Repair Time Research Articles

Concomitant Procedures, Black Race, Male Sex, and General Anesthesia Show Fair Predictive Value for Prolonged Rotator Cuff Repair Operative Time: Analysis of the National Quality Improvement Program Database Using Machine Learning

PurposeThe purpose of this study is to develop machine learning models using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database to predict prolonged operative time (POT) for rotator cuff repair (RCR). Furthermore, this study aims to use the trained machine learning (ML) models, cross-referenced with traditional multivariate logistic regression (MLR), to determine the key perioperative variables that may predict POT for RCR. MethodsData were obtained from a large, national database (NSQIP) from 2021. Patients with unilateral RCR procedures were included. Demographic, preoperative, and operative variables were analyzed. A multivariable logistic regression (MLR) model and various other machine learning techniques, including random forest (RF) and artificial neural network (ANN), were compared using area under the curve (AUC), calibration, Brier score, and decision curve analysis. Feature importance was identified from the overall best-performing model. ResultsA total of 6,690 patients met inclusion criteria. The random forest (RF) ML model had the highest AUC upon internal validation (0.706) and the lowest Brier score (0.15), outperforming the other models. The RF model also demonstrated strong performance upon assessment of the calibration curves (Slope = 0.86, Intercept = 0.08) and decision curve analysis. The model identified concomitant procedure, specifically labral repair and biceps tenodesis, as the most important variable for determining POT, followed by age <30 years, Black or African American race, male sex, and general anesthesia. ConclusionsDespite the advanced machine learning models used in this study, the NSQIP dataset was only able to fairly predict POT following RCR. The RF model identified concomitant procedures, specifically labral repair and biceps tenodesis, as the most important variables for determining POT. Additionally, demographic factors such as age <30 years, Black race, and general anesthesia were significant predictors. While male sex was identified as important in the RF model, the MLR model indicated that its predictive value is primarily in conjunction with specific procedures like biceps tenodesis and subacromial decompression.

Trends in utilization, timing, and outcomes of thoracic endovascular repair for type B aortic dissection in the United States

BackgroundAortic dissection is the most common acute aortic syndrome in the United States. Type B aortic dissection (TBAD) can be managed medically, through open surgical repair, or with thoracic endovascular repair (TEVAR). The present study sought to assess contemporary trends in the use and timing of TEVAR. MethodsAdult nonelective TBAD admissions were identified in the 2010 to 2020 Nationwide Readmissions Database. Patients were categorized as medical management (Medical Management), TEVAR at initial hospitalization (Early), or TEVAR during readmission (Delayed). Multivariable models were developed to assess associations with clinical outcomes and resource utilization. ResultsOf 85,753 patients, 8.7% underwent TEVAR at index hospitalization (Early). From 2010 to 2020, the proportion undergoing TEVAR decreased significantly (from 11.3% to 9.6%; nptrend < .001), while the proportion of TEVAR at a subsequent hospitalization increased (from 13.0% to 21.6%; nptrend < .001). Compared to Medical Management, the Early group was younger (median. 63 [interquartile range (IQR), 52-74] years vs 69 [IQR, 57-81] years), and more frequently privately insured (27.7% vs 17.5%; P < .001). Following adjustment, the Early group had a reduced odds of mortality (adjusted odds ratio [aOR], 0.56; 95% confidence interval [CI], 0.48-0.66) and increased hospitalization costs (β = +$50,000; 95% CI, $48,000-$53,000). Among 4267 TEVAR patients with available procedure timing data, 15.7% were categorized as Delayed. The Early and Delayed groups did not differ in terms of demographics. The Delayed group had a decreased likelihood of major adverse events (aOR, 0.50; 95% CI, 0.39-0.64); however, this did not affect 90-day cumulative hospitalization costs (β = +$2700; 95% CI, -$5000-$11,000, ref: Early). ConclusionsThis study suggests changes to TBAD management in both treatment modality and TEVAR timing. Focused analysis on the timing and long-term costs of TEVAR are needed to optimize care delivery.

