BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it...BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it is critical to have accurate and effective predictive models for fracture risk.Traditionally,clinicians have relied on a combination of factors such as demographics,clinical attributes,and radiological characteristics to predict fracture risk in these patients.However,these models often lack precision and fail to include all potential risk factors.There is a need for a more comprehensive,statistically robust prediction model that can better identify high-risk individuals for early intervention.AIM To construct and validate a model for forecasting fracture risk in patients with spinal osteoporosis.METHODS The medical records of 80 patients with spinal osteoporosis who were diagnosed and treated between 2019 and 2022 were retrospectively examined.The patients were selected according to strict criteria and categorized into two groups:Those with fractures(n=40)and those without fractures(n=40).Demographics,clinical attributes,biochemical indicators,bone mineral density(BMD),and radiological characteristics were collected and compared.A logistic regression analysis was employed to create an osteoporotic fracture risk-prediction model.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the model’s performance.RESULTS Factors significantly associated with fracture risk included age,sex,body mass index(BMI),smoking history,BMD,vertebral trabecular alterations,and prior vertebral fractures.The final risk-prediction model was developed using the formula:(logit[P]=-3.75+0.04×age-1.15×sex+0.02×BMI+0.83×smoking history+2.25×BMD-1.12×vertebral trabecular alterations+1.83×previous vertebral fractures).The AUROC of the model was 0.93(95%CI:0.88-0.96,P<0.001),indicating strong discriminatory capabilities.CONCLUSION The fracture risk-prediction model,utilizing accessible clinical,biochemical,and radiological information,offered a precise tool for the evaluation of fracture risk in patients with spinal osteoporosis.The model has potential in the identification of high-risk individuals for early intervention and the guidance of appropriate preventive actions to reduce the impact of osteoporosis-related fractures.展开更多
The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is...The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes.Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk.Moreover,some antidiabetic medications further enhance the fragility of the bone.On the other hand,antiosteoporosis medications can affect the glucose homeostasis in these patients.It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk.Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature.With the advancement in imaging technology,newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes.The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients.Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.展开更多
<strong>Introduction:</strong> The long term effect of accumulation of genital events as repeated pregnancy and longer breastfeeding in bone heath later in women’s life is still disputed. The objective wa...<strong>Introduction:</strong> The long term effect of accumulation of genital events as repeated pregnancy and longer breastfeeding in bone heath later in women’s life is still disputed. The objective was to assess the impact of parity and cumulated duration of breastfeeding on fracture risk in post-menopausal women aged sixty an over. <strong>Patients and Methods:</strong> It was a leading study from the register “Quality of Bone in Lorraine (QBL)” achieved in the department of endocrinology and osteoporotic disease of Nancy (France). This register included all patients sent for an assessment of the bone mass density from January 1, 2006 to December 31, 2014 (9 years). It was about post-menopausal women aged sixty an over suffering or not from osteoporosis fracture or bone fragility just after the age of 45. The genital events of patients to their age (from puberty to menopause) as well as the existence of hormone replacement therapy use, parity, and breastfeeding duration were taken into account. The assessment of bone fracture was clinical, radiological or by using the vertebral fracture assessment method. <strong>Results:</strong> 861 post-menopausal women were included. In comparison to the control group, the fractured population had a mean age of (74.3 ± 9 vs. 72 ± 8 years), a family history of fracture (32.1% vs. 26%), and an average input of calcium (2.4 ± 1 vs. 2.3 ± 0 portions per day). The age at menarche was of 12.8 ± 1 years in each group, a mean genital activity duration of (36.8 ± 3 vs. 37.2 ± 3 years), a parity of (2.1 ± 1 vs. 1.8 ± 1 children), a cumulated breastfeeding duration (4.2 ± 16 vs. 3.1 ± 5 months) and an age of menopause of (48.6 ± 4 vs. 48.6 ± 4 years) were respectively found in fractured and witness population. Overall, an osteoporotic fracture has been rediscovered in 50.9%. In multivariate analysis, only a cumulative duration of breastfeeding of 6 months and over was associated with a higher fracture risk (OR = 1.5 [1.1 - 2.2]). The impact of parity was not significant (OR = 1.1 [0.7 - 1.8]). Association with obesity was quasi significant (OR = 1.3 [0.9 - 1.9]). There was no correlation between the fracture risk and the genital activity duration (OR = 0.7 [0.5 - 1.0]), hormone replacement therapy use (OR = 1.0 [0.8 - 1.4]), daily calcium input (OR = 0.8 [0.6 - 1.3]), and age of menarche (OR = 1.0 [0.9 - 1.1]). <strong>Conclusion:</strong> This work confirms a negative impact from 6 months of cumulative breastfeeding. The modest effects observed may be related to the selection of Caucasian patients who live in an economically developed country with a limited number of pregnancies and limited duration of breastfeeding.展开更多
Precise evaluation of hip fracture risk leads to reduce hip fracture occurrence in individuals and assist to check the effect of a treatment.A subject-specific QCT-based finite element model is introduced to evaluate ...Precise evaluation of hip fracture risk leads to reduce hip fracture occurrence in individuals and assist to check the effect of a treatment.A subject-specific QCT-based finite element model is introduced to evaluate hip fracture risk using the strain energy,von-Mises stress,and von-Mises strain criteria during the single-leg stance and the sideways fall configurations.Choosing a proper failure criterion in hip fracture risk assessment is very important.The aim of this study is to define hip fracture risk index using the strain energy,von Mises stress,and von Mises strain criteria and compare the calculated fracture risk indices using these criteria at the critical regions of the femur.It is found that based on these criteria,the hip fracture risk at the femoral neck and the intertrochanteric region is higher than other parts of the femur,probably due to the larger amount of cancellous bone in these regions.The study results also show that the strain energy criterion gives more reasonable assessment of hip fracture risk based on the bone failure mechanism and the von-Mises strain criterion is more conservative than two other criteria and leads to higher estimate of hip fracture risk indices.展开更多
Various parameters such as age,height,weight,and body mass index(BMI)influence the hip fracture risk in the elderly which is the most common injury during the sideways fall.This paper presents a parametric study of hi...Various parameters such as age,height,weight,and body mass index(BMI)influence the hip fracture risk in the elderly which is the most common injury during the sideways fall.This paper presents a parametric study of hip fracture risk based on the gender,age,height,weight,and BMI of subjects using the subject-specific QCT-based finite element modelling and simulation of single-leg stance and sideways fall loadings.Hip fracture risk is estimated using the strain energy failure criterion as a combination of bone stresses and strains leading to more accurate and reasonable results based on the bone failure mechanism.Understanding the effects of various parameters on hip fracture risk can help to prescribe more accurate preventive and treatment plans for a community based on the gender,age,height,weight,and BMI of the population.Results of this study show an increase in hip fracture risk with the increase of age,body height,weight,and BMI in both women and men under the single-leg stance and the sideways fall configurations.展开更多
