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.

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.

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.

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.

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.

Minimalistic approach to left atrial appendage occlusion guided by cardiac computed tomography angiography

OBJECTIVE To assess the feasibility and safety of the minimalistic approach to left atrial appendage occlusion(LAAO) guided by cardiac computed tomography angiography(CCTA).METHODS Ninety consecutive patients who underwent LAAO, with or without CCTA-guided, were matched(1:2). Each step of the LAAO procedure in the computed tomography(CT) guidance group(CT group) was directed by preprocedural CT planning. In the control group, LAAO was performed using the standard method. All patients were followed up for 12 months, and device surveillance was conducted using CCTA.RESULTS A total of 90 patients were included in the analysis, with 30 patients in the CT group and 60 matched patients in the control group. All patients were successfully implanted with Watchman devices. The mean ages for the CT group and the control group were 70.0 ± 9.4 years and 68.4 ± 11.9 years(P = 0.52), respectively. The procedure duration(45.6 ± 10.7 min vs. 58.8 ± 13.0 min,P < 0.001) and hospital stay(7.5 ± 2.4 day vs. 9.6 ± 2.8 day, P = 0.001) in the CT group was significantly shorter compared to the control group. However, the total radiation dose was higher in the CT group compared to the control group(904.9 ± 348.0 m Gy vs.711.9 ± 211.2 m Gy, P = 0.002). There were no significant differences in periprocedural pericardial effusion(3.3% vs. 6.3%, P = 0.8) between the two groups. The rate of postprocedural adverse events(13.3% vs. 18.3%, P = 0.55) were comparable between both groups at 12 months follow-up.CONCLUSIONS CCTA is capable of detailed LAAO procedure planning. Minimalistic LAAO with preprocedural CCTA planning was feasible and safe, with shortened procedure time and acceptable increased radiation and contras consumption. For patients with contraindications to general anesthesia and/or transesophageal echocardiography, this promising method may be an alternative to conventional LAAO.

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.

A Deep Learning Based Broadcast Approach for Image Semantic Communication over Fading Channels

We consider an image semantic communication system in a time-varying fading Gaussian MIMO channel,with a finite number of channel states.A deep learning-aided broadcast approach scheme is proposed to benefit the adaptive semantic transmission in terms of different channel states.We combine the classic broadcast approach with the image transformer to implement this adaptive joint source and channel coding(JSCC)scheme.Specifically,we utilize the neural network(NN)to jointly optimize the hierarchical image compression and superposition code mapping within this scheme.The learned transformers and codebooks allow recovering of the image with an adaptive quality and low error rate at the receiver side,in each channel state.The simulation results exhibit our proposed scheme can dynamically adapt the coding to the current channel state and outperform some existing intelligent schemes with the fixed coding block.

Development of a DFN-based probabilistic block theory approach for bench face angle design in open pit mining

In open pit mining,uncontrolled block instabilities have serious social,economic and regulatory consequences,such as casualties,disruption of operation and increased regulation difficulties.For this reason,bench face angle,as one of the controlling parameters associated with block instabilities,should be carefully designed for sustainable mining.This study introduces a discrete fracture network(DFN)-based probabilistic block theory approach for the fast design of the bench face angle.A major advantage is the explicit incorporation of discontinuity size and spatial distribution in the procedure of key blocks testing.The proposed approach was applied to a granite mine in China.First,DFN models were generated from a multi-step modeling procedure to simulate the complex structural characteristics of pit slopes.Then,a modified key blocks searching method was applied to the slope faces modeled,and a cumulative probability of failure was obtained for each sector.Finally,a bench face angle was determined commensurate with an acceptable risk level of stability.The simulation results have shown that the number of hazardous traces exposed on the slope face can be significantly reduced when the suggested bench face angle is adopted,indicating an extremely low risk of uncontrolled block instabilities.

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.

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.

Fitness Sharing Chaotic Particle Swarm Optimization (FSCPSO): A Metaheuristic Approach for Allocating Dynamic Virtual Machine (VM) in Fog Computing Architecture

In recent decades,fog computing has played a vital role in executing parallel computational tasks,specifically,scientific workflow tasks.In cloud data centers,fog computing takes more time to run workflow applications.Therefore,it is essential to develop effective models for Virtual Machine(VM)allocation and task scheduling in fog computing environments.Effective task scheduling,VM migration,and allocation,altogether optimize the use of computational resources across different fog nodes.This process ensures that the tasks are executed with minimal energy consumption,which reduces the chances of resource bottlenecks.In this manuscript,the proposed framework comprises two phases:(i)effective task scheduling using a fractional selectivity approach and(ii)VM allocation by proposing an algorithm by the name of Fitness Sharing Chaotic Particle Swarm Optimization(FSCPSO).The proposed FSCPSO algorithm integrates the concepts of chaos theory and fitness sharing that effectively balance both global exploration and local exploitation.This balance enables the use of a wide range of solutions that leads to minimal total cost and makespan,in comparison to other traditional optimization algorithms.The FSCPSO algorithm’s performance is analyzed using six evaluation measures namely,Load Balancing Level(LBL),Average Resource Utilization(ARU),total cost,makespan,energy consumption,and response time.In relation to the conventional optimization algorithms,the FSCPSO algorithm achieves a higher LBL of 39.12%,ARU of 58.15%,a minimal total cost of 1175,and a makespan of 85.87 ms,particularly when evaluated for 50 tasks.