The Cleft Collective: protocol for a longitudinal prospective cohort study

IntroductionCleft lip and/or palate (CL/P) affects 1 in 700 live births globally. Children born with CL/P and their families face various challenges throughout the child’s development. Extant research is often...

Visual Outcomes and Risk of Endophthalmitis in Open Globe Injuries without Intraocular Foreign Bodies with Delayed Repair

To assess and compare the rate of endophthalmitis and visual outcomes in cases of OGI's without intraocular foreign bodies repaired within and greater than 24 hours from the time of injury. A retrospective review of 2,002 cases of OGI's presenting to a single institution. Patients with OGI's were admitted and managed according to a standardized protocol. The impact of timing of repair was assessed between those undergoing OGI repair within (i) 24 hours, (ii) 25-36 hours, and (iii) greater than 36 hours from the time of injury. Rates of endophthalmitis and postoperative visual acuity of logMAR 1.3, logMAR 1.0, and logMAR 0.3 at 180 days and 1 year following open globe repair. 1,382 patients with OGI's were included, of which 75% were male with an average age of 41 years. Maximal zone of injury was zone 1 for 468 patients, zone 2 for 529 patients and zone 3 for 508 patients. 84% of all OGI's underwent repair within 24 hours from the time of injury, 9% from 25-36 hours, and 7% greater than 36 hours. Average preoperative visual acuity was hand motion. Risk factors associated with repair performed greater than 36 hours from the time of injury included female sex (p=0.042). Endophthalmitis was associated with time to repair greater than 36 hours (p=0.049) but not with 25-36 hours or zone of injury (p=0.111). Time to repair had no significant impact on visual acuity outcomes. Although repair of OGI's within 24 hours is the current standard of care, this study found no statistically significant difference in rates of endophthalmitis or visual outcomes in eyes undergoing repair within 24 hours of injury compared to repair extending to 25 to 36 hours . Endophthalmitis rates did increase after 36 hours. We recommend urgent repair of open globe injuries, but in certain circumstances, it may be reasonable to delay repair beyond 24 hours to optimize operating conditions.

Remaining Useful Life Estimation (RUL) For Critical Mechanical Components In Tractor

The proposed framework utilizes an evolutionary mathematical approach to optimize data-related parameters for estimating the Remaining Useful Life (RUL) of critical mechanical components. By integrating advanced time window techniques and considering factors like downtime and failure occurrences, it offers a comprehensive solution for RUL prediction across various industrial contexts. Continuous monitoring systems play a pivotal role by detecting component degradation early, allowing for proactive maintenance and minimizing catastrophic failures. Combining Mean Time to Repair (MTTR) and Mean Time Between Failures (MTBF) offers valuable insights into system performance, enabling proactive maintenance strategies. This review explores mathematical methodologies for predicting RUL in tractors, crucial for enhancing maintenance planning and remanufacturing engineering.

Comparison of Fibrin Glue With Conventional Suturing in Peripheral Nerve Repairs: A Study of Sensory and Motor Outcomes.

Nerve injuries have traditionally been repaired with sutures, and this method is considered the gold standard technique in the management of nerve injuries. However, fibrin glue has recently become a promising tool for repairing nerve injuries and has advantages including ease of usability, atraumatic application technique, and decreased co-optation time of the nerves. This study aims to clinically evaluate the efficacy of nerve repair with fibrin glue compared with the usual suture technique in terms of sensory and motor outcomes. A total of 80 patients were included in the study; 50 patients underwent primary nerve repair, and 30 patients underwent Oberlin's repair. These subsets were randomly divided into two groups in which the nerves were repaired with microsutures in one group and fibrin glue in the other group. In the comparison of fibrin glue with microsutures, there were no significant differences between the two groups in the 2-point discrimination (2PD) test, Semmes-Weinstein test, motor function, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores. However, the co-optation times were significantly shorter with fibrin glue than with microsutures. Based on our findings, nerve repair with fibrin glue is as effective as microsutures in terms of sensory and motor recovery and has added advantages of ease of usability and shorter repair times. Therefore, fibrin glue may be an effective alternative to sutures in nerve repair.

