Repair Rate Research Articles

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Case series; Level of evidence, 4. A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Management of bone loss in anterior shoulder instability.

Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.

Among-individual differences in risk-taking behavior are associated with shell repair rate but not growth in a marine gastropod

Among-individual differences in risk-taking behavior are associated with shell repair rate but not growth in a marine gastropod

Arthroscopic subscapularis augmentation of the classic Bankart repair leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss.

The long-term failure rate of the arthroscopic Bankart repair may reach unacceptable values, raising the need to augment this classic procedure. Arthroscopic subscapularis augmentation is the tenodesis of the upper part of the subscapularis tendon to the anterior glenoid rim. The aim of the study was to evaluate the mid-term clinical and functional outcomes of patients operated with arthroscopic subscapularis augmentation of the classic Bankart repair due to recurrent anterior shoulder instability. This is a retrospective single-centre case series study with prospectively collected data. All patients suffered from recurrent anterior shoulder instability and had glenoid bone loss less than 13.5% of the inferior glenoid diameter (subcritical glenoid bone loss). Patients with greater anterior glenoid bone defect, engaging Hill-Sachs lesions, multidirectional instability or subscapularis insufficiency were excluded. Postoperatively, all patients were evaluated for recurrence and apprehension. The patient's shoulder range of motion and functional scores were recorded. The final study cohort included 34 patients with a mean age of 29.3 ± 10.2 years. The mean follow-up period was 42.4 ± 10.7 months (range, 24-62 months). Two out of 34 patients (5.8%) experienced a re-dislocation postoperatively, while one additional patient had a subjective feeling of apprehension. External rotation at the last follow-up was lower compared to preoperative values or the healthy side, but only one patient had restrictions in his sporting activities. The functional scores were significantly increased compared to the preoperative values. Twenty-two out of 26 patients (84.6%) returned to the same level of sporting activities, and 30/34 patients (88.2%) were highly satisfied with the results. Arthroscopic subscapularis augmentation of the classic Bankart repair reduces the dislocation recurrence rate and leads to satisfactory clinical and functional mid-term outcomes in patients with recurrent anterior shoulder instability and less than a subcritical glenoid bone loss. Level IV.

Biliverdin improved angiogenesis and suppressed apoptosis via PI3K/Akt-mediated Nrf2 antioxidant system to promote ischemic flap survival

Plastic and reconstructive surgeons frequently utilize random skin flap transplantation to repair skin defects. However, the procedure carries a substantial risk of necrosis. Previous research has suggested that Biliverdin (Bv), the main component of Calculus Bovis, possessed potent anti-ischemic properties, making it a potential therapeutic agent for skin flap survival. Hence, in this study, the potential of Bv in promoting flap survival has been comprehensively investigated. Network pharmacology analysis revealed that the pharmacological effects of Bv on ischemic diseases may be attributed to its modulation of various signaling molecules, including the PI3K-Akt pathway. In vitro results demonstrated that Bv treatment significantly promoted angiogenesis in human umbilical vein endothelial cells (HUVEC), even in the presence of H2O2. This was evident by the increased cell proliferation, enhanced migration, and improved tube formation. Bv also effectively attenuated the intracellular generation of reactive oxygen species (ROS) induced by H2O2, which was achieved by suppressing mitochondrial ROS production through the PI3K/Akt-mediated activation of Nrf2/HO-1 signaling pathway. Consequently, Bv treatment led to a significant reduction in apoptosis and an increase in cell viability of HUVEC. Furthermore, in vivo experiment demonstrated that Bv treatment vastly elevated flap survival through enhancing angiogenesis while decreasing oxidative stress and apoptosis, which was comparable to the results of positive control of N-acetylcysteine (Nac). In conclusion, this study not only established a solid foundation for future study on therapeutic potential of Bv, but also proposed a promising treatment approach for enhancing the success rate of flap transplants and other ischemic-related tissue repair.

