Relative Failure Research Articles

The in-hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta-analysis.

There is a need to address the evidence gap regarding the in-hospital administration of sacubitril/valsartan in acute myocardial infarction patients. After searching MEDLINE, Google Scholars and Scopus, a random-effects meta-analysis of randomized controlled trials comparing the in-hospital administration of the angiotensin receptor-neprilysin inhibitors (ARNis) versus the standard therapy in patients with reduced heart failure due to myocardial infarction was performed. The primary outcome was major adverse cardiovascular events. All-cause mortality, cardiac death, rehospitalization for heart failure, non-fatal myocardial infarction (MI), changes in left ventricular ejection fraction, left ventricular volumes, N terminal pro brain natriuretic peptide and adverse events were the secondary endpoints. Nine studies (eight randomized controlled trials and one echo-substudy) with a total 6597 individuals (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker: 3300 patients vs. ARNis: 3297 patients) were included for quantitative analysis. Median follow-up was 6months. Patients receiving an in-hospital coadministration of ARNi had a lower risk of major cardiovascular event [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.32-0.63, P<0.0001] and lower rate of repeat rehospitalization for heart failure (OR 0.40, 95% CI 0.26-0.62, P<0.0001), compared with a standard regimen. Additionally, left ventricle volumes were significantly lower in the ARNi group [left ventricular end-diastolic volume, mean difference (MD) 11.48mL, 95% CI 6.10-16.85, P<0.0001; left ventricular end-systolic volume, MD 7.09mL, 95% CI 2.89-11.29, P=0.0009] with a significant change in left ventricular ejection fraction (MD 3.07, 95% CI 1.61-4.53, P<0.0001), compared with standard therapy. No significant differences were observed in terms of cardiac death, all cause of mortality, non-fatal myocardial infarction and N terminal pro brain natriuretic peptide. Higher rates of iatrogenic hypotensive events were observed in the ARNi group compared with the standard therapy (OR 1.42, 95% CI 1.26-1.60, P value<0.00001). In patients with acute myocardial infarction related heart failure, the in-hospital administration of ARNis was associated with a reduced risk of major cardiovascular events and re-hospitalization for heart failure, as well as cardiac remodelling, but higher rates of hypotensive events compared with standard therapy.

A General Model for the Ductility of Intermetallics Applied to Fe-Co Alloys

The mechanical properties, specifically ductility, of high performing soft magnets such as Fe-Co alloys are a limiting factor to their broader use in a number of systems. The understanding of the mechanical robustness in these materials is currently insufficient to be able to support the growing interest in applications such as magnetic shielding or electric motors. Fe-Co alloys provide the highest commercially available magnetic saturation and high magnetic permeability but have very poor ductility. The addition of vanadium to these alloys has allowed for significant commercialization and some ductility improvements, but the fundamental reasons for the observed improvements are not well understood. In most published work on mechanical properties in these alloys, the precise chemistry of the alloys investigated, often a critical aspect of intermetallics, is not reported or controlled and thermal history is unclear. This work creates a ductility model that is sensitive to changes in chemistry and can predict relative strain to failure as well as brittle fracture mode for intermetallics and is applied to Fe-Co alloys. Through the application of density functional theory (DFT), this model identifies defect stabilities, anti-phase boundary (APB) energies, the energy necessary to cross-slip, and cleavage energies and combines them through energetic competition to determine a relative failure strain. The model correctly predicts ductility improvements with the addition of vanadium as well as the transition from intergranular to transgranular cleavage, though more precise experiments are necessary to appropriately validate the various improvements observed.