Finite element analysis(FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. Wh...Finite element analysis(FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. When the faster computers have acquired, better FEA, using 3-dimensional computed tomography(CT) has been developed. This CT-based finite element analysis(CT/FEA) has provided clinicians with useful data. In this review, the mechanism of CT/FEA, validation studies of CT/FEA to evaluate accuracy and reliability in human bones, and clinical application studies to assess fracture risk and effects of osteoporosis medication are overviewed.展开更多
Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern eve...Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density(BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture(TBA) during aging and osteoporosis. Magnetic resonance imaging(MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest fractal analysis as a promising approach to quantify morphofunctional changes in both aging and pathology. In this particular context, fractal lacunarity seems to be the proper tool to characterize TBA texture as it is able to describe both discontinuity of bone network and sizes of bone marrow spaces, whose changes are an index of bone fracture risk. In this paper, an original method of MRI texture analysis, based on TBA fractal lacunarity is described and discussed in the light of new perspectives for early diagnosis of osteoporotic fractures.展开更多
Objective: Analysis of clinical documents such as bone mineral density (BMD) reports is an important component of program evaluation because it can provide insights into the accuracy of assessment of fracture risk com...Objective: Analysis of clinical documents such as bone mineral density (BMD) reports is an important component of program evaluation because it can provide insights into the accuracy of assessment of fracture risk communicated to patients and practitioners. Our objective was to compare fracture risk calculations from BMD test reports to those based on the 2010 Canadian guidelines. Methods: We retrieved BMD reports from fragility fracture patients screened through a community hospital fracture clinic participating in Ontario’s Fracture Clinic Screening Program. Fracture risk was determined according to the 2010 Canadian guidelines using age, sex, and T-score at the femoral neck, in addition to three clinical factors. Three researchers classified patients’ fracture risk until consensus was achieved. Results: We retrieved reports for 17 patients from nine different BMD clinics in the Greater Toronto Area. Each patient had a different primary care physician and all BMD tests were conducted after the 2010 Canadian guidelines were published. The fracture risk of 10 patients was misclassified with 9 of the 10 reports underestimating fracture risk. Nine reports acknowledged that the prevalence of a fragility fracture raised the risk category by one level but only four of these reports acknowledged that the patient had, or may have sustained, a fragility fracture. When we raised fracture risk by one level according to these reports, eight patients were still misclassified. Fracture risk in the majority of these patients remained underestimated. Inconsistent classification was found in the majority of cases where reports came from the same clinic. Four reports described risk levels for two different types of risk. Conclusions: More than half of patients received BMD reports which underestimated fracture risk. Bone health management recommendations based on falsely low fracture risk are likely to be sub-optimal.展开更多
Osteoporosis is common among postmenopausal women, giving rise to morbidity and diminishing the quality of life. There is lack of information about the risk factors of Osteoporosis among local Omani women. The aim was...Osteoporosis is common among postmenopausal women, giving rise to morbidity and diminishing the quality of life. There is lack of information about the risk factors of Osteoporosis among local Omani women. The aim was to explore the risk factors of Osteoporosis among Omani women using a Modified Fracture Risk Assessment Tool. This is an exploratory research design using a simple random sampling. A pilot study was conducted among 35 local Omani women from the Muscat region, who completed the validated and reliable Modified Fracture Risk Assessment Tool (MFRAT). Bone Mineral Density (BMD) was measured among 11 women at moderate-high risk based on MFRAT. The data was analyzed using inferential statistics. Fourteen Omani women were at moderate-high risk for Osteoporotic fracture due to factors related premenopausal, Vitamin D deficiency, increased parity, increased lactation period and sedentary lifestyle. Among these five women had low BMD and required early intervention and support. Determinants of Osteoporosis can be assessed among premenopausal Omani women with a specific risk assessment tool. There is a need to construct a culturally sensitive risk assessment tool for Omani women for early screening and detection of Osteoporosis. Nurses can identify, provide intervention and education for Omani women at-risk of fracture.展开更多
Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF)...Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation(PSF),two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.展开更多
BACKGROUND Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated.AIM To investigate the risk factors for pathological fracture in children with benign bone lesions and...BACKGROUND Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated.AIM To investigate the risk factors for pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risk.METHODS We retrospectively reviewed 96 pediatric patients with benign bone lesions.We compared radiographic and clinical features between 40 patients who had fractures through a benign bone lesion and 56 who had no fracture.Information including histological diagnosis,anatomical site,radiographic appearance,severity of pain,and lesion size was recorded for the patients.A modified scoring system was proposed to predict the risk of fracture.RESULTS The univariate comparisons showed a significant difference between the fracture and non-fracture groups in terms of lesion type,pain,lesion-to-bone width,and axial cortical involvement of the patients(P<0.05).Lesion type,pain,lesion-tobone width,and axial cortical involvement were independently correlated with an increased risk of fracture.The mean score of the fracture group was 7.89,whereas the mean score of the non-fracture group was 6.01.The optimum cut-off value of the score to predict pathological fracture was 7.The scoring system had a sensitivity of 70%and a specificity of 80%for detecting patients with fractures.The Youden index was 0.5,which was the maximum value.The area under the receiver operator characteristic was 0.814.CONCLUSION Lesion type,pain,lesion-to-bone width,and axial cortical involvement are risk factors for pathological fracture.The modified scoring system can provide evidence for clinical decision-making in children with benign bone lesions.A bone lesion with a total score>7 indicates a high risk of a pathologic fracture and is an indication for prophylactic internal fixation.展开更多
