Rates, predictors, and causes of readmission after transcatheter aortic valve replacement in patients with chronic kidney disease

BACKGROUND Transcatheter aortic valve replacement(TAVR)is a revolutionary procedure for severe aortic stenosis.The coexistence of chronic kidney disease(CKD)and TAVR introduces a challenge that significantly impacts patient outcomes.AIM To define readmission rates,predictors,and causes after TAVR procedure in CKD stage 1-4 patients.METHODS We used the national readmission database 2018 and 2020 to look into readmission rates,causes and predictors after TAVR procedure in patients with CKD stage 1-4.RESULTS Out of 24758 who underwent TAVR and had CKD,7892(32.4%)patients were readmitted within 90 days,and had higher adjusted odds of being females(adjusted odds ratio:1.17,95%CI:1.02-1.31,P=0.02)with longer length of hospital stay>6 days,and more comorbidities including but not limited to diabetes mellitus,anemia,and congestive heart failure(CHF).CONCLUSION Most common causes of readmission included CHF(18.0%),sepsis,and complete atrioventricular block.Controlling readmission predictors with very close followup is warranted to prevent such high rate of readmission.

Partial phase flow rate measurements for stratified oil-water flow in horizontal wells

To accurately measure and evaluate the oil-water production profile of horizontal wells, a dynamic measurement experiment of oil-water two-phase flow in horizontal wells and numerical simulation were combined to establish a method for measuring the partial phase flow rate of oil-water two-phase stratified flow in horizontal wells. An experimental work was performed in horizontal oil-water two-phase flow simulation well using combination production logging tool including mini-capacitance sensor and mini-spinner. The combination tool provides a recording of holdup and velocity profiles at five different heights of the borehole cross-section. The effect of total flow rate and water-cut on the response of spinner and capacitive sensor at five measured positions were investigated. The capacitance water holdup interpolation imaging algorithm was used to determine the local fluid property and oil-water interface height, and the measured local fluid speed was combined with the numerical simulation result to establish an optimal calculation model for obtaining the partial phase flow rate of the oil-water two-phase stratified flow in the horizontal well. The calculated flow rates of five measured points are basically consistent with the experimental data, the total flow rate and water holdup from calculation are in agreement with the set values in the experiment too, suggesting that the method has high accuracy.

Gas Exchange Rates of Texas Persimmon (Diospyros texana) in Central Texas Woodlands

Diospyros texana (Texas persimmon) is a secondary species in most Juniperus ashei/Quercus fusiformis woodlands in central Texas. It has high density, but plants are mostly in the community understory. Light response curves at ambient and elevated levels of CO2 and temperature were measured for D. texana. The Anet (photosynthetic rate) increased significantly as both light level and CO2 levels increased but not temperature. The Amax (maximum photosynthetic rate) of D. texana in full sun at elevated levels of CO2 was increased for all treatments. Stomatal conductance increased with levels of CO2 but only if the interaction was removed from the model. Intercellular levels of CO2 increased with both temperature and CO2 treatments as did water use efficiency (WUE). Furthermore, light saturation (Lsat) increased with CO2 treatments and light compensation (Lcp) increased with temperature. The dark respiration (Rd) increased with both temperature and CO2 treatments. Markov population models suggested D. texana populations would remain ecologically similar in the future. However, sub-canopy light levels and herbivory should be considered when examining population projections. For example, Juniperus ashei juveniles are not recruited into any canopy unless there are high light levels. Herbivory reduces the success of Quercus juveniles from reaching the canopy. These factors do not seem to be a problem for D. texana juveniles which would allow them to reach the canopy without need of a high light gap and are not prevented by herbivory. Thus, Juniperus/Quercus woodlands will change in the future to woodlands with D. texana a more common species.

