bluuebunny/crossref_metadata_2025 huggingface dataset:
LONG-TERM RESULTS OF THE BIRMINGHAM HIP RESURFACING IMPLANT IN THE UNITED STATES: AN UPDATED ANALYSIS OF A SINGLE INSTITUTION'S EXPERIENCE
Authors: Zuke W. A. , Hannon C. P. , Kromka J. , Granger C. , Clohisy J. C. , Barrack R. L.
Published: August 2024

We previously reported the five to ten-year results of the Birmingham Hip Resurfacing (BHR) implant. The purpose of this study was to evaluate the survivorship, radiographic results, and clinical outcomes of the BHR at long-term follow-up.

We retrospectively reviewed 250 patients from the original cohort of 324 BHRs performed from 2006 to 2013 who met contemporary BHR indications. Of these, 4 patients died and 4 withdrew. From the 242 patients, 224 patients (93%) were available for analysis. Modified Harris hip score (mHHS) and University of California, Los Angeles (UCLA) scores were collected and compared to a matched total hip arthroplasty (THA) cohort. Mean follow-up was 14 years.

Survivorship free of aseptic revision was 97.4% and survivorship free of any revision was 96.0% at 15 years. Revisions included 3 periprosthetic joint infections, 2 for elevated metal ions and symptomatic pseudotumor, 2 for aseptic femoral loosening, and 1 for unexplained pain. The mean mHHS was 93 in BHR patients at final follow-up, similar to the THA cohort (p=0.44). The UCLA score was significantly higher for BHR patients (p=0.02), however there were equal proportions of patients who remained highly active (UCLA 9 or 10) in both groups, 60.5% and 52.2% (p=0.45) for BHR and THA respectively. Metal ion levels at long term follow-up were low (mean serum cobalt 1.8±1.5 ppb and mean serum chromium 2.2±2.0 ppb).

BHR demonstrated excellent survivorship in males less than 60 years of age at time of surgery. Clinical outcomes and activity levels were similar to THA patients. Failures related to the metal-on-metal bearing were rare and metal levels were low at long-term follow-up.

Level of evidence: III

Keywords: survivorship; hip arthroplasty; activity; metal-on-metal

Surface Replacement Arthroplasty demonstrates low revision rates and similar activity level compared to total hip arthroplasty at long-term follow-up.
NO DIFFERENCE IN SHORT-TERM REVISION RATE AND EARLY MORTALITY IN UNCEMENTED VERSUS CEMENTED TOTAL HIP ARTHROPLASTY: A REGRESSION DISCONTINUITY ANALYSIS IN THE DUTCH ARTHROPLASTY REGISTER DATA
Authors: de Graeff J. J. , Kowalska J. , van der Pas S. L. , van Leeuwen N. , Willigenburg N. W. , Neve W. C. , de Vries L. M. A. , Schreurs B. W. , Nelissen R. G. H. H. , van Steenbergen L. N. , Poolman R.W.
Published: August 2024

Controversy persists over whether cemented or uncemented fixation is more effective in reducing revision and mortality risks following primary total hip arthroplasty (THA). Despite a shift towards uncemented THA in Europe, Australia, and the US, no consensus exists on superior outcomes. This ambiguity in evidence from randomized controlled trials (RCTs) and observational studies necessitates advanced research methodologies to derive more definitive conclusions.

This study investigates the causal impact of THA fixation type on 2-year and 5-year revision rates, along with 90-day mortality, utilizing a regression discontinuity (RD) design in scenarios where fixation choice is guided by patient age.

Employing data from the Dutch Arthroplasty Register, we conducted a cohort study on primary THAs for osteoarthritis from 2007 to 2019. A “fuzzy” RD design was executed to compute the Local Average Treatment Effect for subjects around the age-based selection threshold for fixation type. The main outcome of interest was the revision rate at 2 years post-operation.

Analysis for the 2-year revision endpoint, covering any cause, included 2,344 females and 1,671 males across 5 hospitals each, with no significant variation in revision rates observed. For the 5-year mark, 1,058 females in 3 hospitals and 214 males in 1 hospital were examined, similarly showing no significant differences. Mortality within 90 days post-operation was also investigated in 5 female and 7 male cohorts, with 2,180 and 2,145 surgeries respectively, yielding no substantial disparities.

In conclusion, the RD analysis revealed no notable differences in revision rates at 2 and 5 years or in early mortality based on the fixation method used in THA. These outcomes suggest that the age-based preference for THA fixation may not influence the revision or mortality risk, underscoring the value of RD design in deriving causal insights from observational data.
INTRAOPERATIVE FEMORAL FRACTURE DURING UNCEMENTED TOTAL HIP ARTHROPLASTY: DOES THE STEM LENGTH MATTER?
Authors: Dimitriou D. , Almazrua I. , Alhasson M. , Staunton P. , Zukor D. , Huk O. , Antoniou J.
Published: August 2024

Short stems have been developed to conserve bone stock, especially in younger populations undergoing a total hip arthroplasty (THA), and showed similar functional outcomes compared to conventional stems. Recent literature suggested that stem length might be an independent risk factor for acute periprosthetic femoral fracture in direct anterior THA (1) or with different short stem designs (2). The purpose of the present study was to compare the incidence of acute periprosthetic femoral fractures, between stems of the same manufacture (Taperloc microplasty vs Taperloc complete), which have the same stem characteristics, except for the stem length which is 35 mm shorter in Taperloc microplasty during posterior and lateral THA.

