Research review on steel–concrete composite joint of railway hybrid girder cable-stayed bridges

Purpose–This study aims to research the development trend,research status,research results and existing problems of the steel–concrete composite joint of railway long-span hybrid girder cable-stayed bridge.Design/methodology/approach–Based on the investigation and analysis of the development history,structure form,structural parameters,stress characteristics,shear connector stress state,force transmission mechanism,and fatigue performance,aiming at the steel–concrete composite joint of railway long-span hybrid girder cable-stayed bridge,the development trend,research status,research results and existing problems are expounded.Findings–The shear-compression composite joint has become the main form in practice,featuring shortened length and simplified structure.The length of composite joints between 1.5 and 3.0 m has no significant effect on the stress and force transmission laws of the main girder.The reasonable thickness of the bearing plate is 40–70 mm.The calculation theory and simplified calculation formula of the overall bearing capacity,the nonuniformity and distribution laws of the shear connector,the force transferring ratio of steel and concrete components,the fatigue failure mechanism and structural parameters effects are the focus of the research study.Originality/value–This study puts forward some suggestions and prospects for the structural design and theoretical research of the steel–concrete composite joint of railway long-span hybrid girder cable-stayed bridge.

Prosthetic joint infection of the hip and knee due to Mycobacterium species:A systematic review

BACKGROUND Mycobacterium species(Mycobacterium sp)is an emerging cause of hip and knee prosthetic joint infection(PJI),and different species of this organism may be responsible for the same.AIM To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.METHODS A literature search was performed in PubMed using the MeSH terms“Prosthesis joint infection”AND“Mycobacterium”for studies with publication dates from January 1,1990,to May 30,2021.To avoid missing any study,another search was performed with the terms“Arthroplasty infection”AND“Mycobacterium”in the same period as the previous search.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review.In total,51 studies were included for further evaluation of thecases,type of pathogen,and treatment of PJI caused by Mycobacterium sp.RESULTS Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases,whereas in two cases there was no mention of any specific Mycobacterium sp.Mycobacterium tuberculosis(M.tuberculosis)was detected in 50/115(43.3%)of the cases.Nontuberculous mycobacteria(NTM)included M.fortuitum(26/115,22.6%),M.abscessus(10/115,8.6%),M.chelonae(8/115,6.9%),and M.bovis(8/115,6.9%).Majority of the cases(82/114,71.9%)had an onset of infection>3 mo after the index surgery,while in 24.6%(28/114)the disease had an onset in≤3 mo.Incidental intraoperative PJI diagnosis was made in 4 cases(3.5%).Overall,prosthesis removal was needed in 77.8%(84/108)of the cases to treat the infection.Overall infection rate was controlled in 88/102(86.3%)patients with Mycobacterium PJI.Persistent infection occurred in 10/108(9.8%)patients,while 4/108(3.9%)patients died due to the infection.CONCLUSION At least 17 Mycobacterium sp can be responsible for hip/knee PJI.Although M.tuberculosis is the most common causal pathogen,NTM should be considered as an emerging cause of hip/knee PJI.

有限元分析技术在膝关节生物力学应用中的特点与优势

背景:有限元分析是一种先进的计算机工程技术,利用数学近似的方法对真实人体进行模拟,可以真实反映膝关节结构内部的生物力学特征,为理解膝关节疾病发病机制、优化手术方案以及开发新型植入材料提供了有效的工具。目的:对膝关节有限元模型的建立及其在膝关节疾病研究中的应用进行综述,并展望了未来的发展趋势。方法:第一作者于2024年4月以“Finite Element Analysis,FEA,knee joint,Finite Element Model,Knee Biomechanics,Knee Osteoarthritis,Knee Prosthesis,Knee Ligaments,Meniscus”为英文检索词在PubMed和EI数据库进行检索,以“有限元分析,有限元模型,膝关节,生物力学,骨关节炎,计算模型,膝关节假体,膝关节韧带,半月板”为中文检索词在中国知网和万方数据库进行检索,最终纳入75篇文献进行分析。结果与结论:①有限元分析法利用医学影像数据获得三维人体模型,将复杂的人体关节结构简化为有限且相互连接的单元,通过对模型施加外部载荷,直观地显示膝关节内部的应力分布。②研究者通过有限元分析深入研究膝关节在不同工况下的内部应力和应变分布,可发现膝关节内部载荷分配平衡改变时,关节软骨的过度载荷及部分区域的负荷下降,这种长期异常应力会引起软骨变形和磨损,最终缺失,对于理解生物力学因素如何引起膝关节退行性变至关重要。③有研究通过有限元分析评估膝骨关节炎患者采用太极拳、步态调整等物理治疗方法的效果,结果显示这些治疗方法减少了软骨的过度负荷,为临床治疗提供了科学理论依据。④临床医生通过有限元分析在手术前进行三维重建、数据测量和模拟手术,能够优化手术治疗策略;此外,还可以通过模拟不同假体的力学特征,改进假体的形状、材料和固定方式,减少患者的并发症,提高患者的治疗效果。⑤人工智能与有限元分析相结合使得有限元模型的构建更为精确和易于操作,极大提高了临床医生医疗实践的效率和患者的治疗效果。⑥有限元分析仅是数字化的模拟,与真实物理状态仍存在一定差异。

Recurrent anterior shoulder instability: Review of the literature and current concepts

The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.

