Cases Of Failure Research Articles

Bond-slip Behavior of Lapped Sand-Coated Deformed GFRP Rebars in UHPC under Double-Row Splice Test

Novel Ultra-High-Performance-Concrete (UHPC) structures reinforced with Fiber-Reinforced Polymer (FRP) rebars are promising candidates for applications in important infrastructures under exposed environments where normal concrete and steel rebars may falter. This paper aims to assess the bond-slip behavior between lapped sand-coated deformed Glass FRP (GFRP) rebars and UHPC using double-row splice tests, with parameters including bar diameter, splice length and lap clearance. Failure modes including the pullout of GFRP rebars and the splitting of UHPC were identified. For cases of pullout failure, the average bond strengths in samples with splice lengths of 5db were reduced by 17.6-22.1% compared to those of 2.5db. Increasing the lap clearance from 0 to 1db and 2db led to 11.1% and 30.2% increases in average bond strengths. Furthermore, average bond-slip models for lapped sand-coated deformed GFRP rebars in UHPC were developed. The predicted curves matched the experimental ones, showing errors within 20% for both average bond stresses and slips. When the cover is not less than 2db, the splice length is recommended to be at least 15db for sand-coated deformed GFRP rebars with diameters of 10mm to 16mm in UHPC, approximately 1.25 times the corresponding development length proposed by the existing research.

ICARUS registry: findings from the first 1595 cases of acute decompensated heart failure in a single center in a latin american country

Abstract Introduction Institutional aCute decompensAted HeaRt FailUre RegiStry (ICARUS) will provide information on clinical characteristics, medical practice, patterns of treatment, and outcomes of patients hospitalized with Acute Decompensated Heart Failure (ADHF) in a hospital in a middle-income country. Objective Describe the methodological aspects, sociodemographic, and clinical characteristics of patients hospitalized with ADHF and their short-term outcomes. Method Prospective cohort of patients with ADHF from the emergency service of a cardiovascular center. Descriptive statistics were used to synthesize sociodemographic characteristics, clinical characteristics during hospitalization, and outcomes. Results 1595 patients with ADHF. The median age was 68 years (Q1=58; Q3=76), and 69.28% were men. The median hospital stay was six days (Q1=4; Q3=11), with an accumulative incidence (AI) for rehospitalization at 30 days of 8.70 % (95% CI 7.18 to 10.40%), in-hospital mortality AI of 4.33% (95% CI 3.38 to 5.44%), and a median change in the quality-of-life score like Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 30 days of -20 points (Q1=-37; Q3=-5). At discharge, all patients had a percentage greater than 70% of the use of quadruple neurohormonal blockade therapy. Conclusions ICARUS is one of the first registries in Latin America since the indication of the use of SGLT2 inhibitors, evaluating the clinical and sociodemographic characteristics, treatment patterns, and outcomes of a preliminary cohort of 1595 patients hospitalized for ADHF. The results indicate that, at discharge, up to 82.79% of patients were receiving quadruple neurohormonal blockade therapy, which is considerably challenging to achieve in Latin America. Considering the results of the Safety, tolerability and efficacy of up-titration of Guideline-Directed Medical therapies for acute heart failure (STRONG-HF study), our study reinforces the benefit of discharge with Guideline-Directed Medical Therapy (GDMT) for heart failure from hospitalization. The use of GDMT for heart failure may have influenced our positive outcomes in terms of in-hospital mortality, improvement in quality of life, and the percentage of short-term rehospitalizations compared to similar cohorts.Proportion of HF drug group

Control for multiple risk factors and incident heart failure and mortality in patients with diabetes mellitus: insights from the kailuan cohort study

Abstract Purpose This study aimed to evaluate the relationship between control for multiple risk factors and diabetes-related heart failure and all-cause mortality, and to explore the extent to which the excess risk can be reduced. Methods Diabetes participants with pre-existing heart failure documented in discharge register or medical insurance records and incomplete baseline risk factor information were excluded. Each of these patients was then matched randomly to four control subjects. The degree of risk factor control was defined by attainment of target values for blood pressure, body mass index , low-density lipoprotein cholesterol, fasting blood glucose, high-sensitive C-reactive protein and smoking. The primary outcome was newly diagnosed heart failure, and the secondary outcome was all-cause mortality.Fine-Gray and Cox regression were performed to estimate the risk of heart failure and all-cause mortality among diabetes patients in relation to the degree of control for multiple risk factors respectively, and the group with ≤1 risk factor control was set as the reference group. All-cause mortality was used as a competing risk in the Fine-Gray model. Results A total of 17,676 patients with diabetes and 69,493 matched non-diabetic control subjects were included. Of these, 84.2% were men and the mean age was 56.2±10.7 years. Over a median follow-up of 11.2 (13.1-15.0) years, a total of 1,070 cases of heart failure and 4,121 cases of all-cause mortality were identified among patients with diabetes. Significant inverse associations were observed between the number of well-controlled risk factors and the risk of incident adverse outcomes in diabetes patients. For each additional risk factor that was controlled, there was an associated 16% decrease in the risk of heart failure and a 10% decrease in the risk of all-cause mortality. The incidence rate of heart failure among diabetes patients was at its lowest for those with ≥5 risk factors (HR: 0.46, 95% CI: 0.34-0.62), and it constantly increased with a lower number of well-controlled risk factors. As for all-cause mortality, the lowest risk was associated with optimal risk factor control (HR: 0.59, 95% CI: 0.50-0.68). Among diabetes patients with ≥5 risk factors that were well controlled, the adjusted hazard ratio for heart failure and all-cause mortality was 1.25 (95%CI: 0.99-1.56) and 1.17(95%CI: 1.05-1.31) respectively, as compared with controls. The protective impact of comprehensive risk factor control on the risk of heart failure was more pronounced among men than women, as well as among those using antihypertensive medications than non-users. Conclusions Control for multiple risk factors is related to a lower risk of heart failure and all-cause mortality in an accumulative and sex-specific manner. Compared to the general population, patients with diabetes mellitus remains associated with an increased risk for the outcomes in spite of the optimization of risk factor control.

Blood plasma metabolites and heart failure risk: insights from Mendelian randomization analysis

Abstract Background Heart failure remains a leading cause of mortality and disability worldwide. Blood plasma metabolites play a crucial role in influencing heart failure, yet they are subject to numerous confounding factors. Mendelian randomization analysis provides a powerful tool for assessing causal relationships between them. Methods We conducted a Mendelian randomization analysis using a meta-analysis comprising 115,150 heart failure cases (155,331 controls) and 1400 serum metabolites. Various methods including Inverse variance weighting (IVW), MR Egger, Weighted median, and Weighted mode were employed to estimate causal effects. Sensitivity analyses were conducted using Cochran’s Q test, MR Steiger test, leave-one-out analyses, funnel plot, and MR-PRESSO. Results Following rigorous selection, among the 1400 blood plasma metabolites, 71 metabolites including Sphingomyelin, Myristate, AMP to methionine ratio showed significant associations with increased risk of heart failure. Additionally, 40 metabolites including Glycine, octadecenedioylcarnitine (C18:1-DC), 1-palmitoyl-2-dihomo-linolenoyl-GPC (16:0/20:3n3 or 6) exhibited significant associations with decreased risk of heart failure. Conclusion Identified blood plasma metabolites provide crucial insights into screening and prevention strategies for heart failure. Further validation is warranted through animal models and large-scale cohorts.

A retrospective study on real world, 2-stent left main bifurcation PCI using DK crush technique with IVUS guidance - a single center experience

Abstract Objectives The aim of this study is to investigate clinical outcome of the IVUS guided 2-stent bifurcation strategy using DK crush technique performed in a complex Left Main (LM) bifurcation lesions defined according to DEFINITION study in our local setting. We seek to assess the composite endpoint of target vessel failure (TVF) at 9-12 months. Methods All patients underwent IVUS guided 2-stent Bifurcation PCI with DK crush technique for complex LM bifurcation lesions defined by the DEFINITION criteria performed in a heart institute from 1.1.2019 to 31.7.2023 were included..Patient baseline characteristics, post-procedural and 12-months follow-up outcomes including cardiac death,myocardial infarction (MI),rate of target vessel failure (TVF),rate of stent thrombosis (ST) and major adverse coronary event (MACE) were analysed.Exclusion criteria are patients age <18 years and previous stenting in the target vessel Results A total of 50 patients were included in this analysis. Mean age was 64.3±9.1 years with predominant males (n= 38, 76%).Majority were hypertensive (n=37, 74%) and diabetes mellitus accounted for 32 (64%) cases.Patients with pre-existing coronary artery disease were 39 (78%) cases. 40% presented with history of recent myocardial infarction (MI), 12% had new onset angina and 6% had heart failure. Pre-existing chronic renal failure (18%) and history of CVA (2%). Among chronic renal failure cases, 50% had eGFR <50 during index procedure.Additionally, previous PCI was performed in 22 cases (44%) and 2 previous CABG cases included (4%).Majority of the cases were performed as staged elective procedure ( n=45, 90%) and others were indicated for ACS ( n=5, 10%). Radial approach was predominantly preferred with 25 cases (50%), where additional 5 cases (10%) were converted to femoral approach due to severe radial spasm. Among these 50 cases, 1 case required additional PCI to CTO LAD and mid LCX, while 7 cases (14%) had calcified lesions requiring scoring / cutting balloons and atherectomy device utilization for adequate lesion preparation prior to bifurcation stenting.All 50 patients received combination of both aspirin and a P2Y12 inhibitors for 12 months. Follow up done at at 30-day, 60-days and 1 year after the index procedure.Clinical follow-up were available in 46 (92%) patients only.4 cases were lost to follow up due to logistic reasons. At 1 year follow-up, cardiac death occurred in 5 (10.9%) patients, out of which 3 (6.5%) cases were cardiac related and 2 (4.4%) are non-cardiac. Major adverse cardiac events (MACE) and target vessel failure (TVF) occurred in total 4 (8.7%) cases, where 3 (6.5%) cases resulted in cardiac death and 1 (2.2%) case had MI and clinically driven target lesion revascularization. Conclusion Our experience demonstrates that IVUS guided, upfront 2-stent Bifurcation PCI using DK crush technique for complex bifurcation lesions is effective and safe with a low MACE and TLR rate at 1 year follow-up.

Preoperative chemo-CIRT in Re/BRe pancreatic cancer: Insights from a multicenter prospective phase II clinical study (NCT03822936).

There is debate about the optimal management of borderline resectable (bRe) and resectable (Re) pancreatic ductal adenocarcinoma (PDAC). Both preclinical and clinical evidence showed that carbon ion radiotherapy (CIRT) produces superior control on radioresistant histologies compared to conventional photon beam radiotherapy (RT). However, so far there is a lack of data concerning the integration of CIRT in a multimodal approach with chemotherapy and surgery for bRe/Re. We recently presented the first analysis of a multicenter prospective phase II clinical study aimed at assessing the feasibility and effectiveness of a neoadjuvant chemotherapy + short course of CIRT followed by surgery and adjuvant chemotherapy in the management of bRe/Re PDAC. The study was terminated early due to low patient enrollment.Herein, we reported a post-hoc analysis focusing on toxicity, dosimetry and translational assessment. In our experience, CIRT can be integrated into a multimodal treatment strategy for bRe/Re PDAC, alongside chemotherapy and surgery. A case of fatal liver failure occurring three months post-surgery has been documented, likely related to the combination approach. Although the treatment plans were satisfactory according to the Local Effect Model (LEM) model, recalculations using the modified Microdosimetric Kinetic Model (mMKM) revealed suboptimal target coverage. Additionally, we observed an increased expression of PD-L1 following CIRT. This multimodal approach was well tolerated; however, clinicians should carefully monitor for vascular disorders during follow-up and further investigate surgical techniques after CIRT. The increased PD-L1 expression supports the immunogenic effects of particle therapy and lays the groundwork for future studies. To enhance the therapeutic ratio of CIRT treatments, integrating dose-averaged LETd (LETd-based objectives into the plan optimization process should be considered. ClinicalTrials.gov Identifier: NCT03822936.

