Subsequent total joint arthroplasty: Are we learning from the first stage?

BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.

Development of 3D bicontinuous metal-intermetallic composites through subsequent alloying process after liquid metal dealloying

This study presents a novel process for the fabrication of metal-intermetallic composites with a 3D bicontinuous structure, achieved through a combination of liquid metal dealloying(LMD) and subsequent alloying. Initially, porous Ti structures are produced using the LMD process, followed by immersion in a molten Mg-3Al(wt%) metal. Due to the higher thermodynamic miscibility of Al with Ti compared to Mg, the concentration of Al in the Ti matrix increases as the immersion time increases. This results in a sequential phase transition within the Ti matrix: α-Ti → Ti_(3)Al → Ti Al. The phase transition considerably affects the hardness and strength of the composite material,with the Mg-Ti_(3)Al-Ti Al composite exhibiting a maximum hardness nearly twice as high as that of the conventional Mg-Ti composite. This innovative process holds potential for the development of various bicontinuous metal-intermetallic composites.

Comparison of concomitant and subsequent cholangiocarcinomas associated with hepatolithiasis:Clinical implications

AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.

Effects of the Residues of Cuscuta campestris and Mikania micrantha on Subsequent Plant Germination and Early Growth

Cuscuta campestris, a dodder, can parasitize and suppress a scrambling herbaceous to semi-woody perennial vine, Mikania micrantha, one of the most destructive weeds in the world. To assess the effects of the mixed residue of C. campestris and M. micrantha on the subsequent plant community, we conducted a one-year experiment on the germination and seedling growth of subsequent plant community after the application of C. campestris. Seven treatments of varying proportions of C. campestris and M. mierantha residue on 21 subject trees and shrubs, which were commonly found in South China, resulted in a germination rate of 35.3% for all 8 715 seeds from 18 species, ranging from 5.7 to 81.9%; the remaining 3 species failed to germinate. ANOVA analysis showed that the residue did not affect the germination, growth, or mortality of the trees and shrubs. The germinated C. campestris seeds from the residue coiled the seedlings of most of the species, but less than 4% host death caused by C. campestris. In addition, the residue did not affect the germination of the herbaceous seedlings originating from the loam, and the similarity coefficients of the germinated seedlings between the treatments were very high. These results suggested that the residue had no negative impact on the germination and early seedling stages of the tree, shrub and grass species of the subsequent plant community. The use of C. campestris residue had a positive effect on the growth of M. micrantha, but it did not change the trend of M. micrantha being suppressed because re-parasitization occurred soon after the growth restarted. No negative effect was detected on the other species as a result of the parasitization of C. campestris or by the use of the mixed residue. This suggests that C. campestris is likely to be an effective and promising ecologically safe native herbaceous agent for controlling M. micrantha.

Obstructive sleep apnea increases heart rhythm disorders and worsens subsequent outcomes in elderly patients with subacute myocardial infarction

OBJECTIVE Obstructive sleep apnea(OSA)is a potential cardiovascular risk.We aimed to investigate the association of OSA with heart rhythm disorders and prognosis in elderly patients with new-onset acute myocardial infarction(AMI).METHODS We prospectively enrolled 252 AMI elderly patients(mean age,68.5±6.9 years)who were undergoing revascularization and completed a sleep study during their hospitalization.All subjects were categorized into non-OSA(apnea–hypopnea index(AHI)<15,n=130)and OSA(AHI≥15,n=122)groups based on the AHI.The changes in the autonomic nervous system,incidence of arrhythmia during nocturnal sleep,and major adverse cardiovascular and cerebrovascular events(MACCEs)were compared between the groups.RESULTS The mean AHI value in all AMI patients was 22.8±10.9.OSA patients showed higher levels of body mass index and peak high-sensitivity C-reactive protein and lower levels of minimum nocturnal oxygen saturation(Min Sa O2),as well as greater proportion of multivessel coronary artery disease(all P<0.05).The OSA group also showed significant increases in heart rate variability and heart rate turbulence onset(both P<0.05)and higher incidence of arrhythmia(including sinus,atrial,and ventricular in origin).At a median follow-up of 6 months(mean 0.8–1.6 years),OSA(AHI≥15)combined with hypoxia(Min Sa O2≤80%)was independently associated with the incidence of MACCEs(hazard ratio[HR]:4.536;95%confidence interval[CI]:1.461-14.084,P=0.009)after adjusting for traditional risk factors.CONCLUSIONS OSA and OSA-induced hypoxia may correlate with the severity of myocardial infarction,increase the occurrence of heart rhythm disorders in elderly subacute MI patients,and worsen their short-term poor outcomes.