We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations int...We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations into the risk assessment. The ATBM is a finite element model managed by the Joint Non-Lethal Weapons Directorate for the purpose of assessing the risk of injury caused by blunt impacts from non-lethal weapons. In ATBM simulations, the quantity that determines arm bone fracture is the calculated maximum strain in the bone. The main obstacle to accurate prediction is that the calculated strain is incompatible with the measured strain. The fracture strain measured in bending tests of real bones is affected by random inhomogeneity in bones and uncertainty in measurement gauge attachment location/orientation. In contrast, the strain calculated in ATBM simulations is based on the assumption that all bones are perfectly elastic with homogeneous material properties and no measurement uncertainty. To connect test data and ATBM simulations in a proper and meaningful setting, we introduce the concept of elasticity-homogenized strain. We interpret test data in terms of the homogenized strain, and build an empirical dose-injury model with the homogenized strain as the input dose for predicting injury. The maximum strain calculated by ATBM has randomness due to uncertainty in specifications of ATBM setup parameters. The dose propagation uncertainty formulation accommodates this uncertainty efficiently by simply updating the shape parameters in the dose-injury model, avoiding the high computational cost of sampling this uncertainty via multiple ATBM runs.展开更多
Fractures are costly to treat and can significantly increase morbidity.Although dual-energy x-ray absorptiometry(DEXA)is used to screen at risk people with low bone mineral density(BMD),not all areas have access to on...Fractures are costly to treat and can significantly increase morbidity.Although dual-energy x-ray absorptiometry(DEXA)is used to screen at risk people with low bone mineral density(BMD),not all areas have access to one.We sought to create a readily accessible,inexpensive,high-throughput prediction tool for BMD that may identify people at risk of fracture for further evaluation.Anthropometric and demographic data were collected from 492 volunteers(♂275,♀217;[44-20]years;Body Mass Index(BMI)=[27.6-6.0]kg/m^(2))in addition to total body bone mineral content(BMC,kg)and BMD measurements of the spine,pelvis,arms,legs and total body.Multiple-linear-regression with step-wise removal was used to develop a two-step prediction model for BMC followed by BMC.Model selection was determined by the highest adjusted R2,lowest error of estimate,and lowest level of variance inflation(α=0.05).Height(HTcm),age(years),sex^(m=1,f=0),%body fat(%fat),fat free mass(FFMkg),fat mass(FMkg),leg length(LLcm),shoulder width(SHWDTHcm),trunk length(TRNKLcm),and pelvis width(PWDTHcm)were observed to be significant predictors in the following two-step model(p<0.05).Step1:BMC(kg)=(0.0063×HT)+(-0.0024×AGE)+(0.1712×SEX^(m=1,f=0))+(0.0314×FFM)+(0.001×FM)+(0.0089×SHWDTH)+(-0.0145×TRNKL)+(-0.0278×PWDTH)-0.5073;R^(2)=0.819,SE-0.301.Step2:Total body BMD(g/cm^(2))=(-0.0028×HT)+(-0.0437×SEX^(m=1,f=0))+(0.0008×%FAT)+(0.2970×BMC)+(-0.0023×LL)+(0.0023×SHWDTH)+(-0.0025×TRNKL)+(-0.0113×PWDTH)+1.379;R^(2)=0.89,SE-0.054.Similar models were also developed to predict leg,arm,spine,and pelvis BMD(R^(2)=0.796-0.864,p<0.05).The equations developed here represent promising tools for identifying individuals with low BMD at risk of fracture who would benefit from further evaluation,especially in the resource or time restricted setting.展开更多
BACKGROUND Subchondral fatigue fracture of the femoral head(SFFFH)mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head.However,less research focuses on the risk factor ...BACKGROUND Subchondral fatigue fracture of the femoral head(SFFFH)mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head.However,less research focuses on the risk factor for SFFFH.AIM To evaluate the intrinsic risk factors for SFFFH in young military recruits.METHODS X-ray and magnetic resonance imaging data were used for analysis.Acetabular anteversion of the superior acetabulum,acetabular anteversion of the center of the acetabulum(AVcen),anterior acetabular sector angle(AASA),posterior acetabular sector angle,superior acetabular sector angle,neck-shaft angle(NSA),inferior iliac angle(IIA),and ischiopubic angle were calculated.Then,logistic regression,receiver operating characteristic curve analysis,and independent samples t-test were performed to identify the risk factors for SFFFH.RESULTS Based on the results of logistic regression,age[odds ratio(OR):1.33;95%confidence interval(95%CI):1.12-1.65;P=0.0031]and treatment timing(OR:0.86;95%CI:0.75-0.96;P=0.015)could be considered as the indicators for SFFFH.AVcen(P=0.0334),AASA(P=0.0002),NSA(P=0.0007),and IIA(P=0.0316)were considered to have statistical significance.Further,AVcen(OR:1.41;95%CI:1.04-1.95)and AASA(OR:1.44;95%CI:1.21-1.77),especially AASA(area under curve:66.6%),should be paid much more attention due to the higher OR than other indicators.CONCLUSION We have for the first time unveiled that AASA and age could be key risk factors for SFFFH,which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.展开更多
Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are ava...Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.展开更多
BACKGROUND Excellent hip joint function facilitates limb recovery and improves the quality of survival.This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and o...BACKGROUND Excellent hip joint function facilitates limb recovery and improves the quality of survival.This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management.AIM To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients.METHODS The elderly patients who had hip fracture surgery at our hospital between January 1,2021,and December 31,2022 were chosen for this retrospective clinical investigation.Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared.Age,gender,fracture site,surgical technique,laboratory indices,and other variables that could have an impact on postoperative joint function were all included in a univariate study.To further identify independent risk factors affecting postoperative joint function in hip fractures,risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis.In addition to this,we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups.RESULTS A total of 119 elderly patients with hip fractures were included in this study,of whom 37 were male and 82 were female.The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin(IL)-6,IL-8,IL-10,C-reactive protein(CRP),and complement C1q(C1q)between the fair and excellent joint function groups(P<0.05).The results of multiple logistic regression analysis showed that IL-6>20 pg/mL[Odds ratio(OR)3.070,95%CI:1.243-7.579],IL-8>21.4 pg/mL(OR 3.827,95%CI:1.498-9.773),CRP>10 mg/L(OR 2.142,95%CI:1.020-4.498)and C1q>233 mg/L(OR 2.339,95%CI:1.094-5.004)were independent risk factors for poor joint function after hip fracture surgery(all P<0.05).CONCLUSION After hip fractures in older patients,inflammatory variables are risk factors for fair joint function;therefore,early intervention to address these markers is essential to enhance joint function and avoid consequences.展开更多
BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular struct...BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.展开更多
Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Consid...Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Considering the difference in treatment, postoperative complication, and mortality risk, these two fractures should be analyzed separately. This study aimed to analyze 1-year mortality and its risk factors in patients with surgically treated femoral intertrochanteric fractures. Methods: Consecutive patients with intertrochanteric fractures who underwent surgical interventions at our institution between January 2017 and December 2021 were retrospectively reviewed. A total of 238 patients were eligible for inclusion in this study. Patients’ demographic and clinical information were retrospectively collected. Patients were divided into the 1-year mortality (n = 16) and survival (n = 222) groups. The incidence of 1-year mortality and its independent risk factors were investigated using univariate and multivariate logistic regression analyses. Results: The mean age of patients was 85.6 ± 8.5 years. The 1-year mortality rate was 6.7% (16/238). Preoperative albumin level, the Geriatric Nutritional Risk Index (GNRI), and malnutrition status (GNRI p = 0.02, p = 0.02, and p = 0.0011, respectively). Multivariate analysis showed that malnutrition status (GNRI p = 0.035) was an independent risk factor for 1-year mortality. Conclusion: Malnutrition status assessed using GNRI (GNRI < 92) was an independent risk factor for 1-year mortality. Our findings suggest that GNRI may be an effective screening tool for predicting postoperative 1-year mortality of patients with surgically treated femoral intertrochanteric fractures.展开更多
Enterprise risk management holds significant importance in fostering sustainable growth of businesses and in serving as a critical element for regulatory bodies to uphold market order.Amidst the challenges posed by in...Enterprise risk management holds significant importance in fostering sustainable growth of businesses and in serving as a critical element for regulatory bodies to uphold market order.Amidst the challenges posed by intricate and unpredictable risk factors,knowledge graph technology is effectively driving risk management,leveraging its ability to associate and infer knowledge from diverse sources.This review aims to comprehensively summarize the construction techniques of enterprise risk knowledge graphs and their prominent applications across various business scenarios.Firstly,employing bibliometric methods,the aim is to uncover the developmental trends and current research hotspots within the domain of enterprise risk knowledge graphs.In the succeeding section,systematically delineate the technical methods for knowledge extraction and fusion in the standardized construction process of enterprise risk knowledge graphs.Objectively comparing and summarizing the strengths and weaknesses of each method,we provide recommendations for addressing the existing challenges in the construction process.Subsequently,categorizing the applied research of enterprise risk knowledge graphs based on research hotspots and risk category standards,and furnishing a detailed exposition on the applicability of technical routes and methods.Finally,the future research directions that still need to be explored in enterprise risk knowledge graphs were discussed,and relevant improvement suggestions were proposed.Practitioners and researchers can gain insights into the construction of technical theories and practical guidance of enterprise risk knowledge graphs based on this foundation.展开更多
Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure...Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure characteristics of radial borehole fracturing in multiple layers.A series of laboratory experiments with artificial rock samples(395 mm×395 mm×395 mm)was conducted using a true triaxial fracturing device.Three crucial factors corresponding to the vertical distance of adjacent radial borehole layers(vertical distance),the azimuth and diameter of the radial borehole are examined.Experimental results show that radial borehole fracturing in multiple layers generates diverse fracture geometries.Four types of fractures are identified based on the connectivity between hydraulic fractures and radial boreholes.The vertical distance significantly influences fracture propagation perpendicular to the radial borehole axis.An increase in the vertical distance impedes fracture connection across multiple radial borehole layers and reduces the fracture propagation distance along the radial borehole axis.The azimuth also influences fracture propagation along the radial borehole axis.Increasing the azimuth reduces the guiding ability of radial boreholes,which makes the fracture quickly curve to the maximum horizontal stress direction.The breakdown pressure correlates with diverse fracture geometries observed.When the fractures connect multi-layer radial boreholes,increasing the vertical distance decreases the breakdown pressure.Decreasing the azimuth and increasing the diameter also decrease the breakdown pressure.The extrusion force exists between the adjacent fractures generated in radial boreholes in multiple rows,which plays a crucial role in enhancing the guiding ability of radial boreholes and results in higher breakdown pressure.The research provides valuable theoretical insights for the field application of radial borehole fracturing technology in tight oil and gas reservoirs.展开更多
文摘BACKGROUND Spinal osteoporosis is a prevalent health condition characterized by the thinning of bone tissues in the spine,increasing the risk of fractures.Given its high incidence,especially among older populations,it is critical to have accurate and effective predictive models for fracture risk.Traditionally,clinicians have relied on a combination of factors such as demographics,clinical attributes,and radiological characteristics to predict fracture risk in these patients.However,these models often lack precision and fail to include all potential risk factors.There is a need for a more comprehensive,statistically robust prediction model that can better identify high-risk individuals for early intervention.AIM To construct and validate a model for forecasting fracture risk in patients with spinal osteoporosis.METHODS The medical records of 80 patients with spinal osteoporosis who were diagnosed and treated between 2019 and 2022 were retrospectively examined.The patients were selected according to strict criteria and categorized into two groups:Those with fractures(n=40)and those without fractures(n=40).Demographics,clinical attributes,biochemical indicators,bone mineral density(BMD),and radiological characteristics were collected and compared.A logistic regression analysis was employed to create an osteoporotic fracture risk-prediction model.The area under the receiver operating characteristic curve(AUROC)was used to evaluate the model’s performance.RESULTS Factors significantly associated with fracture risk included age,sex,body mass index(BMI),smoking history,BMD,vertebral trabecular alterations,and prior vertebral fractures.The final risk-prediction model was developed using the formula:(logit[P]=-3.75+0.04×age-1.15×sex+0.02×BMI+0.83×smoking history+2.25×BMD-1.12×vertebral trabecular alterations+1.83×previous vertebral fractures).The AUROC of the model was 0.93(95%CI:0.88-0.96,P<0.001),indicating strong discriminatory capabilities.CONCLUSION The fracture risk-prediction model,utilizing accessible clinical,biochemical,and radiological information,offered a precise tool for the evaluation of fracture risk in patients with spinal osteoporosis.The model has potential in the identification of high-risk individuals for early intervention and the guidance of appropriate preventive actions to reduce the impact of osteoporosis-related fractures.
文摘The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes.Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk.Moreover,some antidiabetic medications further enhance the fragility of the bone.On the other hand,antiosteoporosis medications can affect the glucose homeostasis in these patients.It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk.Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature.With the advancement in imaging technology,newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes.The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients.Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.
