Repair Rate Research Articles

Contemporary Outcomes of Degenerative Mitral Valve Surgery in a Regional Tertiary Care Center

Objective: As percutaneous mitral valve techniques become more prevalent, it is important to evaluate the contemporary outcomes of surgical mitral valve interventions. This study assessed the current results and procedural trends of mitral valve surgery for degenerative mitral regurgitation (DMR) at a regional tertiary care center. Methods: Data were analyzed from 693 consecutive DMR patients who underwent isolated mitral valve operations, with or without tricuspid valve repair and atrial fibrillation ablation between 2017 and 2024. The outcomes were defined according to MVARC criteria. The study endpoints included successful mitral valve repair, in-hospital results, and operative and long-term mortality. Logistic regression was applied to assess the impact of valve lesions and patient risk factors on the probability of valve repair. Survival was analyzed using Kaplan–Meier methodology. The follow up was 100% complete. Results: Mitral valve repair was performed in 90.9% of cases, with only 0.9% requiring the conversion to replacement due to unsuccessful repair. Posterior leaflet lesions had the highest success rate (93.4%), while anterior leaflet lesions had a lower rate (86.2%), with anterior pathology being a negative predictor of repair (OR 2.57, p = 0.02). The type of lesion (prolapse vs. flail), the commissural involvement, and the increased risk for SAM had no statistically significant impact on valve repair outcome. Less invasive transaxillary access was used in 63.2% of patients, and its adoption increased significantly (from 50.9% to 67.4% p = 0.03) over time, resulting in more frequent fast-track extubation and home discharges. The rate of in-hospital mortality was 0.6%, while the rate of 5-year survival was 95.5%. Conclusions: Contemporary surgical techniques for DMR lead to high repair rates and excellent recovery outcomes. Despite the rise in transcatheter options, our findings confirm that surgery remains the gold standard for most DMR patients.

Contemporary Single-Center Experience of Complete Aortic Arch Replacement Employing the Frozen Elephant Trunk Technique in Patients with Extensive Aortic Disease

Objective: This study aimed to examine contemporary results of the frozen elephant trunk (FET) procedure in an all-comers patient cohort. Methods: Between January 2017 and May 2024, a total of 132 consecutive patients with either aortic aneurysm (n = 32), acute aortic dissection (n = 32), or chronic aortic dissection (n = 68) underwent total aortic arch replacement employing the FET technique. In-hospital data were collected prospectively and included preoperative characteristics, intraoperative data, and follow-up results. Results: The median cardiopulmonary bypass time, cardiac ischemia time, and selective antegrade cerebral perfusion time were 180 (161–205), 89 (70–113), and 45 (38–54) min, respectively. Total 30-day mortality rate was 7.6% (n = 10). The rate of major postoperative neurological complications was 6.8% (n = 9) for perioperative stroke and 2.3% (n = 3) for permanent spinal cord injury. Five patients (3.8%) required hemofiltration at the time of discharge due to postoperative kidney injury. Rates of subsequent endovascular and open aortic repair following primary FET were 40.9% (n = 54) and 3.8% (n = 5), respectively. The median time to reintervention was 86 (30–439) days. The median follow-up time was 25 (8–52) months, and overall survival rates at 1, 2, and 3 years were 89%, 89%, and 87%, respectively. Conclusions: Our data are consistent with current reports, indicating that the FET technique is a valuable adjunct in treating extensive aortic arch pathologies. The procedure provides an increasingly safe and effective option for complete aortic arch replacement, even in patients requiring a redo procedure.

Tailoring microstructural evolution in laser deposited nickel-aluminum bronze alloy by controlling water cooling condition

Inspired by the application requirements of underwater in-situ repair of nickel-aluminum bronze (NAB), the study proposes whether the water-cooling conditions are conducive to forming an appropriate cooling rate during the repair process to prevent the formation of coarse κ phases. The appropriate cooling rates of underwater repair has been preliminarily verified through numerical simulation. Then onshore laser direct metal deposition (DMD) and underwater laser direct metal deposition (UDMD) technologies are employed to the repair of the trapezoidal grooves on NAB substrates. The experimental results show that the rapid cooling rates during UDMD result in a unique microstructure. Compared to DMD repaired samples, the width of the interlayer heat-affected zone and the average size of nano κⅡ phase are reduced, no κⅣ precipitates were observed in any of the repaired samples. An interesting finding is that the κⅢ phases are dispersively precipitated in the matrix. Both the tensile specimens fail in the substrate zone rather than the repaired zone. However, the thermal exposure on the substrate during deposition causes slight growth of the κⅡ phase in the heat-affected zone. The tensile strength of the samples repaired by DMD and UDMD is reduced by approximately 7% compared to the cast substrate. This study proves the feasibility of in-situ underwater repair for large copper alloy components and can also provide new process references for controlling the evolution of microstructures through external environmental conditions during alloy manufacturing.