ADC-GERT network parameter estimation model for mission effectiveness of joint operation system

Effectiveness evaluation of the joint operation system is an important basis for the demonstration and development of weapon equipment.With the consideration that existing models of system effectiveness evaluation seldom describe the structural relationship among equipment clearly as well as reflect the dynamic,the analog-to-digital converter-graphical evaluation and review technique(ADC-GERT)network parameter estimation model is proposed based on the ADC model and the joint operation system structure.Firstly,analysis of the joint operation system structure and operation process is conducted to build the GERT network,where equipment subsystems are nodes and activities are directed arches.Then the mission effectiveness of equipment subsystems is calculated by the ADC model.The probability transfer parameters are modified by the mission effectiveness of equipment subsystems based on the Bayesian theorem,with the ADC-GERT network parameter estimation model constructed.Finally,a case study is used to validate the efficiency and dynamic of the ADC-GERT network parameter estimation model.

Aspect-Level Opinion Mining of Online Customer Reviews

This paper focuses on how to improve aspect-level opinion mining for online customer reviews. We first propose a novel generative topic model, the Joint Aspect/Sentiment (JAS) model, to jointly extract aspects and aspect-dependent sentiment lexicons from online customer reviews. An aspect-dependent sentiment lexicon refers to the aspect-specific opinion words along with their aspect-aware sentiment polarities with respect to a specific aspect. We then apply the extracted aspectdependent sentiment lexicons to a series of aspect-level opinion mining tasks, including implicit aspect identification, aspect-based extractive opinion summarization, and aspect-level sentiment classification. Experimental results demonstrate the effectiveness of the JAS model in learning aspectdependent sentiment lexicons and the practical values of the extracted lexicons when applied to these practical tasks.

Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs.

备案审查联合审查方式探究:从实践渊源和生成逻辑探索结构属性

联合审查,是《备案审查决定》新确立的第五类审查方式。借鉴其他职权行使中采行联合审查的实践素材,正好可回应已有四类审查方式的功能空缺,基于此实践渊源和生成逻辑,联合审查在整个审查方式体系中呈现出其结构属性:其实质在审查职权的联合,不同于作为工作机制的联合审查会议;其途径在关联审查对象,有限依托于人大主导;其功能特点在提高审查质效,目标重点在保障审查效力和实效,而核心关键在协同审查基准。这一方面为进一步论证建构联合审查的重点机制提供了规范原理基础,另一方面,诸如联合审查等“探索”型条款,引入了“完善和加强”备案审查制度的又一种重要的制度化路径,而且,在规范基础上建构规范机制、生成规范内涵,拓展了备案审查释义学的用武之地。

2023年度国家自然科学基金联合基金项目申请受理、评审与资助情况综述

联合基金作为国家自然科学基金的重要组成部分,在引导和整合社会资源投入基础研究方面发挥了重要作用。2023年国家自然科学基金委员会稳步推进新时期联合基金改革,会同各联合资助方圆满完成了联合基金项目申请受理、评审与资助工作。本文统计分析了2023年度国家自然科学基金联合基金项目申请、受理与资助数据,分别介绍了项目指南发布、项目申请及其特点、项目初审、评审与资助的情况,并对2024年度联合基金工作进行了展望。

钢管混凝土柱-钢梁连接节点形式与研究进展

钢管混凝土结构体系中,梁柱节点的受力状态复杂,是结构体系中的关键连接部位,对结构的承载力、刚度以及稳定性能均有重要影响。对国内外钢管混凝土柱-钢梁连接节点的相关研究进行了全面的综述,总结了内加强型连接节点、外加强型连接节点、贯通式连接节点、螺栓连接节点等各类钢管混凝土柱-钢梁连接节点形式的特点和已有研究,从承载力、刚度、破坏模式、抗震性能、设计方法等方面对各类连接节点的优势和存在的问题进行了分析和归纳。旨在为钢管混凝土柱-钢梁连接节点的相关研究提供参考,促进钢管混凝土柱结构体系的研究和工程应用。