Value of preoperative erythrocyte sedimentation rate, CRP and D-D levels in evaluating the prognosis of elderly patients after hip replacement

Objective: To analyze the clinical value of blood sedimentation rate, C-reactive protein (CRP) and D-dimer (D-D) expression levels in elderly patients before hip replacement for judging the prognosis after operation. Methods 88 patients who needed hip replacement in orthopaedic surgery of our hospital from January 2014 to December 2017 were selected as the research object. According to the prognosis of patients, they were divided into two groups. 42 patients with good prognosis were treated as observation group and 46 patients with poor prognosis were treated as control group. The ESR and CRP of the two groups were recorded and analyzed before and after operation. The expression level of D-D, perioperative changes, and the prognostic value of the area under the curve (AUC) were compared by drawing the patient's working characteristic curve (ROC curve). Results The expression levels of ESR, CRP and D-D in the observation group were significantly higher than those in the control group (P < 0.05). The expression levels of CRP in the observation group were significantly higher than those in the control group (P < 0.05). The expression levels of ESR and CRP in the observation group before discharge were significantly higher than those in the control group (P < 0.05). There was significant difference between the two groups (P < 0.05);the level of ESR expression before and 2 days after operation was significantly lower than that before discharge (P < 0.05);the level of ESR expression before operation was significantly lower than that 2 days after operation (P < 0.05);and the CRP and D-D table before operation were compared between the two groups (P < 0.05). The level of CRP and D-D expression in two groups was significantly higher than that before discharge (P < 0.05). In this study, two groups of patients were infected. The incidence of thrombosis in the observation group was higher than that in the control group, but the difference was not statistically significant (P > 0.05). The Harris score of the observation group was significantly higher than that of the control group (P < 0.05). Conclusion There are abnormal levels of ESR, CRP and D-D expression in elderly patients with hip replacement before operation, and they have certain clinical value in evaluating the prognosis of elderly patients after hip replacement.

Pension replacement rate related to the scope and specific estimates

Pension replacement rate in respect of almost everyone＇s retirement, about the sustainability of the whole pension system, stable relations of society as a whole. For the pension replacement rate study, researchers conducted a more in-depth exploration, according to their different research needs to develop a different pension replacement rate concept. Based on previous studies scholars, for the relevant category of pension replacement rate to sort out, and for different categories of calculation method of the sort, in order to provide a reference for further study of the pension replacement rate.

The Study of Cost Rate for Multiple Cold Standby System Replacement Policies

We consider a replacement policy for a multiple-component cold-standbysystem, and after we analyze this policy, we want to get the mean total cost rate and the preventivepolicy to make it the lowest. In this system, the failure rate of the component in operation isconstant, and the inspection will control all the processes of the operation. The system isinspected at random points over time to determine whether it is to be replaced. During the process,the replacement decision is based on the number of failed components at the time of inspection.

Investigation of awareness rate and current situation in hormone replacement therapy in medical care personnel in Shanghai

Objective:To survey the cognition and requirement of perimenopause health care in Shanghai women,and provide updated situation about hormone replacement therapy(HRT) for further improving the quality of perimenopause health care. Methods:A large survey among 480 medical care personnel at age of 40-60 years in 12 hospitals in Shanghai was launched.The designed questionnaires included the awareness rate> basic knowledge of HRT and request for the information of HRT etc.The data were analyzed. Results:Among the respondents,35.81%(169/472) believed that it is necessary to start HRT in perimenopause women;16.10%(76/472)knew about HRT at some extent;43.22%(204/472) requested for the training of HRT;and 14.19%(67/472) would like to recommend patients using the hormone to treat perimenopause syndrome.In addition,52.41%(76/145)of the medical care personnel who refused to use HRT were worried about the side effects. Conclusion:In Shanghai,the awareness rate of HRT among medical care personnel was relatively low.Only a few medical care personnel prefer to use HRT in perimenopause patients.The main reasons for that were lack of understanding in the treatment of HRT and concerned side effects.