Village (re)commoning: rethinking Hong Kong's rural built heritage as commons

In recent years, a growing number of village revitalisation schemes have been initiated in Hong Kong by nonprofit organisations (NPOs) with expertise in ecological and heritage conservation. Although many projects have been commended for their success, villagers feel excluded and remain largely disengaged from the revitalisation process. This article proposes redefining the current understanding of Hong Kong’s rural heritage by introducing the concepts of commons and commoning as a relatively new theoretical framework for analysing village revitalisation. Although it has been mobilised in Hong Kong’s urban context, the concept of commoning is rarely used as a theoretical framework for discussing rural heritage. What new knowledge can be derived from a commoning approach to Hong Kong’s village heritage? How does this approach elucidate past assumptions regarding the value and significance of built heritage? How can the concept of commoning be used to reinterpret the relative success or failure of recent revitalisation initiatives? First, commoning can provide a better understanding of how village heritage was created and managed over time. Second, the literature on commoning provides better tools for understanding the historical processes that led to the disappearance of Hong Kong built heritage commons in the second half of the 20th century. Third, the concept of recommoning is helpful for better understanding the current situation of Hong Kong and the shortcomings experienced by some villagers. This paper also shows that many of the specificities of global contemporary recommoning are relevant to the case of Hong Kong and can partially explain the success or failure of some village revitalisation initiatives. Overall, this article reflects on how various categories of commons and the complex social process of commoning offer multiple advantages to improve our understanding of built heritage when analysing village revitalisation schemes in Hong Kong.

Post‐Mortem Analysis of Building‐Integrated Flexible Thin Film Modules

ABSTRACTFlexible, lightweight thin film (TF) photovoltaic (PV) modules offer a unique opportunity for integration into non‐planar surfaces unable to support heavy weights. While such applications increase the potential for PV in urban areas, the reliability implications are yet to be investigated. Here, prototypes of corrugated rooftiles with integrated Cu (In,Ga)Se2 (CIGS) modules were investigated after 3 years of outdoor operation. Their performance before and after the outdoor exposure was compared and defects were localized. An unpackaging method was developed, allowing access to the solar cells for more detailed characterization of present defects without causing additional damage or changes to existing defects. To our knowledge, this was the first time such an unpackaging method was successfully applied to flexible TF PV modules. The relative efficiency loss ranged from 17% to 43%, mostly due to short‐circuit current (ISC) loss and series resistance (RS) increase. The predominant cause of the RS increase was the delamination at the interconnects, ascribed to thermomechanical stresses caused by outdoor temperature fluctuations. The ISC loss was mainly caused by localized delamination of CIGS from the molybdenum (Mo) back‐contact. The occurrence of such delaminated areas pointed to presence of high local stresses during outdoor operation, possibly due to thermal fluctuations, applied deformation and/or mechanical impact. Two other types of delamination defects were found with no observable impact on performance. These results show the necessity for further optimization in the material choice and processing of TF flexible modules, to avoid mechanical stress related failures upon integration into curved surfaces.

Engineered Tendon-Fibrocartilage-Bone Composite With Mechanical Stimulation for Augmentation of Rotator Cuff Repair: A Study Using an In Vivo Canine Model With a 6-Month Follow-up

Background: Rotator cuff repair augmentation using biological materials has become popular in clinical practice to reduce the high retear rates associated with traditional repair techniques. Tissue engineering approaches, such as engineered tendon-fibrocartilage-bone composite (TFBC), have shown promise in enhancing the biological healing of rotator cuff tears in animals. However, previous studies have provided limited long-term data on TFBC repair outcomes. The effect of mechanical stimulation on TFBC has not been explored extensively. Purpose: To evaluate functional outcomes after rotator cuff repair with engineered TFBC subjected to mechanical stimulation in a 6-month follow-up using a canine in vivo model. Study Design: Controlled laboratory study. Methods: A total of 40 canines with an acute infraspinatus (ISP) tendon transection model were randomly allocated to 4 groups (n =10): (1) unilateral ISP tendon undergoing suture repair only (control surgery); (2) augmentation with engineered TFBC alone (TFBC); (3) augmentation with engineered TFBC and bone marrow-derived stem cells (BMSCs) (TFBC+C); and (4) augmentation with engineered TFBC and BMSCs, as well as mechanical stimulation (TFBC+C+M). Outcome measures—including biomechanical evaluations such as failure strength, stiffness, failure mode, gross appearance, ISP tendon and muscle morphological assessment, and histological analysis—were performed 6 months after surgery. Results: As shown in the mechanical test, the TFBC+C+M group exhibited higher failure strength compared with other repair techniques. The most common failure mode was avulsion fracture in the TFBC+C+M group, but tendon-bone junction rupture was observed predominantly in different groups. Engineered TFBC with mechanical stimulation showed over 70% relative failure strength compared with normal ISP, and the other groups showed about 50% relative failure strength. Histological analysis revealed less fat infiltration and closer-to-normal muscle fiber structure in the mechanical stimulation group. Conclusion: This study provides evidence that mechanical stimulation of engineered TFBC promotes rotator cuff regeneration, thus supporting its potential for rotator cuff repair augmentation. Clinical Relevance: This study provides valuable evidence supporting the use of a novel tissue-engineered material (TFBC) in rotator cuff repair and paves the way for advancements in the field of rotator cuff regeneration.

