Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion. Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation. Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 } 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05). Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group

Zespół kruchości w gabinecie lekarza praktyka — o czym należy pamiętać?

The aging process does not occur in the same way for all patients. The pace of this process, both physical and mental, is very different. The quality of life of an elderly patient depends on many factors, including lifestyle, genetic predisposition and appropriate medical care. The quality of health care depends, among other things, on how quickly and, whether or not, the doctor sees correctly signs of premature or „abnormal” aging. To facilitate this, a set of symptoms was identified, the occurrence of which should alert the doctor due to the relationship with increased mortality. In the English-language literature, this group is called frailty syndrome. In the Polish literature, the most widely used description of this phenomenon is probably zespół kruchości. The aim of this paper was to present the importance of this syndrome in clinical practice.Nie u wszystkich pacjentów proces starzenia się przebiega w ten sam sposób. Tempo postępowania tego procesu, zarówno fizycznego, jak i psychicznego, jest bardzo różne. Jakość życia pacjenta w podeszłym wieku zależy od bardzo wielu czynników, w tym stylu życia, predyspozycji genetycznych oraz odpowiedniej opieki medycznej. Jakość opieki zdrowotnej zależy między innymi od tego, jak szybko i czy prawidłowo lekarz dostrzeże u pacjenta oznaki przedwczesnego, czy „nieprawidłowego” starzenia się. Aby to ułatwić, wyodrębniono zespół objawów, których występowanie powinno zaalarmować lekarza ze względu na związek ze zwiększoną śmiertelnością. W piśmiennictwie anglojęzycznym zespół ten nosi nazwę frailty syndrome. W piśmiennictwie polskim najszerzej używane określenie tego zjawiska to prawdopodobnie „zespół kruchości”. Celem niniejszego opracowania było przedstawienie znaczenia tego zespołu w praktyce klinicznej

Ocena ciśnienia centralnego w grupie pacjentów poddawanych alloplastyce stawu biodrowego lub stawu kolanowego

Introduction: The assessment of pre-operative cardiovascular risk is extremely important especially in the case of procedures involving increased perioperative risk, which include orthopedic surgery i.e. hip or knee alloplasty. From the point of view of care during the surgery itself and immediately after it, correct control of the arterial blood pressure is very important. Useful in this aspect may be the assessment of modern hypertensive markers suchas central arterial blood pressure (CBP).The aim of the study was to assess the value of CBP in a group of consecutive patients with periodontal disease who were qualified for hip or knee replacement surgery. Material and methods: The study included consecutive patients scheduled for hip or knee arthroplasty, in which, apart from the standard risk assessment, peripheral blood pressure and CBP measurements were taken and the pulse wave velocity (PWV) was measured. All patients enrolled in the study also had a periodical assessmentperformed to assess the severity of another non-classical risk factor — periodontal disease. Results: The study population included 29 patients, of which 17 (59%) were scheduled for a hip replacement and 12 (41%) for a knee replacement. The mean age of the study population was 66.9 ± 10.9. All 29 patients had periodontal disease of which 11 (37.9%) had advanced disease. In the whole cohort 23 (79.3%) patients hada diagnosis of hypertension, 23 (79.3%) were overweight, 4 (13.8%) were diabetic and 8 (27.6%) were smokers.Dyslipidemia was present in 19 (65.5%) of patients but only 9 (31%) were taking a statin on admission. Most notably only 13 patients (44.8%) had a normal central blood pressure and 8 patients (27.6%) had a raised PWV. These findings were independent of the type of orthopaedic procedure the patients were due to undergo. Conclusions: Abnormal CBP values are highly prevalent among patients scheduled for elective hip or knee replacement. This along with the high prevalence of other cardiovascular disease contributes negatively to theperioperative risk in these patients.Wprowadzenie: Ocena przedoperacyjnego ryzyka sercowo-naczyniowego jest niezmiernie ważna, zwłaszcza przy przeprowadzaniu zabiegów obciążonych podwyższonym ryzykiem okołooperacyjnym, do których zalicza się operacje ortopedyczne, w tym alloplastykę stawu biodrowego i kolanowego. Z punktu widzenia opieki w czasie samego zabiegu i bezpośrednio po nim bardzo istotna jest prawidłowa kontrola wartości ciśnienia tętniczego. Przydatna w tym aspekcie może się okazać ocena nowoczesnych markerów hipertensjologicznych, takich jak wartości centralnego ciśnienia tętniczego (CBP). Celem badania była ocena wartości CBP w grupie kolejnych pacjentów z chorobą przyzębia, których zakwalifikowano do operacji alloplastyki stawu biodrowego lub kolanowego — zależnie od współistniejących czynników ryzyka. Materiał i metody: Do badania włączono kolejnych pacjentów poddawanych operacjom alloplastyki stawu biodrowego lub kolanowego, u których poza standardową oceną ryzyka wykonano pomiary wartości obwodowego ciśnienia tętniczego i CBP oraz zmierzono prędkość fali tętna (PWV). U wszystkich włączonych do badania osób dokonano również oceny periodontologiczną w celu określenia stopnia nasilenia innego nieklasycznego czynnika ryzyka — choroby przyzębia. Wyniki: Badana populacja obejmowała 29 pacjentów, spośród których u 17 (59%) zaplanowano wymianę stawu biodrowego, a u 12 (41%) — operację kolana. Średni wiek badanych wynosił 66,9 ± 10,9 roku. U wszystkich 29 pacjentów rozpoznano chorobę przyzębia, w tym u 11 (37,9%) w stopniu zaawansowanym. W całej kohorcie 23 (79,3%) pacjentów miało rozpoznane nadciśnienie tętnicze, 23 (79,3%) — nadwagę, 4 (13,8%) — cukrzycę, a 8 (27,6%) było palaczami tytoniu. Dyslipidemia występowała u 19 (65,5%) chorych, ale tylko 9 (31%) z nich przyjmowało statynę przy przyjęciu do szpitala. Tylko u 13 pacjentów (44,8%) stwierdzono prawidłowe CBP, a 8 chorych (27,6%) PWV była podwyższona. Obserwacje te były niezależne od rodzaju procedury ortopedycznej, której poddawano pacjentów. Wnioski: Nieprawidłowe wartości CBP są szeroko rozpowszechnione wśród pacjentów zakwalifikowanych do planowej wymiany stawu biodrowego lub kolanowego. Wraz z dużą częstością występowania innych chorób układu sercowo-naczyniowego wpływa to negatywnie na ryzyko okołooperacyjne u tych osób