Replacement of Dietary Fish Oil with Vegetable Oils Improves the Growth and Flesh Quality of Large Yellow Croaker(Larmichthys crocea)

We investigated the effect of the replacement of dietary fish oil with vegetable oils on the growth and flesh quality of large yellow croaker(Larmichthys crocea). The basal diet(FO) was formulated to contain 66.5% fish meal and 6.4% menhaden fish oil; whereas the other 3 experimental diets were formulated by replacing the fish oil with 50% soybean oil(SO50), 100% soybean oil(SO100) and 100% palm oil(PO100), respectively. The 4 diets were randomly assigned to 4 floating sea cages(3.0 m × 3.0 m × 3.0 m), and each was stocked with 250 fish individuals with an initial average weight of 245.29 g ± 7.45 g. The fish were fed to apparent satiation twice a day at 5:00 and 17:00, respectively, for 12 weeks. Experimental analysis showed that the specific growth rate of fish fed SO50 or PO100 were significantly higher than that of fish fed FO or SO100(P<0.05), and crude lipid contents of ventral muscle and viscera were significantly lower in fish fed FO than in those fed the other 3 diets(P<0.05). No significant differences in condition factor, viscerosomatic index, hepatosomatic index, gutted yield and colorimetric values of fish among the dietary treatments were observed(P>0.05). Compared to FO diet, SO50, SO100 and PO100 diets led to substantial decreases in the liquid loss and water loss from fresh fillets(1 d, 4℃)(P<0.05). Similarly, thiobarbituric acid reactive substance(TBARS) values of fillets under different storage conditions(1 d, 4℃; 7 d, 4℃; 4 weeks,-20℃; 8 weeks,-20℃) decreased significantly after partial or complete replacement of fish oil with vegetable oils. These findings indicated that the growth performance and selected flesh quality properties(liquid holding capacity and TBARS value) of large yellow croaker were substantially improved by replacing dietary fish oil with vegetable oils.

When to initiate renal replacement therapy: The trend of dialysis initiation

The timing of renal replacement therapy for patients with end-stage renal disease has been subject to considerable variation. The United States Renal Data System shows an ascending trend of early dialysis initiation until 2010, at which point it decreased slightly for the following 2 years. In the 1990s, nephrologists believed that early initiation of dialysis could improve patient survival. Based on the Canadian-United States Peritoneal Dialysis study, the National Kidney Foundation Dialysis Outcomes Quality Initiative recommended that dialysis should be initiated early. Since 2001, several observational studies and 1 randomized controlled trial have found no beneficial effect when patients were placed on dialysis early. In contrast, they found that an increase in mortality was associated with early dialysis initiation. The most recent dialysis initiation guidelines recommend that dialysis should be initiated at an estimated glomerular filtration rate （eGFR） of greater than or equal to 6 mL/min per 1.73 m2. Nevertheless, the decision to start dialysis is mainly based on a predefned eGFR value, and no convincing evidence has demonstrated that patients would benefit from early dialysis initiation as indicated by the eGFR. Even today, the optimal dialysis initiation time remains unknown. The decision of when to start dialysis should be based on careful clinical evaluation.

Optimal Water Pipe Replacement Policy

Water scarcity is the major problem confronting both urban and rural dwellers in Enugu State. This scarcity emanated from indiscriminate pipe failure, lack of adequate maintenance, uncertainty on the time of repair or replacement of pipes etc. There is no systematic approach to determining replacement or repair time of the pipes. Hence, the rule of thumb is used in making such a vital decision. The population is increasing, houses are built but the network is not expanded and the existing ones that were installed for no less than two to three decades ago are not maintained. These compounded the problem of scarcity of water in the state. Replacement or repair of water pipes when they are seen spilling water cannot solve this lingering problem. The solution can be achieved by developing an adequate predictive model for water pipe replacement. Hence, this research is aimed at providing a solution to this problem of water scarcity by suggesting a policy that will be used for better planning. The interests in this paper were to obtain a water pipe failure model, the intensity function λ(t) [failure rate], the reliability R(t) and the optimal time of replacement and they were achieved. It was observed that the failure rate of the pipes increases with time while their reliability deteriorates with time. Hence, the Optimal replacement policy is that each pipe should be replaced after 4th break when the reliability = 0.0011.