Protective Effects of Antimicrobial Peptide Microcin J25 (MccJ25) Isolated From Escherichia coli Against Breast Cancer Cells

ABSTRACTMicrocins are antimicrobial peptides (AMPs) with low molecular weight, which are produced by Enterobacterales and have broad‐spectrum antibacterial activity. Alternative approaches like AMPs could help conventional anticancer treatments to fight malignant cells. The present study endeavors to examine the antitumor activity of microcins isolated from different Enterobacterales strains. In total, 120 Enterobacterales isolates were examined after identification. Subsequently, the bacteria were subjected to an agar diffusion test to assess their antibacterial efficacy. Positive isolates were further examined for the presence of Mccj25 using PCR. The cytotoxic effects of isolates harboring the microcin gene were explored using quantitative real‐time PCR (RT‐qPCR) and the MTT test on breast cancer cells. In addition, the expression levels of BCL2 and STAT3 genes were evaluated, and apoptosis was quantified using flow cytometry. The repair rate of normal cells was determined using a scratch assay. The findings obtained from the phenotypic and biochemical assays have duly verified and established the categorization of the Enterobacterales. After conducting the agar diffusion test, a total of 25 isolates of Escherichia coli and Klebsiella pneumoniae displaying inhibition zones were chosen as suitable specimens possessing AMPs. The analysis conducted on the expression of the Mccj25 gene within the aforementioned isolates indicated that Isolate 83 exhibited significant expression of the Mccj25 gene. The extract obtained from this isolate on the breast cancer cell line exhibited the most significant degree of toxicity after 48 h. Furthermore, the treatment of breast cancer cells with Isolate 83 showed that the rate of apoptosis was about 86%, and the expression of BCL2 and STAT3 genes decreased. Contrarily, it potentiated the reparative ability of nontumoral fibroblasts, supporting the in vitro safety toward normal cells and, at the same time, the selectivity against malignant ones. In summary, our results highlighted a significant growth suppression of breast cancer cells with an escalated rate of cellular demise via the apoptosis pathway.

Reoperation Rates of Meniscal Repair Are Associated With a Higher Reoperation Rate Than Meniscectomy in Patients Aged 40 and Older

To compare the long-term reoperation rates of meniscectomy and meniscal repair and to determine patient and surgical factors associated with earlier reoperation among patients ≥40 years. A retrospective study was conducted using the IBM MarketScan Commercial Claims and Encounters Database from January 1, 2006, through December 31, 2020. Patients 40 and older who received a meniscectomy or a meniscal repair with a minimum 1-year follow-up were included. The primary outcome was ipsilateral knee reoperation during the study period. Kaplan-Meier survival curves were used to determine differences in reoperation rates for meniscal repair and meniscectomy over time. Multivariable Cox regression analysis was performed to identify factors associated with earlier time to reoperation. A total of 3,026 patients (2,367 meniscectomy, 659 meniscal repair) were included. Mean follow-up was 14.5 ± 0.29 years (range, 1.0-14.91 years). There were no significant differences in baseline demographic characteristics of follow-up between the 2 groups. The survival curves of the 2 procedures significantly differed (P= .02), and the overall reoperation rate was higher after meniscal repair than meniscectomy (13.5% vs 10.1%, P= .01). However, the incidence of subsequent ipsilateral meniscectomy, meniscal repair, and knee arthroplasty procedures did not significantly differ. Multivariable Cox regression analysis identified meniscal repair, obesity, concomitant anterior cruciate ligament reconstruction, and increasing age as being significant risks for earlier reoperation, and male sex was protective. In a population of patients aged ≥40 with surgically treated meniscal tears and 14.5-year average follow-up, meniscal repair was associated with higher overall reoperation with shorter survival times compared to meniscectomy. However, the indications for the 2 procedures likely differed. Additionally, obesity, older age, female sex, and concomitant anterior cruciate ligament reconstruction were risk factors for earlier reoperation. Level III, retrospective comparative case series.

Surgeon variability in repair of hiatal hernia at the time of bariatric surgery.

Hiatal hernia (HH) is estimated to affect between 20 and 50% of patients undergoing bariatric surgery. However, there is no consensus regarding the preoperative assessment and intraoperative repair of HH. The aim of this study was to evaluate the variation in surgeon assessment and repair of HH during bariatric surgery across a multi-hospital healthcare system. A retrospective cohort analysis was conducted using data obtained from the metabolic and bariatric accreditation quality improvement program (MBSAQIP) and institutional medical records. All adult patients who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) were included. Preoperative assessment of HH was defined as either EGD or upper GI/Esophagram (UGI) within one year of surgery. Surgeons were evaluated individually and by hospital. Chi-square analysis and ANOVA were performed. From January 2018 to February 2023, 3,487 bariatric surgeries were performed across 4 hospitals and 11 surgeons (2481 SG and 1006 RYGB). HH were concurrently repaired during 24% of operations. The rate of HH repair in SG was 25 and 22% in RYGB (p = 0.06). Preoperatively, 41% of patients underwent EGD and 23% had an UGI. HH was diagnosed in 22% of EGDs. Patients who underwent preoperative EGD had higher rates of HH repair than those without a preop EGD (33% vs. 17%; p < 0.001). The rate of preoperative EGD utilization by surgeon varied significantly from 3 to 92% (p < 0.001) as did HH repair rates between surgeons (range 8-57%; p < 0.001). Even among patients with a preoperatively diagnosed HH, the repair rate ranged 20-91% between individual surgeons (p < 0.001). Within a healthcare system there was significant heterogeneity in approach to assessment and repair of HH during bariatric surgery. This appears to be mediated by multiple factors, including utilization of preoperative studies, individual surgeon differences, and differences between hospitals.

Surgical Applications for Bone Marrow Aspirate Concentrate

Bone marrow aspirate concentrate (BMAC) is an autologous orthobiologic agent that may be of benefit in specific surgical scenarios. Composed of elements isolated from bone marrow, including mesenchymal stromal cells, bone marrow–derived platelets, red and white blood cells, and hematopoietic precursors, BMAC has gained appeal for its potential to slow the progression of chondral degeneration, improve function, and provide symptomatic relief. BMAC is typically prepared during the final stages of a surgical procedure, beginning with bone marrow aspirate harvested from the iliac crest, distal femur, body of the ilium, or proximal humerus and then centrifuged to yield concentrated marrow cells. In a published technique for BMAC use in arthroscopic acetabular labral repair, 120 mL of BMA is harvested from the body of the ilium and then centrifuged to yield approximately 4 to 6 mL of BMAC. The biologic activity of BMAC is 2-fold: (1) mesenchymal stromal cells are pluripotent stem cells that stimulate a robust tissue response for cartilage repair through their potential to differentiate into chondrocytes that induce chondrogenesis, and (2) bone marrow–derived platelets produce growth factors, cytokines, and chemokines that promote collagen synthesis, wound healing, and suppression of proinflammatory cytokines. To date, BMAC has shown promise as an efficacious adjuvant therapy. When comparing patient outcomes, studies have found that patients receiving BMAC achieved lower rates of revision rotator cuff repair, higher functional outcome scores following arthroscopic acetabular labral repair, and significant reductions in pain levels in the context of knee cartilage defects. These findings, however, must be interpreted with caution, as there remains a paucity of randomized controlled trials investigating the mid- and long-term efficacy of BMAC. Overall, as treatments for patients with both progressive chondral degeneration and acute orthopaedic injuries continue to evolve, BMAC serves as promising orthobiologic therapy to improve outcomes.

Formulation and evaluation of ointment containing hydroalcoholic extract derived from the bark of Moringa oleifera for wound healing activity in rat model

Background: This study aimed to assess the effectiveness of a hydroalcoholic extract derived from the bark of Moringa oleifera in facilitating the healing process of second-degree burns wounds. Moreover, a comprehensive assessment was carried out on standardized M. oleifera bark to ascertain its physiochemical characteristics, botanical compound layout, and antioxidant activity, all of which play a crucial role in its capacity to facilitate the healing process of burns. Methods: For 14 days, the efficacy of ointments containing a hydroalcoholic extract of M. oleifera bark at concentrations of 5% and 10% was evaluated for treating second-degree burns in rats. Additionally, histological analysis was conducted on skin tissue samples. Results: The M. oleifera bark extract exhibited TPC (52.56 mg/gm of dried extract) and TFC (84.33 mg/gm of dried extract) value along with antioxidant activity (IC50 value of 0.98 µg/ml) for radical scavenging, in the presence of several phytochemicals. The most favorable outcomes were achieved using a 10% ointment composition, demonstrating a wound closure and tissue repair rate of 83.04 ± 0.89%, along with a noteworthy decrease in tissue oxidative stress indicators. Histological investigations have verified the wound-healing properties of M. oleifera bark extract. Conclusion: Due to its significant antioxidant properties and its capacity to create a moist environment for wounds, M. oleifera has the potential to serve as a natural treatment for burns. Additional clinical trials are recommended to validate the efficacy of M. oleifera bark extract as a therapeutic agent for wound healing.

Effect of MICP-recycled GFRP fiber on the self-repairing properties of concrete

The recycling of waste glass fiber-reinforced polymer (GFRP) holds paramount importance in realizing sustainability goals. This study aims to enhance the efficacy of fiber-reinforced self-healing concrete by employing recycled GFRP (rGFRP) fibers as carriers for Microbiologically Induced Calcite Precipitation (MICP). Preparations involved the development of pretreatment of rGFRP using microbial mineralization. Examination encompassed the assessment of interactions between microorganisms and fibers, microstructural characterization of self-healing specimens, and the strength of repaired specimens. This was conducted through the quantification of CaCO3 precipitation, strength tests, scanning electron microscopy (SEM), X-ray computed topography (CT) analysis, and mercury intrusion porosimetry (MIP). The results revealed that mineralized rGFRP fibers had little impact on the flexural and compressive strength of the reinforced mortar, while increased the tensile strength by up to 34.1 %. The mineralized rGFRP fiber-reinforced mortar achieved a repair rate of 84.5 % for cracks within 0.3 mm after 28 days of water curing. Comparatively, the mineralized rGFRP fiber bacterial mortar exhibited higher water absorption than its non-mineralized counterpart. Using untreated rGFRP fibers for self-healing can reduce the porosity and water absorption of the mortar to some extent, while adding mineralized rGFRP fibers for self-healing increased the crack area repair rate and also increased the porosity of the mortar. Therefore, using untreated rGFRP fibers as a carrier for microorganisms to repair mortar may present a more favorable choice. The results of this study will contribute to further improvement in the application of fiber-reinforced self-healing concrete in the engineering field.

Reliability-centered availability collaborative optimization allocation approach for machine tools

The availability of computer numerical control (CNC) machine tools is a comprehensive reflection of reliability and maintainability. To ensure the availability requirements of products, it is necessary to allocate the availability indicators of the entire machine to all units. Traditional methods based on reliability allocation or maintainability allocation ignore the coupling relationships among them, which cannot comprehensively improve the availability level of machine tools. Therefore, in this paper, a availability collaborative optimization allocation model for CNC machine tools is proposed to maximize the availability under the optimal combination of failure rate and repair rate. Firstly, a two-stage reliability allocation model based on different allocation mechanisms is established by taking the Function-Motion-Action (FMA) decomposition tree as the allocation path. In the first stage, the allocation weights are determined based on global sensitivity analysis. In the second stage, the reliability optimization allocation model based on Copula function is established. Then, with reliability as the center, an availability collaborative optimization allocation model constrained by maintainability is constructed, and the non-dominated sorting genetic algorithm II (NSGA-II) algorithm is used to solve the model. Finally, a CNC gear milling machine is taken as an example to verify the rationality and effectiveness of the method on product availability requirements under collaborative allocation.