CONVERSION OF SURGICALLY VERIFIED UNRESECTABLE TO RESECTABLE HEPATOCELLULAR CARCINOMA(A REPORT OF 26 PATIENTS WITH SUBSEQUENT RESECTION)

During the period 1978-1987, 255 patients with pathologically proven hepatocellular carcinoma (HCC) were determined by laparotomy to be un-resectable, 155 (60.8%) out of them had their tumor mainly confined in right or left lobe and considered to be potentially resectable if remarkable tumor shrinkage appears after treatment. Second look operation was performed in 26 (16.8%) out of the 155 patients after marked reduction of tumor size, resection was done in all of these 26 patients. Triple or quadruple combination treatment with hepatic artery ligation (HAL), hepatic artery infusion (HAI) with chemotherapy, radiotherapy using linear accelerator, and radioimmunotherapy using 131-I antihu-man HCC ferritin antibody yielded the highest conversion rate (29.8%, 14/47) as compared to double combination treatment with HAL+HAI, or cryosur-gery+HAL (16.9%, 12/71) and single treatment with HAL or HAI or HAE (embolization) (0%, 0/37). The median tumor size of these 26 patients was reduced from 9.5 cm to 5.0 cm after combination treatment. The median interval between the first laparotomy and the subsequent resection was 5.0 (2-16) months. The survival rates calculated by life table method were: 1-year 86.5%, 2-year 74.3% and 3-year 74.3%. Nine cases have survival more than 3 years. Thus, multimodality combination treatment with subsequent resection might prolong survival significantly for some patients with unresectable HCC particularly confined in right lobe of a cirrhotic liver.

Neuroprotective effects of ischemic preconditioning on hippocampal CA1 pyramidal neurons through maintaining calbindin D28k immunoreactivity following subsequent transient cerebral ischemia

Ischemic preconditioning elicited by a non-fatal brief occlusion of blood flow has been applied for an experimental therapeutic strategy against a subsequent fatal ischemic insult. In this study, we investigated the neuroprotective effects of ischemic preconditioning（2-minute transient cerebral ischemia） on calbindin D28k immunoreactivity in the gerbil hippocampal CA1 area following a subsequent fatal transient ischemic insult（5-minute transient cerebral ischemia）. A large number of pyramidal neurons in the hippocampal CA1 area died 4 days after 5-minute transient cerebral ischemia. Ischemic preconditioning reduced the death of pyramidal neurons in the hippocampal CA1 area. Calbindin D28k immunoreactivity was greatly attenuated at 2 days after 5-minute transient cerebral ischemia and it was hardly detected at 5 days post-ischemia. Ischemic preconditioning maintained calbindin D28 k immunoreactivity after transient cerebral ischemia. These findings suggest that ischemic preconditioning can attenuate transient cerebral ischemia-caused damage to the pyramidal neurons in the hippocampal CA1 area through maintaining calbindin D28k immunoreactivity.

Effect of drawbead on forming performance of subsequent sheet

In order to research the plastic performance of sheet going through the drawbead and the simple tensile test of sheet, the influence of drawbead structure parameters on sheet performance and the subsequent performance of the sheet were performed to investigate the residual deformation characteristics of the sheet through different drawbead structures, and also the influences of drawbead structures and geometry parameters on pre-deformation and subsequent forming characters of sheet were analyzed. The results show that the pre-deformation decreases with the increase of the round corner radius, the pre-deformation increase with the increase of the height of drawbead, and the subsequent forming characteristics of sheet going through drawbead are remarkably different from undeformed sheet and these differences heavily depend on the pre-deformation. With the increases of pre-deformation, the yield ratio increases, but the subsequent elongation exponential decreases. These means deformability of the sheet is significantly reduced. As the structure of drawbead changes, the mechanical characteristics of material in different cyclic loading conditions also change. For the BUFDE+Z deep drawing steel sheet, the subsequent performance of the sheet is hardened when the pre-deformation is greater than 0.044. For the DC52D+ZF hot-galvanize steel sheet, the subsequent performance of the sheet begins to harden when the pre-deformation is greater than 0.079, and it presents that the pre-deformation is not bigger than 0.052.