二氧化碳置换法开采天然气水合物研究进展

应用CO_(2)置换法开采天然气水合物被认为是一种极具潜力的提高CH_(4)采收率和CO_(2)埋存率的技术。论述了CO_(2)及其混合气置换法开采天然气水合物的机理,梳理了CO_(2)混N_(2)/H_(2)及地热辅助CO_(2)提高水合物中CH_(4)采收率的技术进展。研究表明:①应用纯CO_(2)置换开采天然气水合物时,CH_(4)的采收率较低,而将CO_(2)与N_(2)、H_(2)以不同比例混合后注入天然气水合物藏中进行CH_(4)开采,能够有效提高CH_(4)的采收率。②CO_(2)与N_(2)或H_(2)混合注入水合物层时,多种气体分子在竞争吸附作用下降低了CH_(4)分子与水合物分子笼之间的范德华力,同时降低了混合气中CO_(2)的分压,导致水合物相平衡曲线上移,抑制了置换过程中CO_(2)水合物的生成速率,减轻了包裹作用的不利影响,从而提高CH_(4)采收率。③CO_(2)混合N_(2)注入开采水合物时,N_(2)的混入虽然能够减轻包裹作用的影响,但新形成的N_(2)水合物会堵塞CO_(2)进入水合物分子笼的通道,因此提高CH_(4)采收率效果有限。④在水合物层条件下H_(2)并不会形成新的水合物,而且混入少量的H_(2)又会与N_(2)发生吸附竞争,从而抑制N_(2)水合物的形成,故将低浓度的H_(2)气混入CO_(2)与N_(2)的混合气中能够进一步提高对水合物中CH_(4)的置换率,从而提高CH_(4)的采收率。因此,混入H_(2)被认为是提高CO_(2)置换开发水合物效果的重要途径。⑤混合气周期注气方式可明显提高水合物中CH_(4)的采收率和CO_(2)水合物藏封存率。⑥应用地热辅助CO_(2)开采水合物的方法也能够降低新形成水合物的包裹作用,同时实现CO_(2)在地热层和水合物层的两次埋存,在提高CH_(4)采收率的同时,大大提高CO_(2)在地层中的埋存率。

GFRP筋再生混凝土梁受弯承载力研究

为研究GFRP筋再生混凝土梁(GFRP-RAC)的受弯承载力,完成了5根配GFRP筋、1根配BFRP筋和1根配钢筋的再生混凝土梁抗弯试验,分析了不同再生骨料取代率、纵筋类型以及纵筋配筋率等因素对各试验梁开裂荷载和极限承载力的影响。结果表明:再生骨料取代率对开裂荷载的影响较大,而纵筋类型及纵筋配筋率对其影响不明显;当再生骨料取代率由0增加至50%和100%时,试验梁开裂荷载分别减小了7.9%和17.3%;极限承载力受再生骨料取代率影响较小而受纵筋配筋率影响较大,当GFRP-RAC梁纵筋配筋率由0.38%提高至0.6%和1.17%时,极限荷载分别提升了17.9%和52.5%。另外,结合国内外规范对GFRP-RAC梁的受弯承载力进行对比分析,并基于试验数据和相关试验结果的回归分析,得到开裂荷载修正系数αcr,开裂荷载修正后的计算值与试验值吻合较好。