Unlocking the efficacy of cement-shell encapsulation for microbial self-healing process of concrete cracks

Oxygen supply and bacterial viability are crucial for efficient calcium carbonate precipitation in concrete crack healing processes. However, the open deliverance of oxygen-releasing compounds (ORCs) and bacterial spores during concrete mixing and casting poses a threat to spore viability and limits oxygen availability. To address these challenges, we developed an innovative approach integrating an oxygen self-supply strategy with bacterial strain B6. As such, B6 spores, along with Ca(OH)2 and CaO2 as oxygen sources and essential nutrients, were embedded within cement-shell microcapsules to build a microbial self-healing system. The result shows that in the presence of oxygen source and nutrients, B6 group (BPN) exhibits successful crack repair, achieving a repair ratio of approximately 100% after 30 days, while other control groups show less effective repair rates (20–60%). Moreover, water permeability significantly improves in the BPN specimens after crack repair, reaching 0 ml/cm−2·min, highlighting the efficacy of the developed self-healing system. Encapsulating the healing agent within cement shell effectively mitigates the reactivity between ORCs (CaO2) and water, thereby facilitating stable oxygen supply and safe delivery of microbial agents during crack healing. Furthermore, in-situ micromorphology and composition identification of crack repair materials affirm the presence of calcium carbonate precipitation to seal the concrete cracks. The encapsulation of healing material within cement shell stands out as an innovative approach, demonstrating an efficient self-healing process of concrete cracks. These findings might unveil new possibilities for bio-concrete to be used in sustainable and resilient construction practices, particularly in environments prone to cracking and water ingress.

Stochastic modeling and optimization of turbogenerator performance using meta‐heuristic techniques

AbstractThe objective of this paper is to identify the most sensitive component of a turbogenerator and optimize its availability. To achieve this, we begin by conducting an initial reliability, availability, maintainability, and dependability (RAMD) analysis on each component. Subsequently, a novel stochastic model is developed to analyze the steady‐state availability of the turbogenerator, employing a Markov birth‐death process. In this model, failure and repair rates are assumed to follow an exponential distribution and are statistically independent. To optimize the proposed stochastic model, we employ four population‐based meta‐heuristic approaches: the grey wolf optimization (GWO), the dragonfly algorithm (DA), the grasshopper optimization algorithm (GOA), and the whale optimization algorithm (WOA). These algorithms are utilized to find the optimal solution by iteratively improving the availability of the turbogenerator. The performance of each algorithm is evaluated in terms of system availability and execution time, allowing us to identify the most efficient algorithm for this task. Based on the numerical results, it is evident that the WOA outperforms the GWO, GOA, and DA in terms of both system availability and execution time.

Redundancy allocation problem in repairable systems with variegated components: a simulation-based optimization approach

The redundancy allocation problem (RAP) is one of the most commonly used approaches for improving the reliability of systems. In previous studies, to simplify the problem model and mathematical solution methods, some real conditions were not emphasized in analysing the issue of RAP. But the present study, while considering these conditions, enables considering multiple goals, analysing repairable systems and examining the failure rate and repair rate appropriate to the type of components. Two goals of this purpose are maximizing the Mean Time To First Failure (MTTFF) and minimizing the total cost of the system, considering the weight and volume limitations and number of plugin components. To solve the problem model four Multi-objective meta-heuristic algorithms have been used: NSGA-II, MOPSO, PESA-II and MALO. In addition, the simulation method is used to estimate the first objective function of the problem.

Optimizing outcomes in paraesophageal hernia repair: a novel critical view

BackgroundThe recurrence rate of paraesophageal hernia repair (PEHR) is high with reported rates of recurrence varying between 25 and 42%. We present a novel approach to PEHR that involves the visualization of a critical view to decrease recurrence rate. Our study aims to investigate the outcomes of PEHR following the implementation of a critical view.MethodsThis is a single-center retrospective study that examines operative outcomes in patients who underwent PEHR with a critical view in comparison to patients who underwent standard repair. The critical view is defined as full dissection of the posterior mediastinum with complete mobilization of the esophagus to the level of the inferior pulmonary vein, visualization of the left crus of the diaphragm as well as the left gastric artery while the distal esophagus is retracted to expose the spleen in the background. Bivariate chi-squared analysis and multivariable logistic and linear regressions were used for statistical analysis.ResultsA total of 297 patients underwent PEHR between 2015 and 2023, including 207 with critical view and 90 with standard repair which represents the historic control. Type III hernias were most common (48%) followed by type I (36%), type IV (13%), and type II (2.0%). Robotic-assisted repair was most common (65%), followed by laparoscopic (22%) and open repair (14%). Fundoplications performed included Dor (59%), Nissen (14%), Belsey (5%), and Toupet (2%). Patients who underwent PEHR with critical view had lower hernia recurrence rates compared to standard (9.7% vs 20%, P < .01) and lower reoperation rates (0.5% vs 10%, P < .001). There were no differences in postoperative complications on unadjusted bivariate analysis; however, adjusted outcomes revealed a lower odds of postoperative complications in patients with critical view (AOR .13, 95% CI .05–.31, P < .001).ConclusionWe present dissection of a novel critical view during repair of all types of paraesophageal hernia that results in reproducible, consistent, and durable postoperative outcomes, including a significant reduction in recurrence and reoperation.

Peculiarities of regeneration of an experimental femur fracture in rats with intramedullary fixation with carbon-carbon composite material implants

the issue of finding modern bioinert materials for use in surgical orthopedics and traumatology, as well as other medical fields related to the surgical treatment of diseases of the musculoskeletal system, is the most urgent today. The aim of the study was to establish the features of the course of regeneration of a femur fracture in rats with intramedullary fixation of fragments with a carbon-carbon composite material. The femur of 12 Wistar rats was studied in the work. Six rats - with simulated transverse diaphyseal fracture and intramedullary fixation with carbon-carbon composite material and six rats - with simulated transverse diaphyseal fracture and intramedullary fixation with medical steel. The last one were used as a comparison group. Histological sections prepared according to standard methods for inspection microscopy were stained with hematoxylin and eosin. To study revascularization processes, an immunohistochemical reaction with CD-34 antibodies was performed. As a result of the study, it was established that in animals with a simulated complete transverse diaphyseal fracture of the femur and intramedullary fixation with implants made of carbon-carbon composite material in the bone regenerate, the relative area of ​​CD-34+ vascular endothelial cells probably increases compared to the group of animals in which fixation was performed using medical stainless steel. Thus, the use of carbon-carbon composite material reveals an angiogenic effect in bone regeneration, which accelerates the rate of repair and remodeling of fractures.

First-line (1L) anti-PD-1 plus chemotherapy in HER2-negative advanced gastric cancer: Real-world evidence from a single Korean center.

83 Background: The implementation of immune checkpoint inhibitor combinations as first-line (1L) treatment has shown promising outcomes and is now the standard of care for HER2-negative advanced gastric cancer. However, real-world evidence supporting this approach as 1L treatment remains limited. Here, we present an analysis of real-world outcomes, comparing 1L anti-PD-1 combined with doublet chemotherapy to the previous standard chemotherapy. Methods: Patient from January 2005 to August 2023 were retrospectively reviewed. The study defined the molecular epidemiology cohort (M cohort) as patients with results for HER2, Epstein-Barr virus (EBV), mismatch repair (MMR), or PD-L1. HER2-negative patients who received palliative first-line chemotherapy doublet regimens with or without PD-1 inhibitor were included. Survival analysis included progression-free survival (PFS) and overall survival (OS), as well as subgroup analyses for molecular subtypes. Results: Total 3,028 were enrolled in the M cohort. The incidence rates of HER2-positive, EBV-positive, and deficient Mismatch Repair (dMMR) were 20.0% (606/3028), 3.8% (93/2432), and 4.7% (126/2660), respectively. PD-L1 testing was conducted on 1,394 patients, with 54.3% (1634/3028) having a CPS (Combined Positive Score) of ≥10, and 47.6% (664/1394) having a CPS of ≥1. Among these patients 1,527 had received chemotherapy doublet, and 153 had received chemotherapy doublet with PD-1 inhibitor as their 1L treatment. During a median follow-up of 56.5 months (95% CI,49.9-66.2), patients who had received PD-1 inhibitor combination therapy showed improved PFS (7.1 vs. 6.1 months; Hazard Ratio [HR], 0.77; 95% Confidence Interval [CI], 0.64–0.93) and OS (18.1 vs. 14.6 months; HR 0.80; 95% CI, 0.63–1.01) compared to those without it. The benefits in PFS from PD-1 inhibitor combination therapy were particularly notable in patients with deficient MMR status (HR, 0.22 vs. 0.80 in those without PD-1 inhibitor combination; p for interaction &lt;0.05) and in patients with signet ring cell carcinoma histology (HR, 0.58 vs. 0.92 in those without PD-1 inhibitor combination; p for interaction &lt;0.05). Conclusions: We observed real-world efficacy of the combination of PD-1 inhibitor and chemotherapy doublet as 1L treatment for HER2-negative advanced gastric cancer, consistent with previous clinical trials. [Table: see text]