Gene expression profiles, potential targets and treatments of cardiac remodeling.

Hypertensive and ischemic heart diseases have high morbidity all over the world, and they primarily contribute to heart failure associated with high mortality. Cardiac remodeling, as a basic pathological process in heart diseases, is mainly comprised of cardiac hypertrophy and fibrosis, as well as cell death which occurs especially in the ischemic cardiomyopathy. Myocardial remodeling has been widely investigated by a variety of animal models, including pressure overload, angiotensin II stimulation, and myocardial infarction. Pressure overload can cause compensatory cardiac hypertrophy at the early stage, followed by decompensatory hypertrophy and heart failure at the end. Recently, RNA sequencing and differentially expressed gene (DEG) analyses have been extensively employed to elucidate the molecular mechanisms of cardiac remodeling and related heart failure, which also provide potential targets for high-throughput drug screenings. In this review, we summarize recent advancements in gene expression profiling, related gene functions, and signaling pathways pertinent to myocardial remodeling induced by pressure overload at distinct stages, ischemia-reperfusion, myocardial infarction, and diabetes. We also discuss the effects of sex differences and inflammation on DEGs and their transcriptional regulatory mechanisms in cardiac remodeling. Additionally, we summarize emerging therapeutic agents and strategies aimed at modulating gene expression profiles during myocardial remodeling.

Peridynamics model of torsion-warping: Application to lattice beam structures

This paper presents a finite deformation beam model based on Simo-Reissner theory in peridynamics (PD) framework to deal with torsion induced warping deformation. Seven degrees of freedom, viz. three translational, three rotational, and one warping amplitude are considered at each material point. The governing equations of the beam are obtained by employing global balance of linear and angular momenta in conjunction with Simo's assumption on the deformation field. The relation between PD resultant force, moment, bi-moment, and bi-shear states with their classical counterparts is established using the constitutive correspondence method. Numerical implementation strategy is furnished for both quasi-static and dynamic cases. The solution for quasi-static load is obtained through the Newton-Raphson method. The proposed model is validated against finite element solutions considering cantilever beam and lattice structures. Quasi-static deformation responses of 3×3×3 octet and single unit compression-torsion lattice structures are presented further to demonstrate the effectiveness of proposed beam model. A new bond breaking criterion is proposed based on critical stretch, critical relative rotation, and critical relative warping amplitude and failure of the compression-torsion lattice structures under compressive load is simulated. The Newmark-beta method is utilized to solve the governing equations for dynamic loading. Numerical simulations include dynamic analysis of octet and compression-torsion lattice structures.

Efficacy and safety of artificial liver support system treatment for immune checkpoint inhibitors related liver failure in patients with hepatocellular carcinoma: Protocol for a randomized controlled clinical trial

BackgroundImmune checkpoint inhibitor-induced immune-mediated hepatitis (ICI-IMH) in patients with hepatocellular carcinoma (HCC) has been established to increase the risk of liver failure (LF). Given the accumulating evidence supporting the efficacy of artificial liver support systems (ALSS) in mitigating both IMH and LF, a single-center, non-blinded, randomized controlled clinical trial is proposed to investigate the efficacy and safety of ALSS for HCC patients with ICI-LF. Methodsand analysis: Sixty eligible participants will be enrolled in this trial and randomly assigned to one of two groups in a 1:1 ratio. In addition to standard pharmacological management, patients in the trial group will receive treatment with a double plasma molecular adsorption system (DPMAS) and low-volume plasma exchange (LPE) on three occasions, while patients in the control group will undergo PE three times. Patient assessments, including symptoms and laboratory tests, will be conducted at baseline, before and after the three ALSS treatments, and at 2, 4, 8, and 12 weeks post-enrollment. The primary outcome is the mortality rate at 12-week follow-up. Secondary outcomes include changes in the Model for End-Stage Liver Disease (MELD) score following ALSS treatment and the incidence of adverse events (AEs). DiscussionICI-LF in HCC patients is associated with a high mortality rate and lacks effective treatment options. Our study aims to evaluate the efficacy and safety of ALSS for this patient population, comparing the effectiveness of two ALSS modalities (DPMAS + LPE vs. PE). Trial registrationThis clinical trial has been registered on ClinicalTrials.gov with the identifier NCT05484908 (Release Date: July 30, 2022) (https://clinicaltrials.gov/study/NCT05484908).

