Instrumentation Failure Research Articles

Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study

BackgroundOsteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis.MethodsThis prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann–Whitney and the Rank Wilcoxson tests using Stata version 17 software.ResultsThe mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37).ConclusionThis study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.

Multiphysics calculation of fuses of medium voltage measuring transformers

Introduction. In the medium voltage power grid of 6-35 kV, there is a problem of protecting voltage instrument transformers. This is due to the insufficiently effective level of their protection with fuses. Recently, there have been more and more reports of accidents associated with the failure of voltage instrument transformers not only in Ukraine, but also abroad. The issue of conducting an analytical study of the problem of protection of medium voltage instrument transformers by fuses is relevant. Goal. Investigation of designs and characteristics of fuses for medium voltage instrument transformers to improve the efficiency of their protection. Results. The article shows that protection of medium voltage instrument transformers with epoxy insulation is often provided by fuses, in which the nominal current of the combustion insert is significantly higher than the maximum permissible long-term current of the primary winding of the instrument transformer. A comparative analysis of the current values of the primary winding of medium voltage instrument transformers with the values of the nominal currents of the fusing inserts of fuses of various manufacturers presented on the Ukrainian market is carried out. The design features and technical characteristics of fuses for medium voltage instrument transformers have been investigated in order to increase the efficiency of their protection. The advantages and disadvantages of the designs of fuses from various manufacturers have been investigated and it has been established that the design of fuses requires further improvement in order to increase the efficiency of protection of medium voltage instrument transformers. Discussion and prospects for further development. Since in Ukraine, the need for fuses to protect medium voltage instrument transformers is provided mainly by supplies abroad, a promising direction for further development in this direction is the creation of a domestic competitive design of a fuse and its introduction into production.

Metastasis of spine from adenoid cystic carcinoma of the parotid gland: two case reports

BackgroundSpinal metastasis from adenoid cystic carcinoma of the salivary gland is extremely rare. We present two interesting cases of spinal metastasis from adenoid cystic carcinoma of the parotid gland.Case summaryA 29-year-old Persian male and a 48-year-old Persian female presented with parotid gland mass. The two patients received parotidectomy and radiotherapy. The pathological examination result was adenoid cystic carcinoma. Because of intractable back pain, patients were referred to the hospital after 7 years and 9 months, respectively. Both cases underwent spinal surgery. Histopathology confirmed spinal metastasis from adenoid cystic carcinoma of the parotid gland (case 1: T6, T12, and L1; case 2: T12). Anterior corpectomy of T12 and lateral screw fixation at T11 and L1 were done in case 2. Posterior spinal fusions from T2 to L3 and from T10 to L2 were performed in case 1 and case 2, respectively. Both patients showed good clinical improvement. The last follow-up (case 1: 24 months; case 2: 6 months after surgery), plain radiographs and computed tomography scan showed good fusion without instrumental failure and magnetic resonance imaging revealed good decompression of the spinal cord of both cases.ConclusionAlthough spinal metastasis from adenoid cystic carcinoma of the parotid gland is extremely rare, it is necessary to be careful in the differential diagnosis.

A smart coating with integrated physical antimicrobial and strain-mapping functionalities for orthopedic implants.

The prevalence of orthopedic implants is increasing with an aging population. These patients are vulnerable to risks from periprosthetic infections and instrument failures. Here, we present a dual-functional smart polymer foil coating compatible with commercial orthopedic implants to address both septic and aseptic failures. Its outer surface features optimum bioinspired mechano-bactericidal nanostructures, capable of killing a wide spectrum of attached pathogens through a physical process to reduce the risk of bacterial infection, without directly releasing any chemicals or harming mammalian cells. On its inner surface in contact with the implant, an array of strain gauges with multiplexing transistors, built on single-crystalline silicon nanomembranes, is incorporated to map the strain experienced by the implant with high sensitivity and spatial resolution, providing information about bone-implant biomechanics for early diagnosis to minimize the probability of catastrophic instrument failures. Their multimodal functionalities, performance, biocompatibility, and stability are authenticated in sheep posterolateral fusion model and rodent implant infection model.

Mechanical complications and patient-reported outcome measures associated with high pelvic incidence and persistent pelvic retroversion: the Roussouly "false type 2" profile.

