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.

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.

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.

Efficient and Stable Inverted Perovskite Solar Modules Enabled by Solid-Liquid Two-Step Film Formation

A considerable efficiency gap exists between large-area perovskite solar modules and small-area perovskite solar cells.The control of forming uniform and large-area film and perovskite crystallization is still the main obstacle restricting the efficiency of PSMs.In this work,we adopted a solid-liquid two-step film formation technique,which involved the evaporation of a lead iodide film and blade coating of an organic ammonium halide solution to prepare perovskite films.This method possesses the advantages of integrating vapor deposition and solution methods,which could apply to substrates with different roughness and avoid using toxic solvents to achieve a more uniform,large-area perovskite film.Furthermore,modification of the NiO_(x)/perovskite buried interface and introduction of Urea additives were utilized to reduce interface recombination and regulate perovskite crystallization.As a result,a large-area perovskite film possessing larger grains,fewer pinholes,and reduced defects could be achieved.The inverted PSM with an active area of 61.56 cm^(2)(10×10 cm^(2)substrate)achieved a champion power conversion efficiency of 20.56%and significantly improved stability.This method suggests an innovative approach to resolving the uniformity issue associated with large-area film fabrication.

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.

A new two-step variational model for multiplicative noise removal with applications to texture images

Multiplicative noise removal problems have attracted much attention in recent years.Unlike additive noise,multiplicative noise destroys almost all information of the original image,especially for texture images.Motivated by the TV-Stokes model,we propose a new two-step variational model to denoise the texture images corrupted by multiplicative noise with a good geometry explanation in this paper.In the first step,we convert the multiplicative denoising problem into an additive one by the logarithm transform and propagate the isophote directions in the tangential field smoothing.Once the isophote directions are constructed,an image is restored to fit the constructed directions in the second step.The existence and uniqueness of the solution to the variational problems are proved.In these two steps,we use the gradient descent method and construct finite difference schemes to solve the problems.Especially,the augmented Lagrangian method and the fast Fourier transform are adopted to accelerate the calculation.Experimental results show that the proposed model can remove the multiplicative noise efficiently and protect the texture well.

Two-step growth of β-Ga_(2)O_(3) on c-plane sapphire using MOCVD for solar-blind photodetector

In this work,a two-step metal organic chemical vapor deposition(MOCVD)method was applied for growingβ-Ga_(2)O_(3) film on c-plane sapphire.Optimized buffer layer growth temperature(T_(B))was found at 700℃ and theβ-Ga_(2)O_(3) film with full width at half maximum(FWHM)of 0.66°was achieved.A metal−semiconductor−metal(MSM)solar-blind photodetector(PD)was fabricated based on theβ-Ga_(2)O_(3) film.Ultrahigh responsivity of 1422 A/W@254 nm and photo-to-dark current ratio(PDCR)of 10^(6) at 10 V bias were obtained.The detectivity of 2.5×10^(15) Jones proved that the photodetector has outstanding performance in detecting weak signals.Moreover,the photodetector exhibited superior wavelength selectivity with rejection ratio(R_(250 nm)/R_(400 nm))of 105.These results indicate that the two-step method is a promising approach for preparation of high-qualityβ-Ga_(2)O_(3)films for high-performance solar-blind photodetectors.

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.

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.

Effect of two-step solid solution on microstructure andδphase precipitation of Inconel 718 alloy

Inconel 718 is the most popular nickel-based superalloy and is extensively used in aerospace,automotive,and energy indus-tries owing to its extraordinary thermomechanical properties.The effects of different two-step solid solution treatments on microstructure andδphase precipitation of Inconel 718 alloy were studied,and the transformation mechanism fromγ″metastable phase toδphase was clarified.The precipitates were statistically analyzed by X-ray diffractometry.The results show that theδphase content firstly increased,and then decreased with the temperature of the second-step solid solution.The changes in microstructure andδphase were studied by scanning electron microscopy and transmission electron microscopy.An intragranularδphase formed in Inconel 718 alloy at the second-[100]_(δ)[011]γ step solid solution temperature of 925℃,and its orientation relationship withγmatrix was determined as//and(010)_(δ)//(111)γ.Furthermore,the Vickers hardness of different heat treatment samples was measured,and the sample treated by second-step solid solution at 1010℃ reached the maximum hardness of HV 446.84.

