Durability Of Repair Research Articles

Abstract 4134945: Biomechanical Impact of Crossing Neochords In Mitral Valve Repair Using Ex Vivo Mitral Valve Prolapse Models

Background: Neochord repair is a common technique to mitigate mitral regurgitation (MR). Certain techniques, such as the loop technique, purposefully anchor all neochords to one papillary muscle head, generating crossed configurations. The objective was to evaluate the impact of crossing neochord on mitral valve (MV) biomechanics using ex vivo mitral valve prolapse (MVP) models. Methods: Twenty-four healthy porcine MVs were explanted. The valves were randomly assigned to generate A2 or P2 MVP models by transecting A2 or P2 primary and secondary native chords. For each model, the valves were further randomly assigned to neochord repair by crossing the medial-lateral plane or the anterior-posterior plane. Fiber Bragg grating force sensors were mounted to measure chordal forces. Data were collected using an ex vivo heart simulator for baseline, MVP, and neochord repair in the native and the crossed configuration. Statistical analysis was performed using repeated measures analysis of variance with post-hoc correction. Results: In the P2 MVP model, AP crossed configuration was effective in reducing MR (p=.003) compared with the native configuration (p=.004), but the medial-laterally (ML) crossed configuration was not effective in reducing MR (p=.07) compared with the native configuration (p=.05). In the A2 MVP model, anterior-posteriorly crossed configuration was associated with increased average neochordal force compared with the native configuration (0.16±0.06N vs. 0.09±0.07N, p=.05). The ML crossed configuration was also associated with increased average neochordal force compared with the native configuration (0.05±0.03N vs.0.03±0.03N, p=.03). Peak native secondary chordal forces were increased in the ML crossed configuration compared with the native configuration (0.76±0.45N vs. 0.61±0.38N, p=.05). No differences between the crossed and native configurations were observed in the P2 MVP model. Conclusions: Differences exist in P2 MVP model hemodynamics and A2 MVP model chordal forces when neochords were crossed compared with the native configurations. These findings may provide important biomechanics insight regarding neochord implantation techniques and repair durability.

Tricuspid Anterior and Posterior Patch (TRAPP) Repair of Functional Tricuspid Regurgitation.

Annuloplasty is the most common strategy for repair of functional tricuspid regurgitation (FTR) but is not effective in patients with massive/torrential FTR or leaflet tethering. To address the deficits of tricuspid annuloplasty, TRicuspid Anterior and Posterior Patch (TRAPP) repair was developed, which is a pericardial patch augmentation of the anterior and posterior leaflets. To test this repair, a previously validated ex vivo model in an explanted porcine heart was used, wherein annular and leaflet geometry were evaluated using a 3-dimensional structured light scanner at 4 time points: (1) baseline, (2) induction of FTR, (3) annuloplasty repair, and (4) patch repair. Compared with the regurgitant tricuspid valve, annuloplasty reduced annular circumference (13.7 to 9.5 cm) and area (13.7 vs 6.1 cm2), whereas TRAPP repair did not alter annular dimensions (circumference: 13.7 vs 13.5 cm; area: 13.7 vs 13.6 cm2). Annuloplasty increased leaflet tenting angles (anterior: 53.5° vs 41.0°; posterior: 59.7° vs 48.2°; septal: 38.9° vs 31.4°) whereas TRAPP repair relieved anterior and posterior leaflet tenting (anterior: 28.9° vs 41.0°; posterior: 34.9° vs 48.2°; septal: 33.2° vs 31.4°) and restored geometry comparable to the native tricuspid valve. Central coaptation lengths were greater with TRAPP repair than with annuloplasty for all 3 leaflets (anterior: 12.7 vs 9.5 mm; posterior: 12.2 vs 8.2 mm; septal: 7.4 vs 4.6 mm). Compared with annuloplasty, TRAPP repair yielded greater coaptation length, resolved leaflet tethering, and resulted in a larger annular area that may facilitate durable repair of advanced FTR, which previously would have required replacement.

