Preventive effect of cluster nursing on pressure ulcers in orthopedic patients and predictive value of serum IL-6 and TNF-α for the occurrence of pressure ulcers.

OBJECTIVE: To determine the effect of cluster nursing on pressure ulcer prevention and comfort of orthopedic patients. METHODS: A total of 124 orthopedic inpatients admitted to the Seventh Affiliated Hospital of Sun Yat-sen University from July 2018 to June 2021 were retrospectively analyzed. Among them, 66 cases received cluster nursing who were assigned into the observation group and the other 58 cases received routine nursing and were assigned into the control group. The incidence of pressure ulcers, the degree of pressure the ulcer, quality of life-brief (QOL-BREF), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) scores of the two groups at 7 days after surgery were compared, and the comfort score and nursing satisfaction of the two groups were evaluated and compared. The expression and predictive value of serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in patients with pressure ulcers before operation were analyzed via enzyme-linked immunosorbent assay (ELISA). The levels of IL-6 and TNF-α were compared between the two groups before and after nursing. RESULTS: After nursing, the observation group had significantly lower IL-6, TNF-α, SAS score, and SDS scores than the control group, and showed significantly higher QOL-BREF score, nursing satisfaction and comfort scores than the control group. In addition, the observation group showed a significantly lower incidence of pressure ulcers and a significantly lower severity level than the control group after nursing. Patients with pressure ulcers showed significantly higher serum IL-6 and TNF-α levels before surgery, and receiver operating characteristic curve (ROC) showed that IL-6 and TNF-α had certain value in forecasting the occurrence of pressure ulcers. CONCLUSION: Cluster nursing can substantially lower the incidence of pressure ulcers in hospitalized orthopedic patients and improve their comfort.

Local Corrosion Behaviors in the Coarse-Grained Heat-Affected Zone in a Newly Developed Zr-Ti-Al-RE Deoxidized High-Strength Low-Alloy Steel.

Oxide metallurgy technology can improve the microstructure of a coarse-grained heat-affected zone (CGHAZ) but introduces extra inclusions. Local corrosion behavior of the CGHAZ of a Zr-Ti-Al-RE deoxidized steel was investigated in this work using theoretical calculations and experimental verification. The modified inclusions have a (Zr-Mg-Al-Ca-RE)Ox core claded by a CaS and TiN shell. CaS dissolves first, followed by the oxide core, leaving TiN parts. This confirms that the addition of rare earth can reduce lattice distortion and prevent a galvanic couple between the inclusions and the matrix, while the chemical dissolution of CaS causes localized acidification, resulting in the pitting corrosion initiation.

Effect of Heat-Input on Microstructure and Toughness of CGHAZ in a High-Nb-Content Microalloyed HSLA Steel.

The effect of various heat inputs on the microstructure and impact toughness of the simulated coarse-grained heat-affected zone (CGHAS) of a niobium microalloyed (0.14 wt.%) low-carbon steel was studied. The results showed that higher impact toughness was achieved at a low heat input of 20 kJ/cm, which resulted from the formation of acicular ferrite laths/plates. They sectioned large prior austenite grains into many smaller regions, resulting in smaller crystallographic grains and high-angle grain boundaries. Conversely, when specimens were simulated with larger heat-inputs (100, 200 kJ/cm), the microstructure of the CGHAZ was predominantly composed of granular bainite plus massive MA constituents, thus impairing the impact toughness.

Effect of Niobium Content on the Microstructure and Mechanical Properties of Simulated Coarse-Grained Heat-Affected Zone (CGHAZ) of High-Strength Low-Alloy (HSLA) Steels.

The effect of Nb-content and heat input rate on the mechanical properties and microstructure of simulated coarse-grained heat-affected zone (CGHAZ) of high-strength low-alloy steel (HSLA) was investigated. While using a low heat input (20 kJ/cm), the toughness of simulated CGHAZ was improved by increasing the Nb-content. The maximum toughness was obtained when the Nb-content was 0.110 wt.% and the heat input was 20 kJ/cm. The samples made at this condition had fine martensite/austenite (M/A-constituent), acicular ferrite and refined austenite grains. As the heat input was increased to 200 kJ/cm, the toughness of simulated CGHAZ was significantly decreased irrespective of the Nb-content because of the formation of coarse austenite grains, low angle grain boundaries, and massive M/A-constituents.

The effect of preoperative hypoalbuminemia on complications after primary hip arthroplasty.

