Differentially Expressed miR-511-3p in Stroke Patients Predicts the Presence of Post-Stroke Cognitive Impairment.

INTRODUCTION: Stroke is common cerebrovascular disease in the elderly, which is characterized by neurological defects caused by cerebral vessels. Multiple studies have shown that miRNAs play important roles in stroke. In addition, a large number of evidence suggest that stroke increases the risk and severity of cognitive impairments. METHODS: miR-511-3p expression levels were detected by real-time PCR. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of miR-511-3p in distinguishing stroke patients from healthy controls and to assess risk of post-stroke cognitive impairment (PSCI) in stroke patients. Pearson correlation coefficient was used to determine the relationship between miR-511-3p expression level and Montreal Cognitive Assessment Scale (MoCA) scores. RESULTS: Serum miR-511-3p expression levels were decreased in stroke patients, and the decrease was more significant in PSCI patients. ROC curve results showed that miR-511-3p had high diagnostic accuracy in distinguishing healthy controls from stroke patients. Moreover, the expression level of miR-511-3p can be used as an independent predictor for the occurrence of PSCI and is positively correlated with MoCA scores of PSCI patients. CONCLUSION: miR-511-3p may be involved in the occurrence and development of stroke. In addition, miR-511-3p may be a novel biomarker for predicting PSCI occurred in stroke patients. These results may help improve the quality of prognosis of stroke.

Cardiovascular and renal outcomes in patients with atrial fibrillation and stage 4-5 chronic kidney disease receiving direct oral anticoagulants: a multicenter retrospective cohort study.

The role of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and stage 4-5 chronic kidney disease (CKD) is controversial. Electronic medical records from 2012 to 2021 were retrieved for patients with AF and stage 4-5 CKD receiving oral anticoagulants. Patients were separated into those receiving DOACs (dabigatran, rivaroxaban, apixaban, or edoxaban) or vitamin K antagonists (VKA). Primary outcomes included ischemic stroke (IS), systemic thrombosis (SE), major bleeding, gastrointestinal bleeding, hemorrhagic stroke, acute myocardial infarction, cardiovascular death, and all-cause death. Renal outcomes included eGFR declines, creatinine doubling, progression to dialysis, and major adverse kidney events (MAKE). The primary analysis was until the end of follow up and the results at 1-year and 2-year of follow ups were also assessed. 2,382 patients (DOAC = 1,047, VKA = 1,335) between 2012 and 2021 with AF and stage 4-5 CKD were identified. The mean follow-up period was 2.3 ± 2.1 years in DOCAs and 2.6 ± 2.3 years in VKA respectively. At the end of follow up, the DOAC patients had significantly decreased SE (subdistribution hazard ratio [SHR] = 0.50, 95% confidence interval [CI] = 0.34-0.73), composite of IS/SE (SHR = 0.78, 95% CI = 0.62-0.98), major bleeding (HR = 0.77, 95% CI = 0.66-0.90), hemorrhagic stroke (HR = 0.52, 95% CI = 0.36-0.76), and composite of bleeding events (SHR = 0.80, 95% CI = 0.69-0.92) compared with VKA patients. The IS efficacy outcome revealed neutral between DOAC and VKA patients (HR = 1.05, 95% CI = 0.79-1.39). In addition, DOAC patients had significantly decreased rates of eGFR decline > 50% (SHR = 0.75, 95% CI = 0.64-0.87), creatinine doubling (SHR = 0.80, 95% CI = 0.67-0.95), and MAKE (SHR = 0.81, 95% CI = 0.71-0.93). In patients with AF and stage 4-5 CKD, use of DOAC was associated with decreased rates of a composite of ischemic stroke/systemic embolism, a composite of bleeding events, and renal events compared to VKA. Efficacy and safety benefits associated with apixaban at standard doses were consistent throughout follow-up.

Comparison of young femoral neck fractures treated by femoral neck system, multiple cancellous screws and dynamic hip screws: a retrospectively comparison study.

