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.

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.

Integration system research and development for three-dimensional laser scanning information visualization in goaf

An integration processing system of three-dimensional laser scanning information visualization in goaf was developed. It is provided with multiple functions, such as laser scanning information management for goaf, cloud data de-noising optimization, construction, display and operation of three-dimensional model, model editing, profile generation, calculation of goaf volume and roof area, Boolean calculation among models and interaction with the third party soft ware. Concerning this system with a concise interface, plentiful data input/output interfaces, it is featured with high integration, simple and convenient operations of applications. According to practice, in addition to being well-adapted, this system is favorably reliable and stable.

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.

Assessing vulnerability to panic:a systematic review of psychological and physiological responses to biological challenges as prospective predictors of panic attacks and panic disorder

Background Cognitive-behavioural theories of panic disorder posit that panic attacks arise from a positive feedback loop between arousal-related bodily sensations and perceived threat.In a recently develope computational model formalising these theories of pani attacks,it was observed that the response to a simulate perturbation to arousal provided a strong indicator of vulnerability to panic attacks and panic disorder.In this/review,we evaluate whether this observation is borne o in the empirical literature that has examined responses biological challenge(eg,C02 inhalation)and their relatio to subsequent panic attacks and panic disorder.Method We searched PubMed,Web of Science and PsycINFO using keywords denoting provocation agents(eg,sodium lactate)and procedures(eg,infusion)combined with keywords relevant to panic disorder(eg,panic).Articles were eligible if they used response to a biologic challenge paradigm to prospectively predict panic attac or panic disorder.Results We identified four eligible studies.Pooled effect sizes suggest that there is biological challenge response a moderate prospective association with subsequent pani attacks,but no prospective relationship with panic disorde Conclusions These findings provide support for the prediction derived from cognitive-behavioural theories an some preliminary evidence that response to a biological challenge may have clinical utility as a marker of vulnerab to panic attacks pending further research and developme Trial registration number 135908.

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.

Enzymatic remodeling of heparan sulfate:a therapeutic strategy for systemic and localized amyloidoses?

In 1854,Rudolf Virchow introduced the term＂amyloid＂to indicate white waxy deposits that stained positive for iodine and that were found in many organs of patients with chronic inflammatory diseases.He observed that these deposits stained pale blue after treatment with iodine and became dark blue or black after subsequent addition of sulfuric acid,in a similar manner to that of cellulose or carbohydrate.

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

脑磁图:从标量探测迈向矢量探测

Since its emergence half a century ago,magnetoencephalography(MEG)technology has been recognized as one of the most ideal non-invasive measures to explore functional brain activities^([1]).However,its subsequent development has fallen short of expectations,e.g..

From dolphins to dogs:new opportunities to understand the role of P2X4 receptors in spinal cord injury and neuropathic pain

The P2X4 receptor belongs to the P2X receptor family of trimeric ligand-gated ion channels and was the first member of this family for which a crystal structure was obtained(Kawate et al.,2009).This structure confirmed the trimeric stoichiometry of P2X receptors and subsequent studies from the same group revealed the orthosteric binding site of the natural ligand adenosine 5′-triphosphate(ATP)in a cleft between each adjacent subunit(Hattori and Gouaux,2012).Now synonymous with structural descriptions of P2X receptors,these original studies described the structure of each P2X4 receptor subunit as that resembling a dolphin.

Implementation of Rapid Code Transformation Process Using Deep Learning Approaches

Our previous work has introduced the newly generated program using the code transformation model GPT-2,verifying the generated programming codes through simhash(SH)and longest common subsequence(LCS)algo-rithms.However,the entire code transformation process has encountered a time-consuming problem.Therefore,the objective of this study is to speed up the code transformation process signi􀀀cantly.This paper has proposed deep learning approaches for modifying SH using a variational simhash(VSH)algorithm and replacing LCS with a piecewise longest common subsequence(PLCS)algorithm to faster the veri􀀀cation process in the test phase.Besides the code transformation model GPT-2,this study has also introduced MicrosoMASS and Facebook BART for a comparative analysis of their performance.Meanwhile,the explainable AI technique using local interpretable model-agnostic explanations(LIME)can also interpret the decision-making ofAImodels.The experimental results show that VSH can reduce the number of quali􀀀ed programs by 22.11%,and PLCS can reduce the execution time of selected pocket programs by 32.39%.As a result,the proposed approaches can signi􀀀cantly speed up the entire code transformation process by 1.38 times on average compared with our previous work.

VMAT2 Transport and Inhibition Mechanisms Revealed by Cryo-EM

Neurotransmitters are a class of signaling chemicals,including monoamines such as serotonin,dopamine,and histamine,which play a vital role in a variety of neurological activities,including mood,memory,growth and development,and drug addiction.The cytosolic neurotransmitters in presynaptic neurons must be transported into synaptic vesicles for storage and subsequent release.