The future of treatment for avascular necrosis of the femoral head: hip resurfacing arthroplasty health economics and surgical technology

Introduction Avascular necrosis of the hip (AVN) is a disease which causes a lack of blood supply in the femoral head, resulting in the bone death, and a subsequent biomechanical failure of the hip joint. Current treatment is mainly to seek for total hip replacement. However, the majority of these affected patients < 60 years of age, having total hip replacement will lose the ability to engage in massive physical work, or lower their life qualities. On the contrary, hip resurfacing arthroplasty (HRA), which is a femoral head preserving surgery, seems to be an ideal intervention for AVN patients because HRA does not change native hip anatomy and helps restoring hip joint. The present question when performing HRA on AVN patients is, surgeons do not know to what lesion extent can they perform such surgery. This thesis aims to review all aspects of AVN, to find out whether the HRA is more cost-effective than THA, to determine the maximum lesion extent to perform HRA, and to plan the surgery better. Method First, we did a comprehensive review on AVN’s mechanism, treatments and staging systems. Second, we use a health economic model to simulate the benefits of performing HRA over THA. Third, we simulate a series of lesions with bone graft HRA in composite bone mechanical tests under healthy human walking load in the hip joint, and compare these lesions data to non-lesion data. From these data, we are able to summarise an indication table for AVN-HRA classification. Last, we develop a pre-operative planner to optimse HRA on AVN, and validate the planner’s reliability and reproducibility. All these steps have never been fully studied before. Results First, the AVN prevalence rates in easter Asian countries were quite high, and the non-surgical treatment cannot cure AVN, as well as the lack of hip resurfacing AVN staging system. Second, the health economic model (Markov model), specifically its Monte Carlo simulation showed a 60% probability that HRA was more cost-effective than THA during 10 years post-operatively. Third, the simulated lesions on HRA mechanical tests demonstrated that 10mm depth of lesion down from the tip of the prepared femoral head with autograft, were able to achieve initial stability. Any lesion depth deeper than 10mm is not recommended for hip resurfacing. Four, the inter-observer and intra-observer reliability and repeatability were all higher than 80% using our pre-operative planner, meaning that this planner is reliable enough to be a workhorse for AVN hip resurfacing pre-operative planning. Conclusion Overall, our results showed that HRA is more cost-effective than THA, and we found out that 10mm of lesion depth was on the margin of the safe HRA, with autograft to fill the defect cause by lesion. Finally, we created a reliable planner that helps planning AVN HRA preoperatively. Our results well matched the hypothesis mentioned above.Open Acces

Case report: Sex-specific characteristics of epilepsy phenotypes associated with Xp22.31 deletion: A case report and review

Deletion in the Xp22.31 region is increasingly suggested to be involved in the etiology of epilepsy. Little is known regarding the genomic and clinical delineations of X-linked epilepsy in the Chinese population or the sex-stratified difference in epilepsy characteristics associated with deletions in the Xp22.31 region. In this study, we reported two siblings with a 1.69 Mb maternally inherited microdeletion at Xp22.31 involving the genes VCX3A, HDHD1, STS, VCX, VCX2, and PNPLA4 presenting with easily controlled focal epilepsy and language delay with mild ichthyosis in a Chinese family with a traceable 4-generation history of skin ichthyosis. Both brain magnetic resonance imaging results were normal, while EEG revealed epileptic abnormalities. We further performed an exhaustive literature search, documenting 25 patients with epilepsy with gene defects in Xp22.31, and summarized the epilepsy heterogeneities between sexes. Males harboring the Xp22.31 deletion mainly manifested with child-onset, easily controlled focal epilepsy accompanied by X-linked ichthyosis; the deletions were mostly X-linked recessive, with copy number variants (CNVs) in the classic region of deletion (863.38 kb–2 Mb). In contrast, epilepsy in females tended to be earlier-onset, and relatively refractory, with pathogenic CNV sizes varying over a larger range (859 kb–56.36 Mb); the alterations were infrequently inherited and almost combined with additional CNVs. A candidate region encompassing STS, HDHD1, and MIR4767 was the likely pathogenic epilepsy-associated region. This study filled in the knowledge gap regarding the genomic and clinical delineations of X-linked recessive epilepsy in the Chinese population and extends the understanding of the sex-specific characteristics of Xp22.31 deletion in regard to epilepsy

Chromosomal aberrations in pediatric patients with moderate/severe developmental delay/intellectual disability with abundant phenotypic heterogeneities: A single-center study