The objective of this paper was to report mechanical complications and patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) patients with a Roussouly "false type 2" (FT2) profile. ASD patients treated from 2004 to 2014 at a single center were identified. Inclusion criteria were pelvic incidence ≥ 60° and a minimum 2-year follow-up. FT2 was defined as a high postoperative pelvic tilt (PT), as defined by the Global Alignment and Proportion target, and thoracic kyphosis < 30°. Mechanical complications, defined as proximal junctional kyphosis (PJK) and/or instrumentation failure, were determined and compared. Scoliosis Research Society-22r (SRS-22r) scores were compared between groups. Ninety-five patients (normal PT [NPT] group 49, FT2 group 46) who met the inclusion criteria were identified and studied. Most surgeries were revisions (NPT group 30 [61%], FT2 group 30 [65%]), and most were performed via a posterior-only approach (86%) (mean ± SD 9.6 ± 5 levels). Proximal junctional angles increased after surgery in both groups, without differences between groups. Neither rates of radiographic PJK (p = 0.10), revision for PJK (p = 0.45), nor revision for pseudarthrosis (p = 0.66) were different between groups. There were no differences between groups for SRS-22r domain scores or subscores. In this single-center experience, patients with high pelvic incidence fixed with persistent lumbopelvic parameter mismatch and engaged compensatory mechanisms (Roussouly FT2) had mechanical complications and PROMs not different from those with normalized alignment parameters. Compensatory PT may be acceptable in some cases of ASD surgery.

IoT Based Health Monitoring System using Blynk App

Abstract: Internet of Things (IoT) based remote health monitoring system have an expansive potential of becoming an integral part of the future medical system. In particular, these systems can play life-saving roles for monitoring of patients with critical health issues. Any health care monitoring system must be free from incorrect data, which may arise because of instrument failure or communication errors. In this project, to detect reliability and accuracy of data obtained by the IoT-based remote health monitoring.

Bone microstructure and volumetric bone mineral density in patients with global sagittal malalignment.

Sagittal spinal malalignment often leads to surgical realignment, which is associated with major complications. Low bone mineral density (BMD) and impaired bone microstructure are risk factors for instrumentation failure. This study aims to demonstrate differences in volumetric BMD and bone microstructure between normal and pathological sagittal alignment and to determine the relationships among vBMD, microstructure, sagittal spinal and spinopelvic alignment. A retrospective, cross-sectional study of patients who underwent lumbar fusion for degeneration was conducted. The vBMD of the lumbar spine was assessed by quantitative computed tomography. Bone biopsies were evaluated using microcomputed tomography (μCT). C7-S1 sagittal vertical axis (SVA; ≥ 50mm malalignment) and spinopelvic alignment were measured. Univariate and multivariable linear regression analysis evaluated associations among the alignment, vBMD and μCT parameters. A total of 172 patients (55.8% female, 63.3years, BMI 29.7kg/m2, 43.0% with malalignment) including N = 106 bone biopsies were analyzed. The vBMD at levels L1, L2, L3 and L4 and the trabecular bone (BV) and total volume (TV) were significantly lower in the malalignment group. SVA was significantly correlated with vBMD at L1-L4 (ρ = -0.300, p < 0.001), BV (ρ = - 0.319, p = 0.006) and TV (ρ = - 0.276, p = 0.018). Significant associations were found between PT and L1-L4 vBMD (ρ = - 0.171, p = 0.029), PT and trabecular number (ρ = - 0.249, p = 0.032), PT and trabecular separation (ρ = 0.291, p = 0.012), and LL and trabecular thickness (ρ = 0.240, p = 0.017). In the multivariable analysis, a higher SVA was associated with lower vBMD (β = - 0.269; p = 0.002). Sagittal malalignment is associated with lower lumbar vBMD and trabecular microstructure. Lumbar vBMD was significantly lower in patients with malalignment. These findings warrant attention, as malalignment patients may be at a higher risk of surgery-related complications due to impaired bone. Standardized preoperative assessment of vBMD may be advisable.

Lumbar Pedicle Morphometry of Dry Vertebral Columns in Relation to Transpedicular Fixation: A Cross-Sectional Study From Central India.