碳纤维布加固损伤再生混凝土梁受弯性能研究

为研究因承受荷载而产生损伤的再生混凝土梁经碳纤维布加固后的受弯性能,选取不同的再生骨料取代率,设计了9根再生混凝土梁;通过预加弯曲荷载使试验梁产生初始损伤,卸载后在损伤梁底部粘贴不同宽度的碳纤维布进行加固,再对试验梁进行受弯承载力试验;考虑再生骨料掺量及预损伤程度的影响,提出了碳纤维布加固损伤再生混凝土梁发生剥离破坏时的受弯承载力计算公式。结果表明:因预损伤产生的裂缝降低了碳纤维布与再生混凝土梁间的黏结强度,加固梁均发生了剥离破坏;随再生骨料取代率的增加,试验梁在相同荷载下产生的裂缝宽度和数量逐渐增加,极限承载力有所减小;随碳纤维布加固宽度的增大,试验梁破坏时的挠度减小,极限承载力提高,裂缝分布细而密;随预损伤程度的增大,试验梁破坏时的裂缝宽度逐渐增大,数量明显增多,但极限承载力和挠度变化并不明显;受弯承载力计算值与试验值吻合较好,研究成果可为碳纤维布加固损伤再生混凝土梁的受力性能评估提供参考。

内置CFRP管的钢管再生混凝土短柱轴压性能研究

目的研究不同截面形式下,内置CFRP管的钢管再生混凝土短柱力学性能。方法利用有限元软件建立试件模型,验证模型的正确性,在此基础上,建立组合短柱模型,分析CFRP层数、钢管厚度、再生骨料取代率对不同截面形式下组合柱力学性能的影响。结果增加CFRP层数和钢管厚度可以提高组合短柱的极限承载力和位移延性系数;改变再生骨料取代率,对组合短柱力学性能的影响较小;改变截面形式,圆截面短柱的力学性能优于方截面短柱。结论在工程设计中,使用该组合短柱时建议组合柱内置两层CFRP,截面形式建议优先考虑圆截面;若需提高组合柱承载力,建议采用增加钢管厚度的方式。

企业职工基本养老保险个人账户改革方案比较研究

企业职工基本养老保险的参保职工去世时其个人账户有余额的,余额部分可继承;领空个人账户余额仍然存活的参保职工可以继续领取个人账户待遇直至身故,带来个人账户基金收支缺口。在计发月数偏小、个人账户投资收益率不高、记账利率虚高情况下,基金收支缺口进一步扩大。本文对四种个人账户改革方案进行模拟,比较不同改革方案的优缺点。研究发现:(1)在“仅取消可继承规定”的方案一下,或“不可继承+按平均退休余命调整计发月数”的方案二下,遗产差都远小于长寿差,个人账户无法实现基金收支平衡;(2)如取消可继承规定,能消除个人账户收支缺口的计发月数远高于可支付至平均退休余命的计发月数;(3)在“可继承+个人账户实际余额‘领空不领’”的方案三下,或“可继承+按极限年龄调整计发月数”的方案四下均可实现个人账户基金收支平衡;但方案三下长寿参保职工在领空个人账户余额后养老金替代率会大幅陡降,方案四则将待遇降低的冲击分摊在整个待遇领取期。个人账户改革方案需要在可继承规定、基金收支平衡和养老金替代率之间做权衡选择。上述研究发现对机关事业单位工作人员基本养老保险和城乡居民基本养老保险个人账户改革同样具有参考意义。

早期抗阻训练在髋关节置换术患者中的应用价值

目的 探讨早期抗阻训练在髋关节置换术患者中的应用价值。方法 选取2021年1月—2022年6月中国人民解放军联勤保障部队天津康复疗养中心的80例髋关节置换术患者,依据随机数字表法分为2组。对照组的40例患者进行常规训练,观察组的40例患者进行早期抗阻训练。比较2组的关节功能总优良率,术前、术后的Charnley髋关节功能评分及假体周围骨密度。结果 观察组术后6、12个月关节功能总优良率分别为95.00%、100%,高于对照组的77.50%、87.50%(P<0.05);术前,2组Charnley髋关节功能评分及假体周围骨密度比较,差异无统计学意义(P>0.05);观察组术后6、12个月后Charnley髋关节功能评分及假体周围骨密度均高于对照组(P<0.05)。结论 早期抗阻训练在髋关节置换术患者中的应用效果较好,可更为有效地改善患者关节功能及假体周围骨密度,在髋关节置换术患者中的应用价值较高。