Quality control of functioning of the structure “object-thermoelectric cooler-heat sink” of the system of providing thermal modes

The analysis of the mathematical model of the system of providing thermal modes with the use of thermoelectric cooling to assess the influence of the conditions of heat exchange of the heat sink with the medium on the main parameters, reliability indicators and dynamic characteristics of a single-cascade thermoelectric cooler at a given temperature level of cooling, medium temperature, geometry of branches of thermoelements for different current operating modes is considered. The results of calculations of the main significant parameters, reliability indicators, dynamic and energy characteristics of a single-cascade cooler and heat sink of the selected design at a given temperature level of cooling, medium temperature, thermal load, geometry of branches of thermoelements for various characteristic current operating modes are given, when the conditions of heat exchange on the heat sink of the given design under variation of the heat transfer coefficient. It is shown that with the increase of air flow velocity on the heat sink the heat transfer coefficient increases and thus the temperature drop on the heat sink of the thermoelectric cooler with the medium decreases, which allows to significantly reduce the relative failure rate of the cooler and thus increase the probability of failure-free operation of the whole device. When operating a system for providing thermal modes comprising a cooling device, a heat sink, and an electric fan used for dissipating heat output to the environment, different modes of operation of the electric fan (air flow rate) can be used. With the increase in air flow rate of the electric fan increases the velocity of air flow in the live section of the heat sink of a given design, which leads to an increase in the heat transfer coefficient. This, in turn, makes it possible to reduce the temperature drop at a given design of the system for ensuring thermal modes. The possibility of control of reliability indicators, namely, relative intensity of failures and probability of failure-free operation of thermal mode systems of different designs (current modes, number of thermocouples, surface area of the heat sink) at a given cooling level (medium temperature, thermal load, geometry of thermocouples) under changing conditions of heat exchange of the heat sink with the medium is considered.

Student Perspectives of Success and Failure in Biology Lecture: Multifaceted Definitions and Misalignments.

Investigating definitions of success and failure among introductory biology students is essential for understanding what underlies their self-efficacy; a student who gets a B on an exam may lose self-efficacy if they define failure as anything less than an A. Yet, whether students have the same definitions for success as they have for failure in these classes is unknown, nor how those definitions relate to course performance. To better understand student definitions for success and failure and their implications, this mixed-methods study collected survey data from students in two introductory biology courses about their definitions of success and failure and their self-reported grades. Coding of open-ended responses revealed four broad themes related to both success and failure: Performance, Content, Preparation, and Attitude. Although there were common themes in how students defined success and failure overall, individual students often (65%) described success or failure in relation to different standards. We also found some definitions of success and failure were predicted by grades. These results highlight the complexity of building self-efficacy in introductory biology and suggest the need for greater awareness and acknowledgment of the different standards students use to judge their success and failure.

Ovulatory Failure in Mares During Breeding Seasons

Abstract In the years 2022 and 2023 we investigated the prevalence of the ovulatory failure in 133 mares of different breed, 3 to 24 years old, brought to the Equine clinic of the University of Veterinary Medicine and Pharmacy (UVMP) in Košice. Our research involved the monitoring of the reproduction cycle in these mares with the aim to determine the prevalence of ovulatory failure during the breeding season, focusing on certain specific parameters that were considered sufficiently relevant with respect to the development of such failure. These parameters included environmental temperature and the amount of daylight the mares were exposed to, attributable to the months of the breeding season. In addition, we also evaluated the size of pre-ovulatory follicles and the influence of age of the investigated mares. During the mentioned years, one of the ovulatory failures occurred in 17 out of 133 mares (12.78 %). Examination by ultrasonography (USG) and the subsequent analysis of the occurrence of failures in relation to the investigated parameters allowed us to conclude that the length of daylight, age, and environmental temperature were the most important factors. Our observations indicated that the 15–16 h category of daylight presented the highest risk of development of cycle disorders with the most rapid increase observed for HAF. With respect to age, the highest occurrence of ovulatory failures was observed in the category of 15–24 years. The external temperature in the range of 18.1–23.0 °C affected the most the development of cycle disorders. Again, the effect was most evident with respect to HAF. This resulted in our recommendations for horse breeders that they should manage reproduction of their mares in a way so that the receptive phase of the cycle does not occur in the months during which the daylight length and environmental temperatures support ovulatory failure. We also recommend that if the owner′s wish is to keep in the breeding the mares older than 15 years, regular thorough gynaecological examination of these animals should be ensured, aimed at early diagnosis of ovulatory failure.