Sealing Zone Failures and Durability of Endovascular Aneurysm Repair: Is it Time to Update Instructions for Use, Extend Repairs, or Change Follow Up Protocols?

Sealing Zone Failures and Durability of Endovascular Aneurysm Repair: Is it Time to Update Instructions for Use, Extend Repairs, or Change Follow Up Protocols?

A Historical Perspective and Update on Robotic Mitral Valve Surgery.

Background/Objectives: Minimally invasive techniques for mitral valve repair have evolved over the past thirty years and include mini-thoracotomies and the robotic platform. This study provides a historical perspective on minimally invasive mitral valve approaches and evaluates long-term outcomes of a large series of robotic mitral valve repairs. Methods: A single-institution, prospectively maintained registry was used to evaluate robotic mitral valve repairs performed by four surgeons from 2005 to 2023. There were 1412 robotic mitral valve repairs performed during this time and stratified by the first 120 and subsequent patients. We evaluated operative outcomes and freedom from more than 2+ mitral regurgitation at five years as well as ten-year survival. Results: Of the 1412 robotic mitral valve repairs performed, 93.6% (n = 1322) were for degenerative disease. Compared to the first 120 patients, the subsequent patients had a significant reduction in cross-clamp time (112 (IQR = 103-130) versus 75 (IQR = 65-88) min) and cardiopulmonary bypass time (153.5 (IQR = 134.5-177.5) versus 116 (IQR = 103-136) min), and all with p < 0.01. The majority of patients had posterior leaflet prolapse (65.6%, n = 926). The repair rate was 98.1%, n = 1385. Survival at ten-year follow-up for the patients included in the first 120 procedures was 91.5% (95% confidence interval (CI) = 86.4-96.6%) versus 92.8% (95% CI = 91.7-93.9%) for the patients who were in the latter group, p = 0.58. Freedom from >2+ mitral regurgitation at 5 years was 97.0% (95% CI = 95.3-98.7%) for the patients in the first 120 procedures and 92.7% (95% CI = 91.5-93.9%), p = 0.22, for those in the latter group. Conclusions: The robotic platform offers an excellent durable repair for mitral regurgitation in our experience of over 1400 patients. The robotic platform for mitral valve repair offers a teachable and safe approach to mitral valve disease for patients.

Impact of Combining Iliac Branch Endoprosthesis and Physician-Modified Fenestrated-Branched Endovascular Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms with Concomitant Iliac Artery Aneurysms

ObjectivesTreatment of iliac artery aneurysms (IAA) with the Iliac Branch Endoprosthesis (IBE) during endovascular repair of infrarenal abdominal aortic aneurysm (EVAR) has been well-documented as effective. However, limited data exists evaluating the safety and efficacy of treating complex abdominal (cAAA) and thoracoabdominal aortic aneurysms (TAAA) with associated IAA with combined physician-modified fenestrated branched endovascular aortic repair (PM-FBEVAR) and IBE. Moreover, limited studies exist assessing the impact of adding IBE on the outcomes following PM-FBEVAR. Therefore, we compared the clinical outcomes of patients who underwent PM-FBEVAR with and without IBE for the treatment of cAAA and TAAA. MethodsA single institution retrospective review of consecutive patients who underwent PM-FBEVAR between September 2015 and February 2021 was conducted. Patients with both unilateral and bilateral IBE implantation were included. Infected aneurysms and pseudoaneurysms were excluded. Demographics, technical success, and operative factors were analyzed. Primary outcomes were incidence of pelvic ischemia including buttock and thigh claudication, bowel and spinal cord ischemia, patency of internal and external limbs of IBE, and target vessel instability. Secondary outcomes included technical success, 30-day major adverse events (MAE), 30-day and all-cause mortality, and endoleaks. ResultsAmong 183 patients identified who underwent PM-FBEVAR, 22 patients underwent PM-FBEVAR and IBE with 3 patients treated with bilateral IBEs. There was no pelvic ischemia in the PM-FBEVAR and IBE group. Technical success, fluoroscopy time, and procedure time were comparable between the two groups. Contrast usage was higher in the PM-FBEVAR and IBE group (p=0.01). Thirty-day MAE and mortality were not statistically different between the two groups. At mean follow-up of 23 months, all-cause mortality was similar for both groups (21% vs 27%; p=0.47). Patency of internal iliac artery limb and external iliac artery limb of the IBE were 96% (24 of 25) and 100%, respectively, during mean follow-up of 23 months. The patient with occlusion of internal iliac limb was asymptomatic and received no re-intervention. ConclusionTreatment of cAAA and TAAA associated with IAA using combined PM-FBEVAR and IBE is feasible with high efficacy and safety, and without adverse effect on outcomes. Long-term follow-up is planned to assess durability of repair with PM-FBEVAR and IBE.