Markov Chain Method in Decision Implementation of Preventive Maintenance Scheduling to Reduce Equipment Downtime in PT. ADF Indonesia: Case Study

PT. ADF is a company operating in the shoe manufacturing industry located in Indonesia. PT. ADF has the problem of machine downtime which is currently still relatively high and requires quite a long repair time. The aim of this research is to reduce the high downtime of equipment or machines with the Markov chain method approach used in selecting the next strategy to produce a better probability of implementing scheduled preventive maintenance (PM) compared to Corrective Maintenance (CM), so that implementing a maintenance schedule is chosen to reduce downtime. equipment/machines. This strategy can reduce obstacles or disruption to production schedules. Based on the Pareto diagram, it is known that the largest downtime is caused by damage to the Rotary injection molding machine and molding machine at 80%. After implementing the preventive maintenance scheduling system as intended, the effectiveness of implementing preventive maintenance can be determined by knowing the results of calculating downtime data on Rotary printing machines and printing machines which were previously 2180 minutes/3 months to 729 minutes/3 months or the equivalent of a cost reduction of IDR. 54,735,613.00 to IDR. 18,303,790.00 or the company obtains savings of 66.56%.

Comparison of functional outcomes following early and delayed arthroscopic repair for traumatic and non-traumatic rotator cuff injuries

BackgroundThe effects of the timing of surgical repair on the outcomes of traumatic and non-traumatic rotator cuff injuries (RCI) remain elusive. Thus, this study aimed to compare differences in outcomes following the repair of traumatic and non-traumatic RCI at varying time points.MethodsThe study population comprised 87 patients with traumatic and non-traumatic RCI who underwent arthroscopic rotator cuff repair and were followed up for a minimum of 6 months. Next, the trauma and the non-trauma groups were stratified into subgroups according to the time of injury (early repair: occurring within 3 months; delayed repair: occurring after 3 months). Measurements before and after surgical interventions were compared to evaluate the effect of the duration of RCI on the functional status of patients in the trauma and non-trauma groups. Primary evaluation indices included the Visual Analog Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant shoulder function score, and the University of California, Los Angeles (UCLA) shoulder score. Secondary evaluation indices consisted of shoulder range of motion (ROM), postoperative rotator cuff retear rate, and incidence of joint stiffness.ResultsAmong the 40 patients in the trauma group, 22 underwent early repair, whereas the remaining 18 underwent delayed repair. In the non-trauma group consisting of 47 patients, 18 underwent early repair, whereas the remaining 29 underwent delayed repair. The minimum clinical follow-up time was 6 months, with an average follow-up time of 10.2 months. During postoperative follow-up, 1 and 6 patients who underwent early and delayed repair experienced re-tear in the trauma group, respectively. Contrastingly, 3 and 8 patients who underwent early and delayed repair presented with re-tear in the non-trauma group, respectively.ConclusionEarly repair of traumatic RCI yielded superior outcomes, including improved range of motion, lower pain symptoms, and lower risk of postoperative re-tears compared to delayed repair. Additionally, non-surgical treatment is recommended as the preferred approach for patients with non-traumatic RCI.

Mandibular Nerve and Lingual Nerve Injuries and Their Management Based on Aetiology, Time of Repair and Method of Intervention: A Systematic Review

Introduction: The purpose of this study was to scientifically review to determine the incidence, prevention protocols and recovery rate and reach a desirable protocol for the management of inferior alveolar nerve (IAN) injury and lingual nerve (LN) injury using the comprehensive overview of literature during various maxillofacial surgical procedures. Materials and Methods: Literature was selected through a search of PubMed, Cochrane Library and Google Scholar electronic databases. Articles from January 2010 to March 2023 were searched. All language articles with a minimum of 6-month patient follow-up and injury analysis by a patient’s reporting, radiographic and neurosensory testing were selected. Results: In total, 52 literature sources were reviewed, and 21 of the most relevant articles that are suitable to the criteria were selected. The impact of lower third molar removal (especially impacted) on the LN injury and IAN injury was clearly seen. Conclusions: Based on the study, it was clear that most injuries were occurring during removal of mandibular third molar. Thus, cone-beam computed tomography-based pre-operative analysis is a must in such cases. The results were significantly better in the early treatment group compared to the late group. Direct nerve repair without tension gives the best surgical outcome than other methods. Autogenous nerve graft was superior amongst other grafts which were used. Further studies were required to open a new paradigm for nerve repairs.