The lumbar vertebrae are the largest vertebrae of the vertebral column, which support the maximum body weight. There has been an increased focus on transpedicular spinal fixation for addressing various lumbar spine pathology. However, its safety and efficacy require precise knowledge of the lumbar pedicle anatomy. Mismatched size of screw and pedicle may lead to failure of instrumentation. It may result in cortex perforation or pedicle fracture and loosening of the pedicle screw. The oversizing of the pedicle screw can result in dural tears, leakage of the cerebrospinal fluid, and injuries to the nerve root. As the racial variations in the anatomy of a pedicle are well known, this study was performed to assess the morphological parameters of the lumbar vertebrae pedicles in the Central Indian population so that the appropriate sizes of pedicular implants can be selected. The present study was conducted at a tertiary-level hospital and medical college on dry lumbar vertebrae specimens available in the department of anatomy. The measurement of morphometric parameters of the lumbar vertebrae pedicles was performed in 20 dry lumbar specimens using vernier calipers and a standard goniometer. The morphometric parameters included in the study are pedicle transverse external diameter (pedicle width), pedicle sagittal external diameter (pedicle height), transverse angle of the pedicle, and sagittal angle of the pedicle.Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) system version 25 (Chicago, IL: SPSS Inc.). The broadest external transverse diameter was at the L5 level, with a mean of (17.54±1.6 mm) in the lumbar vertebrae. The broadest external sagittal pedicle diameter was at the L1 level (13.7±0.88 mm). The maximum transverse angle of the pedicle was at L5 with a mean of 25.39±3.10°. The maximum sagittal angle was at L1 with a mean of 5.44±0.71°. The increased concern regarding the internal fixation of the spine with pedicle screw systems created the need to have almost accurate anatomical knowledge of lumbar pedicles. Due to the dynamic nature of the lumbar spine and the body's load, maximum degeneration occurs at this spine segment, making it the most commonly operated region of the vertebral column. In our study, pedicle dimensions are comparable to populations of other Asian countries. However, the pedicle dimension of our population is lower than the White American population. This morphological variation of pedicle anatomy will help surgeons choose appropriate size screws and optimum angulations to insert the implant, decreasing complications.

Multi-physics simulation of 3D in-flight ice-shedding

In-flight ice accretion may possibly jeopardize the safety of fixed- and rotary-wing aircraft. Icing can possibly occur if supercooled water droplets in clouds impinge on the aircraft surfaces and freeze upon impact. It may result in instrument failures and degradation of the aerodynamic performances. A major problem related to ice accretion is the possibility of ice shedding from the main body and impacting other parts of the aircraft or being ingested by the engines. In fixed-wing aircraft, shedding is caused by the action of the aerodynamic forces or the activation of an Ice Protection System. In the present work, a multi-physics framework is presented to simulate ice accretion and shedding from wings and engine nacelles. The aerodynamics is computed using the open-source toolkit SU2 (Economon et al., 2015)[1] . Cloud droplet trajectories are computed using the arbitrary-precision Lagrangian in-house solver PoliDrop. Then, the in-house ice accretion toolkit PoliMIce (Gori et al., 2015) is used to determine the ice layer. An algebraic level-set approach with iterative volume mesh refinement has been developed to extract the ice shape from the iced wing geometry. A FEM structural analysis is performed on the accreted ice shape by means of the open-source code MoFEM (Kaczmarczyk et al., 2014, 2020) [2]. Internal stresses within the ice geometry due to aerodynamic forces are computed. Three-dimensional ice accretion simulations are performed to check the validity of the present approach.

Long-term results comparison after anterior cervical discectomy with BGS-7 spacer (NOVOMAX®-C) and allograft spacer: A prospective observational study.