BACKGROUND: Implant choice for the fixation of femoral neck fracture is one of the most important management controversies. This study aims to evaluate and compare the short-term outcomes associated with the use of the Femoral Neck System (FNS), Multiple Cancellous Screws (MCS), and Dynamic Hip Screws (DHS) in treating femoral neck fractures in a young patient population. METHODS: From June 2018 to June 2021, a total of 120 surgeries for a primary femoral neck fracture were retrospectively analyzed. This review encompassed demographic details of the patients and the mechanisms behind the injuries. Key surgical parameters such as operation duration, intraoperative blood loss, fluoroscopy duration, and hospital stay were meticulously documented. The employed surgical technique was described. All patients were followed up at 6 weeks, 3 months, 6 months, and 12 months postoperatively. Avascular necrosis of the femoral head (AVN), nonunion, malreduction, implant failure or other complications were noted. The functional status at the last follow-up was assessed using the Harris functional scoring criteria. RESULTS: There were 90 males and 30 females, with a mean age of 40.4 years. As to patient characteristics, there were no significant differences between the three groups. DHS group showed longer operation time(52.15 ± 4.80 min), more blood loss(59.05 ± 5.87 ml) and longer time of hospitalization(7.6 ± 0.90 d) than FNS group (39.65 ± 2.84 min, 45.33 ± 9.63 ml and 4.87 ± 0.48 d) and MCS group (39.45 ± 3.10 min, 48.15 ± 7.88 ml and 5.04 ± 0.49 d) (p < 0.05). In addition, the time of fluoroscopy in FNS group (15.45 ± 3.67) was less than that in MCS group (26.3 ± 4.76) and DHS group (27.1 ± 5.67) (p < 0.05). The cost of FNS group(44.51 ± 2.99 thousand RMB) was significantly higher than the MCS and DHS groups. The FNS, MCS and DHS groups showed a similar mean length of femoral neck shortening (LFNS) and Harris score. The FNS, MCS and DHS groups showed a similar mean rate of AVN and internal fixation failure. CONCLUSIONS: Following successful fracture reduction, FNS, MCS, and DHS are effective for in the young femoral neck fractures. No difference was found in complications between the three groups. However, the reduced fluoroscopy time associated with FNS contributes to shorter operation durations. The adoption of minimally invasive techniques correlates with decreased blood loss and shorter hospital stays. Nevertheless, these advantages may be offset by the potential economic burden they impose.

Global Path Planning for Articulated Steering Tractor Based on Multi-Objective Hybrid Algorithm.

With the development of smart agriculture, autopilot technology is being used more and more widely in agriculture. Because most of the current global path planning only considers the shortest path, it is difficult to meet the articulated steering tractor operation needs in the orchard environment and address other issues, so this paper proposes a hybrid algorithm of an improved bidirectional search A* algorithm and improved differential evolution genetic algorithm(AGADE). First, the integrated priority function and search method of the traditional A* algorithm are improved by adding weight influence to the integrated priority, and the search method is changed to a bidirectional search. Second, the genetic algorithm fitness function and search strategy are improved; the fitness function is set as the path tree row center offset factor; the smoothing factor and safety coefficient are set; and the search strategy adopts differential evolution for cross mutation. Finally, the shortest path obtained by the improved bidirectional search A* algorithm is used as the initial population of an improved differential evolution genetic algorithm, optimized iteratively, and the optimal path is obtained by adding kinematic constraints through a cubic B-spline curve smoothing path. The convergence of the AGADE hybrid algorithm and GA algorithm on four different maps, path length, and trajectory curve are compared and analyzed through simulation tests. The convergence speed of the AGADE hybrid algorithm on four different complexity maps is improved by 92.8%, 64.5%, 50.0%, and 71.2% respectively. The path length is slightly increased compared with the GA algorithm, but the path trajectory curve is located in the center of the tree row, with fewer turns, and it meets the articulated steering tractor operation needs in the orchard environment, proving that the improved hybrid algorithm is effective.