Hear no evil, see no evil: Why the United States gets net assessment wrong

ABSTRACT Whether it’s the attack on Pearl Harbor, the outbreak of the Korean War, the start of the Gulf War, or the 9–11 terrorist attacks, the United States has suffered no shortage of strategic intelligence failures in its history. More recently, however, the United States has suffered from a different brand of mishap – a failure of net assessment, where the United States under- or overestimated how our allies would fare in a conflict against known adversaries. This article lays out two competing theories for why these net assessment failures happen – the missing variable hypothesis versus self-delusion. It then tests these theories against three cases of net assessment failures – Iraq in 2014, Afghanistan in 2021 and Ukraine in 2022. This article argues that contrary to popular belief, American net assessment failures are not primarily due a failure to collect the right information or an inability to assess the ‘will to fight’. Rather, American net assessment failures often stem from self-delusion. Because these assessments are often done at the upper rungs of government and include more qualitative judgements about friendly and enemy willpower and proficiency, senior government officials often shape their assessments to best fit their policy preferences. In other words, they fall victim to the confirmation trap. Consequently, if the United States aims to produce better net assessments in the future, then it needs to guard against this bias by professionalizing net assessment.

Transcatheter aortic valve replacement failure: surgical valve explantation after more than a decade.

Transcatheter aortic valve replacement (TAVR) has become an established alternative to surgical aortic valve replacement for severe aortic stenosis. However, the long-term outcomes and need for surgical reintervention following TAVR remain uncertain. This case report describes a 76-year-old woman who underwent surgical explantation of a SAPIEN-XT valve more than a decade after initial TAVR implantation due to late valve failure. The patient presented with severe aortic insufficiency and heart failure symptoms. Surgical intervention involved concomitant ascending aortic replacement, tricuspid annuloplasty, and coronary artery bypass grafting. The TAVR valve was successfully explanted using careful blunt dissection to avoid annulus damage. Postoperative recovery was uneventful, with the patient discharged after 4 weeks. This case highlights the potential need for long-term surgical management of patients after TAVR, and emphasizes the importance of surgical preparedness as TAVR indications expand. It also provides valuable insights for surgeons encountering similar cases of late TAVR failure requiring explantation.

Atrasentan in Patients with IgA Nephropathy.

Patients with IgA nephropathy and severe proteinuria have a high lifetime risk of kidney failure. The efficacy and safety of the selective endothelin type A receptor antagonist atrasentan in reducing proteinuria in patients with IgA nephropathy are incompletely understood. We are conducting a phase 3, multinational, double-blind, randomized, controlled trial involving adults with biopsy-proven IgA nephropathy, a total urinary protein excretion of at least 1 g per day, and an estimated glomerular filtration rate of at least 30 ml per minute per 1.73 m2 of body-surface area. Patients were randomly assigned to receive atrasentan (0.75 mg per day) or matched placebo for 132 weeks. The primary outcome, assessed at a prespecified interim analysis of data from the first 270 patients in the main stratum, was the change in the 24-hour urinary protein-to-creatinine ratio from baseline to week 36; the change was estimated with the use of a repeated-measures model. (An exploratory stratum of patients who were receiving a sodium-glucose cotransporter 2 inhibitor were included in a separate analysis.) Safety analyses were based on adverse events across the entire main stratum. A total of 340 patients were recruited into the main stratum. Among the first 270 patients in the main stratum (135 per trial group) who completed the week 36 visit, the geometric mean percentage change in the urinary protein-to-creatinine ratio relative to baseline was significantly greater with atrasentan (-38.1%) than with placebo (-3.1%), with a geometric mean between-group difference of -36.1 percentage points (95% confidence interval, -44.6 to -26.4; P<0.001). The percentage of patients with adverse events did not differ substantially between the two groups. Fluid retention was reported by 19 of 169 patients (11.2%) in the atrasentan group and in 14 of 170 (8.2%) in the placebo group but did not lead to discontinuation of the trial regimen. No apparent cases of cardiac failure or severe edema occurred. In this prespecified interim analysis, atrasentan resulted in a significant and clinically meaningful reduction in proteinuria as compared with placebo in patients with IgA nephropathy. (Funded by Novartis; ALIGN ClinicalTrials.gov number, NCT04573478.).