Background: This study aimed to examine the clinical usefulness of chromosome microarray (CMA) for selective implementation in patients with unexplained moderate or severe developmental delay/intellectual disability (DD/ID) and/or combined with different dysphonic features in the Han Chinese population. Methods: We retrospectively analyzed data on 122 pediatric patients with unexplained isolated moderate/severe DD/ID with or without autism spectrum disorders, epilepsy, dystonia, and congenital abnormalities from a single-center neurorehabilitation clinic in southern China. Results: A total of 46 probands (37.7%) had abnormal CMA results among the 122 study patients. With the exclusion of aneuploidies, uniparental disomies, and multiple homozygotes, 37 patients harbored 39 pathogenic copy number variations (pCNVs) (median [interquartile range] size: 3.57 [1.6 to 7.1] Mb; 33 deletions and 6 duplications), enriched in chromosomes 5, 7, 15, 17, and 22, with a markedly high prevalence of Angelman/Prader-Willi syndrome (24.3% [nine of 37]). Three rare deletions in the regions 5q33.2q34, 17p13.2, and 13q33.2 were reported, with specific delineation of clinical phenotypes. The frequencies of pCNVs were 18%, 33.3%, 38.89%, 41.67%, and 100% for patients with 1, 2, 3, 4, and 5 study phenotypes, respectively; patients with more concomitant abnormalities in the heart, brain, craniofacial region, and/or other organs had a higher CMA diagnostic yield and pCNV prevalence (P \u3c 0.05). Conclusions: Clinical application of CMA as a first-tier test among patients with moderate/severe DD/ID combined with congenital structural anomalies improved diagnostic yields and the quality of clinical management in this series of patients

Radial Growth of Qilian Juniper on the Northeast Tibetan Plateau and Potential Climate Associations

There is controversy regarding the limiting climatic factor for tree radial growth at the alpine treeline on the northeastern Tibetan Plateau. In this study, we collected 594 increment cores from 331 trees, grouped within four altitude belts spanning the range 3550 to 4020 m.a.s.l. on a single hillside. We have developed four equivalent ring-width chronologies and shown that there are no significant differences in their growth-climate responses during 1956 to 2011 or in their longer-term growth patterns during the period AD 1110–2011. The main climate influence on radial growth is shown to be precipitation variability. Missing ring analysis shows that tree radial growth at the uppermost treeline location is more sensitive to climate variation than that at other elevations, and poor tree radial growth is particularly linked to the occurrence of serious drought events. Hence water limitation, rather than temperature stress, plays the pivotal role in controlling the radial growth of Sabina przewalskii Kom. at the treeline in this region. This finding contradicts any generalisation that tree-ring chronologies from high-elevation treeline environments are mostly indicators of temperature changes

Airborne Radar Anti-Jamming Waveform Design Based on Deep Reinforcement Learning

Airborne radars are susceptible to a large number of clutter, noise and variable jamming signals in the real environment, especially when faced with active main lobe jamming, as the waveform shortcut technology in the traditional regime can no longer meet the actual battlefield radar anti-jamming requirements. Therefore, it is necessary to study anti-main-lobe jamming techniques for airborne radars in complex environments to improve their battlefield survivability. In this paper, we propose an airborne radar waveform design method based on a deep reinforcement learning (DRL) algorithm under clutter and jamming conditions, after previous research on reinforcement-learning (RL)-based airborne radar anti-jamming waveform design methods that have improved the anti-jamming performance of airborne radars. The method uses a Markov decision process (MDP) to describe the complex operating environment of airborne radars, calculates the value of the radar anti-jamming waveform strategy under various jamming states using deep neural networks and designs the optimal anti-jamming waveform strategy for airborne radars based on the duelling double deep Q network (D3QN) algorithm. In addition, the method uses an iterative transformation method (ITM) to generate the time domain signals of the optimal waveform strategy. Simulation results show that the airborne radar waveform designed based on the deep reinforcement learning algorithm proposed in this paper improves the signal-to-jamming plus noise ratio (SJNR) by 2.08 dB and 3.03 dB, and target detection probability by 26.79% and 44.25%, respectively, compared with the waveform designed based on the reinforcement learning algorithm and the conventional linear frequency modulation (LFM) signal at a radar transmit power of 5 W. The airborne radar waveform design method proposed in this paper helps airborne radars to enhance anti-jamming performance in complex environments while further improving target detection performance

Driving event-related potential-based speller by localized posterior activities: An offline study