Introduction: In an anterior cervical discectomy and fusion (ACDF), various types of graft materials including autograft, allograft, and synthetic graft have been used to achieve adequate spinal fusion. Allograft spacer is mainly used in cervical fusion, especially in the anterior approach. The synthetic bone graft material BGS-7(CaO-SiO2-P2O5-B2O3, bioactive Glass-Ceramics) can bind with surrounding bone tissue by forming a hydroxyapatite layer bone bridge, leading to faster graft osseointegration. This study was conducted to compare long-term clinical outcome of BGS-7 spacer and allograft spacer for anterior cervical discectomy and fusion surgery. Materials and Methods: From September 2014 to December 2016, Consecutive anterior cervical discectomy and fusion surgeries using a BGS-7 spacer (N = 18) and Allograft spacer (N = 26) were compared for postoperative clinical outcomes. Radiologic assessments were performed, and Instrumental failure, including breakage, cage migration, subsidence were observed and Fusion status were analyzed. Finite element analysis was performed for simulating mechanical stress between the vertebral body and implant. Clinical outcomes were evaluated using neck VAS, NDI, and JOA on the patient's final follow-up visits. Results: Among the 44 patients who underwent an anterior cervical discectomy and fusion surgery using the BGS-7 spacer and Allograft spacer, there were 30 men and 14 women. The average age at the operation was 47.69 ± 10.49 in allograft spacer and 51.67 ± 11.03 in BGS-7 spacer. The mean follow-up period was 89.18 ± 5.44months. Twenty three (88.46%) patients in allograft spacer and 20(100%) patients in BGS-7 spacer were demonstrated radiologic evidence of interbody fusion in last OPD, which accounts for fusion grade 4 or 5. Peak stresses were 343.85MPa in allograft spacer, and 132.55MPa in BGS-7 spacer. Long-term clinical outcomes including neck VAS, NDI, and JOA didn't show statistical differences between the two groups. There were no adverse events related to the BGS-7 spacer.10.3389/fbioe.2023.110046. Conclusion: The BGS-7 spacer demonstrated reliability as a spacer in anterior cervical discectomy and fusionF surgery without instrumental failure. Early stabilization with a bony bridge formation was observed at the intermediate follow-up period, and the long-term clinical outcome was favorable at more than 60months after surgery without any adverse events. Thus, the BGS-7 spacer is a safe and effective alternative to the allograft spacer in anterior cervical discectomy and fusion surgery.

A comparative study of anomaly detection methods for gross error detection problems

The chemical industry requires highly accurate and reliable measurements to ensure smooth operation and effective monitoring of processing facilities. However, measured data inevitably contains errors from various sources. Traditionally in flow systems, data reconciliation through mass balancing is applied to reduce error by estimating balanced flows. However, this approach can only handle random errors. For non-random errors (called gross errors, GEs) which are caused by measurement bias, instrument failures, or process leaks, among others, this approach would return incorrect results. In recent years, many gross error detection (GED) methods have been proposed by the research community. It is recognised that the basic principle of GED is a special case of the detection of outliers (or anomalies) in data analytics. With the developments of Machine Learning (ML) research, patterns in the data can be discovered to provide effective detection of anomalous instances. In this paper, we present a comprehensive study of the application of ML-based Anomaly Detection methods (ADMs) in the GED context on a number of synthetic datasets and compare the results with several established GED approaches. We also perform data transformation on the measurement data and compare its associated results to the original results, as well as investigate the effects of training size on the detection performance. One class Support Vector Machine outperformed other ADMs and five selected statistical tests for GED on Accuracy, F1 Score, and Overall Power while Interquartile Range (IQR) method obtained the best selectivity outcome among the top 6 AMDs and the five statistical tests. The results indicate that ADMs can potentially be applied to GED problems.

Effect of Celiac Disease on Outcomes After Posterior Lumbar Fusion: A Matched Cohort Study

The purpose of this study was to analyze if celiac disease (CD) is associated with increased postoperative complications following single-level posterior lumbar fusion (PLF). A retrospective database review was performed using the PearlDiver dataset. The study population included all patients older than 18years who underwent elective PLF with diagnosis of CD using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Study patients were compared with controls for 90-day medical complications and 2-year surgical complications including 5-year reoperation rates. A multivariate logistic regression was used to determine the independent effect of CD on the postoperative outcomes. A total of 909 patients with CD and 4483 patients in the matched control group who underwent primary single-level PLF were included in this study. CD patients had a significantly increased risk of 90-day emergency department (ED) visit (OR 1.28; P=0.020). CD patients also demonstrated higher rates of 2-year pseudarthrosis and instrument failure, but they were statistically comparable (P>0.05). There was no difference in 5-year reoperation rate. There were also no significant differences in 90-day medical complication rate and 2-year surgical complication rate between the two groups. In addition, there were no differences in procedure cost and 90-day cost. For CD patients undergoing PLF, the current study demonstrated increased rate of 90-day ED visit. Our findings may be useful for patient counseling and surgical planning for those with this condition.

Trabecular Bone Remodeling After Posterior Lumbar Interbody Fusion: Comparison of Three-Dimensional Porous Tantalum and Titanium-Coated Polyetheretherketone Interbody Cages.

Retrospective cohort study. The criteria for determining completion of intervertebral stability after posterior lumbar interbody fusion (PLIF) remain controversial. Several new radiological indicators of bone growth and osteointegration have been established. We compared computed tomography (CT) findings related to osteointegration after PLIF with interbody cages of two different materials and designs. We retrospectively analyzed data from 103 patients who underwent PLIF with three-dimensional porous tantalum (Tn) cages or titanium-coated polyetheretherketone (TiP) cages. CT images obtained 3months and 1year after surgery were examined for trabecular bone remodeling (TBR), cancellous condensation (CC), and vertebral endplate cyst (VEC) formation. The incidences of each finding were compared by cage type, and rates of instrument failure and pseudarthrosis were determined. Three months postoperatively, 87% of the levels with Tn cages exhibited TBR, whereas 96% of those with TiP cages did not (P < .001). Most levels with Tn cages levels exhibited TBR and no CC 3months (81%) and 1 year (94%) after surgery. Although 78% of levels with TiP cages exhibited CC and no TBR 3months after surgery, 59% exhibited both CC and TBR 1 year after surgery. Significantly fewer VECs formed around the Tn cages than around the TiP cages both 3months (P = .002) and 1year (P < .001) after surgery. Implant-related problems occurred at levels that exhibited neither TBR nor CC. The porous tantalum cage may enable intervertebral stability that is comparable to bony fusion soon after surgery.

Put Down the Tin: Chewing Tobacco Use Is Associated With Worse Outcomes After Primary Lumbar Fusion.

Retrospective study. This study evaluated the impact of chewing tobacco on both medical and spine-related complication rates after spinal lumbar fusions in comparison to both a control cohort and a smoking cohort. Smoking is a prevalent modifiable risk factor that has been demonstrated to be associated with increased complications after lumbar fusion. Although smoking rates have decreased in the United States, chewing tobacco use has not similarly reduced. Despite chewing tobacco delivering up to 4 times the dose of smoking, the impact of chewing tobacco is incompletely understood. A retrospective cohort study was conducted using the PearlDiver database. Patients who underwent lumbar spine fusion and used chewing tobacco were matched with a control cohort and a smoking cohort. Medical complications within 90 days after primary lumbar fusion were evaluated, including deep venous thrombosis, acute kidney injury, pulmonary embolism, transfusion, acute myocardial infarction, and inpatient readmission. Spine-related complications were evaluated at 2 years postoperatively, including pseudoarthrosis, incision and drainage (I&D), instrument failure, revision, and infection. After primary lumbar fusion, the chewing tobacco cohort demonstrated significantly higher rates of pseudoarthrosis [odds ratio (OR): 1.41], revision (OR: 1.57), and any spine-related complication (OR: 1.32) compared with controls. The smoking cohort demonstrated significantly higher rates of pseudoarthrosis (OR: 1.88), I&D (OR: 1.27), instrument failure (OR: 1.39), revision (OR: 1.54), infection (OR: 1.34), and any spine-related complication (OR: 1.77) compared with controls. The chewing tobacco cohort demonstrated significantly lower rates of pseudoarthrosis (OR: 0.84), I&D (OR: 0.49), infection (OR: 0.70), and any spine-related complication (OR: 0.81) compared with the smoking cohort. This study demonstrated that chewing tobacco is associated with higher rates of both spine-related and medical complications after primary lumbar fusion. However, chewing tobacco use is associated with less risk of complications compared with smoking. Level III.

Evaluation of Cyclic Fatigue and Torsional Strength of Three Different Thermally Treated Reciprocating Nickel-Titanium Instruments