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.

Lychrel Numbers in Base 10: A Probabilistic Approach

For decades, Lychrel numbers have been studied on many bases. Their existence has been proven in base 2, 11 or 17. This paper presents a probabilistic proof of the existence of Lychrel number in base 10 and provides some properties which enable a mathematical extraction of new Lychrel numbers from existing ones. This probabilistic approach has the advantage of being extendable to other bases. The results show that palindromes can also be Lychrel numbers.

Probabilistic Analysis of Slope Using Finite Element Approach and Limit Equilibrium Approach around Amalpata Landslide of West Central, Nepal

The stability study of the ongoing and recurring Amalpata landslide in Baglung in Nepal’s Gandaki Province is presented in this research. The impacted slope is around 200 meters high, with two terraces that have different slope inclinations. The lower bench, located above the basement, consistently fails and sets others up for failure. The fluctuating water level of the slope, which travels down the slope masses, exacerbates the slide problem. The majority of these rocks are Amalpata landslide area experiences several structural disruptions. The area’s stability must be evaluated in order to prevent and control more harm from occurring to the nearby agricultural land and people living along the slope. The slopes’ failures increase the damages of house existing in nearby area and the erosion of the slope. Two modeling techniques the finite element approach and the limit equilibrium method were used to simulate the slope. The findings show that, in every case, the terrace above the basement is where the majority of the stress is concentrated, with a safety factor of near unity. Using probabilistic slope stability analysis, the failure probability was predicted to be between 98.90% and 100%.

“Instruction-Category” Approach of Test Suite Construction for Oven Embedded System

Being different from testing for popular GUI software, the “instruction-category” approach is proposed for testing embedded system. This approach is constructed by three steps including refining items, drawing instruction-brief and instruction-category, and constructing test suite. Consequently, this approach is adopted to test oven embedded system, and detail process is deeply discussed. As a result, the factual result indicates that the “instruction-category” approach can be effectively applied in embedded system testing as a black-box method for conformity testing.

Watson-Jones Anatomical Approach for Open Reduction and Internal Fixation of Proximal Femoral Fractures without Image Intensifier in a Low-Resource Setting

Introduction: Standard procedures for surgical fixation of proximal femoral fractures (PFF) require an image intensifier which in developing countries remains a luxury. We hypothesized that, with a well-codified technique, the Watson Jones approach (WJA) without image intensifier nor traction table, can allow open reduction and internal fixation (ORIF) of PFF using Dynamic hip screw (DHS), with satisfactory outcome. Patients and methods: Forty one consecutive patients (mean age 59.5 ± 21.6 years, 61% males) who were followed in a Teaching Hospital for PFF treated by ORIF using the WJA and DHS from January 2016 to December 2020 were reassessed. The outcome measures were the quality of the reduction, the positioning of the implants, the tip-apex distance (TAD), the rate and delay of consolidation, the functional results using Postel Merle d’Aubigné (PMA) score, the rate of surgical site infection (SSI) and the overall mortality. Logistic regression was used to determine factors associated with mechanical failure. Results: The mean follow-up period was 33.8 ± 15.0 months. Fracture reduction was good in 31 (75.6%) cases and acceptable in 8(19.5%) cases. Implant position was fair to good in 37 (90.2%) patients. The mean TAD was 26.1 ± 3.9 mm. Three patients developed SSI. Consolidation was achieved in 38 (92.6%) patients. The functional results were good to excellent in 80.5% of patients. The overall mortality rate was 7.3%. There were an association between mechanical failure and osteoporosis (p = 0.04), fracture reduction (p = 0.003), and TAD (p = 0.025). In multivariate logistic regression, no independent factors were predictive of mechanical failure. Conclusion: This study shows that ORIF using DHS for PFF via the Watson-Jones approach without an image intensifier can give satisfactory anatomical and functional outcomes in low-resource settings. It provides and validates a reliable and reproducible technique that deserves to be diffused to surgeons in austere areas over the world.

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.

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.

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.