Study on Quantitative Assessment of CO2 Leakage Risk Along the Wellbore Under the Geological Storage of the Salt Water Layer

In the process of CO2 geological storage in the salt water layer, CO2 leakage along the wellbore will seriously affect the effective storage of CO2 in the target geological area. To solve this problem, based on the investigation of a large number of failure cases of CO2 storage along the wellbore and failure cases of gas storage wells in the injection stage of the wellbore, the influencing factors of CO2 leakage risk along the wellbore were investigated in detail. Based on the analytic hierarchy process (AHP) and extension theory, 17 basic evaluation indexes were selected from 6 perspectives to establish the evaluation index system of CO2 leakage risk along the wellbore. The established evaluation system was used to evaluate the leakage risk of a CO2 storage well in the X gas field of BZ Block. The results showed that the influencing factors of tubing had the smallest weight, followed by cement sheath, and the influencing factors of casing–cement sheath interface and cement sheath–formation interface had the largest weight, accounting for 23.73% and 34.32%, respectively. The CO2 storage well leakage risk evaluation grade was Ι, with minimal leakage risk. The CO2 storage effect was excellent. The evaluation system comprehensively considers the tubing string, cement sheath, and micro-annulus interface, which can provide a scientific basis for the risk assessment of CO2 leakage along the wellbore under the CO2 geological storage of the salt water layer.

Abbreviated Multiparametric MR Solution (the “Liver Triple Screen”), the Future of Non-Invasive MR Quantification of Liver Fat, Iron, and Fibrosis

Background/Objectives: To review the findings of a multiparametric MRI (the “liver triple screen”) solution for the non-invasive assessment of liver fat, iron, and fibrosis in patients with chronic liver disease (CLD). Methods: A retrospective evaluation of all consecutive triple screen MRI cases was performed at our institution over the last 32 months. Relevant clinical, laboratory, and radiologic data were analyzed using descriptive statistics. Results: There were 268 patients, including 162 (60.4%) males and 106 (39.6%) females. The mean age was 54 ± 15.2 years (range 16 to 71 years). The most common cause of CLD was metabolic dysfunction-associated steatotic liver disease (MASLD) at 45.5%. The most common referring physician group was Gastroenterology at 62.7%. In 23.9% of cases, the reason for ordering the MRI was a pre-existing failed or unreliable US elastography. There were 17 cases (6.3%) of MRI technical failure. Our analysis revealed liver fibrosis in 66% of patients, steatosis in 68.3%, and iron overload in 22.1%. Combined fibrosis and steatosis were seen in 28.7%, steatosis and iron overload in 16.8%, fibrosis and iron overload in 6%, and combined fibrosis, steatosis, and iron overload in 4.1%. A positive MEFIB index, a predictor of liver-related outcomes, was found in 57 (27.5%) of 207 patients. Incidental findings were found in 14.9% of all MRIs. Conclusions: The liver triple screen MRI is an effective tool for evaluating liver fat, iron, and fibrosis in patients with CLD. It provides essential clinical information and can help identify MASLD patients at risk for liver-related outcomes.

Improvement in the psychological resilience of rural left-behind children: The influence of social services from 15 social organisations

This study explores improvements in psychological resilience among rural left-behind children in China through social services provided by social organisations. Semi-structured interviews were conducted with leaders and social workers from 15 social organisations. The results revealed that left-behind children’s academic adaptation improved significantly. However, there were cases of failure to enhance physiological and psychological adaptation. This study provides guidelines for policymakers to formulate targeted support policies, for social organisations to assess their service quality and for service providers to change their role to collaborators, thereby jointly helping rural left-behind children improve their psychological resilience.

