A case of recurrent proximal femoral fracture after open reduction and internal fixation with bilateral locking plates for a Rorabeck type II periprosthetic fracture.

INTRODUCTION AND IMPORTANCE: Periprosthetic distal femur fractures (PDFFs) are rare complications that may occur during or after total knee arthroplasty (TKA). The incidence of PDFFs is increasing. Plate internal fixation has demonstrated positive results. However, there is limited research available on the recurrence of periimplant fractures following open reduction and internal fixation with bilateral locking plates. CASE PRESENTATION: A 70-year-old female patient was diagnosed with a Rorabeck type II fracture. Based on the patient's physical condition and available surgical options, minimally invasive open reduction, bilateral plate fixation, and allograft artificial bone grafting were chosen. The postoperative recovery was successful. However, the patient experienced a fall 2 months after the surgery, resulting in a proximal femoral fracture. After considering the patient's condition and family preferences, conservative treatment was ultimately decided upon. CLINICAL DISCUSSION: Minimally invasive bilateral Locking Compression Plate (LCP) as a surgical approach can effectively reduce surgical risks prior to the procedure. Careful selection of screws and the use of C-arm fluoroscopy during plate contouring and fixation are essential to prevent screw penetration through the contralateral cortex. Treatment outcomes were not impacted in patients with normal bone mass; however, in this particular case, the patient had severe osteoporosis, significantly increasing the risk of refracture. It is crucial to improve postoperative monitoring and raise awareness about safety among patients and their families. CONCLUSION: The management of periprosthetic distal femur fractures (PDFFs) is influenced by the type of fracture and bone quality. Mechanical stability and stress dispersion of internal fixation are key factors to consider. In the perioperative setting, involving experienced clinicians is essential to reduce the risk of secondary injuries that may impact treatment outcomes, especially when choosing screws for fixation in patients with low bone density.

Monocyte-to-lymphocyte ratio: a potential novel predictor for acute kidney injury in the intensive care unit.

Monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) are considered as surrogate inflammatory indexes. Previous studies indicated that NLR was associated with the development of septic acute kidney injury (AKI). The objective of the present study was to explore the value of MLR and NLR in the occurrence of AKI in intensive care unit (ICU) patients. The clinical details of adult patients (n = 1500) who were admitted to the ICU from January 2016 to December 2019 were retrospectively examined. AKI was diagnosed according to the Kidney Disease: Improving Global Outcomes criteria. The development of AKI was the main outcome, and the secondary outcome was in-hospital mortality. Overall, 615 (41%) patients were diagnosed with AKI. Both MLR and NLR were positively correlated with AKI incidence (p < 0.001). Multivariate logistic regression analysis suggested that the risk value of MLR for the occurrence of AKI was nearly three-fold higher than NLR (OR = 3.904, 95% CI: 1.623‒9.391 vs. OR = 1.161, 95% CI: 1.135‒1.187, p < 0.001). The areas under the receiver operating characteristic curve (AUC) for MLR and NLR in the prediction of AKI incidence were 0.899 (95% CI: 0.881‒0.917) and 0.780 (95% CI: 0.755‒0.804) (all p < 0.001), with cutoff values of 0.693 and 12.4. However, the AUC of MLR and NLR in the prediction of in-hospital mortality was 0.583 (95% CI: 0.546‒0.620, p < 0.001) and 0.564 (95% CI: 0.528‒0.601, p = 0.001). MLR, an inexpensive and widely available parameter, is a reliable biomarker in predicting the occurrence of AKI in ICU patients.

Multi-Scenario Simulation and Trade-Off Analysis of Ecological Service Value in the Manas River Basin Based on Land Use Optimization in China.

Rapid socio-economic development has had a significant impact on land use/cover (LULC) changes, which bring great pressure to the ecological environment. LULC changes affect ecosystem services by altering the structure and function of ecosystems. It is of great significance to reveal the internal relationship between LULC changes and ecosystem service value (ESV) for the protection and restoration of ecological environments. In this study, based on the spatial and temporal evolution of ecological service values in the Manas River basin from 1980 to 2020 and considering ecological and economic benefits, we coupled the gray multi-objective optimization model (GMOP) and patch-generating land-use simulation (PLUS) model (GMOP-PLUS model) to optimize the LULC structure under three scenarios (a natural development scenario, ND; ecological priority development scenario, (EPD); and balanced ecological and economic development scenario, EED) in 2030, and analyzed the trade-offs and synergies in the relationships among the four services. We found that from 1980 to 2020, farmland and construction land expanded 2017.90 km2 and 254.27 km2, respectively, whereas the areas of grassland and unused land decreased by 1617.38 km2 and 755.86 km2, respectively. By 2030, the trend of LULC changes will be stable under the ND scenario, the area of ecological land will increase by 327.42 km2 under the EPD scenario, and the area of construction land will increase most under the EED scenario, reaching 65.01 km2. From 1980 to 2020, the ESV exhibited an upward trend in the basin. In 2030, the ESV will increase by 7.18%, 6.54%, and 6.04% under the EPD, EED, and ND scenarios, respectively. The clustering of the four services is obvious in the desert area and around the water system with "low-low synergy" and "high-high synergy"; the plain area and mountainous area are mainly "high-low trade-off" and "low-high trade-off" relationships. This paper provides a scientific reference for coordinating economic development and ecological protection in the basin. It also provides a new technical approach to address the planning of land resources in the basin.