An unsymmetric 8-node hexahedral element with high distortion tolerance

Among all 3D 8-node hexahedral solid elements in current finite element library, the ‘best’ one can produce good results for bending problems using coarse regular meshes. However, once the mesh is distorted, the accuracy will drop dramatically. And how to solve this problem is still a challenge that remains outstanding. This paper develops an 8-node, 24-DOF (three conventional DOFs per node) hexahedral element based on the virtual work principle, in which two different sets of displacement fields are employed simultaneously to formulate an unsymmetric element stiffness matrix. The first set simply utilizes the formulations of the traditional 8-node trilinear isoparametric element, while the second set mainly employs the analytical trial functions in terms of 3D oblique coordinates (R, S, T). The resulting element, denoted by US-ATFH8, contains no adjustable factor and can be used for both isotropic and anisotropic cases. Numerical examples show it can strictly pass both the first-order (constant stress/strain) patch test and the second-order patch test for pure bending, remove the volume locking, and provide the invariance for coordinate rotation. Especially, it is insensitive to various severe mesh distortions

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability