Objectives
To explore the risk factors of preoperative hypoalbuminemia and its’ effects on complications in the elderly with primary hip arthroplasty.
Methods
A total of 211 elderly inpatients who underwent hip arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥35 g/L) and case group (preoperative serum albumin <35 g/L). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed.
Results
Compared to controls, hypoalbuminemia patients were older (P = 0.026), had lower BMI (P = 0.045), higher cardiac function score (P < 0.0001), higher ASA scores (P = 0.023), and longer hospital stay (P < 0.001). The intraoperative albumin loss in the case group was significantly higher than that of in control group (P < 0.001), but there was no significant difference in operation time and intraoperative blood loss between the two groups (P >0.05). Compared to controls, hypoalbuminemia patients had a higher risk for any complication (P = 0.014), such as delayed wound healing, pleural effusion, and pneumonia. The risk of postoperative complications increased by 6.9% with every 1 year old is increasing (age > 60). The risk of postoperative complications in the case group was 1.89 times higher than that in the control group.
Conclusion
Patients with older age, poor nutritional status, and more than 2 concomitant diseases are more likely to develop preoperative hypoalbuminemia. Preoperative hypoalbuminemia is related to the increased incidence of postoperative complications. Perioperative albumin loss is not only due to perioperative blood loss, but also related to vascular permeability and abnormal albumin metabolism.
Although considerable effort has been taken regarding concrete damage, the physical mechanism of concrete damage under compression remains unknown. This paper presents, for the first time, the physical reality of the damage of concrete under compression in the view of statistical and probabilistic information (SPI) at the mesoscale. To investigate the mesoscale compressive fracture, the confined force chain buckling model is proposed; using which the mesoscale parameters concerned could be directly from nanoindentation by random field theory. Then, the mesoscale parameters could also be identified from macro-testing using the stochastic damage model. In addition, the link between these two mesoscale parameters could be established by the relative entropy. A good agreement between them from nano- and macro- testing when the constraint factor approaches around 33, indicates that the mesoscale parameters in the stochastic damage model could be verified through the present research. Our results suggest that concrete damage is strongly dependent on the mesoscale random failure, where meso-randomness originates from intrinsic meso-inhomogeneity and meso-fracture arises physically from the buckling of the confined force chain system. The mesoscale random buckling of the confined force chain system above tends to constitute the physical mechanism of concrete damage under compression.
The effect of various heat inputs on the microstructure and impact toughness of the simulated coarse-grained heat-affected zone (CGHAS) of a niobium microalloyed (0.14 wt.%) low-carbon steel was studied. The results showed that higher impact toughness was achieved at a low heat input of 20 kJ/cm, which resulted from the formation of acicular ferrite laths/plates. They sectioned large prior austenite grains into many smaller regions, resulting in smaller crystallographic grains and high-angle grain boundaries. Conversely, when specimens were simulated with larger heat-inputs (100, 200 kJ/cm), the microstructure of the CGHAZ was predominantly composed of granular bainite plus massive MA constituents, thus impairing the impact toughness.
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