NLRP3炎症小体的激活在骨关节疾病中的研究进展

炎症是对多种刺激的关键反应,细胞因子等炎症分子在包括骨和关节疾病在内的多种疾病的发病机制中发挥核心作用。促炎性细胞因子主要由免疫细胞产生,介导炎症和先天免疫反应。炎症小体是新近公认的先天免疫的重要参与者。最典型的是NOD样受体蛋白3(NLRP3)炎症小体,NLRP3检测外源性致病性侵袭和内源性细胞损伤,并通过形成NLRP3炎症小体做出反应。NLRP3炎症小体的3个主要成分是NLRP3(捕获危险信号并募集下游分子)、半胱氨酸天冬氨酸蛋白水解酶-1[caspase-1,引起细胞因子白细胞介素-1β(IL-1β)和IL-18的成熟以介导细胞因子释放和焦亡]和含有半胱天冬酶募集结构域的细胞凋亡相关斑点样蛋白(ASC,是连接NLRP3和caspase-1的桥梁)。此外,促炎性细胞因子加速骨吸收和软骨破坏,导致骨和关节组织破坏。因此,促炎性细胞因子参与调节骨和关节疾病的发病机制。该文综述了近年来关于NLRP3炎症小体在骨关节疾病中激活和功能等方面的研究进展。

机器人辅助全膝关节置换技术的应用与前景

背景:目前用于全膝关节置换的机器人系统设计的基本原理是将三维手术规划、术中危险区预警、实时数据反馈及机械臂辅助截骨等技术相结合,以实现全膝关节置换的精准化、个性化,这也恰好是它最大优势所在,因此近年来成为关节外科领域热点话题,备受关注。目的:文章将从机器人辅助全膝关节置换在关节外科领域的发展现状及其与传统全膝关节置换优劣势对比进行概述,此外,还将对机器人辅助全膝关节置换技术未来的发展进行展望。方法:应用计算机检索PubMed、中国知网、万方和维普数据库的相关文章,英文检索词:“robot OR robotic OR robotics OR robotically OR computer,total knee arthroplasty OR total knee replacement,TKA OR TKR”,中文检索词:“机器人辅助,计算机导航,全膝关节置换术”,最终纳入64篇文献进行综述分析。结果与结论:①用于辅助全膝关节置换的机器人系统根据其自由度分为主动式、半主动式和被动式。半主动式系统是目前使用最为广泛的机器人系统,该系统有效提高了全膝关节置换手术的精准性和个性化程度,但其高昂的使用成本与较长的学习曲线仍是在该领域内推广时需要权衡的主要因素。②机器人辅助全膝关节置换可实现膝关节局部三维空间的精准截骨、正确安置假体,已被广泛证明可以提供更好的假体植入精准度,减少影像学异常值,在术中可获得良好的软组织平衡,最终改善术后膝关节运动及功能状态。③但目前的机器人辅助系统依然存在客观的不足之处,包括不同机器人设备与术者之间的学习曲线问题、额外增加的安装和维护成本以及与机器人手术相关的潜在并发症,所以其能否让医疗系统及患者真正受益仍需要更长期的研究予以证明,机器人辅助系统也仍需进行更多实质性的改进。④机器人辅助全膝关节置换技术在临床上仍然处于初步研究阶段,并没有大范围地应用到临床,更加明确该技术的用法、完善该技术的临床操作规范和安全性成为了未来对该技术的研究侧重点。

内侧髌股韧带重建的研究进展

髌股关节不稳是一种常见的膝关节损伤,主要见于年轻患者,明显影响患者的日常生活和运动功能。内侧髌股韧带(MPFL)是髌骨内侧限制髌骨外向脱位的主要稳定结构,也是髌骨不稳发生时必然要损坏的结构。因此,通过MPFL重建恢复髌骨的稳定性为必要措施。虽然MPFL重建在临床上应用较为广泛,但部分手术细节,如股骨隧道和髌骨隧道定位、移植物材料选择、移植物固定角度、移植物张力选择等方面是否影响疗效仍存在争议。近年来,生物力学研究和临床研究的不断深入为术式的优化提供了可靠的循证依据。本文笔者将对MPFL重建的研究新进展进行综述。

Ⅳa型黏多糖贮积症枕颈部畸形的诊断和外科治疗现状

J黏多糖贮积症(MPS)是一种溶酶体贮积性疾病,是由于编码糖胺聚糖(GAGs)降解酶的基因突变引起的,导致包括骨骼、关节、心脏、呼吸系统和中枢神经系统等多器官和系统受累。根据所缺乏或缺陷的酶的性质不同,MPS可细分为Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅵ,Ⅶ,Ⅸ型7种类型,其中Ⅲ型又分为Ⅲa、Ⅲb、Ⅲc和Ⅲd亚型,Ⅳ型分为Ⅳa和Ⅳb亚型^([1])。