文摘<strong>Introduction:</strong> The long term effect of accumulation of genital events as repeated pregnancy and longer breastfeeding in bone heath later in women’s life is still disputed. The objective was to assess the impact of parity and cumulated duration of breastfeeding on fracture risk in post-menopausal women aged sixty an over. <strong>Patients and Methods:</strong> It was a leading study from the register “Quality of Bone in Lorraine (QBL)” achieved in the department of endocrinology and osteoporotic disease of Nancy (France). This register included all patients sent for an assessment of the bone mass density from January 1, 2006 to December 31, 2014 (9 years). It was about post-menopausal women aged sixty an over suffering or not from osteoporosis fracture or bone fragility just after the age of 45. The genital events of patients to their age (from puberty to menopause) as well as the existence of hormone replacement therapy use, parity, and breastfeeding duration were taken into account. The assessment of bone fracture was clinical, radiological or by using the vertebral fracture assessment method. <strong>Results:</strong> 861 post-menopausal women were included. In comparison to the control group, the fractured population had a mean age of (74.3 ± 9 vs. 72 ± 8 years), a family history of fracture (32.1% vs. 26%), and an average input of calcium (2.4 ± 1 vs. 2.3 ± 0 portions per day). The age at menarche was of 12.8 ± 1 years in each group, a mean genital activity duration of (36.8 ± 3 vs. 37.2 ± 3 years), a parity of (2.1 ± 1 vs. 1.8 ± 1 children), a cumulated breastfeeding duration (4.2 ± 16 vs. 3.1 ± 5 months) and an age of menopause of (48.6 ± 4 vs. 48.6 ± 4 years) were respectively found in fractured and witness population. Overall, an osteoporotic fracture has been rediscovered in 50.9%. In multivariate analysis, only a cumulative duration of breastfeeding of 6 months and over was associated with a higher fracture risk (OR = 1.5 [1.1 - 2.2]). The impact of parity was not significant (OR = 1.1 [0.7 - 1.8]). Association with obesity was quasi significant (OR = 1.3 [0.9 - 1.9]). There was no correlation between the fracture risk and the genital activity duration (OR = 0.7 [0.5 - 1.0]), hormone replacement therapy use (OR = 1.0 [0.8 - 1.4]), daily calcium input (OR = 0.8 [0.6 - 1.3]), and age of menarche (OR = 1.0 [0.9 - 1.1]). <strong>Conclusion:</strong> This work confirms a negative impact from 6 months of cumulative breastfeeding. The modest effects observed may be related to the selection of Caucasian patients who live in an economically developed country with a limited number of pregnancies and limited duration of breastfeeding.
文摘Precise evaluation of hip fracture risk leads to reduce hip fracture occurrence in individuals and assist to check the effect of a treatment.A subject-specific QCT-based finite element model is introduced to evaluate hip fracture risk using the strain energy,von-Mises stress,and von-Mises strain criteria during the single-leg stance and the sideways fall configurations.Choosing a proper failure criterion in hip fracture risk assessment is very important.The aim of this study is to define hip fracture risk index using the strain energy,von Mises stress,and von Mises strain criteria and compare the calculated fracture risk indices using these criteria at the critical regions of the femur.It is found that based on these criteria,the hip fracture risk at the femoral neck and the intertrochanteric region is higher than other parts of the femur,probably due to the larger amount of cancellous bone in these regions.The study results also show that the strain energy criterion gives more reasonable assessment of hip fracture risk based on the bone failure mechanism and the von-Mises strain criterion is more conservative than two other criteria and leads to higher estimate of hip fracture risk indices.
文摘Various parameters such as age,height,weight,and body mass index(BMI)influence the hip fracture risk in the elderly which is the most common injury during the sideways fall.This paper presents a parametric study of hip fracture risk based on the gender,age,height,weight,and BMI of subjects using the subject-specific QCT-based finite element modelling and simulation of single-leg stance and sideways fall loadings.Hip fracture risk is estimated using the strain energy failure criterion as a combination of bone stresses and strains leading to more accurate and reasonable results based on the bone failure mechanism.Understanding the effects of various parameters on hip fracture risk can help to prescribe more accurate preventive and treatment plans for a community based on the gender,age,height,weight,and BMI of the population.Results of this study show an increase in hip fracture risk with the increase of age,body height,weight,and BMI in both women and men under the single-leg stance and the sideways fall configurations.
基金Supported by Japan Society for the Promotion of Science KAKENHI,No.26462284
文摘Finite element analysis(FEA) is a computer technique of structural stress analysis and developed in engineering mechanics. FEA has developed to investigate structural behavior of human bones over the past 40 years. When the faster computers have acquired, better FEA, using 3-dimensional computed tomography(CT) has been developed. This CT-based finite element analysis(CT/FEA) has provided clinicians with useful data. In this review, the mechanism of CT/FEA, validation studies of CT/FEA to evaluate accuracy and reliability in human bones, and clinical application studies to assess fracture risk and effects of osteoporosis medication are overviewed.
文摘Osteoporosis represents one major health condition for our growing elderly population. It accounts for severe morbidity and increased mortality in postmenopausal women and it is becoming an emerging health concern even in aging men. Screening of the population at risk for bone degeneration and treatment assessment of osteoporotic patients to prevent bone fragility fractures represent useful tools to improve quality of life in the elderly and to lighten the related socio-economic impact. Bone mineral density(BMD) estimate by means of dual-energy X-ray absorptiometry is normally used in clinical practice for osteoporosis diagnosis. Nevertheless, BMD alone does not represent a good predictor of fracture risk. From a clinical point of view, bone microarchitecture seems to be an intriguing aspect to characterize bone alteration patterns in aging and pathology. The widening into clinical practice of medical imaging techniques and the impressive advances in information technologies together with enhanced capacity of power calculation have promoted proliferation of new methods to assess changes of trabecular bone architecture(TBA) during aging and osteoporosis. Magnetic resonance imaging(MRI) has recently arisen as a useful tool to measure bone structure in vivo. In particular, high-resolution MRI techniques have introduced new perspectives for TBA characterization by non-invasive non-ionizing methods. However, texture analysis methods have not found favor with clinicians as they produce quite a few parameters whose interpretation is difficult. The introduction in biomedical field of paradigms, such as theory of complexity, chaos, and fractals, suggests new approaches and provides innovative tools to develop computerized methods that, by producing a limited number of parameters sensitive to pathology onset and progression, would speed up their application into clinical practice. Complexity of living beings and fractality of several physio-anatomic structures suggest fractal analysis as a promising approach to quantify morphofunctional changes in both aging and pathology. In this particular context, fractal lacunarity seems to be the proper tool to characterize TBA texture as it is able to describe both discontinuity of bone network and sizes of bone marrow spaces, whose changes are an index of bone fracture risk. In this paper, an original method of MRI texture analysis, based on TBA fractal lacunarity is described and discussed in the light of new perspectives for early diagnosis of osteoporotic fractures.
文摘Objective: Analysis of clinical documents such as bone mineral density (BMD) reports is an important component of program evaluation because it can provide insights into the accuracy of assessment of fracture risk communicated to patients and practitioners. Our objective was to compare fracture risk calculations from BMD test reports to those based on the 2010 Canadian guidelines. Methods: We retrieved BMD reports from fragility fracture patients screened through a community hospital fracture clinic participating in Ontario’s Fracture Clinic Screening Program. Fracture risk was determined according to the 2010 Canadian guidelines using age, sex, and T-score at the femoral neck, in addition to three clinical factors. Three researchers classified patients’ fracture risk until consensus was achieved. Results: We retrieved reports for 17 patients from nine different BMD clinics in the Greater Toronto Area. Each patient had a different primary care physician and all BMD tests were conducted after the 2010 Canadian guidelines were published. The fracture risk of 10 patients was misclassified with 9 of the 10 reports underestimating fracture risk. Nine reports acknowledged that the prevalence of a fragility fracture raised the risk category by one level but only four of these reports acknowledged that the patient had, or may have sustained, a fragility fracture. When we raised fracture risk by one level according to these reports, eight patients were still misclassified. Fracture risk in the majority of these patients remained underestimated. Inconsistent classification was found in the majority of cases where reports came from the same clinic. Four reports described risk levels for two different types of risk. Conclusions: More than half of patients received BMD reports which underestimated fracture risk. Bone health management recommendations based on falsely low fracture risk are likely to be sub-optimal.
文摘Osteoporosis is common among postmenopausal women, giving rise to morbidity and diminishing the quality of life. There is lack of information about the risk factors of Osteoporosis among local Omani women. The aim was to explore the risk factors of Osteoporosis among Omani women using a Modified Fracture Risk Assessment Tool. This is an exploratory research design using a simple random sampling. A pilot study was conducted among 35 local Omani women from the Muscat region, who completed the validated and reliable Modified Fracture Risk Assessment Tool (MFRAT). Bone Mineral Density (BMD) was measured among 11 women at moderate-high risk based on MFRAT. The data was analyzed using inferential statistics. Fourteen Omani women were at moderate-high risk for Osteoporotic fracture due to factors related premenopausal, Vitamin D deficiency, increased parity, increased lactation period and sedentary lifestyle. Among these five women had low BMD and required early intervention and support. Determinants of Osteoporosis can be assessed among premenopausal Omani women with a specific risk assessment tool. There is a need to construct a culturally sensitive risk assessment tool for Omani women for early screening and detection of Osteoporosis. Nurses can identify, provide intervention and education for Omani women at-risk of fracture.
基金supported by the National High Technology Research and Development Program("863"Program)of China(No.SS2012AA022811)the Science and Technology Program of Guangzhou(No.201508020253)the Special Project on the Integration of Industry,Education and Research of Guangzhou(No.158100062)
文摘Adjacent vertebral fractures are common in patients with osteoporotic vertebral compression fractures(OVCFs) after kyphoplasty.This finite element study was to examine whether short segment pedicle screw fixation(PSF) with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae after kyphoplasty for OVCFs.By simulating cement augmentation with or without short segment pedicle screw fixation(PSF),two tridimensional,anatomically detailed finite element models of the T10–L2 functional spinal junction were developed.The insertion of pedicle screws into the intact vertebra apparently decreased the stress distribution of the treated vertebra in vertical compression and other load situations.The stress distribution in the bone structures of the intact vertebra adjacent to the intact-screwed vertebra was much less than that in the one adjacent to the treated vertebra.The insertion of pedicle screws into the intact vertebra greatly decreased the maximum displacement of the cortical bones and cancellous bones of the vertebrae.Our results indicated that short segment PSF with kyphoplasty may decrease the fracture risk of the treated and adjacent non-treated vertebrae in the management of OVCFs.
基金Natural Science Foundation of Zhejiang Province,No.LY20H060001.
文摘BACKGROUND Fracture risk assessment in children with benign bone lesions of long bones remains poorly investigated.AIM To investigate the risk factors for pathological fracture in children with benign bone lesions and to propose a modified scoring system for quantitative analysis of the pathologic fracture risk.METHODS We retrospectively reviewed 96 pediatric patients with benign bone lesions.We compared radiographic and clinical features between 40 patients who had fractures through a benign bone lesion and 56 who had no fracture.Information including histological diagnosis,anatomical site,radiographic appearance,severity of pain,and lesion size was recorded for the patients.A modified scoring system was proposed to predict the risk of fracture.RESULTS The univariate comparisons showed a significant difference between the fracture and non-fracture groups in terms of lesion type,pain,lesion-to-bone width,and axial cortical involvement of the patients(P<0.05).Lesion type,pain,lesion-tobone width,and axial cortical involvement were independently correlated with an increased risk of fracture.The mean score of the fracture group was 7.89,whereas the mean score of the non-fracture group was 6.01.The optimum cut-off value of the score to predict pathological fracture was 7.The scoring system had a sensitivity of 70%and a specificity of 80%for detecting patients with fractures.The Youden index was 0.5,which was the maximum value.The area under the receiver operator characteristic was 0.814.CONCLUSION Lesion type,pain,lesion-to-bone width,and axial cortical involvement are risk factors for pathological fracture.The modified scoring system can provide evidence for clinical decision-making in children with benign bone lesions.A bone lesion with a total score>7 indicates a high risk of a pathologic fracture and is an indication for prophylactic internal fixation.
文摘We consider the problem of assessing bone fracture risk for a subject hit by a blunt impact projectile. We aim at constructing a framework for integrating test data and Advanced Total Body Model (ATBM) simulations into the risk assessment. The ATBM is a finite element model managed by the Joint Non-Lethal Weapons Directorate for the purpose of assessing the risk of injury caused by blunt impacts from non-lethal weapons. In ATBM simulations, the quantity that determines arm bone fracture is the calculated maximum strain in the bone. The main obstacle to accurate prediction is that the calculated strain is incompatible with the measured strain. The fracture strain measured in bending tests of real bones is affected by random inhomogeneity in bones and uncertainty in measurement gauge attachment location/orientation. In contrast, the strain calculated in ATBM simulations is based on the assumption that all bones are perfectly elastic with homogeneous material properties and no measurement uncertainty. To connect test data and ATBM simulations in a proper and meaningful setting, we introduce the concept of elasticity-homogenized strain. We interpret test data in terms of the homogenized strain, and build an empirical dose-injury model with the homogenized strain as the input dose for predicting injury. The maximum strain calculated by ATBM has randomness due to uncertainty in specifications of ATBM setup parameters. The dose propagation uncertainty formulation accommodates this uncertainty efficiently by simply updating the shape parameters in the dose-injury model, avoiding the high computational cost of sampling this uncertainty via multiple ATBM runs.
文摘Fractures are costly to treat and can significantly increase morbidity.Although dual-energy x-ray absorptiometry(DEXA)is used to screen at risk people with low bone mineral density(BMD),not all areas have access to one.We sought to create a readily accessible,inexpensive,high-throughput prediction tool for BMD that may identify people at risk of fracture for further evaluation.Anthropometric and demographic data were collected from 492 volunteers(♂275,♀217;[44-20]years;Body Mass Index(BMI)=[27.6-6.0]kg/m^(2))in addition to total body bone mineral content(BMC,kg)and BMD measurements of the spine,pelvis,arms,legs and total body.Multiple-linear-regression with step-wise removal was used to develop a two-step prediction model for BMC followed by BMC.Model selection was determined by the highest adjusted R2,lowest error of estimate,and lowest level of variance inflation(α=0.05).Height(HTcm),age(years),sex^(m=1,f=0),%body fat(%fat),fat free mass(FFMkg),fat mass(FMkg),leg length(LLcm),shoulder width(SHWDTHcm),trunk length(TRNKLcm),and pelvis width(PWDTHcm)were observed to be significant predictors in the following two-step model(p<0.05).Step1:BMC(kg)=(0.0063×HT)+(-0.0024×AGE)+(0.1712×SEX^(m=1,f=0))+(0.0314×FFM)+(0.001×FM)+(0.0089×SHWDTH)+(-0.0145×TRNKL)+(-0.0278×PWDTH)-0.5073;R^(2)=0.819,SE-0.301.Step2:Total body BMD(g/cm^(2))=(-0.0028×HT)+(-0.0437×SEX^(m=1,f=0))+(0.0008×%FAT)+(0.2970×BMC)+(-0.0023×LL)+(0.0023×SHWDTH)+(-0.0025×TRNKL)+(-0.0113×PWDTH)+1.379;R^(2)=0.89,SE-0.054.Similar models were also developed to predict leg,arm,spine,and pelvis BMD(R^(2)=0.796-0.864,p<0.05).The equations developed here represent promising tools for identifying individuals with low BMD at risk of fracture who would benefit from further evaluation,especially in the resource or time restricted setting.
文摘BACKGROUND Subchondral fatigue fracture of the femoral head(SFFFH)mainly occurs in young military recruits and might be confused with osteonecrosis of the femoral head.However,less research focuses on the risk factor for SFFFH.AIM To evaluate the intrinsic risk factors for SFFFH in young military recruits.METHODS X-ray and magnetic resonance imaging data were used for analysis.Acetabular anteversion of the superior acetabulum,acetabular anteversion of the center of the acetabulum(AVcen),anterior acetabular sector angle(AASA),posterior acetabular sector angle,superior acetabular sector angle,neck-shaft angle(NSA),inferior iliac angle(IIA),and ischiopubic angle were calculated.Then,logistic regression,receiver operating characteristic curve analysis,and independent samples t-test were performed to identify the risk factors for SFFFH.RESULTS Based on the results of logistic regression,age[odds ratio(OR):1.33;95%confidence interval(95%CI):1.12-1.65;P=0.0031]and treatment timing(OR:0.86;95%CI:0.75-0.96;P=0.015)could be considered as the indicators for SFFFH.AVcen(P=0.0334),AASA(P=0.0002),NSA(P=0.0007),and IIA(P=0.0316)were considered to have statistical significance.Further,AVcen(OR:1.41;95%CI:1.04-1.95)and AASA(OR:1.44;95%CI:1.21-1.77),especially AASA(area under curve:66.6%),should be paid much more attention due to the higher OR than other indicators.CONCLUSION We have for the first time unveiled that AASA and age could be key risk factors for SFFFH,which further verifies that deficient anterior coverage of the acetabulum might be the main cause of SFFFH.
文摘Introduction: The lack of follow-up and adequate management of chronic kidney disease-mineral and bone disorder (CKD-MBD) in chronic hemodialysis patients is associated with pathological fractures. Few studies are available on the subject in sub-Saharan Africa. The objective of this work was to evaluate the prevalence of pathological fractures in our chronic hemodialysis patients, to analyze their clinical aspects and to determine the factors associated with their occurrence. Patients and Methods: We conducted a retrospective, descriptive and analytical study over 9 years (January 1, 2011, to December 31, 2020) based on the medical records of chronic hemodialysis patients at the CHU Aristide Le Dantec. The diagnosis of pathological fracture was retained in front of any fracture occurring spontaneously or following minimal trauma and confirmed by X-ray. Results: Nineteen cases of pathological fractures were collected with a hospital prevalence of 19.39%. The mean age was 53.32 ± 13.94 years with a sex ratio of 0.36. The average seniority in dialysis was 84.16 ± 29.88 months. Among these patients, one had had 3 episodes of fractures and another 6 episodes. The circumstances of occurrence of the fractures were the fall in 63% of the cases, spontaneously in 37% of the cases. The predominant site of fractures was the femoral neck (47.38% cases). Female gender (p 5 years (p = 0.049), gait disturbances prior to the fracture (p = 0.001), positive CRP (p = 0.028) and the presence of vascular calcifications (p = 0.002) were significantly associated with the occurrence of pathological fractures. Conclusion: This study has identified the factors associated with the occurrence of pathological invoices in hemodialysis patients in our context. These fractures are often associated with the lack of regular biological follow-up due to the low socioeconomic level of our patients.
基金Supported by Leading Talents Training Program of Pudong New Area Health Commission,No.PWR 12020-06and Shanghai Science and Technology Commission,No.20Y11901800.
文摘BACKGROUND Excellent hip joint function facilitates limb recovery and improves the quality of survival.This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management.AIM To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients.METHODS The elderly patients who had hip fracture surgery at our hospital between January 1,2021,and December 31,2022 were chosen for this retrospective clinical investigation.Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared.Age,gender,fracture site,surgical technique,laboratory indices,and other variables that could have an impact on postoperative joint function were all included in a univariate study.To further identify independent risk factors affecting postoperative joint function in hip fractures,risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis.In addition to this,we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups.RESULTS A total of 119 elderly patients with hip fractures were included in this study,of whom 37 were male and 82 were female.The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin(IL)-6,IL-8,IL-10,C-reactive protein(CRP),and complement C1q(C1q)between the fair and excellent joint function groups(P<0.05).The results of multiple logistic regression analysis showed that IL-6>20 pg/mL[Odds ratio(OR)3.070,95%CI:1.243-7.579],IL-8>21.4 pg/mL(OR 3.827,95%CI:1.498-9.773),CRP>10 mg/L(OR 2.142,95%CI:1.020-4.498)and C1q>233 mg/L(OR 2.339,95%CI:1.094-5.004)were independent risk factors for poor joint function after hip fracture surgery(all P<0.05).CONCLUSION After hip fractures in older patients,inflammatory variables are risk factors for fair joint function;therefore,early intervention to address these markers is essential to enhance joint function and avoid consequences.