O&M-aware techno-economic assessment for floating offshore wind farms: A geospatial evaluation off the North Sea and the Iberian Peninsula

The development of accurate techno-economic models is crucial to boost the commercialisation of floating offshore wind farms. However, conventional techno-economic models oversimplify operation and maintenance (O&M) aspects, neglecting key maintenance factors, such as component failure rates, metocean conditions, repair times, maintenance vessels and ports. To address this limitation, this paper presents an O&M-aware techno-economic model that comprehensively incorporates the most relevant maintenance factors and evaluates their impacts on site-identification across the North Sea and the Iberian Peninsula based on diverse O&M strategies. Results reveal that operational expenditure can contribute significantly to the levelised cost of energy, ranging from 22% to 50% in the North Sea and 19% to 46% in the Iberian Peninsula. Furthermore, results demonstrate that suitable sites vary based on O&M strategy: preventive strategies favour areas with abundant wind resources like northern Scotland, Norway and Galicia, whereas corrective strategy prioritise sites with less severe metocean conditions, such as southern Scotland and extensive regions in the Mediterranean Sea, including the Gulf of Roses and the Alboran Sea. Finally, the downtime of turbines, an aspect traditionally neglected in techno economic frameworks, emerges as a key factor for accurate techno-economic assessment and site-identification.

When Chromatin Decondensation Affects Nuclear γH2AX Foci Pattern and Kinetics and Biases the Assessment of DNA Double-Strand Breaks by Immunofluorescence.

Immunofluorescence with antibodies against phosphorylated forms of H2AX (γH2AX) is revolutionizing our understanding of repair and signaling of DNA double-strand breaks (DSBs). Unfortunately, the pattern of γH2AX foci depends upon a number of parameters (nature of stress, number of foci, radiation dose, repair time, cell cycle phase, gene mutations, etc…) whose one of the common points is chromatin condensation/decondensation. Here, we endeavored to demonstrate how chromatin conformation affects γH2AX foci pattern and influences immunofluorescence signal. DSBs induced in non-transformed human fibroblasts were analyzed by γH2AX immunofluorescence with sodium butyrate treatment of chromatin applied after the irradiation that decondenses chromatin but does not induce DNA breaks. Our data showed that the pattern of γH2AX foci may drastically change with the experimental protocols in terms of size and brightness. Notably, some γH2AX minifoci resulting from the dispersion of the main signal due to chromatin decondensation may bias the quantification of the number of DSBs. We proposed a model called "Christmas light models" to tentatively explain this diversity of γH2AX foci pattern that may also be considered for any DNA damage marker that relocalizes as nuclear foci.

Traumatic Thoracic Aortic Coarctation after Blunt Thoracic Aortic Injury Mandates Emergent Thoracic Endovascular Aortic Repair.

This study sought to elucidate clinical and imaging findings predictive for malperfusion syndrome after blunt thoracic aortic injury (BTAI). There is limited literature on malperfusion syndrome after BTAI, and the timing of thoracic endovascular aortic repair (TEVAR) in patients with this condition has not been defined. A retrospective analysis of prospectively collected data of patients with BTAI treated between January 2021 and October 2023. Clinical and thoracic aortic (TA) imaging data, time to TEVAR, in-hospital death, and malperfusion/reperfusion sequelae (paraplegia, renal/visceral/limb ischemia, and compartment syndromes) were assessed. Correlations between clinical and imaging findings, time to TEVAR, and outcomes were evaluated. Of the 19,203 trauma patients evaluated, 13,717 (71%) had blunt injuries and 77 (0.6%) had BTAI. The majority (67.5%) were male, with a median age of 40 years (IQR: 33-55). TEVAR was performed in 42 (54.5%) patients. Seven (9.1%) patients presented with clinical and TA imaging criteria for traumatic thoracic aortic coarctation (TTAC), including diminished/absent femoral pulses and TA luminal narrowing of 50% to 99%. The median time to TEVAR was 9 (IQR: 5-32), 11, and 4 hours for all non-TTAC and TTAC BTAI patients, respectively ( P =0.037). Only TTAC patients presented/developed malperfusion/reperfusion sequelae. In-hospital mortality rates were 7.8%, 5.8%, and 29% for all non-TTAC and TTAC BTAI patients, respectively ( P =0.09). Aortic-related mortality occurred in only 2 (2.6%) TTAC patients. Patients with clinical and TA imaging manifestations of TTAC are predisposed to malperfusion/reperfusion sequelae if TEVAR is delayed. We recommend the emergent repair of all BTAIs with TTAC.

Seismic fragility and resilience assessment of steel frame with replaceable T-stub connection components

Based on a rational design, steel beam-column joints with replaceable T-stub connection components (SBCJ-RTCCs) possess superior structural fuse performance and seismic resilience performance. To further evaluate the benefits of steel frames using RTCCs in terms of dynamic response, structural and non-structural components damage as well as seismic resilience, a 12-story steel frame equipped with RTCCs (SF-RTCCs) and a steel moment resisting frame (SMRF) were designed and established. On the basis of validating the simulation results with the experimental findings, the nonlinear dynamic analyses and incremental dynamic analysis (IDA) based seismic fragility analysis was performed. The results confirm that the introducing RTCCs into steel frames can significantly mitigate base shear and floor acceleration as well as produce a more uniform inter-story deformation and a more rational yielding mechanism. Meanwhile, the SF-RTCCs can obtain comparable collapse-resistant performance compared to SMRF, and both frames possess sufficient redundancy to resist structural collapse. Thanks to the lower floor acceleration responses, the SF-RTCCSs performs much better than SMRF in controlling non-structural components damage. After DBE excitations, the probabilities of RTCCs can be replaced by 1st class and 2nd class was 17.2 % and 84.9 %, respectively. After MCE excitations, RTCCs has about 29.3 % and 67.2 % probability that it can be replaced by 2nd class and 3rd class, respectively. Considering the lower economic losses, short repair time and fewer casualties, the rating of seismic resilience of SF-RTCCs was enhanced from one-star of SMRF to two-star.

Self-Healing Conductive Hydrogels with Dynamic Dual Network Structure Accelerate Infected Wound Healing via Photothermal Antimicrobial and Regulating Inflammatory Response.

Wound infections are an escalating clinical challenge with continuous inflammatory response and the threat of drug-resistant bacteria. Herein, a series of self-healing conductive hydrogels were designed based on carboxymethyl chitosan/oxidized sodium alginate/polymerized gallic acid/Fe3+ (CMC/OSA/pGA/Fe3+, COGFe) for promoting infected wound healing. The Schiff base and catechol-Fe3+ chelation in the dynamical dual network structure of the hydrogels endowed dressings with good toughness, conductivity, adhesion, and self-healing properties, thus flexibly adapting to the deformation of skin wounds. In terms of ultraviolet (UV) resistance and scavenging of reactive oxygen species (ROS), the hydrogels significantly reduced oxidative stress at the wound site. Additionally, the hydrogels with photothermal therapy (PTT) achieved a 95% bactericidal rate in 5 min of near-infrared (NIR) light radiation by disrupting the bacterial cell membrane structure through elevated temperature. Meanwhile, the inherent antimicrobial properties of GA could reduce healthy tissue damage caused by excessive heat. The composite hydrogels could effectively promote the proliferation and migration of fibroblasts and possess good biocompatibility and hemostatic effect. In full-thickness infected wound repair experiments in rats, the COGFe5 hydrogel combined with NIR effectively killed bacteria, modulated macrophage polarization (M1 to M2 phenotype) to improve the immune microenvironment of the wound, and shortened the repair time by accelerating the expression of collagen deposition (TGF-β) and vascular factors (CD31). This combined therapy might provide a prospective strategy for infectious wound treatment.