血友病病人膝关节功能评估工具的研究进展

综述血友病病人膝关节功能相关评估工具的内容、特点、应用现状及局限性,提示医务人员在使用工具时应依据不同疾病的发展阶段和治疗情况选择评估工具,也可同时使用多个量表达到全面评估的目的。此外,现有的评估工具均来自国外,尚未检索到我国本土化的血友病病人关节功能和生活质量的相关评估工具,建议研究者开发适合我国国情的、具有良好信效度的评估工具,不断完善我国血友病关节功能的评估。

老年人髋关节或膝关节置换术后延续护理对关节功能恢复的有效性及安全性:系统评价

目的系统评价延续护理促进老年人关节功能恢复的有效性及安全性。方法检索Cochrane Library、Web of Science、PubMed、Embase数据库中有关延续护理应用于老年关节置换患者的随机对照试验和队列研究,检索时间从建库到2023年10月25日。2名研究员独立完成文献筛选、数据提取,随机对照试验通过Cochrane偏倚风险工具进行文献偏倚分析,队列研究通过纽卡斯尔-渥太华标准进行文献质量评价。结果共纳入15篇文献,包括34186例膝关节和髋关节置换患者。促进老年髋关节置换患者功能改善的主要指标包括髋关节评分、出院后日常生活指数评分(Barthel Index)及生活质量;对老年膝关节置换患者进行延续护理明显改善的指标包括膝关节运动范围、骨关节炎指数、关节损伤和骨关节炎结果评分;延续护理对术后并发症并没有明显作用。文献质量评价显示纳入文献总体质量较高,但仅1项针对髋关节置换术后患者的研究运用了理论框架。结论延续护理在缓解膝关节疼痛、改善关节活动度及髋关节功能方面发挥了重要作用,但是对生活质量、患者满意度、经济、减少关节置换术后并发症和再次入院率方面的有效性尚需进一步明确。

针刺治疗髌股疼痛综合征临床研究进展

髌股疼痛综合征(PFPS)是导致髌股关节功能障碍的主要疾病之一,严重影响患者的生活质量。PFPS可归属中医学“膝痹”“筋痹”等范畴,针刺治疗效果显著。本文围绕毫针刺、温针灸、火针、针刀、电针等针刺疗法梳理近年针刺治疗PFPS临床研究,探讨不同疗法的临床效果和适用范围。研究结果表明,针刺可有效改善PFPS症状和功能,通过调节中枢神经系统功能、促进炎症因子吸收和关节腔积液清除、改善局部血液循环等机制发挥作用,可为临床治疗PFPS提供参考。

中西医治疗类风湿关节炎腕关节病变的进展

类风湿关节炎(RA)是一种以侵蚀性和对称性为特点且累及多关节的慢性自身免疫性疾病,主要累及腕关节;而腕关节是人体最复杂的关节,也是人体最重要的关节之一,对人日常生活劳动产生重要影响。文章通过查阅中国知网、万方数据库、PubMed等数据库文献资料,回顾10年来国内外中西医治疗类风湿关节炎腕关节病变研究进展,结果发现临床上对于该病治疗方法趋于多样化,中西医治疗理念都更加注重减缓病程发展改善腕关节功能,提高患者生活质量,而不是仅仅控制症状。文章就中西医各自的治疗优缺点作如下综述,为类风湿关节炎腕关节病变治疗提供思路。

关节置换术病人合并衰弱的研究进展

从衰弱定义及相关理论框架、衰弱对关节置换术病人不良结局的影响、关节置换术病人的衰弱评估及干预措施进行综述,提出医护人员应尽早识别关节置换术病人合并衰弱状态,结合我国病人需求,组建多学科团队,从医患双方视角下探索并制定适合我国关节置换术病人合并衰弱的标准化综合干预措施,以最大限度改善病人的功能状态和健康结局。

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目的:对比研究我国药用辅料关联审评制度与美国药品主文件登记制度的核心要素,为完善我国药用辅料管理制度提出几点建议。方法:对我国药用辅料关联审评制度和美国药品主文件登记制度涉及的登记范围、登记主体、登记资料要求,以及完整性审查、关联审评、变更管理6个核心要素做了对比研究。结果与结论:我国药用辅料关联审评制度的核心要素与美国药品主文件登记制度基本一致,但我国药用辅料管理在一些理念和实践层面均有进一步完善的空间,包括以风险为基础的管理理念有待深入贯彻,登记状态的意义有待进一步澄清,辅料的变更管理可进一步优化。