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.

Multi-soliton solutions for the coupled modified nonlinear Schrdinger equations via Riemann–Hilbert approach

The coupled modified nonlinear Schrodinger equations are under investigation in this work. Starting from analyzing the spectral problem of the Lax pair, a Riemann-Hilbert problem for the coupled modified nonlinear Schrodinger equations is formulated. And then, through solving the obtained Riemann-Hilbert problem under the conditions of irregularity and reflectionless case, N-soliton solutions for the equations are presented. Furthermore, the localized structures and dynamic behaviors of the one-soliton solution are shown graphically.

A Hybrid Unit Commitment Approach Incorporating Modified Priority List with Charged System Search Methods

This paper presents a new hybrid approach that combines Modified Priority List (MPL) with Charged System Search (CSS), termed MPL-CSS, to solve one of the most crucial power system’s operational optimization problems, known as unit commitment (UC) scheduling. The UC scheduling problem is a mixed-integer nonlinear problem, highly-dimensional and extremely constrained. Existing meta-heuristic UC solution methods have the problems of stopping at a local optimum and slow convergence when applied to large-scale, heavily-constrained UC applications. In the first step of the proposed method, initial hourly optimum solutions of UC are obtained by Modified Priority List (MPL);however, the obtained UC solution may still be possible to be further improved. Therefore, in the second step, the CSS is utilized to achieve higher quality solutions. The UC is formulated as mixed integer linear programming to ensure the tractability of the results. The proposed method is successfully applied to a popular test system up to 100 units generators for both 24-hr and 168-hr system. Computational results show that both solution cost and execution time are superior to those of published methods.

Pseudospin symmetric solutions of the Dirac equation with the modified Rosen-Morse potential using Nikiforov-Uvarov method and supersymmetric quantum mechanics approach

Employing the Pekeris-type approximation to deal with the pseudo-centrifugal term,we analytically study the pseudospin symmetry of a Dirac nucleon subjected to equal scalar and vector modified Rosen-Morse potential including the spin-orbit coupling term by using the Nikiforov-Uvarov method and supersymmetric quantum mechanics approach.The complex eigenvalue equation and the total normalized wave functions expressed in terms of Jacobi polynomial with arbitrary spin-orbit coupling quantum number k are presented under the condition of pseudospin symmetry.The eigenvalue equations for both methods reproduce the same result to affirm the mathematical accuracy of analytical calculations.The numerical solutions obtained for different adjustable parameters produce degeneracies for some quantum number.

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.

Computer-Based Modelling of Network Functions for Linear Dynamic Circuits Using Modified Nodal Approach

In this paper,a computer-based systematic and efficient formulation method is presented for obtaining the network functions of linear or linearized time-invariant dynamic circuits.The method employs the modified nodal approach to obtain the system equations.The technique is based on developing a matrix formulation for modelling network functions.By using both symbolic manipulation of algebraic expressions and numeric processes,the network functions are expressed with a matrix-based method.Application examples are given to illustrate the features of the method.

Modified pararectus approach for treatment of atypical acetabular anterior wall fracture:A case report

BACKGROUND Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare.It is different from anterior wall fracture classified by Judet and Letournel.Few studies have reported cases treated by open reduction and internal fixation via the Smith-Petersen or iliofemoral approach.CASE SUMMARY We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m.Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim.First,the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d.Then,we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate.At the 9-mo follow-up,the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification,and the X-rays and computed tomography scan reconstructions showed good bone union.CONCLUSION The modified pararectus approach described here can facilitate exposure,reduction,and osteosynthesis for atypical acetabular fracture with less invasiveness.

Modified surgical techniques in total en bloc spondylectomy for thoracic and lumbar tumors with a single posterior approach

Objective To investigate the operation key points,instrument improvement and shortterm effects in total en bloc spondylectomy (TES) via a single posterior approach for thoracic and lumbar tumors.Methods A series of modified

改良Watson-Jones入路微创全髋关节置换术的初步临床应用

目的探讨改良Watson-Jones入路微创全髋关节置换术（THA）的技术要点和临床效果。方法对22例患者行改良Watson-Jones入路微创THA,观察切口长度、手术时间、术中出血量、输血量、术后引流量、术后住院天数及假体位置,并进行随访。结果手术切口长7-9 cm,平均8 cm;手术时间70-120 min,平均92.1 min;术中出血量60-610 ml,平均210.5 ml;引流量60-640 ml,平均220.5 ml;输血量0-800 ml,平均318.2 ml。患者术后第2天在医生指导下下床活动,术后平均住院7.9 d。无1例发生感染、脱位、血管神经损伤等并发症。随访假体位置良好,髋关节活动度为优,Harris评分90-96分,平均92.1分。结论改良Watson-Jones入路是经臀中肌和阔筋膜张肌肌间隙显露髋关节,具有不损伤周围肌肉、创伤小、术后恢复快、并发症少、几乎无后脱位的优点。

Folded localized excitations in the (2+1)-dimensional modified dispersive water-wave system

By using a mapping approach and a linear variable separation approach, a new family of solitary wave solutions with arbitrary functions for the （2＋1）-dimensional modified dispersive water-wave system （MDWW） is derived. Based on the derived solutions and using some multi-valued functions, we obtain some novel folded localized excitations of the system.