Global Dynamic Path Planning of AGV Based on Fusion of Improved A* Algorithm and Dynamic Window Method.

Designed to meet the demands of AGV global optimal path planning and dynamic obstacle avoidance, this paper proposes a combination of an improved A* algorithm and dynamic window method fusion algorithm. Firstly, the heuristic function is dynamically weighted to reduce the search scope and improve the planning efficiency; secondly, a path-optimization method is introduced to eliminate redundant nodes and redundant turning points in the path; thirdly, combined with the improved A* algorithm and dynamic window method, the local dynamic obstacle avoidance in the global optimal path is realized. Finally, the effectiveness of the proposed method is verified by simulation experiments. According to the results of simulation analysis, the path-planning time of the improved A* algorithm is 26.3% shorter than the traditional A* algorithm, the search scope is 57.9% less, the path length is 7.2% shorter, the number of path nodes is 85.7% less, and the number of turning points is 71.4% less. The fusion algorithm can evade moving obstacles and unknown static obstacles in different map environments in real time along the global optimal path.

The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease.

BACKGROUND: To determine whether glucagon-like peptide 1 receptor agonists (GLP-1RAs) have cardiovascular and renal protective effects in patients with advanced diabetic kidney disease (DKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m2. METHODS: In this cohort study, patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m2 with a first prescription for GLP-1RAs or dipeptidyl peptidase 4 inhibitors (DPP-4is) from 2012 to 2021 (n = 125,392) were enrolled. A Cox proportional hazard model was used to assess the cardiorenal protective effects between the GLP-1RA and DDP-4i groups. RESULTS: A total of 8922 participants [mean (SD) age 68.4 (11.5) years; 4516 (50.6%) males; GLP-1RAs, n = 759; DPP-4is, n = 8163] were eligible for this study. During a mean follow-up of 2.1 years, 78 (13%) and 204 (13.8%) patients developed composite cardiovascular events in the GLP-1RA and DPP-4i groups, respectively [hazard ratio (HR) 0.88, 95% confidence interval CI 0.68-1.13]. Composite kidney events were reported in 134 (38.2%) and 393 (44.2%) patients in the GLP-1RA and DPP-4i groups, respectively (subdistribution HR 0.72, 95% CI 0.56-0.93). CONCLUSIONS: GLP-1RAs had a neutral effect on the composite cardiovascular outcomes but reduced composite kidney events in the patients with advanced DKD compared with DPP-4is.

Analysis of Onboard Verification Flight Test for the Salinity Satellite Scatterometer.

The upcoming Salinity Satellite, scheduled for launch in 2024, will feature the world's first phased array radar scatterometer. To validate its capability in measuring ocean surface backscatter coefficients, this paper conducts an in-depth analysis of the onboard verification flight test for the Salinity Satellite scatterometer. This paper provides a detailed introduction to the system design of the Salinity Satellite scatterometer, which utilizes phased array radar technology and digital beamforming techniques to achieve accurate measurements of sea surface scattering characteristics. The paper elaborates on the derivation of backscatter coefficients, system calibration, and phase amplitude correction for the phased array scatterometer. Furthermore, it describes the process of the onboard calibration flight test. By analyzing internal noise signals, onboard calibration signals, and external noise signals, the stability and reliability of the scatterometer system are validated. The experiment covers both land and ocean observations, with a particular focus on complex sea surface conditions in nearshore areas. Through the precise analysis of backscatter coefficients, the paper successfully distinguishes the different backscatter coefficient characteristics between ocean and land. The research results effectively demonstrate the feasibility of the Salinity Satellite scatterometer for measuring backscatter coefficients in a phased array configuration, as well as its outstanding performance in complex marine environments.

Study on Extraction Valuable Metal Elements by Co-Roasting Coal Gangue with Coal Gasification Coarse Slag.