Adjuncts to annuloplasty in atrial functional mitral regurgitation.

Atrial fibrillation is the most common cardiac arrhythmia, leading to progressive dilation of cardiac chambers, abnormal contraction patterns of the atria and ventricles and, potentially, atrioventricular valvular insufficiency. Moreover, heart failure with preserved ejection fraction is often present and closely intertwined with disease initiation and progression. Surgical valve repair with a true-sized ring annuloplasty is a well-established treatment option in atrial functional mitral regurgitation. While early results are good, recent studies have brought the durability of this repair approach into question, highlighting the need for further refinement of the surgical strategy. In particular, repair strategies that simultaneously target the mitral valve as well as the left ventricle could provide improved repair durability.

Survival Correlates with Regurgitation Degree Before and After Invasive Atrioventricular Valve Treatment.

The degree of both mitral (MR) and tricuspid valve regurgitation (TR) correlates with mortality. A vicious cycle has been proposed consisting of increasing regurgitation and decreasing ventricular function. Restoration of valve competence should break this vicious cycle and improve life expectancy. However, a "pop-off" mechanism keeps being entertained, presumably allowing poorly pumping ventricles to relieve volume into the low-pressure atrium through an incomplete repair, avoiding pump failure. We reasoned that if such a mechanism exists, it should offset the relationship between mortality and valve regurgitation after an invasive procedure. In this context, we meta-analytically compared valve regurgitation degree and survival before or after atrio-ventricular valve treatment. The results show significant relationships between valve regurgitation and mortality under all conditions (i.e., before and after surgery or intervention) and irrespective of the underlying pathology (i.e., functional or structural). In summary, the ubiquitously present relationship between valve regurgitation and mortality suggests that generating a tight and durable repair of the affected valve is key to long-term exploitation of a symptom-reducing and life-prologing mechanism, independent of the underlying valve pathology. This recognition may explain current controversies in the treatment effects of MR and TR.

The New Era of Three-Dimensional Annuloplasty Devices for Mitral Valve Repair: Rationale and First Experiences.

Annuloplasty should always accompany mitral valve repair in order to achieve proper annular remodeling and stabilization. Numerous types of annuloplasty rings-that differ from rigid to semi-rigid and flexible devices, from complete to partial, and from flat to saddle-shaped rings-are clinically available. A deeper understanding of mitral valve function, in conjunction with several recent studies, suggest it is advisable to prefer annuloplasty rings that mimic the physiological mitral annulus shape and three-dimensional (3D) dynamic changes in order to reduce haemodynamic stress on valve components and optimize leaflet coaptation, perhaps improving valve repair durability too. This paper aims to focus on 3D annuloplasty rings, with dynamic features: MEMO 3D™ and MEMO 4D™ (Sorin Medical, New York, New York), as well as Physio Flex (Edwards Lifesciences, Irvine, California).

Surgical experience in adults with Ebstein's anomaly: Long-term results.

The aim of this study was to review late results of the surgical treatment of Ebstein's anomaly with reconstruction and replacement in adults. Medical records of 28 consecutive patients operated on between 1991 and 2014 were reviewed retrospectively. Surgical repair was performed in 19 (67.9%) patients (Hardy: two, Danielson: three, modified Danielson: six, Carpentier: three, Kay annuloplasty reinforced with ring: two), whereas tricuspid valve replacement was performed in nine patients (32.1%). Primary long-term outcomes consisted of right ventricular function, survival and freedom from re-operation. We evaluated the additional impacts of residual tricuspid insufficiency and type of surgery on survival. In-hospital mortality rate was 7.1% (n = 2) due to low cardiac output status and sepsis. Patients showed a significant postoperative decrease in tricuspid regurgitation (p < 0.001), right atrial size (p < 0.001) and pulmonary hypertension (p = 0.002). The mean follow-up time was 140 ± 71.4 months, with a median of 126 months (105 - 192). Late mortality occurred in two patients and there was no significant difference in terms of survival based on residual tricuspid insufficiency (p = 0.57) and type of surgery (p = 0.094). Overall survival rates were 89.3, 85.4, 85.4 and 68.3% at five, 10, 15 and 20 years, respectively. Although complex leaflet reconstruction techniques have evolved to achieve a more physiological and durable repair, both approaches can be performed safely on specific patients and can be alternated, with acceptable rates of survival and re-operation.

Effectiveness of Xanthan Gum-based composite in repairing cracks in reinforced concrete structures

Abstract This study investigates the enhancement of concrete slabs using a biopolymer-modified cementitious repair material (CXT) composed of Ordinary Portland Cement, Xanthan Gum, and Tartaric Acid Powder. The innovative formulation of CXT aims to improve the mechanical properties of repaired concrete structures. Experimental results demonstrate that CXT significantly enhances mechanical properties such as the load-bearing capacity of concrete slabs. Non-destructive testing methods, including the Rebound Hammer test and Ultrasonic Pulse Velocity (UPV), as well as destructive testing methods, were employed to evaluate the performance of CXT in repairing cracks. The study highlights the improved load-bearing capacity and structural integrity of CXT-repaired slabs, contributing to increased longevity and reduced maintenance costs of concrete structures. Furthermore, the sustainability metrics of CXT, including Process Mass Intensity (PMI), Energy Intensity (EI), Environmental Factor (E-Factor), and Reaction Mass Efficiency (RME), are evaluated, illustrating its cost-effectiveness and environmental benefits. This comprehensive approach underscores the potential of CXT as a durable and sustainable repair material for concrete infrastructure.

Long-term outcomes of open midline ventral hernia repair using a narrow well-fixed retrorectus polypropylene mesh.

The ultimate measure of successful abdominal wall reconstruction is a pain-free, complication-free, and durable hernia repair. Open techniques have generally lost favor, but they still have much to offer for patients with skin deficits and excess. The long-term complication rates for open hernia repairs is unknown. Electronic medical records now provide the ability to easily follow patients who have switched medical institutions. Using this tool, we followed a cohort of abdominal wall reconstruction patients who had an early high "success" rate. We performed a retrospective chart review of 101 patients who underwent open ventral hernia repair with a narrow well-fixed retrorectus uncoated polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. These patients were initially reported in a 2016 publication. Patients' post-operative follow-up by any medical provider assessing the abdominal region were studied up until August 2023. Patient demographics, operative reports, and postoperative course were re-reviewed. A total of 101 patients underwent ventral hernia repair. Mean follow-up time was 7.68years (range 1.8 - 13.0years). There were no recurrent hernias across the studied time period and no instances of enterocutaneous fistulas. 15 patients (15%) had abdominal surgery after hernia repair unrelated to their original surgery and 5 patients (5%) reported chronic post-operative pain. 13 patients died in the follow-up period, all unrelated to the abdominal wall surgery. Open well-fixed narrow retrorectus mesh hernia repairs perform well in the long-term without fistulas, extrusions, and hernia recurrence.

Mitral Valve Repair for Mitral Regurgitation in Patients With Marfan Syndrome.

There is concern about the durability of mitral valve repair (MVr) for mitral regurgitation (MR) in Marfan patients due to limited long-term data. Furthermore, a detailed time course of changes in cardiac function after MVr in Marfan patients has not been reported. We examined repair techniques, postoperative cardiac function, and outcomes of MVr in Marfan patients. We retrospectively reviewed 29 Marfan patients (mean [±SD] age 27.4±14.8 years) who underwent MVr at The University of Tokyo Hospital from 2010 to 2022. The mean follow-up period was 5.2±3.2 years. The causes of MR were isolated anterior leaflet prolapse in 25% of patients, isolated posterior leaflet prolapse in 11%, and bileaflet prolapse in 64%. Echocardiographic findings showed significant decreases in left ventricular (LV) diastolic and left atrial diameters 1 week after MVr. LV systolic diameter was significantly decreased 3 years after MVr, and LV ejection fraction initially declined before subsequently increasing. The in-hospital and 30-day mortality rates were 0%. At 5 years, the overall survival rate was 94% and the rate of freedom from MR was 84%. The mid- to long-term outcomes after MVr in Marfan patients were satisfactory, supporting the durability of MVr in these patients. Postoperative cardiac reverse remodeling occurred in a phased manner in Marfan patients, similar to that in patients with degenerative MR.

Mitral valve repair in ventricular functional mitral regurgitation: a simplified technique of papillary muscles relocation.

Mitral valve repair techniques in ventricular functional mitral regurgitation are controversial due to ongoing debates about long-term repair durability in the setting of left ventricular remodelling. To address the limitations of conventional annuloplasty, subannular techniques, such as papillary muscle relocation, have been developed. However, the limited reproducibility of these techniques has hindered their widespread adoption. In this context, we introduce a simplified and reproducible method for papillary muscle relocation. This method utilizes transoesophageal echocardiographic guidance and premeasured polytetrafluoroethylene loops to streamline the procedure.

Papillary Muscle Maneuvers: Pathophysiology-based Approach in Secondary Mitral Regurgitation.

The treatment of secondary mitral regurgitation (SMR) remains challenging despite the implementation of modern heart failure medication and established catheter-based techniques. Only a subgroup of SMR patients benefit from mitral valve (MV) intervention, and the long-term prognostic benefit of different therapeutic approaches in SMR remains controversial. A literature search was conducted through PubMed and Embase databases to identify relevant studies addressing the pathophysiological background for papillary muscle maneuvers in SMR and currently available surgical techniques. Furthermore, the studies evaluating patients' selection criteria for papillary muscle maneuvers were specifically considered. Articles were selected based on quality and relevance. Over the last two decades, papillary muscle maneuvers have evolved as a pathophysiology-based treatment strategy to address left ventricular (LV) remodeling in SMR. In particular, patients with severe leaflet tenting and moderate heart failure phenotype seem to benefit most from papillary muscle maneuvers that improve LV geometry and thereby the durability of MV repair. We conclude that papillary muscle maneuvers are an evolving pathophysiology-based treatment strategy of ventricular SMR which target papillary muscle displacement due to LV remodeling.

Durability of annuloplasty in patients with atrial functional mitral regurgitation associated with atrial fibrillation