A retrospective nationwide comparison of laparoscopic vs open inguinal hernia repair in children

BackgroundUtilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort. MethodsThis retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017-2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates. ResultsWe identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p=0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p<0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS. ConclusionLaparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia. Level of EvidenceTreatment Study – Level III

Analysis of Six Cases Attached to Postoperative Infection after Shoulder Arthroscopic Rotator Cuff Repair: A Case Report

Background: The purpose of this case report was to investigate the incidence of departmental infections following arthroscopic rotator cuff repair over a three-year period as well as to compare the clinical efficacy of treating postoperative infections following rotator cuff repair using incisional debridement sutures, arthroscopic shoulder debridement and lavage treatment, and arthroscopic debridement and lavage in combination with antibiotic-cement beading. Case presentation: A retrospective evaluation of 600 shoulder arthroscopic rotator cuff repairs performed in our hospital between 2021.1 and 2023.12 was conducted to screen the data of six Chinese women aged 51-71 years, who completed routine hematological and radiological examinations after admission, were treated with antibiotics, and the use of antibiotics was adjusted according to the results of wound secretion culture. Among them, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic cemented nails, 1 case was treated with incision and debridement and suture, and 1 case was treated conservatively. Postoperative anti-infective treatment with antibiotics was continued, and the relevant indexes were rechecked. Preoperative and postoperative follow-up were performed using the visual analog scale (VAS) and the American Shoulder and Elbow Surgeons (ASES) score. Results: The infection rate of patients who underwent rotator cuff repair during the evaluation period was 1%. Culture of wound secretions from six infected patients showed culture results of Staphylococcus aureus, Serratia marcescens, Mycobacterium xylosoxidans colorless, and Mycobacterium tuberculosis, with no obvious abnormalities, and no cultures were performed. Two cases were treated with shoulder arthroscopic debridement and irrigation, two cases were treated with shoulder arthroscopic debridement and irrigation combined with antibiotic bone cement beading, one case was treated with incision and debridement and suturing, and one case was treated conservatively. At the final follow-up, the scores of two patients treated with arthroscopic debridement and irrigation of the shoulder improved, two patients treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic-cemented beading did not show significant improvement, one patient treated with incisional debridement and suturing improved significantly, and one patient treated conservatively improved significantly. Conclusion: The overall infection rate of arthroscopic rotator cuff repair of the shoulder over 3 years was 1% (6/600). The use of incisional debridement and suturing or shoulder arthroscopic debridement and irrigation has better clinical outcomes than shoulder arthroscopic debridement and irrigation combined with cement beading for the treatment of infection after arthroscopic rotator cuff repair.

Variation in care in individuals hospitalised with abdominal aortic aneurysm in nine high-income countries: a cross-sectional cohort study