文摘BACKGROUND Adult distal humeral fractures(DHF)comprise 2%-5%of all fractures and 30%of all elbow fractures.Treatment of DHF may be technically demanding due to fracture complexity and proximity of neurovascular structures.Open reduction and internal fixation(ORIF)are often the treatment of choice,but arthroplasty is considered in case of severe comminution or in elderly patients with poor bone quality.Ulnar nerve affection following surgical treatment of distal humerus fractures is a well-recognized complication.AIM To report the risk of ulnar nerve affection after surgery for acute DHFs.METHODS We retrospectively identified 239 consecutive adult patients with acute DHFs who underwent surgery with ORIF,elbow hemiarthroplasty(EHA)or total elbow arthroplasty(TEA)between January 2011 and December 2019.In all cases,the ulnar nerve was released in situ without anterior transposition.We used our institutional database to review patients’medical records for demographics,fracture morphology,type of surgery and ulnar nerve affection immediately;records were reviewed after surgery and at 2 wk and 12 wk of routine clinical outpatient follow-up.Twenty-nine percent patients were excluded due to pre-or postoperative conditions.Final follow-up examination was a telephone interview in which ulnar nerve affection was reported according to the McGowen Classification Score.A total of 210 patients were eligible for interview,but 13 patients declined participation and 17 patients failed to respond.Thus,180 patients were included.RESULTS Mean age at surgery was 64 years(range 18-88 years);121(67.3%)patients were women;59(32.7%)were men.According to the AO/OTA classification system,we recorded 47 patients with type A3,55 patients with type B and 78 patients with type C fractures.According to the McGowen Classification Score,mild ulnar nerve affection was reported in nine patients;severe affection,in two.A total of 69 patients were treated with ORIF of whom three had mild temporary ulnar nerve affection and one had severe ulnar nerve affection.In all,111 patients were treated with arthroplasty(67 EHA,44 TEA)of whom seven had mild ulnar nerve affection and one had severe persistent ulnar nerve affection.No further treatment was provided.CONCLUSION The risk of ulnar nerve affection after surgical treatment for acute DHF is low when the ulnar nerve is released in situ without nerve transposition,independently of the treatment provided.
文摘Background: The incidence of femoral intertrochanteric fractures in older adults is higher than that of femoral neck fractures;however, both conditions are often analyzed together as proximal femoral fractures. Considering the difference in treatment, postoperative complication, and mortality risk, these two fractures should be analyzed separately. This study aimed to analyze 1-year mortality and its risk factors in patients with surgically treated femoral intertrochanteric fractures. Methods: Consecutive patients with intertrochanteric fractures who underwent surgical interventions at our institution between January 2017 and December 2021 were retrospectively reviewed. A total of 238 patients were eligible for inclusion in this study. Patients’ demographic and clinical information were retrospectively collected. Patients were divided into the 1-year mortality (n = 16) and survival (n = 222) groups. The incidence of 1-year mortality and its independent risk factors were investigated using univariate and multivariate logistic regression analyses. Results: The mean age of patients was 85.6 ± 8.5 years. The 1-year mortality rate was 6.7% (16/238). Preoperative albumin level, the Geriatric Nutritional Risk Index (GNRI), and malnutrition status (GNRI p = 0.02, p = 0.02, and p = 0.0011, respectively). Multivariate analysis showed that malnutrition status (GNRI p = 0.035) was an independent risk factor for 1-year mortality. Conclusion: Malnutrition status assessed using GNRI (GNRI < 92) was an independent risk factor for 1-year mortality. Our findings suggest that GNRI may be an effective screening tool for predicting postoperative 1-year mortality of patients with surgically treated femoral intertrochanteric fractures.
基金supported by the Shandong Province Science and Technology Project(2023TSGC0509,2022TSGC2234)Qingdao Science and Technology Plan Project(23-1-5-yqpy-2-qy).
文摘Enterprise risk management holds significant importance in fostering sustainable growth of businesses and in serving as a critical element for regulatory bodies to uphold market order.Amidst the challenges posed by intricate and unpredictable risk factors,knowledge graph technology is effectively driving risk management,leveraging its ability to associate and infer knowledge from diverse sources.This review aims to comprehensively summarize the construction techniques of enterprise risk knowledge graphs and their prominent applications across various business scenarios.Firstly,employing bibliometric methods,the aim is to uncover the developmental trends and current research hotspots within the domain of enterprise risk knowledge graphs.In the succeeding section,systematically delineate the technical methods for knowledge extraction and fusion in the standardized construction process of enterprise risk knowledge graphs.Objectively comparing and summarizing the strengths and weaknesses of each method,we provide recommendations for addressing the existing challenges in the construction process.Subsequently,categorizing the applied research of enterprise risk knowledge graphs based on research hotspots and risk category standards,and furnishing a detailed exposition on the applicability of technical routes and methods.Finally,the future research directions that still need to be explored in enterprise risk knowledge graphs were discussed,and relevant improvement suggestions were proposed.Practitioners and researchers can gain insights into the construction of technical theories and practical guidance of enterprise risk knowledge graphs based on this foundation.
基金The authors gratefully acknowledge the financial support received from the Strategic Cooperation Technology Projects of CNPC and CUPB(No.ZLZX2020-01)the National Key Scientific Research Instrument Research Project of NSFC(No.51827804).
文摘Radial borehole fracturing that combines radial boreholes with hydraulic fracturing is anticipated to improve the output of tight oil and gas reservoirs.This paper aims to investigate fracture propagation and pressure characteristics of radial borehole fracturing in multiple layers.A series of laboratory experiments with artificial rock samples(395 mm×395 mm×395 mm)was conducted using a true triaxial fracturing device.Three crucial factors corresponding to the vertical distance of adjacent radial borehole layers(vertical distance),the azimuth and diameter of the radial borehole are examined.Experimental results show that radial borehole fracturing in multiple layers generates diverse fracture geometries.Four types of fractures are identified based on the connectivity between hydraulic fractures and radial boreholes.The vertical distance significantly influences fracture propagation perpendicular to the radial borehole axis.An increase in the vertical distance impedes fracture connection across multiple radial borehole layers and reduces the fracture propagation distance along the radial borehole axis.The azimuth also influences fracture propagation along the radial borehole axis.Increasing the azimuth reduces the guiding ability of radial boreholes,which makes the fracture quickly curve to the maximum horizontal stress direction.The breakdown pressure correlates with diverse fracture geometries observed.When the fractures connect multi-layer radial boreholes,increasing the vertical distance decreases the breakdown pressure.Decreasing the azimuth and increasing the diameter also decrease the breakdown pressure.The extrusion force exists between the adjacent fractures generated in radial boreholes in multiple rows,which plays a crucial role in enhancing the guiding ability of radial boreholes and results in higher breakdown pressure.The research provides valuable theoretical insights for the field application of radial borehole fracturing technology in tight oil and gas reservoirs.