Effects of Helium Implantation and Subsequent Electron Irradiation on Microstructures of Fe-11 wt.% Cr Model Alloy

Helium effects on dislocation and cavity formation of Fe-11 wt.% Cr model alloy are investigated. Single-beam(electron) and dual-beam(He^+/e^-) irradiations are performed at 350℃ and 400℃ using an ultra-high voltage electron microscope combined with ion accelerators. In-situ observation shows that the growth rate of dislocation loops is reduced in the helium pre-injected specimen. The mean size of cavities decreased in the helium preinjected specimen. The possible mechanisms are discussed.

Shake-up Processes in the 3d Photoionization of Sr I and the Subsequent Auger Decay

The shake-up processes accompanied by 3d photoionization and subsequent Auger decay are studied using multiconfiguration Dirac-Fock methods.Generalagreement is obtained with the experimental results for both the photoelectron and Auger electron spectra.The energy and relative intensity of the 5s → 6s shake-up accompanied by the 3d photoionization process are identified quantitatively.

Study on Key Problems of a New Environmental Dredging Based on Ecological Protection and Subsequent Ecological Restoration

[Objective] The research aimed to study key problems of a new environmental dredging based on ecological protection and subsequent ecological restoration. [Method] People paid more attention to sediment pollutant removal in environmental dredging, without considering coming aquatic eco-restoration work after dredging. Factor affecting aquatic ecosystem existence and growth was screened, and ecological dredging manner was put forward. [Result] On the basis of analyzing dredging objective, effect and influence, started from ecological protection and subsequent ecological restoration, water depth and substrate were screened as priority control factors of the environmental sediment dredging. New manner of combining sediment dredging to reshape underwater terrain was put forward. [Conclusion] The research provided solution for water depth and substrate demands of the subsequent ecological restoration.

The Time-Space Features of Ms≥6.0 Earthquakes Subsequent to Ms≥7.0 Earthquakes in the Mainland of China

In this paper,the time-space features of Ms≥6.0 strong earthquakes that have occurred on the Chinese mainland since the beginning of this century were analyzed; the effect of Ms≥7.0 large shocks in mitigating Ms≥6.0 strong earthquakes subsequent to them vas studied both temporally and spatially; and the accumulative probabilities for the occurrence of Ms≥6.0 strong earthquakes subsequent to Ms≥7.0 large shocks were calculated.The results seem to imply that the effect of Ms≥7.0 large shocks in mitigating subsequent strong events is relatively obvious within certain time-space ranges.This is because the strain energy accumulated over a long time in the region around the source has been mostly released through the fracture produced by the large shock,the possibility for another large fracture to occur again in the same region within a certain period of time has been greatly reduced and therefore the probability for subsequent strong earthquakes to occur in that region is very low.These results can

Risk Factors for Gestational Diabetes Mellitus(GDM)in Subsequent Pregnancy Among Women Without GDM History in China:A Multicenter Retrospective Study