Wear mechanisms and failure analysis of a tool used in refill friction stir spot welding of AA6061-T6

Investigating tool wear in refill friction stir spot welding (RFSSW) is essential for understanding its limitations and improving its efficiency. Increasing the tool's service life is important to push the technology's readiness level and transfer the technology from the laboratory to industrial applications. In this study, the quasi-static lap shear performance of AA6061-T6 similar welded spots was investigated and tool wear was continuously monitored until tool failure at 3450 welding cycles. Furthermore, the fundamentals of the wear mechanisms in RFSSW were further elucidated. The investigation shows that it is possible to achieve steady quasi-static lap shear performance of the spot welds over advancing tool wear by adjusting the heat input to compensate for losses in frictional heat generation efficiency (related to tool profile changes by abrasion). A subsequent tool failure case analysis showed the main causes for the continuous wear degradation of the shoulder. Tool wear was driven by plastic deformation of the hot-work tool steel and subsequent break-out of tool steel ridges, introducing big hard particles into the contact region between the moving and rotating tools. In addition, the formation and detachment of Fe-Al intermetallic compounds counteract with the rotating tools and increase tool wear.

A machine learning tool for identifying newly diagnosed heart failure in individuals with known diabetes in primary care.

We aimed to create a predictive model utilizing machine learning (ML) to identify new cases of congestive heart failure (CHF) in individuals with diabetes in primary health care (PHC) through the analysis of diagnostic data. We used a sex- and age-matched case-control design. Cases of new CHF were identified across all outpatient care settings 2015-2022 (n=9098). We included individuals 30years and above, by sex and age groups of 30-65years and >65years. The controls (five per case) were sampled from the individuals in 2015-2022 without CHF at any time between 2010 and 2022, in total 45 490. From the stochastic gradient boosting (SGB) technique model, we obtained a rank of the 10 most important factors related to newly diagnosed CHF in individuals with diabetes, with the normalized relative influence (NRI) score and a corresponding odds ratio of marginal effects (ORME). Area under curve (AUC) was calculated. For women 30-65years and >65years, we identified 488 and 3240 new cases of CHF, respectively, and men 30-65years and >65years 1196 and 4174 new cases. Among the 10 most important factors in the four groups (divided by sex and lower and higher age) for newly diagnosed CHF, we found the number of visits 12months before diagnosis (NRI 44.3%-55.9%), coronary artery disease (NRI 2.9%-7.8%), atrial fibrillation and flutter (NRI 6.6%-12.2%) and 'abnormalities of breathing' (ICD-10 code R06) (NRI 2.6%-4.4%) were predictive in all groups. For younger women, a diagnosis of COPD (NRI 2.7%) contributed to the predictive effect, while for older women, oedema (NRI 3.1%) and number of years with diabetes (NRI 3.5%) contributed to the predictive effect. For men in both age groups, chronic renal disease had predictive effect (NRI 3.9%-5.1%) The model prediction of CHF among patients with diabetes was high, AUC around 0.85 for the four groups, and with sensitivity over 0.783 and specificity over 0.708 for all four groups. An SGB model using routinely collected data about diagnoses and number of visits in primary care, can accurately predict risk for diagnosis of heart failure in individuals with diabetes. Age and sex difference in predictive factors warrant further examination.

Outcomes of operative fixation of loose trochlear osteochondral defects: A case series with subgroup analysis