Contemporary strategies and approaches for characterizing composition and enhancing biofilm penetration targeting bacterial extracellular polymeric substances

Extracellular polymeric substances(EPS)constitutes crucial elements within bacterial biofilms,facili-tating accelerated antimicrobial resistance and conferring defense against the host's immune cells.Developing precise and effective antibiofilm approaches and strategies,tailored to the specific charac-teristics of EPS composition,can offer valuable insights for the creation of novel antimicrobial drugs.This,in turn,holds the potential to mitigate the alarming issue of bacterial drug resistance.Current analysis of EPS compositions relies heavily on colorimetric approaches with a significant bias,which is likely due to the selection of a standard compound and the cross-interference of various EPS compounds.Considering the pivotal role of EPS in biofilm functionality,it is imperative for EPS research to delve deeper into the analysis of intricate compositions,moving beyond the current focus on polymeric materials.This ne-cessitates a shift from heavy reliance on colorimetric analytic methods to more comprehensive and nuanced analytical approaches.In this study,we have provided a comprehensive summary of existing analytical methods utilized in the characterization of EPS compositions.Additionally,novel strategies aimed at targeting EPS to enhance biofilm penetration were explored,with a specific focus on high-lighting the limitations associated with colorimetric methods.Furthermore,we have outlined the challenges faced in identifying additional components of EPS and propose a prospective research plan to address these challenges.This review has the potential to guide future researchers in the search for novel compounds capable of suppressing EPS,thereby inhibiting biofilm formation.This insight opens up a new avenue for exploration within this research domain.

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.

Gastrointestinal tuberculosis:Diagnostic approaches for this uncommon pathology

A case report entitled“Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction”recently published in the World Journal of Clinical Cases presented a rare cause of gastric outlet obstruction and highlighted the atypical manner in which gastrointestinal tuberculosis(TB)can present.The literature with regards to this rare pathology is limited to case reports and case series with the largest being published using data from between 2003 and 2013.However,since then the diagnostic tools available have significantly changed with more modern and increasingly accurate tests now available.This editorial reviews the current state of the art with regards to diagnosis in gastrointestinal TB.

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.

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.

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.

Applying an Ordinal Priority Approach Based Neutrosophic Fuzzy Axiomatic Design Approach to Develop Sustainable Geothermal Energy Source

Geothermal energy is considered a renewable,environmentally friendly,especially carbon-free,sustainable energy source that can solve the problem of climate change.In general,countries with geothermal energy resources are the ones going through the ring of fire.Therefore,not every country is lucky enough to own this resource.As a country with 117 active volcanoes and within the world’s ring of fire,it is a country whose geothermal resources are estimated to be about 40%of the world’s geothermal energy potential.However,the percentage used compared to the geothermal potential is too small.Therefore,this is the main energy source that Indonesia is aiming to exploit and use.However,the deployment and development of this energy source are still facing many obstacles due to many aspects from budget sources due to high capital costs,factory construction location,quality of resources,and conflicts of the local community.In this context,determining the optimal locations for geothermal energy sites(GES)is one of the most important and necessary issues.To strengthen the selection methods,this study applies a two-layer fuzzy multi-criteria decision-making method.Through the layers,the Ordinal Priority Approach(OPA)is proposed to weight the sub-criteria,the main criterion,and the sustainability factors.In layer 2,the Neutrosophic Fuzzy Axiomatic Design(NFAD)is applied to rank and evaluate potential locations for geothermal plant construction.Choosing the right geothermal energy site can bring low-cost efficiency,no greenhouse gas emissions,and quickly become the main energy source providing electricity for Indonesia.The final ranking shows Papua,Kawah Cibuni,and Moluccas as the three most suitable cities to build geothermal energy systems.Kawah Cibuni was identified as the most potential GES in Indonesia,with a score of 0.46.Papua is the second most promising GES with a score of 0.45.Next is the Moluccas,with a score of 0.39.However,the three least potential sites among the 15 studied sites are Lumut Balai,Moluccas and Patuha,with scores of 0.08,0.11 and 0.17,respectively.The conclusion of this study also classifies positions into groups to aid in decision-making.