Exploring the relationship between cleft type and speech outcome in 4-to-6-year-olds with non-syndromic cleft palate using different measures: A preliminary report

ABSTRACT Cleft type affects speech outcomes, but exact relationships remain unclear as outcome measures vary. The primary aim was to investigate the relationship between cleft type and speech outcome using different measures in 4-to-6-year-olds with non-syndromic clefts. Secondary aims were to explore the relationships between (i) speech measures used; and (ii) parent perception of speech intelligibility and listener familiarity. Twenty-two pre-schoolers with clefts, plus one parent for each child, were recruited through a hospital outpatient clinic. Children with cleft lip and palate (CLP; n = 11) and those with cleft palate only (CP; n = 11), matched on age and time of palate repair, were compared on Percentage Consonants Correct (PCC), clinician-reported speech intelligibility, and parent rating on the Intelligibility-in-Context Scale (ICS). Children with CLP had significantly lower PCC scores than children with CP (p = .020), but had no significant differences in their clinician- or parent-reported speech intelligibility. Clinician-reported speech intelligibility correlated significantly with both PCC (τ = .594, p < 0.01) and ICS (τ = .424, p = 0.009). No significant correlation was found between PCC and ICS (τ =.197, p = 0.113). Overall, parents rated their child’s intelligibility higher for familiar compared to unfamiliar communication partners (τ = 2.325, p = 0.001, r = .76). Cleft type is crucial for intervention planning when objective measures are employed. Speech outcomes should be evaluated at impairment, activity, and participation levels, and by different communication partners, to comprehensively evaluate communicative effectiveness.

Streamlining Iliac Bone Harvest for Maxillary Reconstruction With Novel Use of Arthrex Osteochondral Autograft Transfer System.

This study introduces a novel application of the Osteochondral Autograft Transfer System (OATS) for autologous bone grafting during alveolar cleft repair. Approximately 75% of patients with cleft lip and palate have an alveolar cleft, which often necessitates secondary bone grafting from common donor sites such as the iliac crest. Traditional harvesting techniques, although effective, can be labor-intensive and increase the risk of donor site injury. Here the authors describe the use of OATS, which has primarily been used in orthopedic procedures like anterior cruciate ligament reconstruction, for the first time in alveolar cleft repair. It involves a minimally invasive, single-use transfer system for harvesting osteochondral autografts from the anterior iliac crest, and thereby reduces harvest time compared with traditional open approaches. The procedure is detailed from pre-operative evaluation through long-term follow-up and highlights the technique's benefits related to surgical time, ease of use, and maintenance of sizable autograft volumes. Similarly, the authors discuss other advantages of OATS, including its single-use and cordless nature, which is believed to contribute to a lower contamination risk and better intraoperative ergonomics.

Multihazard resilience and economic loss evaluation method for cable-stayed bridges under the combined effects of scour and earthquakes

Cable-stayed bridges (CSBs) commonly experience scour-induced foundation issues during their service life, impacting both structural seismic resilience and economic losses. Nonetheless, these aspects remain inadequately addressed in existing seismic codes. This paper presents a comprehensive probabilistic multihazard fragility, resilience, and economic loss evaluation method for CSBs influenced by scour and earthquakes. Numerical models with various scour depths considering epistemic uncertainties in loads, structural properties, and soil conditions are first established using the Latin-hypercube sampling (LHS) method. Incremental dynamic analyses (IDAs) are then conducted on these models in cases with near-fault and far-field bidirectional ground motions, yielding probabilistic multihazard demand models and component- and system-level multihazard fragility surfaces for diverse limit states. Subsequently, resilience and economic losses are comparatively evaluated by integrating damage probabilities with corresponding uncertain functional recovery functions. Eventually, a rapid bridge traffic capacity evaluation method based on the critical traffic capacity surface concept is devised to effectively assess CSB open patterns under various peak ground accelerations (PGAs), scour depths, and repair times. The numerical results show apparent shifts in the nonmonotonic seismic fragility, resilience, and economic loss of the case CSB due to scour effects, with the rates of change reaching 31.4 %, 34 %, and 24.8 %, respectively, associated with a critical scour depth of 12 m at IM = 0.8 g. The developed analysis framework provides a reference for the life-cycle design and maintenance of CSBs affected by multihazard scour and earthquakes.