Our institution's arthroplasty database was searched for all primary total hip arthroplasties utilizing short femoral stems performed between August 2016 and August 2023. Pre-operative X-rays for each case were analysed to characterize the proximal femoral geometry, specifically the canal bone ratio (CBR) and canal flare index (CFI). Data analysis was performed to identify risk factors for periprosthetic fractures.

For the time period assessed, 2107 femoral stems (Taperloc Microplasty:1727, Taperloc complete: 380) were implanted. Females constituted 53% of the cohort. The average patient age was 70±11 years. The periprosthetic fracture rate was 0.94%, with 20 periprosthetic fractures (Taperloc Microplasty:17, Taperloc complete: 3) excluding 2 greater trochanteric fractures (1 at each group), identified at follow-up of three months. There was no significant difference between the periprosthetic fracture rates between the two stems (0.98% vs 0.79%, p>0.72) The multivariate regression analysis demonstrated that the stem length, CBR, CFI, age, and gender were not risk factors for periprosthetic fracture.

The present study demonstrated that both Taperloc Microplasty and Taperloc complete stems had similar rates of periprosthetic fractures, and the stem length was not a risk factor for a periprosthetic fracture during uncemented THA.

1. Tamaki T, Cementless Tapered-Wedge Stem Length Affects the Risk of Periprosthetic Femoral Fractures in Direct Anterior Total Hip Arthroplasty. J Arthroplasty. 2018 Mar;33(3):805-809. 2. Staunton P. Acute Periprosthetic Hip Fracture with Short Uncemented Femoral Stems. J Arthroplasty 2024 accepted.
RE-REVISION RISK OF MODULAR AND MONOBLOC REVISION STEMS AFTER REVISION TOTAL HIP ARTHROPLASTY
Authors: Morlock M. , Wu Y. , Grimberg A. , Günther K.-P. , Michel M. , Perka C.
Published: August 2024

Implant fracture of modular revision stems is a major complication after total hip arthroplasty revision (rTHA). Studies looking at specific modular designs report fracture rates of 0.3% to 0.66% whereas fractures of monobloc designs are only reported anecdotally. It is unclear whether the overall re-revision rate of modular designs is higher and if, whether stem fractures or other revision reasons are responsible for this elevation.

All revisions within 5 years after implantation of a revision stems (n0=13,900; n5=2506) were analysed using Cox regression with design (modular: n=17, monobloc: n=27), BMI, Sex and Elixhauser Score as independent variables. One stage and two stage revisions were analysed separately (1-stage: modular n= 7,102; monobloc n= 4,542; 2-stage: 1,551 / 704). The revision volume of the hospitals was also considered (low: <20 revisions, medium: 21–50 revisions, high: >50 revisions).

For the 1-stage revisions, the re-revision risk after 4 years was 14,3% [13.2%, 15.5%] for monobloc and 17.4% [16.40%, 18.40%] for modular stems (p< 0.001). Stem fracture was the reason for re-revision in 2.4% of the modular (fracture rate 0.42%) and 0.6% of the monobloc revisions. The difference in re-revision rates between the designs was mainly due to differences in dislocation and stem loosening. For the 2-stage revisions, the revision risks for either design were similar (21.7% [18,5%, 25.4%] vs. 23.0% [20.8%, 25.4%]; p=0.05). Patient characteristics influenced the comparison between the two designs in the 1-stage group but very little in the 2-stage group.

Modular revision stem fractures only contribute very minor to re-revision risk. In 2-stage revisions, no difference in overall re-revision rates between designs was observed. This might indicate that the differences observed for 1-stage procedures are due to differences between the patient cohorts, not reflected by the parameters available or surgeon choice.
REVISION HIP ARTHROPLASTY IN PATIENTS WITH SEVERE SICKLE-CELL DISEASE: CHALLENGES AND EARLY OUTCOMES
Authors: Karachalios T. , Hasan Y. , Aqeel M.
Published: August 2024

Total hip arthroplasty (THA) has proved to be an effective treatment modality for sickle-cell hip arthropathy (mosaic-like dense bone due to infarcts). However, mode of failure, survival rates and challenges associated with revision hip arthroplasty in sickle-cell disease patients are mostly unknown.

We retrospectively evaluated prospectively collected data from all patients with sickle-cell disease who underwent revision hip arthroplasty from 2016. Patient, surgery, medical and surgical complications related data were collected. The pinnacle and reclaim revision system with gription augments (JJ) was used in all patients. Pre-op and post-op clinical outcome data (both objective and subjective, HOOS Jr and OHS) were recorded. Cumulative success rates were recorded with re-revision surgery as an end point.

We performed fifteen revision THAs on 13 patients (mean follow up of 6.6 years). The mean age of the patients was 48 years (range, 30–59). At final follow-up, a statistically significant improvement of mean OHS and HOOS JR scores eas found in all patients. reported (OHS: 34.0 and HOOS JR: 77.7). Cumulative success rate was 100% for re-revision for all reasons at 6 years. Five intensive care unit (ITU) admissions, two vaso-occlusive sickle cell crises, one transfusion-related complication and one acute chest syndrome (ACS) were recorded. On admission, the mean percentage of HbS was 75.25% (64.6–86.4%).