Objective:This study aimed to determine the likelihood of gestational diabetes mellitus(GDM)in subsequent pregnancy among women without GDM history and to identify risk factors for GDM in subsequent pregnancy.Methods:This retrospective cohort study involved participants who delivered twice in same hospital of 18 research centers when delivered the second baby from January 2018 to December 2018.Finally 6204 women were enrolled and 5180 women without GDM history were analyzed further.Women were categorized as non-GDM or GDM based on the blood glucose values of the subsequent pregnancy,and the characteristics and GDM risk of these groups were compared.A univariate analysis of potential risk factors was performed using the Chi-squared test and/ort-test for qualitative or quantitative variables,respectively.Associations withP values<0.1 were chosen to be included in the multivariate binary logistic regression model.Results:In primary analysis of 6204 women,the incidence of GDM in subsequent pregnancy is 48.9%(490/1002)in women with GDM history and 16.1%(835/5202)in women without GDM history.In a further analysis for 5180 women without GDM at index pregnancy,compared with the non-GDM group,the GDM group had a significantly higher age,prepregnancy body mass index,and blood glucose value at each oral glucose tolerance test(OGTT)timepoint(fasting,1 h and 2 h)during the index and subsequent pregnancies,as well as higher weight retention during the interval between the two pregnancies(P<0.001).Age above 35 years in subsequent pregnancy(odds ratio(OR)=1.540,95%confidence interval(CI)=1.257-1.886,P<0.001),macrosomia in index pregnancy(OR=1.749,95%CI=1.277-2.395,P=0.001),OGTT blood glucose values in index pregnancy(fasting,OR=2.487,95%CI=1.883-3.285,P<0.001;1 h,OR=1.142,95%CI=1.051-1.241,P=0.002;2 h,OR=1.290,95%CI=1.162-1.432,P<0.001)and weight retention(OR=1.052,95%CI=1.035-1.068,P<0.001)were independent risk factors for GDM in subsequent pregnancy.Conclusion:For women without GDM history,GDM risk factors including age,macrosomia history,OGTT value,and weight retention,these can be evaluated before a subsequent pregnancy.Early warning and interventions are needed for women at high risk.

An improved prediction method of subsequent commutation failure of an LCC-HVDC considering sequential control response

Subsequent commutation failure(SCF)can be easily generated during the first commutation failure(CF)recovery process in a line-commutated converter-based high voltage direct-current system.SCF poses a significant threat to the safe and stable operation of power systems,and accurate prediction of CF is thus important.However,SCF is affected by the operating characteristics of the main circuit and the coupling effects of sequential control response in the inverter station.These are difficult to predict accurately.In this paper,a new SCF prediction method considering the control response is proposed based on the physical principle of SCF.The time sequence and switching conditions of the controllers at different stages of the first CF recovery process are described,and the corresponding equations of commutation voltage affected by different controllers are derived.The calculation method of the SCF threshold voltage is proposed,and the prediction method is established.Simulations show that the proposed method can predict SCF accurately and provide useful tools to suppress SCF.

Efficacy and safety of subsequent radiotherapy in patients with advanced-stage hepatocellular carcinoma treated with immune checkpoint inhibitors

Background:The development of immunotherapy resistance is associated with a poor prognosis in patients diagnosed with hepatocellular carcinoma(HCC)who are undergoing treatment with immune checkpoint inhibitors(ICI).This study aimed to evaluate the efficacy and safety of subsequent radiotherapy(RT)for patients with advanced-stage HCC who had lesion enlargement or new lesions(NLs)during ICI therapy.Methods:This retrospective observational study enrolled 36 patients with advanced-stage HCC who underwent subsequent RT for lesion enlargement or NLs during ICI therapy from two centers.The primary endpoints were progression-free survival(PFS)and overall survival(OS).The secondary endpoints included objective response rate(ORR),disease control rate(DCR),1-and 2-year local control(LC)rates,in-field PFS(IFPFS),out-field PFS(OFPFS),and safety.Results:The median follow-up time was 15.3 months.The median PFS was 7.4 months[95%confidence interval(CI):3.1-11.7 months],and the median OS was 18.8 months(95%CI:17.1-20.5 months).ORR and DCR were 38.9%and 72.2%,respectively.In addition,the median IFPFS was 17.8 months(95%CI:11.5-24.2 months),median OFPFS was 7.9 months(95%CI:3.4-12.5 months),and estimated 1-and 2-year LC rates were 67.1%and 31.9%,respectively.The most common treatment-related adverse events(all grades)were diarrhea(33.3%),rash(30.6%),and malaise(27.8%);a total of 14(38.9%)patients developed grade 3-4 AEs.Conclusions:Subsequent RT showed reliable antitumor effects and an acceptable safety profile in patients with advanced-stage HCC who had unsatisfactory response to ICI therapy;therefore,it could serve as an optional salvage strategy.