Coal gangue (CG) and coal gasification coarse slag (CGCS) possess both hazardous and resourceful attributes. The present study employed co-roasting followed by H2SO4 leaching to extract Al and Fe from CG and CGCS. The activation behavior and phase transformation mechanism during the co-roasting process were investigated through TG, XRD, FTIR, and XPS characterization analysis as well as Gibbs free energy calculation. The results demonstrate that the leaching rate of total iron (TFe) reached 79.93%, and Al3+ achieved 43.78% under the optimized experimental conditions (co-roasting process: CG/CGCS mass ratio of 8/2, 600 °C, 1 h; H2SO4 leaching process: 30 wt% H2SO4, 90 °C, 5 h, liquid to solid ratio of 5:1 mL/g). Co-roasting induced the conversion of inert kaolinite to active metakaolinite, subsequently leading to the formation of sillimanite (Al2SiO5) and hercynite (FeAl2O4). The iron phases underwent a selective transformation in the following sequence: hematite (Fe2O3) → magnetite (Fe3O4) → wustite (FeO) → ferrosilite (FeSiO3), hercynite (FeAl2O4), and fayalite (Fe2SiO4). Furthermore, we found that acid solution and leached residue both have broad application prospects. This study highlights the significant potential of co-roasting CG and CGCS for high-value utilization.

Automatic Key Update Mechanism for Lightweight M2M Communication and Enhancement of IoT Security: A Case Study of CoAP Using Libcoap Library.

The ecosystem for an Internet of Things (IoT) generally comprises endpoint clients, network devices, and cloud servers. Thus, data transfers within the network present multiple security concerns. The recent boom in IoT applications has accelerated the need for a network infrastructure that provides timely and safe information exchange services. A shortcoming of many existing networks is the use of static key authentication. To enable the use of automatic key update mechanisms in IoT devices and enhance security in lightweight machine-to-machine (M2M) communications, we propose a key update mechanism, namely, double OTP (D-OTP), which combines both one-time password (OTP) and one-time pad to achieve an IoT ecosystem with theoretically unbreakable security. The proposed D-OTP was implemented into the Constrained Application Protocol (CoAP) through the commonly used libcoap library. The experimental results revealed that an additional 8.93% latency overhead was required to obtain an unbreakable guarantee of data transfers in 100 CoAP communication sessions.

Low strength wastewater anammox start-up and stable operation by inoculating sponge-iron sludge: Cooperation of biological iron and iron bacteria.

The application of anaerobic ammonium oxidation (Anammox) technology in low-strength wastewater treatment still faces difficult in-situ start-ups and unstable operations. Sponge-iron sludge (R1) was used as a novel inoculum to provide a promising solution. Conventional activated sludge (R0) was used as the control. However, little is known about the feasibility and performance during the start-up and operation of Anammox combined with biological iron and iron bacteria in an iron sludge system. Anammox was successfully started both in R1 (87 days) and R0 (89 days) with a low-strength influent (with a nitrogen loading rate (NLR) of 43.64 ± 0.41 g N/(m3⋅d)). During long-term operation, the R0 nevertheless produced higher nitrates (9.7 ± 0.1 mg/L) than expected. In contrast, R1 presented no excess nitrate production (2.1 ± 0.06 mg/L). The total inorganic nitrogen (TIN) removal efficiency increased from 78.2 ± 7.1% in R0 to 86.1 ± 4.3% in R1. The iron sludge in R1 was divided equally into three parts and three different nitrogen-feeding methods were used over the 34 days of operation, as follows: first using a mixture of ammonium (27.15 ± 1.0 mg/L) and nitrite (32.7 ± 1.7 mg/L), then only ammonium (27.15 ± 1.0 mg/L) and lastly only nitrite (32.7 ± 1.7 mg/L) as the influent. R1 was a coupled system composed of Anammox, Feammox, and NOx--dependent Fe(II) oxidation (NDFO). The contribution of Feammox and NDFO to TIN removal was 27.1 ± 1.2% and 31.9 ± 0.7%. However, Anammox was the primary nitrogen transformation pathway. X-ray diffraction (XRD) analysis shows that iron hydroxide (Fe(OH)3) and iron oxide hydroxide (FeOOH) were generated in R1. The produced Fe(OH)3 and FeOOH were capable of participating in Feammox and formed a Fe(II)/Fe(III) cycle which further removed nitrogen. Therefore, a highly stable and impressive nitrogen removal performance was demonstrated in the iron sludge Anammox system under the cooperation of biological iron and iron bacteria. The study considered the enrichment of norank_c_OM190, Desulfuromonas, and Thiobacillus and their contribution to the Anammox, Feammox, and NDFO processes, respectively. This study provides a new perspective for the start-up and stable operation of low-strength wastewater Anammox engineering applications.