Social Media Use, Emotional Investment, Self-Control Failure, and Addiction in Relation to Mental and Sleep Health in Hispanic University Emerging Adults.

The number of social media users has increased dramatically in recent years. Common correlates of social media use may be poor mental and sleep health which are pressing issues among emerging adults and Hispanic groups. This study investigated the relationships between five different forms of social media use and mental and sleep health in Hispanic university emerging adults. Hispanic university emerging adults (n = 358) completed a survey assessing sociodemographics, overall social media use frequency, nighttime in-bed social media use, social media addiction, social media self-control failure, emotional investment in social media, depression, anxiety, stress, and sleep quality. Findings demonstrated that social media addiction and social media self-control failure were positively associated with stress and poor sleep quality. Emotional investment in social media was positively associated with depression. Findings may suggest that Hispanic university emerging adults may use social media emotionally and problematically to cope with negative affect and poor sleep quality, or that negative affect and poor sleep quality stem from using social media emotionally and problematically. The clinical implications of these results are discussed. Prospective studies are warranted to assess temporality.

COVID-19 Related Tracheal Stenosis Requiring Tracheal Resection: A Case Series.

To characterize the preoperative and intraoperative findings of symptomatic tracheal stenosis associated with COVID-19 related respiratory failure requiring tracheal resection. We performed a retrospective review identifying all patients with a history of tracheal stenosis secondary to COVID-19 related respiratory failure who subsequently received a tracheal resection at our institution between January 2020 and June 2023. Clinical, radiological, pathological, and surgical characteristics were recorded to describe and characterize pre-operative and intraoperative findings associated with tracheal stenosis in the setting of a previous COVID-19 infection. We retrospectively reviewed 11 patients with COVID-19 related tracheal stenosis that required open tracheal or cricotracheal resection. The mean age was 54.1. Patients were hospitalized for a mean of 49.5 days related to COVID-19 complications. Tracheotomy was completed in 10 patients (90.9%) during their initial hospitalization with COVID-19 related respiratory failure. Patients were intubated a mean of 18.6 days prior to tracheotomy completion. Ten patients (90.9%) underwent endoscopic operative interventions for their tracheal stenosis prior to open resection. Intraoperatively, the mean stenosis length was 3.33 cm. The mean tracheal resection length was 3.96 cm. Patients were hospitalized for a mean of 8.27 days post operatively with no significant post operative complications. Symptomatic tracheal stenosis in the setting of prolonged intubation due to COVID-19 is an under-described etiology. This is one of the largest single institution retrospective reviews that identifies 11 patients with prolonged intubation who developed symptomatic tracheal stenosis refractory to conservative management and ultimately requiring tracheal resection.

The use of foresight to anticipate and prioritise innovation system failures: The case of machine learning in broadcasting in South Korea

This article reports on a study applying foresight methods to explore and anticipate innovation system failures in relation to a particular case sector, that of broadcasting in South Korea. Although previous studies of system failures have contributed to an in-depth understanding of innovation system as an analytical concept and provided the base of policy intervention, they have failed to capture different degrees of system failures and their changes in the process of sectoral transformation. Through the application of a sectoral innovation system foresight approach to the broadcasting sector in South Korea’s encounters with artificial intelligence (AI), a series of current and future priorities among nine system failures are identified. The shift of nine system failure priorities between current and five-year time points is captured: the highest priority of system failures moves from directionality failures to market structure failures. By applying a sectoral innovation system foresight approach, we advance theory on system failures and innovation systems. We show that the use of sectoral innovation system foresight approaches can productively be applied to the understanding of current and potential system failures.