Revision arthroplasty in sickle-cell disease patients poses increased risks, with medical and surgical challenges. However, with careful preparation, planning and a multi-disciplinary team approach, revision arthroplasty can result in excellent clinical outcomes and excellent functional scores in the majority of patients in the short and mid-term.
A RANDOMIZED PROSPECTIVE DOUBLE-BLIND TRIAL COMPARING CROSS-LINKED WITH CONVENTIONAL POLYETHYLENE IN TOTAL HIP ARTHROPLASTY: MINIMUM 20-YEAR RESULTS
Authors: Devane P. A. , Horne J. G. , Chu A.
Published: August 2024

We present minimum 20 year results of a randomized, prospective double blinded trial (RCT) of cross-linked versus conventional polyethylene (PE), using a computer assisted method of PE wear measurement.

After Ethics Committee approval, 122 patients were enrolled into an RCT comparing Enduron (non cross-linked PE) and highly cross-linked Marathon PE (DePuy, Leeds, UK). Other than the PE liners, identical components were used, a Duraloc 300 metal shell with one screw, a 28mm CoCr femoral head and a cemented Charnley Elite femoral stem. All patients were followed with anteroposterior (A∼P) and lateral radiographs at 3 days, 6 weeks, 3 months, 6 months, 1, 2, 3, 4, 5, 10 and 20 years. PE wear was measured with PolyMig, which has a phantom validated accuracy of ± 0.09mm.

At minimum 20 year follow-up, 47 patients had died, 5 of which had been revised prior to their death. Another 32 patients were revised and alive, leaving 43 patients unrevised and alive (15 Enduron, 28 Marathon). No patients were lost to follow-up, but 2 were not able to be radiographed (dementia), leaving 41 patients (15 Enduron, 26 Marathon) available for PE wear measurement. After the bedding-in period, Enduron liners had a wear rate of 0.182 mm/year, and Marathon liners had a wear rate of 0.028 mm/year. At 20 years follow-up, 37 patients had required revision. Patients with conventional PE had three times the revision rate (28/37) of those who received XLPE (9/37).

This is the longest term RCT showing substantially improved clinical and radiological results when XLPE is used as the bearing surface.
TRUE FEMORAL NECK LENGTHENING OSTEOTOMY WITH PERIACETABULAR OSTEOTOMY FOR COXA BREVA THROUGH SURGICAL HIP DISLOCATION
Authors: Chen X.
Published: August 2024

Sequelae of Legg-Calve -Perthes disease (LCPD) and treatment of developmental dysplasia of the hip (DDH) can present a coxa breva or coxa magna deformity, sometimes associated with coxa vara. This unique deformity decreases the efficiency of the abductor mechanism, causing a Trendelenburg gait and hip pain, leg length discrepancy and leads to intra- and extra-articular impingement, and eventually osteoarthritis. Several surgical techniques have been advocated to treat this kind deformity, such as great trochanter transfer, relative femoral neck lengthening. We evaluated primary results of true femoral neck-lengthening osteotomy (TFNLO) in combination with periacetabular osteotomy (PAO) for treatment of Coxa Breva through surgical hip dislocation (SHD).

Fourteen patients with Coxa Breva received true femoral neck lengthening osteotomy in combination of PAO through SHD between March 2020 and October 2023. Ten patients with minimum 1 year followed-up were retrospectively reviewed clinically and radiographically. Eight patients had Perthes disease, 2 had DDH received closed reduction and fixation during childhood. The mean age at surgery was 16 years (range, 12 to 31 years). Clinical findings, radiographic analyses including the change in horizontal femoral offset and the leg length discrepancy as well as complications were assessed.

Horizontal femoral offset improved 19.5mm(6–28mm). Limb length increase 16.8mm(11–30mm). Mean HHS increased from 80.6(66–91) to 91.8(88–96). Complication: screw broken in 1(no need operation). Asymptomatic fibrous union of the great trochanter was found in 1. No infection and joint space narrow as well as nerve palsy happened.

TFNLO combined with PAO can be effective for the treatment of patients with Coxa breva. But long term follow up is warranted.
ACETABULAR DEVELOPMENT AFTER PERIACETABULAR OSTEOTOMY IN HIPS WITH OPEN TRIRADIATE CARTILAGE
Authors: Ganz R. , Blümel S. , Stadelmann V. A , Leunig M.
Published: August 2024

The Bernese periacetabular osteotomy (PAO) is not indicated for growing hips as it crosses the triradiate cartilage in its posterior branch, and experimental work has shown this can induce substantial deformations, similar to posttraumatic dysplasia, which is observed after pelvis crash injuries in childhood.

Upon examination, all injuries in the 19 cases of posttraumatic dysplasia described in literature plus 16 hips of our personal collection took place before the age of 6, which is striking as pelvic injuries in children increase with age.

Based on this observation, we started to extend the PAO indication to severe dysplasias in children with open growth plate, initially aged 9 years and older. Following the positive results, it was extended further, our youngest patient being 5 years old.

We retrospectively examined radiographic outcomes of 23 hips (20 patients), aged 10.6±1.8 years [range 5.0 – 13.2], operated by us in four centers. Pre- and 3-months postoperative, and the latest FUP radiograph at growth plate closure were measured. We evaluated the acetabular index (AI), lateral center-edge (LCE), ACM-value and compared them with reference values adjusted for age. The age at triradiate cartilage closure was compared with the non-operated side.

The follow-up time was 5.4±3.7 years [0.8 - 12.7]. In 5 hips, growth plate closure was delayed by a few months. All angles significantly normalized after PAO (LCE: 14±8° → 38±11°, AI: 20±8° → 7±4°, ACM: 53±5° → 48±4°), with >80% of them severe pathological pre-PAO, none afterwards. Acetabular molding was normal. Only few complications occurred; one had signs of coxarthosis, one sciatic nerve pain, one interfering osteosynthesis material that was removed, one had an additional valgus osteotomy, and all resolved.