Oxidative storm in a patient with acute rotenone-containing plant poisoning.

A 64-year-old woman presented with coma, seizure, and lactic acidosis after ingesting 80 yam bean seeds. This rotenone-containing seeds cause cellular asphyxia via blockage of the mitochondrial electron transport. Subsequent oxidative stress results in the formation of lipid peroxidation (LPO). Rotenone analysis via liquid chromatography mass spectrometry revealed the following: 31,590 ng/mL in cooked yam bean seed and 100 ng/mL in the blood. We attempted to use N-acetylcysteine to alleviate oxidative stress and documented the continuous decline in the plasma concentration of LPO.

Astilbin prevents bone loss in ovariectomized mice through the inhibition of RANKL-induced osteoclastogenesis.

Osteoporosis is the most common osteolytic disease characterized by excessive osteoclast formation and resultant bone loss, which afflicts millions of patients around the world. Astilbin, a traditional herb, is known to have anti-inflammatory, antioxidant and antihepatic properties, but its role in osteoporosis treatment has not yet been confirmed. In our study, astilbin was found to have an inhibitory effect on the RANKL-induced formation and function of OCs in a dose-dependent manner without cytotoxicity. These effects were attributed to its ability to suppress the activity of two transcription factors (NFATc1 and c-Fos) indispensable for osteoclast formation, followed by inhibition of the expression of bone resorption-related genes and proteins (Acp5/TRAcP, CTSK, V-ATPase-d2 and integrin ß3). Furthermore, we examined the underlying mechanisms and found that astilbin repressed osteoclastogenesis by blocking Ca2+ oscillations and the NF-κB and MAPK pathways. In addition, the therapeutic effect of MA on preventing bone loss in vivo was further confirmed in an ovariectomized mouse model. Therefore, considering its ability to inhibit RANKL-mediated osteoclastogenesis and the underlying mechanisms, astilbin might be a potential candidate for treating osteolytic bone diseases.

Identifying Features that Enhance Older Adults' Acceptance of Robots: A Mixed Methods Study.

BACKGROUND: With global aging, robots are considered a promising solution for handling the shortage of aged care and companionships. However, these technologies would serve little purpose if their intended users do not accept them. While the socioemotional selectivity theory predicts that older adults would accept robots that offer emotionally meaningful relationships, selective optimization with compensation model predicts that older adults would accept robots that compensate for their functional losses. OBJECTIVE: The present study aims to understand older adults' expectations for robots and to compare older adults' acceptance ratings for 2 existing robots: one of them is a more human-like and more service-oriented robot and the other one is a more animal-like and more companion-oriented robot. METHODS: A mixed methods study was conducted with 33 healthy, community-dwelling Taiwanese older adults (age range: 59-82 years). Participants first completed a semi-structured interview regarding their ideal robot. After receiving information about the 2 existing robots, they then completed the Unified Theory of Acceptance and Use of Technology questionnaires to report their pre-implementation acceptance of the 2 robots. RESULTS: Interviews were transcribed for conventional content analysis with satisfactory inter-rater reliability. From the interview data, a collection of older adults' ideal robot characteristics emerged with highlights of humanlike qualities. From the questionnaire data, respondents showed a higher level of acceptance toward the more service-oriented robot than the more companion-oriented robot in terms of attitude, perceived adaptiveness, and perceived usefulness. From the mixed methods analyses, the finding that older adults had a higher level of positive attitude towards the more service-oriented robot than the more companion-oriented robot was predicted by higher expectation or preference for robots with more service-related functions. CONCLUSION: This study identified older adults' preference toward more functional and humanlike robots. Our findings provide practical suggestions for future robot designs that target the older population.