Abstract Background Abdominal aortic aneurysms (AAA) can be safely repaired using either endovascular aneurysm repair (EVAR) or open repair when intact, but after rupture morbidity and mortality are extremely high. Treatment patterns and outcomes for intact AAA are likely to differ between countries due to differences in AAA screening policies, health system capacity and payment approaches, and other factors, such as demographics and lifestyle, but are poorly studied. Methods We conducted a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalised for with an intact AAA and repair procedure in the same admission between 2011 and 2019 in nine countries (US, Canada, England, Denmark, Netherlands, Switzerland, Taiwan, South Korea and Israel) using population-representative administrative data. We investigated age-sex standardised (to the 2019 US population) repair rates (open repair or EVAR) and health system performance measures, including hospital length of stay (LOS), 30-day readmission, and all-cause mortality (30 days and 1 year). Results The number of intact AAA hospital admissions between 2011 and 2019 ranged from 1,290 in Israel to 199,764 in the US. The rates of intact AAA repair per 1000 population varied between countries and over time, from 0.11 per 1000 (South Korea) to 0.69 per 1000 (US) in 2011 and from 0.14 per 1000 (Taiwan) to 0.57 per 1000 (the Netherlands) in 2019. Most countries saw a decline in the rate of AAA repair over the study period. The proportion repaired using open repair vs EVAR also varied widely across the countries. In the US, Israel and Taiwan open repair was used in 11% or fewer cases whereas in the remaining countries we observed open repair in 25.1 % (South Korea) to 56.7% (Denmark) of cases. (Figure 1) Mortality was generally higher following open repairs compared to EVAR in all countries. In 2019, following EVAR, 30-day mortality varied from 0.6% (8.1% at 1 year) in South Korea to 2.3% (11.7% at 1 year) in Israel and following open repair varied from 2.9 (4.4% at 1 year) in England to 7.6% (15.1% at 1 year) in the US. (Figure 2) Mean hospital LOS in 2019 ranged from 2.5 days (US) to 12.2 days (South Korea), following EVAR and from 9.1 days (Taiwan) to 21.5 days (South Korea) following open repair. The 30-day readmission rate in 2019 ranged from 8.1% (US) to 31.8% in Israel following EVAR and from 11.4% (US) to 22.2% (South Korea) following open repair. Conclusions We observed substantial between-country variation in surgical approaches, mortality, and health system performance measures for AAA. Further research is needed to understand and plan optimal, evidence-based AAA screening and treatment strategies.Rates of EVAR and open repairAdjusted 30-day all-cause mortality

Systematic review of clinical effectiveness and safety of abdominal aortic aneurysm screening in men

Abstract Background Abdominal aortic aneurysm (AAA) is characterised by a bulging in the aortic wall. AAA is typically asymptomatic until aneurysm rupture, which is associated with a very high mortality rate (approximately 80%). In the context of an ageing population and increasing life expectancy, innovative approaches to early detection and intervention are needed. The aim of this review was to assess the clinical effectiveness and safety of one-time ultrasound screening for AAA in men. Methods Systematic searches were conducted in electronic databases and grey literature sources. The primary outcomes of interest were AAA-related mortality, AAA rupture, all-cause mortality, rate of surgical repair and safety. The following study designs were included: systematic reviews, randomised controlled trials (RCTs), comparative observational studies and population-based non-comparative observational studies. Results Results from a systematic review by the US Preventive Services Task Force analysed 4 population-based RCTs, showing that one-time population-based screening for AAA in men (≥ 65 years) led to significant reductions in AAA-related mortality (OR = 0.65, 95% CI: 0.57 to 0.74), AAA rupture (OR = 0.61, 95% CI: 0.54 to 0.69) and emergency surgeries (OR = 0.53, 95% CI: 95% CI: 0.44 to 0.64) at 13-15 years follow-up, relative to no screening. Separate to this systematic review an additional 24 studies reported on clinical effectiveness, safety and psychosocial harms of AAA screening. Limited evidence from these studies suggest screening was associated with a reduction in AAA-related mortality and rupture but also transient psychological distress in some cases. Conclusions One-time ultrasound screening in men ≥65 years appears to offer benefits in terms of reducing AAA ruptures and AAA-related mortality, though the balance of benefits and harms requires careful consideration. In an ageing population, AAA screening could be transformative, by reducing mortality and rupture risks. Key messages • One-time ultrasound screening for AAA in older men (≥ 65 years) can reduce AAA-related mortality and rupture. • In the context of an ageing population in Europe, AAA screening could be transformative, but benefits must be weighed against potential risks.

A cycle slip detection and repair method based on generalized-cross-validation regularization for BDS-3 quad/pent-frequency data