Based on 20 cases with follow-up until complete triradiate cartilage closure, we believe to have sufficient information to extend the PAO indication to growing hips of 9 years and older.
PLASMA CALPROTECTIN VERSUS CONVENTIONAL INFECTION BIOMARKERS IN HIP FRACTURE PATIENTS: A PROSPECTIVE COHORT STUDY
Authors: Pyrhönen H.-S. , Tham J. , Stefansdottir A. , Malmgren L. , Rogmark C.
Published: August 2024

After a hip fracture, infections are common, but signs of infection resemble those of systemic inflammatory response to trauma and surgery, and conventional infection markers lack specificity. Plasma-calprotectin, a novel marker of neutrophil activation, has shown potential as an infection marker in ER and ICU settings.

To investigate if plasma-calprotectin is superior compared to conventional infection biomarkers after hip fracture.

Prospective cohort study of hip fracture patients admitted to our department. Calprotectin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count were measured in blood plasma upon admission and on day 3 post-surgery. Patients with infection (pneumonia, UTI, sepsis, SSI, other soft tissue infections) pre- or post-surgery were compared to a control group without infection within 30 days.

Statistics: Wilcoxon rank-sum test, medians with interquartile range, and area under the curve (AUC) with 95% confidence intervals.

Pilot study comprises calprotectin obtained at least once for 60 patients at admission and 48 on day 3. Mean age 84 years (SD 8.4), 65% women.

9/60 patients (23%) were admitted with infections. They had higher levels of CRP (median 111 [73-149]) and PCT (0.35 [0.18–0.86]) compared to the control group (29 [16-64], p=0.037; 0.10 [0.07–0.17], p=0.007). Calprotectin (2.67 vs 2.51) and WBC (12.2 vs 9.3) did not differ significantly. AUC was highest for PCT (0.79 [CI 0.60–0.97]), followed by CRP (0.71 [0.46–0.96]), WBC (0.60 [0.35–0.84]), and calprotectin (0.58, [0.33–0.83]).

Day 3, 6/48 (13%) had infections, without significant differences between groups in any marker. The median levels were: calprotectin 3.5 vs 3.1, CRP 172 vs 104, WBC 12 vs 9, PCT 0.16 vs 0.17. Calprotectin had highest AUC 0.68 (0.41–0.93, n.s.). AUC for WBC was 0.67 (0.31–1.00), CRP 0.66 (0.38–0.94), PCT 0.56 (0.29–0.82).

Preliminary data show no significant associations with postoperative infection for any of the studied biomarkers. However, plasma-calprotectin might perform slightly better compared to conventional markers.
DIAGNOSTIC INJECTIONS ARE PREDICTIVE OF SIMILAR IMPROVMENTS FOLLOWING TOTAL HIP ARTHROPLASTY IN PATIENTS WITH RADIOLOGICALLY MILD OSTEOARTHRITIS
Authors: Kendall J. , Forlenza E. M. , DeBenedetti A. , Levine B. R. , Valle C. J. Della , Sporer S.
Published: August 2024

An intra-articular steroid injection can be a useful diagnostic tool in patients presenting with debilitating hip pain and radiographically mild osteoarthritis. The clinical and patient reported outcomes associated with patients who have radiographically mild osteoarthritis and undergo total hip arthroplasty (THA) remain poorly studied.

Patients undergoing primary, elective THA at a single academic medical center by a fellowship-trained adult reconstruction surgeon between 2017–2023 were identified. Only those patients who underwent an intra-articular corticosteroid injection into the operative hip within one year of surgery were included. Patients were divided into two cohorts based on the severity of their osteoarthritis as determined by preoperative radiographs; those with Kellgren-Lawrence (KL) grade I-II arthritis were classified as “mild” whereas those with KL grade III-IV arthritis were classified as “severe”. Clinical and patient reported outcomes at final follow-up were compared between cohorts.

The final cohorts included 25 and 224 patients with radiographically mild and severe osteoarthritis, respectively. There were no baseline differences in age, gender or time between intra-articular corticosteroid injection and THA between cohorts. There were no significant differences in the preoperative or postoperative HOOS JR values between patients with mild or severe arthritis (all p>0.05). There were no significant differences in the change in HOOS JR scores from the preoperative to final follow-up timepoints between cohorts. There were no significant differences in the percentage of patients who achieved the minimal clinically important difference (MCID) on the HOOS JR questionnaire between cohorts.

Patients with radiographically mild osteoarthritis who feel relief of their hip pain following an intra-articular corticosteroid injection report similar preoperative debility and demonstrate similar improvements in patient reported outcome scores following THA compared to patients with radiographically severe osteoarthritis.
PREOPERATIVE ACTIVITY LEVEL IN PATIENTS WHO UNDERWENT TOTAL HIP ARTHROPLASTY HAS A DISTINCT IMPACT ON POSTOPERATIVE RECOVERY PROCESS AND FJS-12
Authors: Sakai T. , Kaneoka T. , Okazaki T. , Matsuki Y. , Kawakami T. , Yamazaki K. , Imagama T.
Published: August 2024

Recently, some smart media devices including portable accelerometers have been used to measure objective physical activity (OPA) after total hip arthroplasty (THA). The aim of this study was to longitudinally assess OPA changes in patients who underwent THA using a compact triaxial accelerometer and to investigate the impact of this recovery process on patient-reported outcomes.