考虑碳化影响的纤维增强再生混凝土吸水特性研究

考虑再生粗骨料取代率与聚丙烯纤维体积率的影响,开展了再生混凝土快速碳化以及碳化后的毛细吸水试验研究。试验结果表明:混凝土碳化深度随着再生粗骨料取代率的增加而增大,随聚丙烯纤维体积率增大呈先下降后上升的趋势,纤维会降低再生混凝土的碳化深度。再生混凝土毛细吸水系数随碳化程度的增加先减小后增大;随再生粗骨料取代率增加而增大;随聚丙烯纤维体积率增加先降低后增大。碳化对再生混凝土初始毛细吸水系数的影响大于后期吸水系数,且混凝土孔隙率越大,碳化对初始吸水系数的影响越显著。最后,建立了考虑碳化影响的再生混凝土初始毛细吸水系数预测模型。

橡胶粗细集料含量对FRP约束橡胶混凝土应力-应变关系的影响

为研究橡胶粗细集料体积分数对纤维增强复合材料(fiber reinforced polymer, FRP)约束橡胶混凝土应力-应变关系的影响,提出了橡胶粗细集料体积替换率的概念,并通过收集已发表文献的110组应力-应变关系试验曲线,分析了橡胶粗细集料体积替换率对FRP约束不同截面橡胶混凝土柱应力-应变关系关键参数的影响,基于分析结果建立了FRP约束橡胶混凝土的应力-应变关系模型和抗压强度模型,两个模型中均考虑了橡胶粗细集料体积替换率和橡胶混凝土截面形状的影响.模型评估结果表明:随着橡胶粗细集料体积替换率、FRP约束应力比和截面倒角半径比的增加,FRP约束橡胶混凝土的抗压强度均呈增大的趋势;建立的抗压强度模型可准确预测橡胶颗粒取代部分细集料或粗细集料的FRP约束橡胶混凝土抗压强度,平均误差仅为1.03;建立的应力-应变关系模型能够较好预测FRP约束橡胶混凝土的应力-应变关系曲线变化.

规范化疼痛干预联合功能锻炼对髋关节置换术患者睡眠质量效果观察

目的:探究在对髋关节置换术患者护理时开展规范化疼痛干预联合功能锻炼对患者睡眠质量、疼痛程度以及关节功能的影响。方法:选取2023年3月至2024年3月厦门大学附属第一医院收治的行髋关节置换术患者66例作为研究对象,按照随机数字表法分为对照组和观察组,每组33例。对照组开展常规护理,观察组开展规范化疼痛干预联合功能锻炼。针对患者睡眠质量、疼痛程度、关节功能进行对比。结果:匹兹堡睡眠质量指数量表(PSQI)、视觉模拟量表(VAS)组间比较,干预后观察组评分较低,差异有统计学意义(P<0.05);日平均睡眠时间、夜间最长连续睡眠时间长于对照组,差异有统计学意义(P<0.05);Harris髋关节功能评分组间比较,干预后观察组较高,差异有统计学意义(P<0.05)。结论:在对髋关节置换术患者护理时开展规范化疼痛干预联合功能锻炼,可以提升患者手术期间睡眠质量,降低疼痛程度,促进关节功能恢复。

粉煤灰再生混凝土力学性能试验研究

利用试验检测机构废弃的混凝土试块作为再生粗骨料的原材料,配制不同粗骨料取代率的混凝土,再加入适量粉煤灰,制成试件(取代率分别为0、30%、60%和100%),用于混凝土立方体抗压、劈裂抗拉、轴心抗压和弹性模量试验,通过观察其破坏过程和破坏形态,获取荷载-位移全过程曲线,研究并提出了本构方程。试验结果表明,粉煤灰再生骨料混凝土与天然骨料混凝土相比,各项力学指标随着再生骨料取代率的增大先是呈现增长趋势,当达到峰值后,各项力学指标均下降;两者的应力-应变曲线具有相似的形状,在上升阶段,再生混凝土与天然混凝土的应力-应变曲线变化不大,但在下降段再生混凝土的应力-应变曲线急剧下降。