Abstract Multi-frequency (quad/pent-frequency) observations improve the success rate for BeiDou Navigation Satellite System (BDS-3) cycle slip detection and repair. Three factors are comprehensively considered: the combination of observation wavelength, the amplification factor of ionospheric delay, and the insensitivity, to select the optimal combination coefficients for BDS-3 multi-frequency cycle slip detection. Due to the ill-conditioned equation in multi-frequency cycle slip repair, the generalized-cross-validation regularization auxiliary LAMBDA method is proposed. To validate the effectiveness of the proposed detection and repair method under different observation environments, two stations are selected for the test. Using real data, the effectiveness of the selected optimal combination coefficients and the proposed method are tested. The conclusions are as follows: (1) for quad-frequency, one geometry-free and ionosphere-free (GFIF) combination [−1, 2, −4, 3] and three linearly independent geometry free carrier phase (GF) combinations [−1, 1, 0, 0], [−1, 1, 1, −1], and [−1, 2, −1, 0] are employed to detect cycle slips. For pent-frequency, one GFIF combination [−2, 2, 1, −2, 1] and four linearly independent GF combinations [−1, 1, 0, 0, 0], [0, 0, −1, 1, 0], [0, 0, −1, 0, 1], and [0, −1, 1, 1, −1] are adopted for cycle slip detection. (2) The algorithm proposed in this paper has been demonstrated to achieve a quad/pent-frequency cycle slip detection success rate of 99.99% and 100% in the coastal environment, and both 100% for quad/pent-frequency detection success in the urban environment. (3) The success rate of repair were 99.27% and 99.94% for the coastal stations, and 99.83% and 100% for the urban stations, respectively. The proposed algorithm offers a dependable approach for the identification and rectification of multi-frequency cycle slips, while also providing a point of reference for the future advancement of multi-frequency cycle slip repair techniques.

Wide Variation in Mitral Valve Repair Rates Among U.S. Surgeons: Analysis of Medicare Claims Data

Mitral valve repair is the preferred treatment for primary mitral regurgitation, offering significant short- and long-term advantages over valve replacement. This study was designed to evaluate the contemporary national mitral valve surgery practice patterns, focusing on the impact of surgeon-specific factors, such as operative volume and years of practice, on repair rates. A retrospective analysis was conducted using 100% Medicare fee-for-service claims data over a 3-year period (January 2020 to December 2022). Mitral valve procedures were identified using specific CPT codes. We excluded patients with active infective endocarditis, mitral stenosis, or a history of prior mitral valve repair or replacement. Multivariable binomial regression was used to assess the impact of surgeon-specific factors on repair rates. We identified 2,072 surgeons in 770 hospitals who performed 12,339 mitral valve operations, with an overall repair rate of 68.8%. The median number of mitral valve operations performed per surgeon during the three-year study period was 3 (IQR 2 - 7), and the median number of mitral valve repairs was 2 (IQR 1 - 5). A subset of 312 surgeons (15%) performed more than 10 mitral valve procedures each and over half (57%) of all repairs nationally. This subgroup's median repair rate was 77%, with significant variability within the group: 17% of surgeons had a repair rate below 50%, 59% had a repair rate between 50 - 90%, and 24% had a repair rate above 90%. Multivariable regression analysis indicated significant associations between repair rates and surgeon-specific factors, including surgical volume, years of practice, and region of practice. Each additional procedure was associated with a 1.5% average increase in repair rate likelihood (95% CI 1.2 - 1.8%, p < 0.001), and each additional year of practice was associated with a 1.4% average increase (95% CI 0.8 - 2%, p < 0.001). Regional differences were notable: surgeons in the South demonstrating lower repair rates (median 71%, IQR 55% - 85%) compared to those in the Northeast (median 78%, IQR 68% - 91%, p = 0.02) and Midwest (median 86%, IQR 63% - 92%, p = 0.04). This study has identified significant variability in mitral valve repair rates among surgeons treating Medicare beneficiaries. Notably, even among the surgeons responsible for most of these procedures, the variability in repair rates is pronounced. These findings suggest substantial opportunities to improve outcomes for patients undergoing mitral valve operations in North America.

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.

Insights into self-healing capacity of cement matrix containing high-efficiency bacteria under challenging conditions

This study provides novel insights into enhancing the self-healing capacity of cement matrix through the integration of natural Bacillus isolates derived from leached and calcified soils. The challenging and highly alkaline environment of cement matrix typically impedes bacterial activity, making the successful application of these bacteria in such conditions particularly significant. In this research, Bacillus licheniformis-Bacillus muralis co-culture was identified as highly effective in inducing calcium carbonate precipitation, a critical factor for self-healing. The selected co-cultured bacterial activity resulted in the formation of up to 2.885 g/100 mL of CaCO₃, while the co-culture's effectiveness was demonstrated by the complete repair of a 0.5 mm crack within 96 h demonstrating a repair rate of approximately 0.125 mm per 24 h. Furthermore, the study showed that the bacterial co-culture could survive and remain active under varying environmental conditions, including wet-dry cycles and extreme pH levels, which are typical of construction sites. This rapid crack closure, achieved without additional protective measures for the bacteria, marks a significant advancement in the application of microbial co-cultures for enhancing the durability of cement-based materials. The study also provides a detailed analysis of bacterial behavior under various environmental stresses typical of construction sites, highlighting the robustness and practical applicability of this biotechnological approach. As the long-term output, the obtained results represent a substantial advancement in the practical application of microbial co-cultures for self-healing effect of cement-based materials.