This prospective cohort study involved 163 consecutive patients who had unilateral osteoarthritis of the hip and were followed up for 12 months after THA. There were 132 women and 31 men with average age of 66 years. OPA was measured using a compact triaxial accelerometer preoperatively and at 1, 3, 6, and 12 months postoperatively. This study investigated the recovery process of OPA in four patient groups classified by the median of age and preoperative activity levels (younger and higher activity (YH), younger and lower activity (YL), older and higher activity (OH), and older and lower activity (OL)), and examined its impact on patient-reported outcomes, including forgotten joint score-12 (FJS-12).

The target period for regaining preoperative activity levels was approximately 3 months for patients with lower preoperative activity, and about 6 months for those with higher preoperative activity. The OPA at 12 months postoperatively was higher in the patients with higher preoperative activity levels than in those with lower preoperative activity levels. In patients with higher preoperative activity levels, FJS-12 scores significantly increased between 6 and 12 months postoperatively (p=0.018). FJS-12 at 12 months postoperatively was best in YH (81.7±18.9), followed by YL (73.5±22.9), OH (73.2±17.4), and OL (66.3±21.8).

Differences in the recovery process of postoperative activity levels impacted the duration required for improvement in FJS-12 scores. These results can serve as indicators for setting activity goals in patients undergoing THA.
EFFECT OF BODY MASS INDEX ON THE RISK OF POSTOPERATIVE COMPLICATIONS FOLLOWING TOTAL HIP ARTHROPLASTY
Authors: Orringer M. , Palmer R. , Ball J. , Telang S. , Lieberman J. R. , Heckmann N. D.
Published: August 2024

While obesity is associated with an increased risk of complications after total hip arthroplasty (THA) the relationship between body mass index (BMI) and the risk of early postoperative complications has not been fully characterized. This study sought to describe the relationship between BMI and the risk of early postoperative complications, including periprosthetic joint infection (PJI), composite surgical, and composite medical complications.

Primary, elective THAs performed from 2016–2021 were identified using the Premier Healthcare Database (PHD). The study's primary outcome was the diagnosis of PJI within 90 days of THA. Using BMI as a continuous variable, logistic regression was used to develop restricted cubic splines (RCSs) to determine the impact of BMI on PJI risk. Bootstrap simulation was used to identify an inflection point in the final RCS model. The same technique was used to characterize the effects of BMI on composite medical and surgical complications.

We found that PJI risk increased exponentially beyond a BMI cutpoint of 37.4 kg/m2. Relative to the cutpoint, patients with a BMI of 40 or 50 kg/m2 were at a 1.22- and 2.55-fold increased risk of developing PJI, respectively. Surgical complications increased at a BMI of 32 kg/m2 and medical complications increased at a BMI of 39 kg/m2. Relative to these cutpoints, patients with a BMI of 50 kg/m2 were at a 1.36- and 2.07-fold increased risk of developing medical and surgical complications, respectively.

The results of this study indicate a non-linear relationship between patient BMI and early postoperative risk of PJI, composite medical complications, and composite surgical complications following THA. The identified cutpoints with associated odds ratios can serve as tools to help risk-stratify and counsel patients seeking primary THA.
AN OVERNIGHT SENSATION: HOW THE ACUTE INTRODUCTION OF A SHORT-STAY PATHWAY CAN BENEFIT A PREVIOUSLY COMPROMISED NHS ARTHROPLASTY SERVICE
Authors: Ilo K. , Van Duren B. H. , Higgins M. A. , Manktelow A. R. J. , Bloch B. V.
Published: August 2024

We report the impact of implementing a new short-stay hip and knee arthroplasty pathway in a National Health Service (NHS) hospital. This was enacted due to existing concerns with a long length of stay (LOS) and reduced elective operating capacity each winter due to emergency bed pressures. The overnight introduction of this pathway was aimed to reduce LOS, alleviate bed pressures, minimise readmission rates and generate financial savings, all combining to facilitate full elective activity during the winter.

We conducted a prospective study at a regional tertiary arthroplasty centre. The new pathway was introduced across the service overnight. It includes rigorous preoperative optimisation, specific anaesthetic protocols and uniform changes in surgical practice to allow a focus on early mobilization and discharge on the day of surgery where possible.

Data collection spanned 17 months, including the initial six months post implementation of the short-stay pathway. LOS data was collected for the full period and data was compared pre- and post-implementation of the new pathway. Patient satisfaction and 30-day readmission data were also collected.

There was an immediate and significant decrease in median LOS from 4 days pre-implementation to 1 day post-implementation. Patient satisfaction was high, and the 30-day readmission rate was unchanged (5.95%), with no readmissions directly related to decreased inpatient stay. Financial analyses revealed substantial cost savings due to reduced LOS and the elimination of routine post-operative blood tests, estimated at over £1.6m per year. Elective activity over winter was significantly higher (79%) than in the same time period in the previous year.