DNA Damage and Repair in PBMCs after Internal Ex Vivo Irradiation with [223Ra]RaCl2 and [177Lu]LuCl3 Mixtures.

The combination of high and low LET radionuclides has been tested in several patient studies to improve treatment response. Radionuclide mixtures can also be released in nuclear power plant accidents or nuclear bomb deployment. This study investigated the DNA damage response and DNA double-strand break (DSB) repair in peripheral blood mononuclear cells (PBMCs) after internal exposure of blood samples of 10 healthy volunteers to either no radiation (baseline) or different radionuclide mixtures of the α- and β-emitters [223Ra]RaCl2 and [177Lu]LuCl3, i.e., 25 mGy/75 mGy, 50 mGy/50 mGy and 75 mGy/25 mGy, respectively. DSB foci and γ-H2AX α-track enumeration directly after 1 h of exposure or after 4 h or 24 h of repair revealed that radiation-induced foci (RIF) and α-track induction in 100 cells was similar for mixed α/β and pure internal α- or β-irradiation, as were the repair rates for all radiation qualities. In contrast, the fraction of unrepaired RIF (Qβ) in PBMCs after mixed α/β-irradiation (50% 223Ra & 50% 177Lu: Qβ = 0.23 ± 0.10) was significantly elevated relative to pure β-irradiation (50 mGy: Qβ, pure = 0.06 ± 0.02), with a similar trend being noted for all mixtures. This α-dose-dependent increase in persistent foci likely relates to the formation of complex DNA damage that remains difficult to repair.

The Influence of Vasopressors on Free Flap Outcomes in Head and Neck Cancer Patients.

To compare free flap outcomes between those who received and did not receive vasopressors (VPs) at the time of free flap reconstruction. This retrospective cohort study includes patients from January 2013 to January 2023. This multicenter cohort study utilized data from the TriNetX Research Network which includes 80 health care organizations. Head and neck cancer patients older than 18 years who underwent free flap reconstruction were separated into those who received or did not receive VPs on the day of surgery. The primary outcomes were flap failure defined by need for secondary free flap procedures, blood vessel repair, and other flap revision procedures. After propensity score matching, 7446 patients were analyzed. The VP group included 3723 patients (mean age [SD], 62.9 [11.4] years; 2511 males [67.4%]). The non-VP group included 3723 patients (mean age [SD], 63.0 [11.2] years; 2479 males [66.6%]). Free flap outcomes were not statistically different between groups (secondary free flap: 166 [4.5%] VP vs 155 [4.2%] non-VP, P = .04; vessel repair: 314 [8.4%] vs 319 [8.6%], P = .06; other flap revision procedures: 416 [11.2%] vs 449 [12.1%], P = .02). Bony flaps were found to have decreased rates of vessel repair in the VP group (47 [6.1%] vs 69 [9.0%], P = .003]. For secondary outcomes, pneumonia (173 [4.6%] vs 231 [6.2%], P = .0002), urinary tract infection (34 [1.0%] vs 59 [1.6%], P = .0007), and deep vein thrombosis (93 [2.5%] vs 122 [3.3%], P = .004) were significantly different. VP use is not significantly associated with free flap complications. These results imply that VP use on the same day as surgery may be safe if clinically necessary.