Optimizing System Efficiency and Reliability: Integrating Semi-Markov Processes and Regenerative Point Techniques for Maintenance Strategies in Plate Manufacturing

This paper offers a modeling methodology to evaluate similar systems’ performance and optimize system effectiveness with customized maintenance plans. This strategy, which combines regeneration point techniques with semi-Markov processes, is used to assess a plate manufacturing company’s system. Key insights are obtained using a thorough cost-benefit analysis that includes numerical analysis, graphical interpretations, and system efficacy indicators. The study clarifies the dynamics of the system’s reliability under different repair rates by showing an inverse relationship between Mean Time to System Failures (MTSF) and failure rate. Additionally, the analysis clarifies how profit is affected by failure rate, highlighting the necessity of efficient maintenance plans from an economic standpoint. This research highlights the growing significance of availability and dependability in technology-driven sectors and emphasizes the need for dependable systems. This paper makes a substantial contribution to the knowledge already available in the field of reliability engineering by providing a thorough framework that combines regeneration point approaches and semi-Markov processes. The metrics that are obtained offer a comprehensive understanding of the behavior of the system, which in turn helps industry practitioners make well-informed decisions.

A Data-Driven Approach to Inguinal Hernia Repairs in Infants and Children.

Introduction: Laparoscopic inguinal hernia repair has become increasingly popular in children. The laparoscopic technique inherently assesses the contralateral processus vaginalis, reducing the risk of metachronous contralateral hernias. We hypothesized that primary laparoscopic repair would be associated with lower rates of subsequent hernia repair in the youngest patients, in whom metachronous contralateral hernias are most common. Materials and Methods: The Pediatric Health Information System database was queried for patients 0-15 years old, who underwent inguinal hernia repair between 2016 and 2022. The primary outcome was the need for subsequent hernia repair. Current Procedural Terminology (CPT) and ICD-10 procedure codes were used to determine laparoscopic versus open repair. Patients were excluded if the only recorded code was for recurrent hernia or if both laparoscopic and open codes were present for the same procedure. Results: A total of 109,456 patients were included in the study, with 20,338 patients (18.58%), undergoing laparoscopic inguinal hernia repair initially, and 2535 patients (2.32%) requiring a second hernia repair. Patients 6 months old and younger undergoing unilateral laparoscopic repair were less likely to require subsequent surgery (OR 0.82, 95% CI = 0.69-0.96). Across all ages, open bilateral repair less often required subsequent repairs (OR 1.93, 95% CI 1.48-2.51). Conclusion: Laparoscopic unilateral inguinal hernia repair decreases the need for subsequent surgical repair in infants 6 months and younger. No difference was detected in older patients. Open repair of bilateral hernias decreases the need for a second hernia operation in all age groups, suggesting that open repair is more durable.

Comparative Assessment of Success Rate of Lesion Sterilization and Tissue Repair and Vitapex in Necrosed Primary Teeth: A Systematic Review

Comparative Assessment of Success Rate of Lesion Sterilization and Tissue Repair and Vitapex in Necrosed Primary Teeth: A Systematic Review

Investigation on the restoration properties of wood oil microcapsules in wood coatings

Wood coatings endure wear and tear and may experience reduced service life. Therefore, the self-healing feature is crucial for practical application in wood protection. The study involved preparing a self-healing microcapsule through in-situ polymerization. Wood oil was utilized as the core material and urea-formaldehyde resin (UF) as the wall structure, forming a “core-shell” structure. The average particle size of the microcapsules is approximately 2.8 μm. Wood oil Microcapsules of varying content are added to water-based coatings and applied to form a self-healing wood coating. When external forces damaged the wood coating, the microcapsules ruptured and released the inner core to repair the coating. The study results indicated that adding microcapsules at a 6 % level significantly increased the coating's repair rate to over 30 %, enhancing its mechanical properties. This microcapsule type in wood oil can protect wood coatings and guide future wood coating repair methods.