Objectives To evaluate results of open reduction and internal fixation (ORIF) of loose osteochondritis dissecans (OCD) fragments of the trochlea including identification of any cases of fixation failure and assessment of post-operative patient-reported outcomes and activity level. Methods A retrospective chart review of OCD fixation surgeries performed between 2010 and 2021 identified 12 patients who underwent ORIF of loose OCD trochlear fragments. Patient demographics, history, imaging findings, surgical factors, and skeletal maturity were all collected. Primary outcome measures included reoperation for fixation failure, Knee Osteoarthritis Outcome Scores (KOOS), and Marx scores. Results The 12 patients (12 knees) with a mean age of 17.7 ± 6.4 years (range, 13-37 years) were included in the case series. Mean trochlear OCD size was 3.20 cm2 (range, 1.69-5.06 cm2) with mean follow-up of 78.9 months (range, 8 – 145). Failure of fixation occurred in. Failure of fixation occurred in 2 patients (17%). Of the 10 patients (83%) who completed PROs, the mean KOOS global score for all patients was 86.8 ± 16.3, symptoms/stiffness sub score 90.0 ± 11.0, pain 91.2 ± 12.1, Functions of daily living 95.5 ± 8.3, Sports/recreation 82.0 ± 23.9, quality of life 75.7 ± 28.6, and a mean Marx activity score of 10.5 ± 4.9. Conclusion ORIF of loose OCD lesions of the trochlea is associated with a low risk of failure of fixation and acceptable patient-reported outcomes.

Perioperative changes of serum interleukin 6 levels in elderly male patients with intertrochanteric fracture

To investigate the perioperative changes in serum interleukin 6 (IL-6) levels in elderly male patients with intertrochanteric fractures, and provide evidence for inflammatory control in this patient population. The clinical data of 40 male patients aged more than 60 years with intertrochanteric fractures who met the selection criteria between January 2021 and December 2022 were retrospectively analyzed, including 25 non-osteoporosis patients (T value>-2.5, group A) and 15 osteoporosis patients (T value≤-2.5, group B). In addition, 40 healthy men aged more than 60 years old were included as controls (group C) according to the age matching rule. There was no significant difference in age, smoking history, drinking history, body mass index, complications (hypertension and diabetes), alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, and total protein among the 3 groups ( P>0.05). Serum samples were collected from group C subjects and from groups A and B patients preoperatively and on postoperative days 1, 3, 5, and 7. IL-6 levels were measured using ELISA assay. Pearson correlation analysis was used to assess the relationship between IL-6 levels and T values at various time points in groups A and B. Postoperative complications during hospitalization and 1-year mortality rates were recorded for groups A and B. Preoperative IL-6 levels were significantly higher in groups A and B than in group C ( P<0.05), with group B being significantly higher than group A ( P<0.05). In groups A and B, IL-6 levels increased significantly on postoperative day 1 compared to preoperative levels and then gradually decreased, approaching preoperative levels by postoperative day 7. IL-6 levels in group B were significantly higher than those in group A at all postoperative time points ( P<0.05). Correlation analysis showed that IL-6 levels were negatively correlated with T values at all perioperative time points in all patients from groups A and B ( P<0.05). Complications occurred in 4 patients (16.0%) in group A, including 2 cases of pulmonary infection, 1 case of urinary tract infection, and 1 case of heart failure, and in 3 patients (20.0%) in group B, including 2 cases of pulmonary infection and 1 case of gastrointestinal bleeding. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.104, P=0.747). There were 2 cases (8.0%) and 4 cases (26.7%) died within 1 year after operation in groups A and B, respectively, and there was no significant difference in 1-year mortality rates between the two groups ( χ 2=2.562, P=0.109). Serum IL-6 levels significantly increase in the early postoperative period in elderly male patients with intertrochanteric fractures, especially in those with osteoporosis. Monitoring the inflammatory state and promptly controlling the inflammatory response during the perioperative period, may reduce complications and improve postoperative survival in this patient population.

Evidence of tosufloxacin deposition in the kidneys of a patient presenting with crystal nephropathy.

Tosufloxacin tosilate is classified as a new quinolone antibacterial agent, which has been reported to cause crystal nephropathy. However, the origin of these crystal deposits has not yet been elucidated. We encountered a case of renal failure that progressed slowly owing to crystal-forming interstitial nephritis after long-term exposure to tosufloxacin. Mass spectrometry of the renal specimens revealed that tosufloxacin was deposited in the kidneys. The patient's renal function improved slowly with the withdrawal of tosufloxacin and steroid therapy. This is the first case to demonstrate the presence of crystal deposits consisting of tosufloxacin.