A two Identical Unit Cold Standby System with two Repairmen and Correlated Failure and Repair Times

The paper deals with the stochastic analysis of a two identical unit cold standby system model. As soon as a unit fails it is attended first by assistant repairman, who completes its repair to make it as good as new with fixed known probability p. Otherwise, with probability q( =1-p), the unit repaired by assistant repairman goes to expert repairman so as to make it as good as new. Both the repairmen are always available with the system and they work their jobs simultaneously. The failure time and repair time by assistant repairman are correlated random variables having their joint distribution as Bivariate exponential. Various measures of system effectiveness useful to system designers and operation managers are obtained by using regenerative point technique. The MTSF and steady state profit have also been studied through graphs in respect of parameter alpha for three different values of repair rate by expert repairman and two different values of correlation coefficient between failure and repair times and important conclusions are drawn.. KEYWORDS :Bivariate exponential distribution, Mean time to system failure (MTSF), Regenerative point, Laplace transform.

Management of Meniscus Pathology with Concomitant Anterior Cruciate Ligament Injury.

The purpose of this review is to summarize current clinical knowledge on the prevalence and types of meniscus pathology seen with concomitant anterior cruciate ligament (ACL) injury, as well as surgical techniques, clinical outcomes, and rehabilitation following operative management of these pathologies. Meniscus pathology with concomitant ACL injury is relatively common, with reports of meniscus pathology identified in 21-64% of operative ACL injuries. These concomitant injuries have been associated with increased age and body mass index. Lateral meniscus pathology is more common in acute ACL injury, while medial meniscus pathology is more typical in chronic ACL deficiency. Meniscus tear patterns associated with concomitant ACL injury include meniscus root tears, lateral meniscus oblique radial tears of the posterior horn (14%), and ramp lesions of the medial meniscus (8-24%). These meniscal pathologies with concomitant ACL injury are associated with increased rotational laxity and meniscal extrusion. There is a paucity of comparative studies to determine the optimal meniscus repair technique, as well as rehabilitation protocol, depending on specific tear pattern, location, and ACL reconstruction technique. There has been a substantial increase in recent publications demonstrating the importance of meniscus repair at the time of ACL repair or reconstruction to restore knee biomechanics and reduce the risk of progressive osteoarthritic degeneration. Through these studies, there has been a growing understanding of the meniscus tear patterns commonly identified or nearly missed during ACL reconstruction. Surgical management of meniscal pathology with concomitant ACL injury implements the same principles as utilized in the setting of isolated meniscus repair alone: anatomic reduction, biologic preparation and augmentation, and circumferential compression. Advances in repair techniques have demonstrated promising clinical outcomes, and the ability to restore and preserve the meniscus in pathologies previously deemed irreparable. Further research to determine the optimal surgical technique for specific tear patterns, as well as rehabilitation protocols for meniscus pathology with concomitant ACL injury, is warranted.

Performance assessment of a newly developed non-invasive 2D beam profile monitor for high-intensity accelerators

In high-intensity accelerators, minimizing beam loss is paramount to avoid damages and activation of accelerator components. To achieve this, a reliable beam profile monitor is essential for assessing the beam center and spread. Additionally, the beam profile can be used to steer the beam during regular operation, thus reducing beam loss. In cases of irregular events, the monitor can initiate beam profile recording to identify and address any issues promptly. In this manuscript, we present a detailed description of a non-invasive 2D beam profile monitor, focusing on its components, operation, and most importantly, its reliability and failure modes. From operation experience, failure modes of the system and its effects were identified. Fault tree analysis was carried out. Failure rate of sheet generator was estimated using response surface method. Failure rates of components were used to estimate the failure rate of the system. From the target reliability, the required maximum repair time of the system was calculated.