OBJECTIVES: To explore the risk factors of preoperative hypoalbuminemia and its' effects on complications in the elderly with primary hip arthroplasty. METHODS: A total of 211 elderly inpatients who underwent hip arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥35 g/L) and case group (preoperative serum albumin <35 g/L). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed. RESULTS: Compared to controls, hypoalbuminemia patients were older (P = 0.026), had lower BMI (P = 0.045), higher cardiac function score (P < 0.0001), higher ASA scores (P = 0.023), and longer hospital stay (P < 0.001). The intraoperative albumin loss in the case group was significantly higher than that of in control group (P < 0.001), but there was no significant difference in operation time and intraoperative blood loss between the two groups (P >0.05). Compared to controls, hypoalbuminemia patients had a higher risk for any complication (P = 0.014), such as delayed wound healing, pleural effusion, and pneumonia. The risk of postoperative complications increased by 6.9% with every 1 year old is increasing (age > 60). The risk of postoperative complications in the case group was 1.89 times higher than that in the control group. CONCLUSION: Patients with older age, poor nutritional status, and more than 2 concomitant diseases are more likely to develop preoperative hypoalbuminemia. Preoperative hypoalbuminemia is related to the increased incidence of postoperative complications. Perioperative albumin loss is not only due to perioperative blood loss, but also related to vascular permeability and abnormal albumin metabolism.

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China.

BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. METHODS: A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients' Experience with Anticoagulation in the Post-discharge Period) for quality improvement. RESULTS: The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2-4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. CONCLUSIONS: These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.

Fraudulent News Headline Detection with Attention Mechanism.

E-mail systems and online social media platforms are ideal places for news dissemination, but a serious problem is the spread of fraudulent news headlines. The previous method of detecting fraudulent news headlines was mainly laborious manual review. While the total number of news headlines goes as high as 1.48 million, manual review becomes practically infeasible. For news headline text data, attention mechanism has powerful processing capability. In this paper, we propose the models based on LSTM and attention layer, which fit the context of news headlines efficiently and can detect fraudulent news headlines quickly and accurately. Based on multi-head attention mechanism eschewing recurrent unit and reducing sequential computation, we build Mini-Transformer Deep Learning model to further improve the classification performance.

Patellar Tendon Versus 4-Strand Semitendinosus and Gracilis Autografts for Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Randomized Controlled Trials With Mid- to Long-Term Follow-Up.

PURPOSE: To compare patellar tendon (PT) autografts with 4-strand semitendinosus and gracilis (STG) autografts concerning knee stability, functional outcomes, as well as complications after anterior cruciate ligament (ACL) reconstruction at minimal follow-up of 5 years. METHODS: A systematic search of the literature was performed in PubMed, Embase, and the Cochrane Library to identify published prospective randomized controlled trials on clinical studies comparing PT autograft and 4-strand STG autografts for ACL reconstruction. The results of the eligible studies were analyzed in terms of knee stability (laxity measurements, Lachman test, and pivot-shift test), functional outcomes (Lysholm score, International Knee Documentation Committee score, Cincinnati score, Tegner score, single-legged hop test, and return to preinjury activity level), and complications (loss of range of motion [ROM], pain, graft re-rupture, revision, and osteoarthritis [OA]). RESULTS: Nine clinical studies with 630 patients (313 PT and 317 STG autografts) met the inclusion criteria. No statistically significant differences were found between the PT and STG group in Lachman test, pivot-shift test, International Knee Documentation Committee score, Cincinnati score, loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA rate. The STG group was found with less anterior knee pain (P = .003). There were no clinically significant differences for the outcomes of SSD, Lysholm score, and Tegner score. CONCLUSIONS: Except for significantly greater risk of anterior knee pain, PT autograft had comparable results with 4-strand STG autograft in terms of knee stability and functional outcomes after ACL reconstruction with mid- to long-term follow-up. Besides, we found no statistically significant difference in loss of ROM, kneeling pain, graft re-rupture rate, revision rate, and OA change, but these results were underpowered. LEVEL OF EVIDENCE: Level I, meta-analysis of Level I studies.

Physical Mechanism of Concrete Damage under Compression.

Although considerable effort has been taken regarding concrete damage, the physical mechanism of concrete damage under compression remains unknown. This paper presents, for the first time, the physical reality of the damage of concrete under compression in the view of statistical and probabilistic information (SPI) at the mesoscale. To investigate the mesoscale compressive fracture, the confined force chain buckling model is proposed; using which the mesoscale parameters concerned could be directly from nanoindentation by random field theory. Then, the mesoscale parameters could also be identified from macro-testing using the stochastic damage model. In addition, the link between these two mesoscale parameters could be established by the relative entropy. A good agreement between them from nano- and macro- testing when the constraint factor approaches around 33, indicates that the mesoscale parameters in the stochastic damage model could be verified through the present research. Our results suggest that concrete damage is strongly dependent on the mesoscale random failure, where meso-randomness originates from intrinsic meso-inhomogeneity and meso-fracture arises physically from the buckling of the confined force chain system. The mesoscale random buckling of the confined force chain system above tends to constitute the physical mechanism of concrete damage under compression.