Zespół kruchości w gabinecie lekarza praktyka — o czym należy pamiętać?

Nie u wszystkich pacjentów proces starzenia się przebiega w ten sam sposób. Tempo postępowania tego procesu, zarówno fizycznego, jak i psychicznego, jest bardzo różne. Jakość życia pacjenta w podeszłym wieku zależy od bardzo wielu czynników, w tym stylu życia, predyspozycji genetycznych oraz odpowiedniej opieki medycznej. Jakość opieki zdrowotnejzależy między innymi od tego, jak szybko i czy prawidłowo lekarz dostrzeże u pacjenta oznaki przedwczesnego, czy „nieprawidłowego” starzenia się. Aby to ułatwić, wyodrębniono zespół objawów, których występowanie powinno zaalarmować lekarza ze względu na związek ze zwiększoną śmiertelnością. W piśmiennictwie anglojęzycznym zespół ten nosi nazwę frailty syndrome. W piśmiennictwie polskim najszerzej używane określenie tego zjawiska to prawdopodobnie „zespół kruchości”. Celem niniejszego opracowania było przedstawienie znaczenia tego zespołu w praktyce klinicznej

Ocena ryzyka sercowo-naczyniowego przed operacjami ortopedycznymi

Patients undergoing orthopaedic surgery of hip or knee joints are burdened with increased risk of cardiovascular disease, postoperative complications and death. Besides routine preoperative assessment of risk associated with surgical procedure, type of anaesthesia and general clinical condition of a patient, should be also paid attention to modifiable and non-modifiable cardiovascular risk factors and estimated total cardiovascular risk. Implementation of preventive procedures before surgery allows to minimize risk of cardiovascular complications and faster recovery of a patient in the postoperative period.Pacjenci poddawani zabiegom ortopedycznym stawów biodrowych lub kolanowych są obciążeni podwyższonym ryzykiem wystąpienia chorób układu sercowo-naczyniowego, komplikacji pooperacyjnych oraz zgonu. Oprócz rutynowej przedoperacyjnej oceny ryzyka związanego z samą procedurą chirurgiczną, rodzajem znieczulenia i stanem klinicznym chorego, szczególną uwagę należy zwrócić także na modyfikowalne i niemodyfikowalne czynniki ryzyka sercowo-naczyniowego oraz oszacować całkowite ryzyko sercowo-naczyniowe. Wdrożenie działań prewencyjnych jeszcze przed operacją pozwoli na zminimalizowanie ryzyka powikłań sercowo-naczyniowych oraz szybszy powrót pacjenta do sprawności w okresie pooperacyjnym