Anterior Choroidal Artery Infarction Evaluated with 123I-Imp Single-Photon Emission Computed Tomography and 7 Tesla Magnetic Resonance Imaging.

Anterior choroidal artery (AchA) infarction remains a challenging diagnosis although it was first described almost 100 years prior. N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography (123I-IMP SPECT) and 7 Tesla magnetic resonance angiography (7T-MRA) are not routinely performed in cases of AchA infarction. Therefore, the application of 123I-IMP SPECT and 7T-MRA for AchA infarction has not been reported previously. A 67-year-old man presented with disturbed consciousness, gaze preference to the left, aphasia, right homonymous hemianopia, and right hemiparesis. Brain magnetic resonance imaging revealed infarction of the left posterior limb of the internal capsule. Left middle cerebral artery was clearly seen on MRA. However, 123I-IMP SPECT on day 13 showed cortical hypoperfusion which indicated thalamus involvement with neural deactivation. Additionally, 7T-MRA on day 15 revealed an intact left AchA suggesting reperfusion. The neurological deficits improved gradually after treatment and rehabilitation. This case demonstrates AchA infarction with cortical hypoperfusion associated with thalamus involvement, which was clarified by performing 123I-IMP SPECT and 7T-MRA. Perfusion analysis and evaluation of detailed vascular anatomy in stroke can be expected to elucidate pathological conditions.

Acute acromioclavicular joint dislocation treated with tightrope : Mini-open versus percutaneous stabilization.

The purpose of this study was to compare prospecti- vely the radiographic and clinical results of patients treated with tightrope through either mini-open or percutaneous stabilization for acute AC joint injuries. Eighty patients were included in this study and were randomly divided into two groups. Group A included 40 injuries treated with mini-open repair. Group B consisted of 40 injuries treated with percutaneous stabilization. Demographic and clinical data were comparable between the two groups before surgery (P>0.05). Peri-operative data, complications and clinical outcomes between the two groups were compared. The average follow-up time of Group A, was 26.5±4.3 months and Group B, was 25.2±5.6 months (P>0.05). The mean operative time was 63.2±9.6 minutes and 45.6±7.1 minutes, and the mean incision length was 6.0±1.5 cm and 4.0±0.8 cm, respectively. The operative time and incision length were significantly longer in Group A (both P<0.05). However, the radiological assessment revealed no significant difference in the coracoclavicular (CC) distance between the two groups (P>0.05). The rate of loss of reduction in the Group A was similar to that in Group B (6/40 vs. 5/40, P>0.05). Both methods were efficient methods for acute AC joint dislocation. However, percutaneous fixation had the advantages of a shorter surgical time and smaller incision length.

Nutrition therapy in esophageal cancer-Consensus statement of the Gastroenterological Society of Taiwan.