ObjectiveTo determine the durability of mitral valve repair (MVr) with complete ring or flexible band annuloplasty in patients with atrial functional mitral regurgitation (AFMR) due to atrial fibrillation (AF) and identify risk factors associated with postoperative recurrence of mitral regurgitation. MethodsBetween January 1, 2000, and January 1, 2023, 194 adults with a history of AF underwent MVr with annuloplasty alone for moderate/severe AFMR. Exclusion criteria were prior cardiac surgery, additional repair techniques, ejection fraction <45%, ischemic heart disease, aortic valve disease, mitral annular calcification, and concomitant procedures other than surgical ablation or tricuspid repair/replacement. The durability of annuloplasty was assessed using longitudinal analysis of postoperative echocardiographic data. ResultsComplete ring annuloplasty was performed in 126 of 194 patients (65%); partial ring (posterior band) in the other 68 (35%). Concomitantly, 124 of the 194 patients underwent tricuspid valve surgery, and 173 (89%) had a procedure for AF, including biatrial Cox-Maze III/IV lesion set in 152 (88%) and pulmonary vein isolation in 21 (12%). All patients were discharged with no/trace MR. Freedom from moderate/severe MR after repair with annuloplasty alone was 89% at 10 years, and no significant differences were noted between complete and partial ring annuloplasty (early, P = .41; late, P = .92). Forty-eight percent of patients developed AF at 3 months or longer after surgery, and the presence of postoperative AF was not associated with a greater likelihood of recurrence of MR (P = .15). Freedom from mitral reintervention was 96% at 10 years. ConclusionsIn appropriate patients with AFMR, the long-term durability of annuloplasty is excellent with complete ring and posterior band annuloplasty techniques.

Outcomes of Leaflet Resection vs Chordal Replacement for Degenerative Mitral Regurgitation

BackgroundDebate persists regarding the outcomes of leaflet resection (RESECT) vs chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the RESECT vs CHORD techniques for degenerative mitral regurgitation. MethodsA total of 1066 consecutive patients undergoing mitral repair for degenerative regurgitation with the RESECT vs CHORD techniques were evaluated from a prospectively maintained database. Propensity score matching was used to compare outcomes in RESECT vs CHORD repairs. ResultsPatients who underwent CHORD had later operative dates, more flail leaflet, and more anterior leaflet disease. With the switch to predominant use of the CHORD technique in 2010, the percentage of repair for all degenerative valves improved significantly from 83% to 91% (P = .002). A total of 467 patients were matched for baseline characteristics. Patients in the CHORD group had larger rings (34 mm vs 32 mm; P < .001) and greater use of an Alfieri stitch (66% vs 22%; P < .001) in matched patients. The 10-year survival was similar for matched patients (RESECT vs CHORD, 86% ± 3% vs 84% ± 4%; P = .5).Patients in the RESECT group had a lower 10-year cumulative incidence of mitral reoperation (RESECT vs CHORD, 1% ± 1% vs 8% ± 3%; P = .002) and severe mitral regurgitation (RESECT vs CHORD, 1% ± 1% vs 9% ± 5%; P = .05) compared with matched patients in the CHORD group. The late ejection fraction and mitral gradient were not different between the 2 groups in matched patients, respectively (P = .9 and P = .2, respectively). ConclusionsThe use of the CHORD technique for degenerative mitral regurgitation increased the repair rates, but the CHORD technique had slightly lower repair durability at 10 years compared with the RESECT technique. These results could be related to more complex disease in CHORD group.

Poster 193: Long-Term Outcomes of Partial Proximal Hamstring Avulsion Repair: Average 10-Year Follow-Up

