to determine the process of patients with newly diagnosed breast cancer in Japan telling their children about the disease, and how they have thought about it after the diagnosis. Methods: Semi-structured interviews were conducted with 15 patients with newly diagnosed breast cancer who had 3- to 14-year-old children. Narratives of participants about how they told their children about the disease were analysed by a qualitative and descriptive study design using the Modified Grounded Theory Approach (M-GTA). Results: In the process by which patients with newly diagnosed breast cancer tell their children about the disease, participants were [Maintaining mental balance in the face of the threat of the cancer] after the breast cancer diagnosis, and used the “Facing the cancer through the relationship with the children” as the core category in the process. The participants had [Determined to tell the children about the disease], while [Being worried about the influence of cancer on the children], [Thinking about the benefits of not hiding the cancer], and [Feeling difficulty in communicating the diagnosis of cancer to their children]. They were [Encouraged to tell about the disease to the children] by people around them, and did tell the children that they had a “disease” or “cancer”. The participants who told the children that they had the disease while [Determining the impact on the children] repeated the [Making herself look unconcerned] in the process. Those who told the children that they had cancer while [Determining the impact on the children] repeated [Talking openly about cancer and death] between parents and children. Conclusions: The participants came to face their own cancer by maintaining mental balance in the face of the threat of the cancer and telling their children about the disease. Nurses need to assist these patients to be able to deal openly with their children from the early stage of the diagnosis and solve problems by family members.

The Process of Support by Nursing Professionals for Families Having a Member with Borderline Personality Disorder

The purpose of this study was to explore the process of family support provided by nurses to families with a borderline personality disorder (BPD) patient. Semi-structured interviews were conducted with 16 nurses who had provided care to BPD patients. Data obtained from the interviews were qualitatively analyzed using a modified grounded theory approach. As an overall core category of family support processes practiced by nurses for families with BPD patients, family support practiced without awareness that the nurses were supporting families was extracted. Through this process, nurses held perceptions that were premises for family support, which were formed through their individual nursing experiences and perspectives. Nurses also had diverse perceptions concerning the image of families. Through the integration of perceptions that were premises for family support and perceptions of an image of the family, nurses underwent a process of “determination and ambivalence about the need for family support.” Then, nurses provided “family support practice” when they acknowledged the need for family support. During the “family support practice,” nurses had difficulties in providing family support. When family support was not successfully provided, nurses provided “family support practice with seeking more effective ways through trial and error.” For cases in which nurses did not acknowledge the need for intervention, they intentionally chose “not to provide family support.” Furthermore, during the “family support practice,” nurses had contradictory perspectives of family support. Such family support processes ultimately led to an awareness of the same family support required for the future. Family support was provided with “family support practice” and “family support practice with seeking more effective ways through trial and error.” In some cases, however, the process ended in “not to provide family support intentionally.” Experiences and perspectives in providing family support are important factors in carrying out future family support. Developing the positive implications of these factors and reducing psychological strain on nurses may ensure smooth implementation of family support. Thus, nurses need to recognize that they are supporting the family, which is identified as a core category.

On the modified(G′/G^(2))-expansion method for finding some analytical solutions of the traveling waves

This work investigates three nonlinear equations that describe waves on the oceans which are the Kadomtsev Petviashvili-modified equal width(KP-MEW)equation,the coupled Drinfel’d-Sokolov-Wilson(DSW)equation,and the Benjamin-Ono(BO)equation using the modified(G′/G^(2))-expansion approach.The solutions of proposed equations by modified(G′/G^(2))-expansion approach can be trigonometric,hyperbolic,or rational solutions.As a result,some new exact solutions are obtained and plotted.

Construction of multiple new analytical soliton solutions and various dynamical behaviors to the nonlinear convection-diffusion-reaction equation with power-law nonlinearity and density-dependent diffusion via Lie symmetry approach together with a couple of integration approaches

By taking advantage of three different computational analytical methods:the Lie symmetry analysis,the generalized Riccati equation mapping approach,and the modified Kudryashov approach,we construct multiple new analytical soliton solutions to the nonlinear convection-diffusion-reaction equation(NCDR)with power-law nonlinearity and density-dependent diffusion.Lie symmetry analysis is one of the pow-erful techniques that reduce the higher-order partial differential equation into an ordinary differential equation by reduction of independent variables.By the Lie group technique,we obtain one-parameter in-variant transformations,determining equations and corresponding vectors for the considered convection-diffusion-reaction equation.By treating the parameters of the governing equation as constants,the ap-plied methods yield a variety of new closed-form solutions,including inverse function solutions,periodic solutions,exponential function solutions,dark solitons,singular solitons,combo bright-singular solitons,and the combine of bright-dark solitons and dark-bright solitons.Moreover,using the Bäcklund transfor-mation of the generalized Riccati equation and modified Kudryashov method,we can construct multiple solitons and other solutions of the considered equation.The obtained new solutions of this work demon-strate that the used approaches are powerful and effective in dealing with nonlinear equations,and that these solutions are required to explain many biological and physical phenomena.Comparing our obtained solutions of this paper with the ones obtained in the literature,we see that our solutions are new and not reported elsewhere.These newly formed soliton solutions will be more beneficial in the various dis-ciplines of ocean engineering,plasma physics,and nonlinear sciences.