Objectives. This article's objective was to assess the reciprocating single-file systems Reciproc Blue 25.08 and Pro design R 25.06's cyclic and torsion fatigue resistance. The systems Reciproc Blue R25 (RB #25.08 taper), Prodesign R (PDR #25.06 taper), and WaveOne Gold (WOG #25.07 taper) (n = 20) were utilized to make sixty reciprocating instruments. The period to breakdown in an artificial stainless-steel canal with a 60° angle of curvature and a 5-mm radius was measured during cyclic fatigue resistance testing (n = 10). The torque and angle of rotation at failure of new instruments (n = 10) were assessed during the torsional test (ISO 3630-1) in the area 3 mm from the tip. Scanning electron microscopy was also used to view each fragment's shattered surface (SEM). In addition, a supplementary examination was performed to measure the cross- sectional area of each instrument 3 and 5 mm from the tip. The data were analyzed using one-way ANOVA and Tukey’s test, and the level of significance was set at 5%. Cycle Fatigue Resistance scores for PDR 25.06 were much higher (P 0.05). Both WOG 25.07 and RB 25.08 showed less resistance to fatigue (P 0.05). Based on the torsional analysis, PDR 25.06 had weaker torsional strength (P 0.05). No changes were found with RB 25.08 and WOG 25.07 (P &gt; 0.05). PDR 25.06 showed higher angular rotation values than RB 25.08 and WOG 25.07. (P 0.05). Greater angular rotation was seen in both WOG 25.07 and RB 25.08. (P 0.05). The cross-sectional area analysis revealed that PDR 25.06 had the smallest cross-sectional areas at 3 and 5 mm from the tip (P 0.05). In comparison to RB 25.08 and WOG 25.07, PDR 25.06 had the highest cyclic fatigue resistance and angular rotation until fracture. Additionally, torsional strength was higher in RB 25.08 and WOG 25.07 than PDR 25.06. Clinical applicability in endodontic practise, reciprocating instruments that have undergone thermal treatment are used to prepare the root canals of canals that are curved and constrained; as a result, these instruments must exhibit high flexibility and suitable torsional strength to reduce the risk of instrument deformation.

The Cyclic Fatigue Resistance of Different Lengths of CM Gold Wire and CM Blue Wire NiTi Alloy Endodontic Rotary Files: An In Vitro Study

Background: The objective of the present study was to measure and compare how the length of CM Gold Wire and CM Blue Wire NiTi alloy endodontic rotary files impacts their resistance to cyclic fatigue. Methods: A total of 40 sterile endodontic rotary files were chosen and allocated to the following study groups: (A) 25.06 CM Gold wire NiTi alloy endodontic rotary files, 31 mm in length (n = 10); (B) 25.06 CM Gold wire NiTi alloy endodontic rotary files, 25 mm in length (n = 10); (C) 25.06 CM Gold wire NiTi alloy endodontic rotary files, 21 mm in length (n = 10); and (D) 25.06 CM Blue wire NiTi alloy endodontic rotary files, 17 mm in length (n = 10). A specialized device was designed using artificial root canal systems made from stainless steel for the dynamic cyclic fatigue tests, with an apical diameter of 250 µm, curvature angle of 60°, radius of curvature of 5 mm, lengths of 31, 25, 21, and 17 mm, and a 6% taper. An individual operator determined failure of the endodontic rotary instrument through direct observation and the tests were filmed so as to precisely measure the exact time to failure. The results were analyzed using ANOVA and Weibull statistical analysis. Results: The results found statistically significant differences across all study groups (p &lt; 0.05). Conclusions: Rotary file length is inversely proportional to the cyclic fatigue resistance of the 25.06 CM Gold wire NiTi alloy at 31 mm, 25 mm, and 21 mm in length and of the 25.06 CM Blue wire NiTi alloy 17 mm length endodontic rotary files, with a greater length contributing to lower resistance to cyclic fatigue.

High Failure Rates in Prisoners Undergoing Spine Fusion Surgery.

The medical literature on prisoner health care is limited, despite data showing that prisoners experience high rates of physical and mental health challenges. We compared clinical outcomes for prisoners undergoing spine fusion with comparable nonincarcerated patients and determined what factors were implicated in differences in outcomes. Prisoners who underwent spinal fusion in 2011-2021 were retrospectively compared with an age-, sex-, and procedure-matched 3:1 control group of nonincarcerated spinal fusion patients. Fusion failure was confirmed by lack of bridging bone between vertebrae on CT or radiographic images >1year postoperatively or evidence of instrumentation failure with resultant >2mm of translation on flexion/extension radiographs. Twenty-seven identified prisoners were compared with 81 nonincarcerated controls. Ten prisoners and 6 controls experienced nonunion (37% vs. 7%, P < 0.01). Rates of risk factors for nonunion, such as smoking history, elevated body mass index, chronic steroid use, diabetes mellitus, previous spine surgery, and levels fused, were not significantly different between prisoners and controls. Among prisoners, those with nonunion were younger (45 vs. 53years, P= 0.03), had greater body mass index (34 vs. 29, P= 0.02), and were more likely to undergo reoperation (30% vs. 0%, P= 0.02). Multivariate analysis revealed that prisoners carry a 9.62 increased odds of nonunion compared with controls. This is one of few studies investigating health care outcomes in prisoners. We found they had a significantly higher rate of nonunion than matched control patients from the general population treated at the same hospital, suggesting additional measures may be necessary postoperatively to support fusion in prisoners.