An acute introduction of a carefully planned and coordinated short-stay hip and knee pathway is safe, cost-effective and popular with patients, but also contributes to increased efficiency in the delivery of elective healthcare in the context of increasing demand and financial constraints in the NHS.
The ‘service user’ label through critical constructivist lenses
Authors: Cockain Alex
Published: August 2024

Mindful of the risk of seeming to cover ‘old ground’, this article strives to open new ground, or make old ground fresh again, by regarding the ‘service user’ label through critical constructivist lenses. Specifically, this article seeks to demonstrate how the agentive, self-determining qualities attached to ‘service users’, as opposed to ‘clients’ or ‘customers’, are complicated by more pejorative connotations ascribed to the term in everyday, social work and neoliberal discourses while highlighting how words matter. Not only do tensions between and within discourses register and generate tensions in practice, but, especially, language also constitutes social reality and the people and things making it up. Although frightening, yet inescapably ‘normal’, instances of structural violence and harsh austerity measures must be regarded in the context of discourse, albeit while not being determined by it, questioning common-sense discourses and the practices they index may produce possibilities for creating alternate languages and practices.
Real-time optical-wireless cooperative switching on wireless quality degradation for end-to-end video delay guarantee
Authors: Ujikawa Hirotaka , Okamoto Yuka , Harada Takumi , Shimada Tatsuya , Yoshida Tomoaki
Published: August 2024

This paper proposes an optical-wireless cooperative control method to guarantee end-to-end delays in the case of radio quality degradation in wireless networks by switching optical paths. The method leverages the control information from mobile systems to dynamically switch the optical path between the distributed unit (DU) and the far aggregated central unit (CU) to another path forward to the nearest virtualized central unit (vCU) at the edge sight, on the basis of the radio quality. This enables demanding applications that require a combination of high bandwidth and low latency, such as remote operation using drones. Preliminary simulations were conducted to investigate the effect of quality degradation in the wireless domain and the potential effectiveness of the proposed delay compensation method. In the experiments conducted to verify the feasibility of the proposed method, the results demonstrated that the optical path switching was successfully performed without packet loss and within 4 ms from the transmission of the control frame. The proposed method was also able to correctly switch back when the processing rate of mobile edge computing (MEC) was exceeded after the radio quality recovered. This study demonstrates the effectiveness of further coordination between wired and wireless control for a wider range of real-time applications using video.
Ghost reduction and brightness enhancement of aerial images using lens diffusers in MMAP
Authors: Kurihara Atsutoshi , Bao Yue
Published: August 2024

In recent years, attempts have been made to operate devices in a non-contact manner from a hygienic point of view, and technologies to make displays appear in mid-air have attracted attention. One device that projects an aerial image is called a micro-mirror array plate (MMAP). Although it is relatively easy to realize an aerial display, it has the disadvantage that ghosting is visible at the same time as the aerial image. Conventional methods responded to this problem by blocking the light rays that form ghosts, but this resulted in a decrease in brightness. In this study, we proposed a method to reduce ghosts without shading by using a directional light source and a lens diffuser. Experimental results showed that at all angles from 0° to 25°, the operating range of the MMAP used, the brightness of the aerial image improved and the luminance of the ghost was reduced compared to the conventional method using louvers. The results of this study can in principle be applied to the dihedral corner reflector array (DCRA).
Physics-aware cross-domain fusion aids learning-driven computer-generated holography
Authors: Yuan Ganzhangqin , Zhou Mi , Liu Fei , Chen Mu Ku , Jiang Kui , Peng Yifan , Geng Zihan
Published: August 2024

The rapid advancement of computer-generated holography has bridged deep learning with traditional optical principles in recent years. However, a critical challenge in this evolution is the efficient and accurate conversion from the amplitude to phase domain for high-quality phase-only hologram (POH) generation. Existing computational models often struggle to address the inherent complexities of optical phenomena, compromising the conversion process. In this study, we present the cross-domain fusion network (CDFN), an architecture designed to tackle the complexities involved in POH generation. The CDFN employs a multi-stage (MS) mechanism to progressively learn the translation from amplitude to phase domain, complemented by the deep supervision (DS) strategy of middle features to enhance task-relevant feature learning from the initial stages. Additionally, we propose an infinite phase mapper (IPM), a phase-mapping function that circumvents the limitations of conventional activation functions and encapsulates the physical essence of holography. Through simulations, our proposed method successfully reconstructs high-quality 2K color images from the DIV2K dataset, achieving an average PSNR of 31.68 dB and SSIM of 0.944. Furthermore, we realize high-quality color image reconstruction in optical experiments. The experimental results highlight the computational intelligence and optical fidelity achieved by our proposed physics-aware cross-domain fusion.
Non-pharmaceutical interventions and epigenetic aging in adults: Protocol for a scoping review
Authors: Liebich Alina , Zheng Shenglin , Schachner Theresa , Mair Jacqueline , Jovanova Mia , Müller-Riemenschneider Falk , Kowatsch Tobias
Published: August 2024

Introduction

Aging is the strongest risk factor for most chronic diseases. The rising burden of an aging population and non-communicable diseases (NCDs), contributes to escalating costs for society. Several non-pharmaceutical interventions can lower the risk of NCDs, including common mental disorders (CMDs), and may slow down biological aging, as evidenced by outcome markers such as epigenetic clocks. However, a comprehensive overview of whether and which non-pharmaceutical interventions may impact human epigenetic aging is missing. Synthesizing evidence of interventions on epigenetic aging that can be adopted by a wider population is key to guide healthy aging initiatives and to reduce the burden of NCDs and CMDs. This scoping review will identify and assess non-pharmaceutical interventions aimed to slow down epigenetic aging, including their intervention components, and the mode used for intervention delivery.

Methods and analysis

This protocol will include single- and multicomponent intervention studies that target individuals ≥ 18 years of age and use epigenetic clocks as primary or secondary outcomes. Five electronic databases will be searched for studies between July 2011 until December 2023. The final search will include the search terms adults, non-pharmaceutical interventions, epigenetic aging and their respective synonyms. We will include randomized controlled trials, non-randomized controlled studies, cohort studies, and case-control studies. Additionally, the reference list of other reviews will be screened for relevant articles. Study selection is carried out based on the defined eligibility criteria by two authors. Quality and risk of bias for the included studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist. Data extraction will include generic key information such as the research question and results, the intervention components, and specific epigenetic outcome measures used. Further data regarding the delivery mode of the treatment protocol will be collected.