Transient receptor potential channels and calcium dysregulation: a pathogenic duo in Parkinson's disease

Parkinson's disease(PD) has a complex and multifactorial pathophysiology. Various studies, conducted both in pre-clinical models and PD patients, have reported a link between the disruption of calcium(Ca^(2+)) homeostasis and the subsequent development of PD. Ca^(2+) regulation is crucial for neuronal survival, differentiation,exocytosis at synapses,gene transcription,and proliferation.

Stability analysis of large-scale stope using stage subsequent fillingmining method in Sijiaying iron mine

To improve mining production capacity, a stage subsequent filling mining(SSFM) method is employed for Sijiaying iron mine. The height of the stage stope is approximately 100 m. As there are farmlands and villages on the surface of the mine, the surface deformation should be controlled when the ore is mined out for the purpose of stope stability and minimizing surface subsidence. In this paper, according to the site-specificgeological conditions, the self-stability of the stagefi lling body was analyzed, and the failure mechanism of back filling body was defined. Thus the relationship between the exposed height of filling body and the required strength was obtained. Next, the stability of back filling body and the characteristics of surface subsidence due to mining of 450 m level were analyzed using physical modeling.Finally, a three-dimensional numerical model was established using FLAC3 D, with which the surface subsidence and the stability of stope were achieved. The results show that the stope basically remains stable during the two-step recovery process. The maximum magnitude of the incline is 10.99 mm/m, a little larger than the permissible value of 10 mm/m, and the horizontal deformation is 5.9 mm/m,approaching the critical value of 6.0 mm/m, suggesting that the mine design is feasible for safety mining.

Origin of Subsequent Condensate Pool in Lunnan Low Uplift,Northwest China

Lunnan （轮南） low uplift,where developed amounts of condensate pools in both Ordovician and Carboniferous reservoirs,locates in the north uplift of Tarim basin,Northwest China.Lunnan area has experienced intensive gas invasion since the Himalayan movement,causing multiple types of accumulation coexisting in the Ordovician reservoir.Geochemical evidence shows that these condensate oils are of low maturity （vitrinite reflectance levels near 1.0%） and the dominant component of the condensate gas is dry gas （the content of CH4 over 94%）,which reflects that the condensate pool in Lunnan area is not the product of thermal cracking,but the subsequent accumulation derived from the phase fractionation.Furthermore,our observations on the C6-C7 hydrocarbons in Lunnan area are qualitatively similar to the effect of phase fractionation with condensates having higher paraffin and lower aromaticity than residual oils.Thus,two types of the condensates are defined by their phase behavior,which are saturated condensate pool and the nonsaturated one.The saturated condensate pool with an oil ring mainly developed in Ordovician reservoir,with large difference between formation pressure （FMP） and the dew point pressure （DPP）.The origin of these condensates is considered as the in-situ segregation triggered by the invasion of excessive dry gas.On the other hand,the nonsaturated condensate pool that almost existed in the Carboniferous reservoir is a hydrocarbon reservoir containing slight difference between FMP and DPP,without oil ring,and evaporative fractionation due to the fault movement controls its generation.

Subsequent Treatment after Transarterial Chemoembolization Failure/Refractoriness: A Review Based on Published Evidence

Transarterial chemoembolization(TACE)is widely applied for the treatment of hepatocellular carcinoma.Repeat TACE is often required in clinical practice because a satisfactory tumor response may not be achieved with a single session.However,repeated TACE procedures can impair liver function and increase treatment-related adverse events,all of which prompted the introduction of the concept of“TACE failure/refractoriness”.Mainly based on evidence from two retrospective studies conducted in Japan,sorafenib is recommended as the first choice for subsequent treatment after TACE failure/refractoriness.Several studies have investigated the outcomes of other subsequent treatments,including locoregional,other molecular targeted,anti-programmed death-1/anti-programed death ligand-1 therapies,and combination therapies after TACE failure/refractoriness.In this review,we summarize the up-to-date information about the outcomes of several subsequent treatment modalities after TACE failure/refractoriness.

Prevalence and characteristics of macrosomia in the first and subsequent pregnancy: a multi-center retrospective study

To the Editor:Macrosomia is of growing prevalence and concern worldwide.In China,there has been a marked increase in the prevalence of macrosomia over the past few decades as a result of economic development and improvements in living standards.