Objectives: While a growing body of literature supports the benefit of surgical repair of complete proximal hamstring avulsions involving all 3 tendons, the optimal treatment for partial proximal hamstring avulsions remains uncertain. Initial nonoperative management of partial proximal hamstring avulsions is typically recommended, but several recent studies have shown improved pain and function at short- and mid-term follow-up. However, the durability of surgical repair at long-term follow-up is unknown. The purpose of this study was to report the long-term outcomes of partial proximal hamstring avulsion repair compared to outcomes at midterm follow-up. It was hypothesized that hamstring function and patient satisfaction would remain stable over time. Methods: All patients who underwent surgical repair of a partial proximal hamstring avulsion by a single surgeon between 2006 and 2018 with a minimum 5-year follow-up were included. Institutional review board approval was obtained prior to study initiation, and all patients signed informed consent. Exclusion criteria were complete avulsions involving all 3 hamstring tendons, retraction &gt; 2 cm, or magnetic resonance imaging (MRI) findings of isolated tendinopathy. All patients had first attempted nonoperative treatment, including nonsteroidal anti-inflammatory drugs and physical therapy. Patient characteristics were collected including age, sex, injury, laterality, sports played, level of participation, length of time from injury to intervention, and length of follow-up. Patients completed a HIPPA-compliant online questionnaire (REDCap) containing the patient-reported outcomes scores of the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS (%), and custom Marx (%). A Total Proximal Hamstring Score was calculated by averaging the custom Marx score and the custom LEFS. Patient satisfaction with surgical outcome (yes/no) was also determined. A portion of the included patients had the same outcome measures available from a previous study entailing a minimum 2-year follow-up, with an average follow-up of 6.2 years. Paired comparisons of current outcome scores with earlier scores were performed using a paired Mann-Whitney U test for continuous variables and Fisher exact test for categorical variables. Results: Fifty-three patients (57 hamstrings) with a mean age at surgery of 47.4 years were included at an average follow-up time of 10.1 years. Of the 53 patients, 4 had bilateral injuries and 4 underwent revision surgery. The right (n = 29) and left (n = 28) hamstrings were equally affected with a predominance of female patients (41 female, 16 male). Running was the most common sport at the time of injury (Table 1). Excellent functional outcomes were seen at average 10.1 years (Table 2). 91.2% of patients were satisfied with the results of surgery and were able to return to their desired sport at an average of 10.9 months after surgery. Nearly 88% of hamstrings considered their strength to be &gt;75% strength of the contralateral side, with approximately 58% of hamstrings reporting equal (100%) strength. When comparing the 44 partial hamstring repairs with outcome scores available at both midterm (6.2 years) and long-term follow-up (10.7 years), only the Marx and custom Marx scores were found to decline with time. Scores for LEFS, custom LEFS, Total Proximal Hamstring, satisfaction, and subjective strength were unchanged between midterm and long-term follow-up (Table 3). Conclusions: Excellent patient-reported outcomes and high levels of satisfaction were found at 10-year follow-up following partial proximal hamstring avulsion repair. Notably, the LEFS and custom LEFS, which are the most common patient-reported outcome measures used to assess hamstring function following injury, remained high at midterm and long-term follow-up. The Marx (12.5 vs. 8.5) and custom Marx scores (100% vs. 94%) did achieve statistically significant differences between time points, with lower scores at long-term follow-up possibly in part due to self-determined reduction in strenuous activities with aging. Patient-reported satisfaction and subjective strength remained high at long-term follow-up. Surgical repair of partial proximal hamstring avulsions remains a successful and durable treatment strategy in active patients who have failed nonoperative measures at an average follow-up exceeding 10 years.

Durability enhancement of cement-based repair mortars through waterborne polyurethane modification: Experimental characterization and molecular dynamics simulations

With the rapid development of society and economy, more and more concrete structures are facing severe damage and deterioration, requiring repair. However, traditional cement repair materials generally suffer from brittleness, poor durability, and other deficiencies, failing to meet the demands for durable repair materials. In this study, we designed and synthesized an anionic waterborne polyurethane (WPU) emulsion for cement-based materials, characterized its performance, and applied it to modify cement mortars, evaluating the durability of the WPU-modified cement composite repair materials. The experimental results showed that the cured WPU exhibited good radiation resistance, tensile properties, and alkali resistance, and the WPU emulsion demonstrated good compatibility with cement mortars. The WPU-modified cement mortars exhibited improved resistance to drying shrinkage, thermal expansion, freeze-thaw cycles, and water penetration, with increasing WPU content further enhancing the durability of mortar. Simultaneously, the organic-inorganic phase distribution and microstructure of the WPU-modified cement-based composites were investigated. WPU can interact with the cement paste, forming an interpenetrating network structure and increasing the material's density. Finally, molecular dynamics simulations were employed to study the adsorption behavior of WPU on calcium silicate hydrate (CSH) and the transport of water molecules in WPU-modified CSH nanopores. The study found that WPU spontaneously adsorbed onto the CSH surface through hydrogen bonding and weakened the transport efficiency of water molecules in CSH nanopores. Overall, the WPU modification enhanced the density and durability of the cement repair mortars, and the MD method provided molecular-scale insights into the improved water penetration resistance. This study hopes to aid in the design and practical application of polymer-modified cement-based repair materials.