Ethics and dissemination

This scoping review will summarize the characteristics of non-pharmaceutical intervention studies on epigenetic aging. This review will be the first step to formally identify key intervention components and delivery modes to guide future research on healthy aging interventions. The results will be disseminated through a peer-reviewed publication and presented at relevant conferences. This review will synthesize information from available publications and does not require further ethical approval.

Registration details

Open Science Framework https://doi.org/10.17605/OSF.IO/FEHNB.
Assessing anti
oxidant, antidiabetic potential and GCMS profiling of ethanolic root bark extract of Zanthoxylum rhetsa (Roxb.) DC: Supported by in vitro, in vivo and in silico molecular modeling
Authors: Barman Apurba Kumar , Mahadi Sumaiya , Hossain Md Arju , Begum Rahima , Acharyya Rabindra Nath , Alam Marjana , Rahman Md. Habibur , Biswas Nripendra Nath , Hossain A. S. M. Monjur Al
Published: August 2024

Zanthoxylum rhetsa (ZR) is used traditionally to manage a variety of ailments, including diabetes. Oxidative stress may accelerate the diabetic condition. The available antidiabetic and antioxidant drugs have many shortcomings including resistance, inefficiency, higher dose, side effects and costs. The goal of the current investigation was to assess the antioxidant capacity and antidiabetic activity of an ethanolic extract of Zanthoxylum rhetsa root bark (ZRRB) through in vitro, in vivo, and in silico methods. The antioxidant capacity of the ZRRB extract was measured using both the DPPH radical assay and the total antioxidant activity test. The oral glucose tolerance test (OGTT) and alloxan-induced diabetic mice model were also used to examine in vivo antidiabetic efficacy. Phytochemicals identification was done by GCMS analysis. Additionally, computational methods such as molecular docking, ADMET analysis, and molecular dynamics (MD) modeling were performed to determine the above pharmacological effects. The extract demonstrated significant DPPH scavenging activity (IC50 = 42.65 μg/mL). In the OGTT test and alloxan-induced diabetes mice model, the extract effectively lowered blood glucose levels. Furthermore, in vitro inhibition of pancreatic α-amylase studies demonstrated the ZRRB extract as a good antidiabetic crude drug (IC50 = 81.45 μg/mL). GCMS investigation confirmed that the crude extract contains 16 major phytoconstituents, which were docked with human peroxiredoxin-5, α-amylase, and sulfonylurea receptor 1. Docking and pharmacokinetic studies demonstrated that among 16 phytoconstituents, 6H-indolo[3,2,1-de] [1,5]naphthyridin-6-one (CID: 97176) showed the highest binding affinity to targeted enzymes, and imitated Lipinski’s rule of five. Furthermore, MD simulation data confirmed that the aforementioned compound is very steady to the binding site of α-amylase and sulfonylurea receptor 1 receptors. Findings from in vitro, in vivo and in silico investigation suggest that ZRRB extract contains a lead compound that could be a potent source of antidiabetic drug candidate.
Exploring the spatial spillover effects of Yangtze River Delta ports on urban economic growth
Authors: Hou Jian , Shi Juming , Chen Liangyu , Zhang Zhouping , Kuang Edwin
Published: August 2024

The Yangtze River Delta (YRD) ports are pivotal in shaping the Yangtze River Economic Belt and advancing urban economies across China. This article utilizes panel data from 20 cities with ports in the YRD area, spanning from 2011 to 2020, using the spatial Durbin model to explore how these ports influence urban economic growth. The findings indicate that: (1) The YRD ports significantly contribute to economic growth in both the port cities and their surrounding areas, with the indirect impact on neighboring cities being more substantial than the direct effect on the cities themselves; (2) The beneficial spillover effects of the YRD ports on the economic growth of nearby cities vary in intensity over different spatial ranges, marked by distinct boundary effects and geographical attenuation. The influence extends up to approximately 110km; (3) Within the various elements impacting the economic growth of cities in the YRD, financial development prominently exhibits a threshold effect on urban economic growth; (4) Upon analyzing heterogeneity, inland and coastal port cities manifest divergent spillover effects, with inland port cities predominantly exerting a positive spillover on adjacent regions. Accordingly, in order to eventually achieve the shared prosperity of the region’s economy, it is recommended that a strong top-level design be established and that efforts be made to transform the YRD region into a core region a diffusion and driving effect.
Enhancing prebiotic, antioxidant, and nutritional qualities of noodles: A collaborative strategy with foxtail millet and green banana flour
Authors: Farzana Tasnim , Abedin Md. Jaynal , Abdullah Abu Tareq Mohammad , Reaz Akter Hossain , Bhuiyan Mohammad Nazrul Islam , Afrin Sadia , Satter Mohammed Abdus
Published: August 2024