A dynamic risk assessment model for evacuation in healthcare facilities during fire scenarios

Evacuation is a critical procedure for safeguarding individuals during a fire incident within a healthcare facility. Assessing the risk associated with the evacuation process is instrumental in enhancing emergency decision-making and developing contingency strategies. Evacuation, a dynamic process, poses challenges in accurate risk evaluation using conventional static quantitative risk assessment (QRA) techniques. This study introduces a dynamic QRA approach to precisely evaluate the evacuation risk to individuals in healthcare settings during a fire. The dynamic event tree methodology is initially utilized to determine the evolving probabilities of various fire scenarios, considering the equipment failure and repair rates. Subsequently, data on fire products and the evacuation of individuals under different fire scenarios are gathered through simulations conducted with Fire Dynamics Simulator (FDS) and Pathfinder software. In addition, this research proposes a dynamic incapacitation model to calculate the consequences of fire, incorporating changes in individuals' locations and the fire products surrounding them during evacuation to accurately estimate the casualty risk. Lastly, the dynamic scenario probability was integrated with the average incapacitation probability for all individuals, introducing the concept of a fire evacuation safety time window to comprehensively assess hospital fire evacuation risk. The findings revealed that the dynamic quantitative risk analysis (DQRA) approach more effectively captures the influence of fire products on the evacuation risk compared to static methods. Specifically, the peak incapacitation probability in a hospital fire reached 0.85, with firefighting equipment, especially the sprinkler system, reducing this risk by over 97% and decreasing evacuation time by 45%. In addition, the risk of fire evacuation in hospitals reaches a critical threshold in the fourth year, enhancing the repair rate of the firefighting system postpones the risk's escalation to a critical threshold until the fourteenth year.

Assessing the need for specialty consultation for isolated medial orbital wall fractures

ObjectiveThis objective was to assess if the current practice of interfacility transfer and immediate specialty consult is justified by the rate of surgical repair for isolated medial orbital wall fractures. Study DesignThis is a retrospective descriptive study utilizing the records of all patients with isolated medial orbital wall fractures who presented to the ED at Boston Medical Center from January 2014 to December 2022. A descriptive analysis was completed. Results65 patients with isolated medial orbital wall fractures were identified. No patient underwent surgical intervention for repair of their fracture. 15% of the patients were transferred from an outside facility. The facial trauma team was consulted for 70% of the patients. Concomitant consultation of the ophthalmology and facial trauma teams occurred for 54% of the patients. Patients with no specialty consult had the shortest average length of ED stay. The no-show rate for follow-up appointments was 70%. ConclusionsThe absence of surgical repair for isolated medial orbital wall fractures across multiple surgical specialties, multiple attending providers, a wide age range, and all mechanisms of injury along with a 70% follow-up no-show rate may call into question the conventional approach of interfacility transfer and specialty consult for these fractures.

Salubrious effects of proanthocyanidins on behavioral phenotypes and DNA repair deficiency in the BTBR mouse model of autism

Autism is a neurodevelopmental disorder distinguished by impaired social interaction and repetitive behaviors. Global estimates indicate that autism affects approximately 1.6% of children, with the condition progressively becoming more prevalent over time. Despite noteworthy progress in autism research, the condition remains untreatable. This serves as a driving force for scientists to explore new approaches to disease management. Autism is linked to elevated levels of oxidative stress and disturbances in the DNA repair mechanism, which may potentially play a role in its comorbidities development. The current investigation aimed to evaluate the beneficial effect of the naturally occurring flavonoid proanthocyanidins on the behavioral characteristics and repair efficacy of autistic BTBR mice. Moreover, the mechanisms responsible for these effects were clarified. The present findings indicate that repeated administration of proanthocyanidins effectively reduces altered behavior in BTBR animals without altering motor function. Proanthocyanidins decreased oxidative DNA strand breaks and accelerated the rate of DNA repair in autistic animals, as evaluated by the modified comet test. In addition, proanthocyanidins reduced the elevated oxidative stress and recovered the disrupted DNA repair mechanism in the autistic animals by decreasing the expressions of Gadd45a and Parp1 levels and enhancing the expressions of Ogg1, P53, and Xrcc1 genes. This indicates that proanthocyanidins have significant potential as a new therapeutic strategy for alleviating autistic features.

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.