A number of clinical guidelines on nutrition therapy in cancer patients have been published by national and international societies; however, most of the reviewed data focused on gastrointestinal cancer or non-cancerous abdominal surgery. To collate the corresponding data for esophageal cancer (EC), a consensus panel was convened to aid specialists from different disciplines, who are involved in the clinical nutrition care of EC patients. The literature was searched using MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the ISI Web of Knowledge. We searched for the best evidence pertaining to nutrition therapy in the case of EC. The panel summarized the findings in 3 sections of this consensus statement, based on which, after the diagnosis of EC, an initial distinction is made between the patients, as follows: (1) Assessment; (2) Therapy in patients with resectable disease; patients receiving chemotherapy or chemoradiotherapy prior to resection, and patients with unresectable disease, requiring chemoradiotherapy or palliative therapy; and (3) Formula. The resulting consensus statement reflects the opinions of a multidisciplinary group of experts, and a review of the current literature, and outlines the essential aspects of nutrition therapy in the case of EC. The statements are: Patients with EC are among one of the highest risk to have malnutrition. Patient generated suggestive global assessment is correlated with performance status and prognosis. Nutrition assessment for patients with EC at the diagnosis, prior to definitive therapy and change of treatment strategy are suggested and the timing interval can be two weeks during the treatment period, and one month while the patient is stable. Patients identified as high risk of malnutrition should be considered for preoperative nutritional support (tube feeding) for at least 7-10 days. Various routes for tube feedings are available after esophagectomy with similar nutrition support benefits. Limited intrathoracic anastomotic leakage postesophagectomy can be managed with intravenous antibiotics and self-expanding metal stent (SEMS) or jejunal tube. Enteral nutrition in patients receiving preoperative chemotherapy or chemoradiation provides benefits of maintaining weight, decreasing toxicity, and preventing treatment interruption. Tube feeding or SEMS can offer nutrition support in patients with unresectable esophageal cancer, but SEMS is not recommended for those with neoadjuvant chemoradiation before surgery. Enteral immunonutrition may preserve lean body mass and attenuates stress response after esophagectomy. Administration of glutamine may decrease the severity of chemotherapy induced mucositis. Enteral immunonutrition achieves greater nutrition status or maintains immune functions during concurrent chemoradiation.

Management of pin tract infection in pediatric supracondylar humerus fractures: a comparative study of three methods.

The objective of this study was to prospectively compare the incidence of pin tract infection in pediatric supracondylar humerus fractures managed with pin care daily or every other day or weekly. We hypothesized that there were some differences between these three methods. From June 2012 to May 2015, 135 children with supracondylar humerus fractures were randomized to postoperative pin care by cleaning pin tracts daily (group A, 45 cases) or cleaning every 2 days (group B, 45 cases) or cleaning weekly (group C, 45 cases). The three groups were comparable with respect to age, gender, affected side, body mass index (BMI), fracture type, injury to surgery time, number of intraoperative percutaneous pinning, and follow-up time. We collected data on pin retention time, union time, and pin tract infection. The average follow-up time of group A was 4.5 ± 1.3 and 4.2 ± 1.6 months in group B and 4.3 ± 1.4 months in group C. The patient demographics and intraoperative variables of three groups were comparable. No significant difference between these three groups was found in union time and pin fixation time. Of the 135 children, 48 (35.6%) cases had pin tract infection. Grade I infections (Checketts-Otterburns classification) occurred around 28.9% of 270 pin and grade II around 6.7%. We found no differences between three groups as regards frequency and severity of pin tract infections (both P > 0.05). However, complain of pain was more frequent in group A than other two groups (P < 0.05). CONCLUSIONS: All of the three methods were effective for the management of pin site infection in pediatric supracondylar humerus fractures. However, excessive frequent care as well as pin care daily had the disadvantages of child's fear and parental anxiety. What is Known: • Pin site infection is a common complication after fracture fixation and bone lengthening using percutaneous pins or wires. • Closed reduction and percutaneous K-wires fixation are the mainstay of treatment in pediatric supracondylar humeral fractures. What is New: • All of the three methods were effective for the management of pin site infection. • Excessive frequent care as well as pin care daily has the disadvantages of child's fear and parental anxiety.

Simultaneous heterotrophic nitrification and aerobic denitrification at high concentrations of NaCl and ammonia nitrogen by Halomonas bacteria.