Foxtail millet (FM) and green banana (GB) are rich in health-promoting nutrients and bioactive substances, like antioxidants, dietary fibers, and various essential macro and micronutrients. Utilizing GB and FM flour as prebiotics is attributed to their ability to support gut health and offer multiple health benefits. The present study aimed to evaluate the impact of incorporating 10% GB flour (GBF) and different proportions (10–40%) of FM flour (FMF) on the prebiotic potential, antioxidant, nutrient, color, cooking quality, water activity and sensory attributes of noodles. The prebiotic potential, antioxidant, and nutrient of the produced noodles were significantly improved by increasing the levels of FMF. Sensorial evaluation revealed that noodles containing 30% FMF and 10% GBF attained comparable scores to the control sample. Furthermore, the formulated noodles exhibited significantly (p < 0.05) higher levels of protein, essential minerals (such as iron, magnesium, and manganese), dietary fiber (9.37 to 12.71 g/100 g), total phenolic compounds (17.81 to 36.35 mg GA eq./100 g), and total antioxidants (172.57 to 274.94 mg AA eq./100 g) compared to the control. The enriched noodles also demonstrated substantially (p < 0.05) increased antioxidant capacity, as evidenced by enhanced DPPH and FRAP activities, when compared to the control noodles. Overall, the incorporation of 30% FMF and 10% GBF led to a noteworthy improvement in the nutritional and antioxidant qualities of the noodles, as well as the prebiotic potential of the noodles with regard to L. plantarum, L. rhamnosus, and L. acidophilus. The implementation of this enrichment strategy has the potential to confer a multitude of health advantages.
Emergent coordination in temporal partitioning congestion games
Authors: Cohen Reuven , Perez Oren
Published: August 2024

In this article we study the social dynamic of temporal partitioning congestion games (TPGs), in which participants must coordinate an optimal time-partitioning for using a limited resource. The challenge in TPGs lies in determining whether users can optimally self-organize their usage patterns. Reaching an optimal solution may be undermined, however, by a collectively destructive meta-reasoning pattern, trapping users in a socially vicious oscillatory behavior. TPGs constitute a dilemma for both human and animal communities. We developed a model capturing the dynamics of these games and ran simulations to assess its behavior, based on a 2×2 framework that distinguishes between the players’ knowledge of other players’ choices and whether they use a learning mechanism. We found that the only way in which an oscillatory dynamic can be thwarted is by adding learning, which leads to weak convergence in the no-information condition and to strong convergence in the with-information condition. We corroborated the validity of our model using real data from a study of bats’ behaviour in an environment of water scarcity. We conclude by examining the merits of a complexity-based, agent-based modelling approach over a game-theoretic one, contending that it offers superior insights into the temporal dynamics of TPGs. We also briefly discuss the policy implications of our findings.
Micro-osteoperforation for enhancement of orthodontic movement: A mechanical analysis using the finite element method
Authors: Gomes João Ricardo Cancian Lagomarcino , Vargas Ivana Ardenghi , Rodrigues Antônio Flávio Aires , Gertz Luiz Carlos , Freitas Maria Perpétua , Miguens Sergio Augusto Quevedo , Ozkomur Ahmet , Hernandez Pedro Antonio González
Published: August 2024

Background

Micro-osteoperforation is a minimally invasive technique aimed at accelerating tooth movement. The goal of this novel experimental study was to assess tooth movement and stress distribution produced by the force of orthodontic movement on the tooth structure, periodontal ligament, and maxillary bone structure, with and without micro-osteoperforation, using the finite element method.

Materials and methods

Cone-beam computed tomography was used to obtain a virtual model of the maxilla and simulate the extraction of right and left first premolars. Three micro-osteoperforations (1.5 x 5 mm) were made in the hemiarch on the distal and mesial surfaces of upper canines, according to the power tip geometry of the Propel device (Propel Orthodontics, Ossining, New York, USA). An isotropic model of the maxilla was fabricated according to the finite element method by insertion of mechanical properties of the tooth structures, with orthodontic force (1.5 N) simulation in the distal movement on the upper canine of a hemiarch.

Results

Initial movement was larger when micro-osteoperforations were performed on the dental crown (24%) and on the periodontal ligament (29%). In addition, stress distribution was higher on the bone structure (31%) when micro-osteoperforations were used.

Conclusions

Micro-osteoperforations considerably increased the movement of both the dental crown and periodontal ligament, which highlights their importance in the improvement of orthodontic movement, as well as in stress distribution across the bone structure. Important stress absorption regions were identified within micro-osteoperforations.
High-percentage new energy distribution network line loss frequency division prediction based on wavelet transform and BIGRU-LSTM
Authors: Wu Xiangming , Song Nan , Liang Jifeng , Lv Ye , Wang Zitian , Yang Lijun
Published: August 2024

The access of new energy improves the flexibility of distribution network operation, but also leads to more complex mechanism of line loss. Therefore, starting from the nonlinear, fluctuating and multi-scale characteristics of line loss data, and based on the idea of decomposition prediction, this paper proposes a new method of line loss frequency division prediction based on wavelet transform and BIGRU-LSTM (Bidirectional Gated Recurrent Unit-Long Short Term Memory Network).Firstly, the grey relation analysis and the improved NARMA (Nonlinear Autoregressive Moving Average) correlation analysis method are used to extract the non-temporal and temporal influencing factors of line loss, and the corresponding feature data set is constructed. Then, the historical line loss data is decomposed into physical signals of different frequency bands by using wavelet transform, and the multi-dimensional input data of the prediction network is formed with the above characteristic data set. Finally, the BIGRU-LSTM prediction network is built to realize the probabilistic prediction of high-frequency and low-frequency components of line loss. The effectiveness and applicability of the method proposed in this paper were verified through numerical simulation. By dividing the line loss data into different frequency bands for frequency prediction, the mapping relationship between different line loss components and influencing factors was accurately matched, thereby improving the prediction accuracy.