Analysis from a policy perspective: The importance of strengthening in maritime axis policy design in Indonesia

This study analyzes the importance of strengthening the design of Indonesia’s maritime axis policy. This research uses a qualitative approach to systematically explain the dynamics and importance of strengthening world maritime policy, where the Nvivo 12 Plus tool is used to analyze data and answer the research questions posed. This research shows that Indonesia still has complex bureaucratic and institutional problems and aspects of political identity and leadership attitudes that require systematic and comprehensive improvement. Then, the draft for strengthening the maritime axis policy in Indonesia includes three policy recommendations: reformulating the focus of the maritime axis policy, comprehensive and coherent governance, and an integrated administrative framework, as well as improving the political identity and attitudes of leaders in public policy. Substantially, the relative failure of the Global Maritime Axis (GMA) policy, known as Joko Widodo’s concept of regulating the Indonesian government based on geographical location, was caused by the dominance of political factors and domestic bureaucratic problems. Apart from that, the lack of priority narratives in the maritime and development sectors means that the Indonesian government’s priorities are more oriented towards GMA infrastructure aspects and at the expense of other fundamental elements. This study encourages the Indonesian government to accelerate a more substantive GMA. However, this research needs to be expanded because the analysis results were only carried out through secondary data and focused on two important aspects of GMA. Therefore, further research is needed that explains the prospects for GMA policy in Indonesia in more detail.

Parameter sharing fault data generation method based on diffusion model under imbalance data

Abstract Rotating machinery will inevitably fail under long-term heavy load working conditions. Obtaining enough data to train the deep learning model can enable managers to detect and deal with related failures in time, which greatly improves the safety of equipment operation. Mechanical fault samples are often much smaller than healthy samples. Traditional data enhancement methods mostly change the original data, but cannot improve the diversity of its features, so that the number of fault samples becomes larger, but the features remain unchanged. Aiming at the above problems, a diffusion model based on parameter sharing and inverted bottleneck residual structure (DDPM) is proposed. Firstly, the diffusion process gradually covers the original data with Gaussian noise, to learn the corresponding fault characteristics of the original data. In the diffusion process, the parameter sharing attention mechanism is embedded in the learning process of the diffusion process. Then, the feature extraction module is constructed by using the inverted bottleneck residual structure to enhance the learning ability of the network. After obtaining the fault characteristics of the original data, the reverse process of the results restores the Gaussian noise to data with different fault characteristics through the same steps as the diffusion process. By comparing the results of various generation models and analysing the characteristics of the generated data, the feasibility and universality of the proposed method in data augmentation tasks are verified.

Performance of Bonded Lithium Disilicate Partial-coverage Crowns in the Restoration of Endodontically Treated Posterior Teeth: An Up to Seven-Year Retrospective Study.

To evaluate the clinical performance of adhesively bonded lithium disilicate glass-ceramic (LDG) partial-coverage crowns in restoring posterior endodontically treated teeth (ETT). A total of 121 morphologically compromised posterior ETT were restored with LDG partial-coverage crowns between October 2015 and January 2018. The restorations were fabricated in the laboratory or at the chairside. Two adhesive systems and resin cements were used to cement the restorations. Tooth and restoration survival rates were calculated. The restorations were evaluated clinically using the modified United States Public Health Service (USPHS) criteria for an observation period of 5-7 years. The Cox proportional hazards model was used to estimate relative failure risks such as tooth type, resin cements, gender, and sleep bruxism. The standard chi-squared test was used to compare the survival of different tooth types for significant differences (α=0.05). In addition, survival probability was calculated using the Kaplan-Meier algorithm. Among seven failed cases, one was a tooth fracture, and six were restoration fractures. According to the Kaplan-Meier analysis, the estimated survival rate of the teeth was 99% for seven years, while the estimated survival rate of the restorations was 94.8% for 5 years and 92.8% for 7 years. Tooth type and resin cements did not influence restoration survival rates (p>0.05), while sleep bruxism and male patients might increase the risk of failure (p<0.05). The indirect adhesively bonded LDG partial-coverage crowns of posterior ETT exhibited favorable clinical outcomes. Ceramic fracture was the most common failure pattern.