Appraisal of Intraoperative Adverse Events to Improve Postoperative Care.

Intraoperative adverse events (iAEs) are associated with adverse postoperative outcomes and cause a significant healthcare burden. However, a critical appraisal of iAEs is lacking. Considering the details of iAEs could benefit postoperative care. We comprehensively analyzed iAEs in a large series including all types of operations and their relation to postoperative complications. All patients enrolled in the multicenter ClassIntra® validation study (NCT03009929) were included in this analysis. The surgical and anesthesia team prospectively recorded all iAEs. Two researchers, blinded to each other's ratings, appraised all recorded iAEs according to their origin into four categories: surgery, anesthesia, organization, or other, including subcategories such as organ injury, arrhythmia, or instrument failure. They further descriptively analyzed subcategories of all iAEs. Postoperative complications were assessed using the Comprehensive Complication Index (CCI®), a weighted sum of all postoperative complications according to the Clavien-Dindo classification. The association of iAE origins in addition to the severity grade of ClassIntra® on CCI® was assessed with a multivariable mixed-effects generalized linear regression analysis. Of 2520 included patients, 778 iAEs were recorded in 610 patients. The origin was surgical in 420 (54%), anesthesia in 283 (36%), organizational in 34 (4%), and other in 41 (5%) events. Bleeding (n = 217, 28%), hypotension (n = 118, 15%), and organ injury (n = 98, 13%) were the three most frequent subcategories in surgery and anesthesia, respectively. In the multivariable mixed-effect analysis, no significant association between the origin and CCI® was observed. Analyzing the type and origin of an iAE offers individualized and contextualized information. This detailed descriptive information can be used for targeted surveillance of intra- and postoperative care, even though the overall predictive value for postoperative events was not improved by adding the origin in addition to the severity grade.

Design of Fine Life Cycle Prediction System for Failure of Medical Equipment

The inquiry process of traditional medical equipment maintenance management is complicated, which seriously affects the efficiency and accuracy of medical equipment maintenance management, and causes a lot of waste of manpower and materials. In order to accurately predict the failure of medical equipment, an accurate prediction system for failure life cycle of medical equipment was designed. The system is divided into four modules: the whole life cycle management module constructs the life cycle data set of medical devices from the three parts of the management in the early stage, the middle and the later stage; the status detection module monitors the main operation data of the medical device components through the normal value of the relevant sensitive data in the whole life cycle management module; the main function of the fault diagnosis module is based on the medical equipment whole life cycle management module. The operation data of equipment is diagnosed by inference machine; the fault prediction module builds a fine prediction system based on least square support vector machine algorithm, and uses AFS ABC algorithm to optimize the model to obtain the optimal model with the regularized parameters and width parameters, and the optimal model is used to predict the medical equipment failure. In order to verify the effectiveness of the design system, comparative experiments are designed to verify. The results show that the designed system can accurately predict the failure of electrocardiogram diagnostic instrument and incubator, and has high support and reliability. Compared with the comparison system, the prediction error of the design system is the smallest and the program running time is the shortest. Therefore, the design system can accurately predict the different failure types and causes of medical devices.&#x0D;

Development of autonomous downhole vibration measuring equipment

Background. Drilling vibrations may cause damage to the bit and early failure of downhole instruments. The main approach to solving this problem consists in measuring downhole vibrations while drilling by adding sensors near the bit in to the bottom hole assembly (BHA). When drilling vibrations are registered, measures are taken to avoid their reaching the critical values. If necessary the drilling stoops and the section is worked out to avoid accidents due to the high critical values. Not always drilling companies add such sensors to the BHA due to high price of the equipment. Constant problems with vibrations while drilling, require the creation of domestic low-cost autonomous equipment for measuring downhole vibrations and transmitting respective signals to the surface.Aim. To develop domestic low-cost autonomous downhole vibration measuring equipment.Materials and methods. Analysis of the experimental studies on drilling vibrations. Development technical solution such as domestic low-cost autonomous equipment for measuring downhole vibrations.Results. The problem of drilling vibrations can be controlled by downhole measuring equipment located in the vicinity of the bit. The device under development is presented in the article.Conclusion. In order to achieve maximum economic efficiency and avoid the costs of eliminating the consequences of vibrations, domestic low-cost autonomous downhole vibration measuring equipment should be developed to register torsional and longitudinal vibrations.