To improve the efficiency of simultaneous heterotrophic nitrification and aerobic denitrification (SND) at high concentrations of NaCl and ammonia nitrogen (NH4+-N), we investigated the SND characteristics of Halomonas bacteria with the ability to synthesize the compatible solute ectoine. Halomonas sp. strain B01, which was isolated, screened and identified in this study, could simultaneously remove nitrogen (N) by SND and synthesize ectoine under high NaCl conditions. Gene cloning and sequencing analysis indicated that this bacterial genome contains ammonia monooxygenase (amoA) and nitrate reductase (narH) genes. Optimal conditions for N removal in a solution containing 600 mg/L NH4+-N were as follows: sodium succinate supplied as organic carbon (C) source at a C/N ratio of 5, pH 8 and shaking culture at 90 rpm. The N removal rate was 96.0% under these conditions. The SND by Halomonas sp. strain B01 was performed in N removal medium containing 60 g/L NaCl and 4,000 mg/L NH4+-N; after 180 h the residual total inorganic N concentration was 21.7 mg/L and the N removal rate was 99.2%. Halomonas sp. strain B01, with the ability to synthesize the compatible solute ectoine, could simultaneously tolerate high concentrations of NaCl and NH4+-N and efficiently perform N removal by SND.

Comparison of Hybrid Fixation to Dual Plating for Both-Bone Forearm Fractures in Older Children.

When operative stabilization of forearm fractures in older children is necessary, the optimal method of fixation is controversial. This study compared the radiographic and functional outcomes of dual plating to a hybrid fixation construct with elastic intramedullary nailing of the radius and plate fixation of the ulna of forearm fractures in children aged between 10 and 16 years. Nineteen patients were treated using a hybrid fixation construct and 13 patients were treated with dual plating fixation. The 2 groups were compared retrospectively according to perioperative data and patient outcome measures. The hybrid fixation construct group had 19, with a mean age of 13.3 years (range, 10-16 years) and the dual plate group had 13 patients, with a mean age of 12.9 years (range, 10-16 years). Groups were similar for sex, arm injured, and fracture location. Duration of surgery and tourniquet use was significantly shorter in the hybrid fixation construct group. There was no significant difference in either time to union or Price scores for function evaluation between the 2 groups. Complication rates were also similar between groups, with 1 ulna delayed unions, 1 superficial infection at entry of nail in hybrid fixation construct group, and 1 ulna delayed unions in the dual plating group. Hybrid fixation, using open reduction and internal fixation with a plate-and-screw construct on the ulna and closed reduction and elastic intramedullary fixation of the ulna, is an acceptable method for treating both-bone diaphyseal forearm fractures in skeletally immature patients aged 10-16 years.

Comparison of intramedullary and extramedullary fixation of stable intertrochanteric fractures in the elderly: a prospective randomised controlled trial exploring hidden perioperative blood loss.

BACKGROUND: Hip fracture is a severe and common injury that occurs predominantly in the elderly. Blood loss in the perioperative period is associated with a greater risk of dying in anaemic patients. The aim of the study was to explore the best way to treat stable intertrochanteric fractures, taking hidden blood loss into account. METHODS: This prospective, randomised blinded study included patients aged over 65 years with stable intertrochanteric fractures (Evans grades I and II). The patients were allocated to one of two groups treated via extramedullary or intramedullary fixation. Patient data were retrieved from electronic charts. Functional recovery was evaluated using the Functional Recovery Score of Zuckerman. Postoperative complications were also recorded. The formula of Nadler and Gross was used to calculate blood loss. RESULTS: There were 92 patients in the extramedullary and 106 in the intramedullary group. Age, sex, the cause of injury, the type of fracture, the observed blood loss, functional recovery, time to union, complications, and American Society of Anesthesiologists classification did not differ significantly between the two groups (all p-values > 0.05). The frequencies of lung infection, electrolyte imbalance, and hypoproteinemia differed between groups (all p-values < 0.05). Total and hidden blood loss were higher in the intramedullary group (p = 0.001). CONCLUSION: Extramedullary (compared with intramedullary) fixation of stable intertrochanteric fractures significantly reduces perioperative blood loss but affords similar functional outcomes and times to union. In view of the morbidity and complications associated with acute anaemia and transfusions, extramedullary fixation may be the optimal choice for treatment of stable fractures, being associated with reduced blood loss. TRIAL REGISTRATION: The study was retrospectively registered at the Chinese Clinical Trial Registry, number: ChiCTR-INQ-16009754 , trial registration date: 6th Nov. 2016.