Comparative Study between Percutaneous Ilioilial Fixator versus Percutaneous Iliosacral Screw in Managing Sacral Fractures

Abstract Background The sacrum is the mechanical nucleus of the axial skeleton, located at the base of the lumbar spine and acts as the keystone at the centre of the pelvic ring. Traumatic sacral fractures are an increasingly recognized diagnosis. Sacral fractures remain a relative uncommon entity in the general population. Objective The aim of this work is to compare between percutaneous iliosacral screw and ilioilial fixation in sacral fractures fixation as regard operative time, need of intraoperative fluoroscopy, blood loss &amp; related transfusion, infection, neurovascular complication, hardware failure and screws miss- displacement, clinical and radiological outcomes, revision rate and rate of non-union. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients. This study was carried on 51 Patients with sacral fractures injuries through the period from August 2019 to November 2021. A prospective randomized controlled clinical trial was conducted to compare the functional and radiological outcome of closed reduction and percutaneous fixation of traumatic sacral fractures using iliosacral screw or ilioilial fixator. Results There is no statistically significant difference in functional outcome, radiological outcome operative time, blood loss, postoperative complication, union rate or follow up. There is statistically significant difference in incision length between the two groups as mean length of incision in iliosacral screw and Ilioilial fixator is 1.2 cm and 4.8 cm respectively. There is statistically significant relation between number of intraoperative fluoroscopic and fixation principles (P value &amp;lt;0.001) with higher risk for radiation exposure in IS screw group. Conclusion Iliosacral screw and ilioilial fixator have comparable functional and radiological outcome and similar biomechanical stability .We suggest the ilioilial fixator as an alternative to IS screw in sacral fracture management. The ilioilial fixator is a useful option in patients who do not qualify for IS screw fixation.

Multiscale mechanical performance evaluation of L-DED Ti6Al4V by novel ultrasonic burnishing (UB)

Laser-directed energy deposition (L-DED), as a novel technology to produce titanium (Ti) alloys (e.g., Ti6Al4V), has potential impactful applications. However, Ti alloys by L-DED is largely compromised by defects (porosity, cracks, etc.) at or near surfaces, which prevents strength-ductility synergy. In this study, a new method for Ti6Al4V sample preparation using ultrasonic burnishing coupled with heat treatment (UB/HT) after L-DED has been suggested. The results show that UB/HT has a more positive effect than mere UB to overcome turning's disadvantages, when the roughness, porosity, microstructures, and multiscale mechanical performance of L-DED Ti6Al4V are considered. UB/HT transforms residual tensile stress into compressive stress and causes severe plastic deformation (SPD) within a depth of approximately 10 μm on the surface layer. With this, UB/HT improves multiscale mechanical properties, e.g., hardness to 428 HV and strength to 976.7 MPa, and the related failure modes and fracture features induced by the UB/HT crack inhibition effect are confirmed with the fatigue results. With these observations, this research provides a good theoretical and practical reference for multi-scale mechanical analysis and understanding of L-DED Ti6Al4V, which expand the UB/HT applications.

Benign tumors and non-melanoma skin cancers in patients with Fanconi anemia

Fanconi anemia (FA) is an inherited bone marrow failure syndrome (IBMFS) characterized by pathogenic variants in the FA/BRCA DNA repair pathway genes. Individuals with FA have an elevated risk of developing myelodysplastic syndrome, acute myeloid leukemia, and solid tumors. Hematopoietic cell transplantation (HCT) is the most effective treatment for FA related bone marrow failure but can increase the risk of cancer development. Information on benign tumors and NMSC is lacking in patients with FA. Our objective was to characterize patients with FA enrolled in the National Cancer Institute IBMFS Study who have experienced non-melanoma skin cancers (NMSC) and/or benign tumors (BT). A total of 200 patients diagnosed with FA were enrolled in the Institutional Review Board approved study “Etiologic Investigation of Cancer Susceptibility in IBMFS: A Natural History Study” (NCT00027274). Through medical records review, we identified 30 patients with at least one NMSC, either squamous or basal cell carcinoma, or benign tumor. The remaining 170 patients comprised the control group. Out of 200 patients, 12 had NMSC, 25 had benign tumors, with an age range of 11–64 and 0–56 years, respectively. The median age at HCT was 30.5 years for NMSC patients, 9 years for benign tumor patients, and 9.1 years for controls. The most common genotype observed was FANCA, followed by FANCC and FANCI. Benign tumors spanned diverse anatomical locations. Early onset NMSC in patients with FA compared to the general population emphasizes the need for consistent monitoring in patients with FA, while the diverse anatomical locations of benign tumors underscore the importance of comprehensive surveillance for timely interventions in managing symptomatology and heightened cancer risk.