Long-term comparative outcomes in patients undergoing transcatheter aortic valve implantation with self-expanding valves versus balloon-expandable valves

ABSTRACT Background This study aimed to compare long-term clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) with self-expanding (SEV) valve versus balloon-expandable valve (BEV), with a minimum follow-up period of five years. Materials and Methods Utilizing a prospectively maintained database, this observational study identified patients who underwent TAVI using either SEV or BEV for severe aortic stenosis and were followed for at least five years. Clinical outcomes encompassed both 30-day post-TAVI outcomes and long-term outcomes, including all-cause mortality, cardiovascular mortality, structural valve deterioration (SVD), heart failure related hospitalization, bioprosthetic valve failure, and valve related hospitalization and complications. Results A total of 74 patients were included in this study, with 64 patients in the SEV group and 10 patients in the BEV group. The median follow-up duration was 6.8 years, ranging from 5.0 to 10.2 years. Throughout the post-TAVI period, the SEV group consistently demonstrated a lower mean pressure gradient than the BEV group. No significant differences were observed between the two groups in terms of short-term or long-term outcomes. Within the study, four patients encountered moderate or severe SVD and one experienced thrombosis, and no cases of bioprosthetic valve failure or endocarditis were observed. Conclusions This study revealed that SEV and BEV demonstrated comparable long-term outcomes in patients undergoing TAVI, including all-cause and cardiovascular mortality, as well as the risk of SVD.

Retrieval of a Separated Instrument using Combination of Ultrasonics and Braiding Technique- A Case Report

The fracture of endodontic instruments represents a procedural error that poses a significant challenge to root canal therapy. A separated instrument, especially a broken file, obstructs the root canal and hinders effective cleaning and shaping. When bypassing the separated instrument proves difficult, mechanical devices should be employed for retrieval. With minimal equipment and patience, it is feasible to recover the separated instrument from the canal. The application of ultrasonics in endodontics has demonstrated reliability in retrieving broken instruments from the root canal. Ultrasonic tips can effectively loosen the instrument fragment, which can then be removed using the Braiding technique. This case report illustrates both the successful retrieval of a separated instrument and a failure case using the same method, providing insight into its advantages and limitations.

Predictive Value of Diaphragm and Lung Ultrasonography for Weaning Failure in Critically Ill Patients with Acute Respiratory Failure Due to COVID-19 Pneumonia.

This study analyzed weaning characteristics and assessed the association of clinical and ultrasonographic indices-maximum inspiratory pressure (MIP), rapid shallow breathing index (RSBI), peak flow expiratory (PFE), diaphragm-thickening fraction (DTF), diaphragm thickness (DT), diaphragm excursion (DE), diaphragm-RSBI (D-RSBI), and lung ultrasound (LUS) patterns-with weaning failure. This retrospective cohort study included critically ill COVID-19 patients aged 18 and older who had been on invasive mechanical ventilation for at least 48 h and undergoing weaning. Exclusion criteria included absence of ultrasound assessments, neuromuscular diseases, and chronic cardio-respiratory dysfunction. Among 61 patients, 44.3% experienced weaning failure, 27.9% failed the spontaneous breathing trial (SBT), 16.4% were re-intubated within 48 h, and 28% required tracheostomy. Weaning failure was associated with prolonged ventilation (29 vs. 7 days, p < 0.001), extended oxygen therapy, longer ICU stays, and higher ICU mortality. These patients had higher pressure support, lower oxygenation levels, a higher RSBI, and a lower MIP. While PEF, DTF, DE, and D-RSBI showed no significant differences, both right and left diaphragm thicknesses and the inspiratory thickness of the left diaphragm were reduced in failure cases. LUS scores were significantly higher before and after SBT in the failure group. Bivariate analysis identified RSBI [OR = 1.04 (95% CI = 1.01-1.07), p = 0.010], MIP [OR = 0.92 (95% CI = 0.86-0.99), p = 0.018], and LUS [OR = 1.15 (95% CI = 0.98-1.35), p = 0.025] as predictors of weaning failure; however, these associations were not confirmed in multivariate analysis. Ultrasound provides supplementary information during weaning, but no definitive association between ultrasound indices and weaning failure was confirmed in this study.