Machinability of INCONEL718 alloy with a porous microstructure produced by laser melting powder bed fusion at higher energy densities

Products produced by additive manufacturing (AM) seek to exploit net shape manufacturing by eliminating or minimizing post-process stages such as machining. However, many applications which include turbo machinery components with tight dimensional tolerances and a smooth surface finish will require at least a light machine finishing stage. This paper investigates the machinability of the additively fabricated INCONEL718 (IN718) alloy produced by laser melting powder bed fusion (LM-PBF) with different levels of spherical porosity in the microstructure. The literature suggests that the band width for laser energy density, which combines the various scan process parameters to obtain a low spherical type porosity in the LM-PBF IN718 alloy (~1%), has wide breadth. With the increasing laser energy density and above a threshold, there is a rapid increase in the spherical pore size. In this paper, three tube samples each with different levels of spherical porosity were fabricated by varying the laser energy density for LM-PBF of the IN718 alloy within the stable and higher energy density range and the porosity measured. A low laser energy density was avoided due to balling up, which promotes highly irregular lack of fusion defects and poor consolidation within the alloy microstructure. An orthogonal turning test instrumented, with a three-component dynamometer to measure the cutting forces, was performed on AM produced IN718 tube samples under light cut conditions to simulate a finish machining process. The orthogonal turning tests were also performed on a tube sample obtained from the wrought extruded stock. The machining process parameters, which were studied include varying the cutting speed at three levels, at a fixed feed and under dry cut conditions for a short duration to avoid the tool wear. The results obtained were discussed and a notable finding was the higher rate of built-up-edge formation on the tool tip from the AM samples with a higher porosity and especially at a higher cutting speed. The paper also discusses the mechanisms that underpin the findings.N/

Wczesne koncepcje Internetu i ich urzeczywistnienie w teraźniejszości

The article shows in a cross-sectional way a fascinating journey through the history of the realization and evolution of human thought, based on the desire to develop an intellectual face of humanity. The Internet has become a key tool for this purpose. From the first „lo” to today’s standalone network systems, human development is increasingly associated with the cybernetic world. Will this lead to a great unification of human life and the web

Investigations on Mechanical Properties of Lattice Structures with Different Values of Relative Density Made from 316L by Selective Laser Melting (SLM)

Nine variants of regular lattice structures with different relative densities have been designed and successfully manufactured. The produced structures have been subjected to geometrical quality control, and the manufacturability of the implemented selective laser melting (SLM) technique has been assessed. It was found that the dimensions of the produced lattice struts differ from those of the designed struts. These deviations depend on the strut orientation in relation to the specimen-building direction. Additionally, the microstructures and phase compositions of the obtained structures were characterized and compared with those of conventionally produced 316L stainless steel. The microstructure analysis and X-ray diffraction (XRD) patterns revealed a single austenite phase in the SLM samples. Both a certain broadening and a displacement of the austenite peaks were observed due to residual stresses and a crystallographic texture induced by the SLM process. Furthermore, the mechanical behavior of the lattice structure material has been defined. It was demonstrated that under both quasi-static and dynamic testing, lattice structures with high relative densities are stretch-dominated, whereas those with low relative densities are bending-dominated. Moreover, the linear dependency between the value of energy absorption and relative density under dynamic loading conditions has been established

Fractal Dimension as Robust Estimate of Low Carbon Steels Hardness

Application of computational methods in engineering and science constantly increases, which is also visible in sector of material science, often with promising results. In following paper, authors would like to propose fractal dimension, a mathematical method of quantifying self-similarity and complexity of spatial patterns, as robust method of hardness estimation of low carbon steels. A dataset of microstructure images and corresponding Vickers hardness measurements of S235JR steel under different delivery conditions was created. Then, three different computational methods for evaluation of materials hardness based on microstructure image were tested. In this paper those methods are called: (i) Otsu-based index, (ii) fractal dimension index and (iii) vision transformer index. The results were compared with method used in literature for similar problems. Comparison showed that fractal dimension performs better than other evaluated methods, in terms of median absolute error, which value was equal to 4.12 HV1, which is significantly lower than results achieved by Otsu-based index and vision transformer index, which were 4.49 HV1 and 5.07 HV1 respectively. Those results can be attributed to the relative robustness of fractal dimension index, when compared to other methods. Robust estimation is preferable, due to the high amount of noise in the dataset, which is a consequence of the nature of used material