改良Watson-Jones手术入路行人工股骨头置换术

目的 :探索一种简便、有效的手术入路行人工股骨头置换术。方法 :采用改良的Watson -Jones手术入路 ,即在原Watson -Jones手术入路基础上 ,皮肤切口向后弧度加大 ,不通过切断臀中肌及股外侧肌来显露术野 ,而是将其连同两者的腱性连接部向前侧翻转直至转子间线 ,来充分显露股骨大、小粗隆及髋关节。作者从 1994年 1月至 1998年10月采用此入路行人工股骨头置换术 86例。结果 :全组患者无手术死亡及术后感染。术后随访 6～ 12月 ,总优良率为 91.9%。其中有 17例患者术后发生轻度跛行 ,7例患者患肢缩短超过 2cm。无术后髋关节脱位病例。结论 :作者认为此手术入路有操作简便、安全、创伤小、暴露好 ,有利于假体定位、固定以及术后外展肌功能恢复快等优点 ,是一种较为理想的手术入路。

Symmetry and Exact Solutions of (2+1)-Dimensional Generalized Sasa-Satsuma Equation via a Modified Direct Method

In this paper, first, we employ classic Lie symmetry groups approach to obtain the Lie symmetry groupsof the well-known (2+1)-dimensional Generalized Sasa-Satsuma (GSS) equation. Second, based on a modified directmethod proposed by Lou [J. Phys. A: Math. Gen. 38 (2005) L129], more general symmetry groups are obtained andthe relationship between the new solution and known solution is set up. At the same time, the Lie symmetry groupsobtained are only special cases of the more general symmetry groups. At last, some exact solutions of GSS equationsare constructed by the relationship obtained in the paper between the new solution and known solution.

Modified Concrete Using Polyethylene Terephthalate Plastic Waste as a Partial Replacement for Coarse Aggregate

The present work evaluated the properties of modified concrete using polyethylene terephthalate (PET) bottle waste as a partial replacement for coarse aggregate. Modified concrete samples were designed using a water/cement (W/C) ratio of 0.50 and varying percentages of PET replacement (3%, 7%, 10%, and 15% by volume). Dreux Gorisse’s formulation approach was used to make the final products, and the mechanical properties of the samples were determined using Controlab presses. This modified concrete with PET chips has shown that with a 10% replacement of PET chips, the fresh density decreases by 3.56%, and the hardened state density decreases by 2.01%. The water absorption and thermal conductivity of the formulated concretes decreased. However, the results showed that the slump of these fresh concretes increased as the percentage of plastic aggregate replacement increased. Based on the results, incorporating PET aggregates into concrete contributes to good workability, and lightweight concrete structures, and provides some thermal comfort in concrete structures.

Clinical Application of Exclusive Right-Thoracic Approach in Surgery with or without Laparotomy for Mid-Upper Esophageal Cancer

OBJECTIVE To evaluate the clinical application of a right-thoracic approach with or without laparotomy for mid-upper esophageal cancer. METHODS We retrospectively reviewed the data of 34 esophageal cancer patients who received Belsey surgery or a modified Ivor-Lewis surgery from November 1992 to April 2007. Twenty of the patients underwent a Belsey prodecdure （Group A） from November 1992 to January 2001 and 14 underwent a modified Ivor-Lewis prodecdure （Group B） from May 2001 to April 2007. RESULTS Twenty patients with esophageal cancer received an esophagectomy through an exclusive right-thoracic approach （Belsey surgery）, and 14 patients received an esophagectomy through a right-thoracic approach combined with a laparotomy （modified IvorLewis surgery）. The complication rate was 15% （3/20） and 7.1% （1/14） respectively. The survival rate was 42.9% （5-year survival） and 38.7% （5-year survival） respectively for these two groups. CONCLUSION An exclusive right-thoracic approach （Belsey surgery） is associated with more complications. It is not a routine surgery for cancer of the mid-upper thorax of the esophagus, but can be selectively used as palliative esophagectomy for esophageal cancer patients with poor pulmonary function. Modified Ivor-Lewis surgery can simultaneously be utilized to resect the primary tumor and dissect lymph nodes of the thorax and abdomen. With a shorter time period of surgery and postoperative recovery period, modified Ivor-Lewis surgery can achieve better effects with patients who have midupper esophagus cancer.

A Novel Approach for Evaluation of Food Functions and Safety Applied in RR GM Soybeans

[Objective] This study aimed to evaluate tbe healthy risk of genetically modified （ GM ） soybeans by using a novel approach for functions and safety of food. [ Me^od] Different from traditional evaluation of substantial equivalence, three great innovations were performed in this study, involving in basic diet, evalu- ation approaches and principle, as well as the clarification of connotation differences between absolute and relative mass of organs. Hence a novel BDI-GS （Bendib Damage Index and General Score） evaluation approach was established and applied in comparative evaluation between RR GM and natural soybeans. Healthy male ICR mice during linear growth were selected; experimental mice were fed with 15% RR GM soybeans and 15% natural soybeans blending maize meal diets, and control mice were fed with single maize meal diet for 13 d; the mice were dissected after collecting blood samples and perfectly obtained nine organs or tissues to re- cord their masses and conduct statistical analyses. [Result] Plenty of matching information was obtained through simple design. The growth performance of treated mice was markedly of individual differences, some mice were thwarted due to regular intake of RR soybeans. Meanwhile, the functions and safety of RR soybeans were markedly lowered in overall nutritional and healthy effects than those of natural soybeans expressed in GS values, and presents some declines in nutrition and health of thymus, pancreas and spermary; especially, it can make thymus immune （P 〈0.05） in markedly lower level than that of natural soybeans. [ Conclusion] Therefore, major troubles and risks of RR soybeans intake are of personal risks in different degrees, in addition, it may increase sub-health and related chronic epi- demics risks, and herein it will presents certain safety issues. The creation of this novel evaluation system provides a simple and available evaluation approach for functions and potential risks revelation of food effects, and will yield far-reaching influences to safety evaluation and healthy development of GM foods, as well as public health.

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

比较OCM入路与改良Hardinge入路在半髋关节置换术中治疗高龄股骨颈骨折的临床效果

目的比较OCM入路与改良Hardinge入路在双极头半髋关节置换术中对高龄股骨颈骨折患者早期临床效果的差异。方法回顾性分析2021年3月至2022年12月期间江苏省丹阳市人民医院收治的105例高龄股骨颈骨折患者进行双极头半髋关节置换术的疗效。根据手术入路的不同,将患者分为OCM组(45例)和改良Hardinge组(60例)。评价指标包括手术一般情况(手术时间、切口长度、术后住院时间、下地时间),围手术期出血情况(术前血红蛋白,术中出血量,术后1、3 d的血红蛋白下降量及隐性失血量),血清学指标(肌酸激酶和C反应蛋白),VAS疼痛评分,Harris髋关节功能评分及并发症等关键指标。结果两组患者随访6~20个月,平均(11.02±2.72)个月。两组患者在手术时间、输血率上,差异无统计学意义(P>0.05)。OCM组的切口长度、术后住院时间、下地时间、术中出血量、术后血红蛋白下降量、隐性失血量、术后3 d的血清学指标和VAS评分,以及术后3个月内的Harris评分均显著优于改良Hardinge组(P<0.05)。但术后6周的VAS评分及6个月的Harris评分比较,差异无统计学意义(P>0.05)。两组均未出现深静脉血栓形成、切口感染、脱位及神经损伤等严重并发症,两组的假体周围骨折、肌间静脉血栓、Trendelenburg步态、双下肢不等长的发生率比较,差异无统计学意义(P>0.05)。结论对于高龄股骨颈骨折患者,采用OCM入路双极头半髋关节置换术较改良Hardinge入路在减少手术创伤和加速术后恢复方面表现显著,有更优的早期临床效果,值得临床推荐。

改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果

目的:探讨改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果。方法:选取2020年2月—2021年12月麻城市人民医院收治的三踝骨折患者72例作为研究对象,采用双盲法分为对照组和试验组,各36例。两组患者均行切开复位内固定术治疗,对照组采用常规踝关节后外侧入路联合内侧入路,试验组采用改良踝关节后外侧入路联合内侧入路。比较两组治疗效果。结果:试验组并发症总发生率低于对照组,差异有统计学意义(P=0.006)。治疗前,两组踝关节背伸、跖屈、外翻、内翻活动度比较,差异无统计学意义(P>0.05);治疗后6个月,两组踝关节背伸、跖屈、外翻、内翻活动度均大于治疗前,且试验组大于对照组,差异有统计学意义(P<0.05)。治疗前,两组美国矫形足踝学会(AOFAS)踝-后足指数评分量表评分比较,差异无统计学意义(P>0.05);治疗后6个月,两组AOFAS踝-后足指数评分量表评分高于治疗前,且试验组高于对照组,差异有统计学意义(P<0.001)。结论:改良踝关节后外侧入路联合内侧入路切开复位内固定治疗三踝骨折的临床效果显著,能改善踝关节活动度与功能,减少并发症。