Durable Self-Cleaning Radiative Cooling Coatings for Building Energy Efficiency.

Passive daytime radiative cooling (PDRC) is an energy-saving technology without an additional energy supply or environmental pollution. At present, most PDRC coatings for buildings are only aiming at high solar reflectivity (RS) and high mid-infrared emissivity (EMIR) while ignoring practicalities such as adhesion strength, scalability, and durability. In this work, modified calcined kaolin/(ethylene trifluorochloroethylene copolymer-polydimethylsiloxane) (MK/(FEVE-PDMS)) coating with super practicability is prepared by using MK as a filler, FEVE as an adhesive, and PDMS as a hydrophobic modifier. The RS and EMIR of the coating are 92.5 and 94.6%, respectively. The MK/(FEVE-PDMS) coating exhibits superhydrophobicity, with an advancing contact angle (ACA) of 160.2° and a hysteresis contact angle of 7.3°. At an average solar irradiance of 742.78 W m-2, the coating achieved a temperature drop of 13.12 °C (shielded with PE film) and 3.09 °C (without shielding), respectively, relative to the environment. The coating adheres firmly to the substrate with an adhesion strength of class 2. The superhydrophobicity of the coating provides excellent durability and ease of repair, which can resist UV aging and mechanical damage. The durable superhydrophobicity gives the coating long-term stability in PDRC performance. Additionally, the cheap raw materials and the preparation process, consistent with the production of existing paints, show excellent scalability. Moreover, the energy consumption simulation results show that the energy saving ratio of the coating is more than 10% in the densely populated Yangtze River Delta and Pearl River Delta. The durable self-cleaning radiative coating developed in this work has potential application prospects in areas where the demand for cooling in summer is large and the demand for heating in winter is small.

Open Retromuscular Sugarbaker vs Keyhole Mesh Placement for Parastomal Hernia Repair

Durable parastomal hernia repair remains elusive. There is limited evidence comparing the durability of the open retromuscular Sugarbaker and keyhole mesh configurations. To determine if the open retromuscular Sugarbaker mesh placement technique would lower parastomal hernia recurrence rates. In this single-center, randomized clinical trial, 150 patients with a permanent stoma and associated parastomal hernia who were candidates for open retromuscular parastomal hernia repair were enrolled and randomized from April 2019 to April 2022 and followed up for 2 years. Following intraoperative assessment to determine the feasibility of either technique, enrolled patients were randomized to receive either retromuscular Sugarbaker or keyhole synthetic mesh placement. The primary outcome was parastomal hernia recurrence at 2 years. Secondary outcomes included mesh-related complications, wound complications, reoperations, as well as patient-reported pain, abdominal wall-specific quality of life, stoma-specific quality of life, and decision regret at 1 year and 2 years. A total of 150 patients were randomized, and with 91% follow-up at 2 years, there were 13 (17%) parastomal hernia recurrences in the retromuscular Sugarbaker arm and 18 (24%) in the keyhole arm (adjusted risk difference, -0.029; 95% CI, -0.17 to 0.153, and adjusted risk ratio, 0.87; 95% CI, 0.42 to 1.69). There were no statistically significant differences between the Sugarbaker and keyhole groups regarding reoperations for recurrence (2 vs 7, respectively), nonhernia intra-abdominal pathology (4 vs 10, respectively), stoma necrosis (1 vs 0, respectively), mesh-related complications (4 vs 1, respectively), patient-reported pain, abdominal wall-specific quality of life, stoma-specific quality of life, and decision regret at any time point. In the setting of open parastomal hernia repair, a retromuscular Sugarbaker mesh placement technique was not superior to a keyhole configuration 2 years after repair. Further innovation is necessary to improve parastomal hernia repair outcomes. ClinicalTrials.gov Identifier: NCT03972553.