Multi-sensor recordings are normally used in event-related potential (ERP)-based brain computer interfaces (BCIs), for capturing brain activities widely distributed over the cortical surface. However, this may lead to an increased number of sensors for boosting classification performance, as well as a complicated computational effort for optimizing/reducing sensors, limiting the popularization of mobile/wearable BCIs for the end use. The localization of brain activities may help fix this issue by making useful information concentrated on relatively local brain areas, thus greatly reducing the number of sensors required and computational burden arising from the sensor selection. In the present study, we examined localization of brain activities for an ERP speller, by using novel visual graphic stimuli to induce specific brain responses. Participants were instructed to perform a spelling task under both the graphic stimuli-based and traditional character-flashing-based ERP speller paradigms. Experimental results showed that, compared to character-flashing stimuli, localized brain activities, concentrated over the posterior region, were observed for the graphic stimuli. Classification accuracies and information transfer rates were further evaluated and compared among full- (FS), normal- (NS), and localized- (LS) sensor settings. Effects of PARADIGM, SENSORSETTING, and TRIAL LENGTH were examined by a three-way repeated measure analysis of variance (ANOVA). ANOVA results showed that, the graphic paradigm achieved significantly better performance under LS than those achieved by the traditional paradigm at any of the three sensor settings, indicating that with visual graphic stimuli, localized posterior activities were enough to drive an ERP-based speller to achieve comparable or even better performance, compared to the traditional paradigm using global activities

The Relationship between Mindfulness and Social Adaptation among Migrant Children in China: The Sequential Mediating Effect of Self-Esteem and Resilience

Social adaptation of migrant children is not only related to the physical and mental health and development of individuals, but also reflects the level of urban social integration and stable development. Mindfulness has a protective effect on individual social adaptation. Self-esteem and resilience were found to be positively associated with mindfulness and social adaptation. Based on the Positive Youth Development Perspective, this study aimed to explore whether self-esteem and resilience sequentially mediated the associations among mindfulness and social adaptation. A total of 526 migrant children were assessed with the questionnaires regarding mindfulness, self-esteem, resilience, and social adaptation. The results indicated that mindfulness was positively associated with social adaptation of migrant children. Self-esteem and resilience played the sequential mediating roles between mindfulness and social adaptation. The present study revealed the influence and mechanism of mindfulness on social adaptation and provided some guidance for the intervention programs to promote migrant children&rsquo;s adaptability

The Optimized Roadway Layouts and Surrounding Rock Control Technology of the Fully Mechanized Mining Surface with Large Mining Heights in High-Gas Mines

Many problems exist in the layout of working surfaces in high-gas mines, such as the low efficiency of roadway excavation, difficulties in maintenance after excavation, and serious resource wastes due to difficulties in recovering coal pillars between roadways. Taking the project profile in the west wing mining area of Sihe Coal Mine as the background, this work proposed an optimization plan for the staggered-layer arrangement of roadways. The minimum retained size of the coal pillar was calculated through theoretical analysis, and the plastic failure and deformations of surrounding rocks under different coal pillar sizes and roadway layouts were compared based on finite difference numerical simulations. The reasonable retained size of the coal pillar was determined to be 45 m, and the roadway layout was determined according to the distribution of coal and rock strata in the mining field. The technical measures of base angle pressure relief blasting and strengthening support were proposed to ensure the safety and stability of surrounding rocks of roadways during the service period after the layout plan was optimized. Similar simulation tests were used to study the damage deformations and stress changes of the blasting pressure relief floor. On-site tests showed that the optimized roadway layout greatly improved the recovery rate of coal resources. In addition, surrounding rocks had good stability, and they could be simply repaired or serve the next working surface directly without being repaired. These research results provide a scientific basis and useful reference for similar projects

Overlying Strata Movement and Mine-Pressure Weakening Law of High-Efficiency Longwall Paste Backfilling of Thick Coal

This work focused on the serious coal compression under buildings, railways, and water bodies in central and eastern China; the wide range of rock formation damage during the collapse mining process; the high pressure of mines; and difficulties in controlling surface subsidence after mining. The E1302 working face of Shanxi Gaohe Energy was taken as the engineering background in the work. The mechanical properties of gangue paste-filling materials were studied through laboratory tests, and the critical conditions for bending and fracture of the coal seam roof were analyzed. Discrete-element numerical simulation software was used to study the fracturing process of the roof, and the reasonable filling rate to ensure roof stability was determined to be 95%. Meanwhile, overlying stratum movement and mine-pressure weakening law were studied through numerical simulations and field measurement. The results showed that fracture development during the mining process of thick-coal paste filling was divided into the advanced development, re-compaction, and steady-state maintenance of fractures. Fractures advanced in a “sail shape” and developed only in the main-roof rock strata after recompaction. The maximum subsidence angle of the working face was 87.13° after mining, with a subsidence factor of 0.034 and a maximum horizontal movement coefficient of 0.71. The advanced stress value was weakened by 40%, and the influenced area was reduced by 13%. Overlying stratum movement was controlled, and mine pressures were significantly weakened. The work can provide a scientific basis for green backfill mining, roadway support design, and backfill mining equipment selection