Type Of Repair Research Articles

Recurrent Inguinal Hernia (A Descriptive Study on Etiology & Management)

Background: Recurrent inguinal hernia constitutes a significant problem for the surgical community. Incidence of recurrence and chronic groin pain after hernia repair require continuous audit, participation in a register and follow-up by selective physical examination provides a solid basis for quality control.
 Objective: Description of cases with recurrent inguinal hernia, type of previous repair, factors contributed to recurrence of hernia and type of repair used with the study of post-operative complications in the early postoperative period.
 Patients and Methods: Descriptive studies on patients with recurrent inguinal hernia were evaluated and data collected.
 History; age, occupation, time of previous operation, predisposed factors extracted from the previous operation and change of lifestyle. General examination; the presence of predisposing factors, comorbid factors, obesity. Local examination: to describe the type of hernia. Local examination: to describe the type of hernia.
 Results: In our study 18(40%) patients had an indirect recurrent hernia, 24 patients with recurrent direct inguinal hernia, and 3 patients presented with pantaloon hernia. Males constitute 93.33% of cases. Smoking and chronic cough were the most common predisposing factors. The right side constitutes 80% of cases and the other 20% on the left side. The interval between the previous operation and clinical presentation of recurrence is the highest number presented after 2-5 years.
 Conclusion: Mesh repair was superior to other types of repair (less no. of patients with previous mesh repair and less post-operative complications).

Recurrent Inguinal Hernia (A Descriptive Study on Etiology & Management)

Background: Recurrent inguinal hernia constitutes a significant problem for the surgical community. Incidence of recurrence and chronic groin pain after hernia repair require continuous audit, participation in a register and follow-up by selective physical examination provides a solid basis for quality control. Objective: Description of cases with recurrent inguinal hernia, type of previous repair, factors contributed to recurrence of hernia and type of repair used with the study of post-operative complications in the early postoperative period. Patients and Methods: Descriptive studies on patients with recurrent inguinal hernia were evaluated and data collected. History; age, occupation, time of previous operation, predisposed factors extracted from the previous operation and change of lifestyle. General examination; the presence of predisposing factors, comorbid factors, obesity. Local examination: to describe the type of hernia. Local examination: to describe the type of hernia. Results: In our study 18(40%) patients had an indirect recurrent hernia, 24 patients with recurrent direct inguinal hernia, and 3 patients presented with pantaloon hernia. Males constitute 93.33% of cases. Smoking and chronic cough were the most common predisposing factors. The right side constitutes 80% of cases and the other 20% on the left side. The interval between the previous operation and clinical presentation of recurrence is the highest number presented after 2-5 years. Conclusion: Mesh repair was superior to other types of repair (less no. of patients with previous mesh repair and less post-operative complications).

Women of Childbearing Age Have Higher Mortality Rates Following Inpatient Interventions for Splenic Artery Aneurysms

Splenic artery aneurysms (SAAs) are the most common type of splanchnic aneurysms. Current guidelines recommend repair of SAAs in women of childbearing age because maternal mortality is high. The purpose of this study was to evaluate treatment modalities and outcomes following inpatient SAA repair in women. The National Inpatient Sample database from 2012 to 2018 was queried. Patients with SAAs were identified using International Classification of Diseases (ICD) 9 and 10 codes. Childbearing age was defined as 14-49years. The primary outcome was in-hospital mortality. A total of 561 patients were admitted with a diagnosis of SAA between the years of 2012 and 2018. There were 267 (47.6%) female patients and of these 103 (38.6%) were of childbearing age. The overall in-hospital mortality rate was 2.7% (n=15). There were no differences in rates of elective admissions or type of repair (open versus endovascular) between women of childbearing age and the remainder of the cohort. However, women of childbearing age were significantly more likely to undergo a splenectomy compared to the remainder of the cohort (32.0% vs. 21.4%, P=0.028). Women of childbearing age had higher rates of in-hospital mortality compared to the remainder of the cohort (5.8% vs. 2.0%, P=0.040). Subset analysis of the women of childbearing age revealed that those undergoing a splenectomy versus no splenectomy (14.8% vs. 2.6%, P=0.039) and those treated in the nonelective versus elective setting (10.5% vs. 0%, P=0.032) had higher rates of in-hospital mortality. There was 1 patient with an ICD code associated with pregnancy and they survived. Women of childbearing age had higher in-hospital mortality following inpatient interventions for SAAs with all of the deaths occurring in the nonelective setting. These data support the pursuit of aggressive elective treatment of SAAs in women of childbearing age.

MP18-08 SHOULD CONTEMPORARY UROLOGY RESIDENTS EXPECT TO BE ABLE PERFORM HYPOSPADIAS REPAIR WHEN THEY GRADUATE WITHOUT FELLOWSHIP TRAINING: RESULTS FROM A SURVEY OF SPU MEMBERSHIP

You have accessJournal of UrologyCME1 Apr 2023MP18-08 SHOULD CONTEMPORARY UROLOGY RESIDENTS EXPECT TO BE ABLE PERFORM HYPOSPADIAS REPAIR WHEN THEY GRADUATE WITHOUT FELLOWSHIP TRAINING: RESULTS FROM A SURVEY OF SPU MEMBERSHIP John M. Masterson, Michael Zaliznyak, Aurash Naser-Tavakolian, Peris Castaneda, and Andrew Freedman John M. MastersonJohn M. Masterson More articles by this author , Michael ZaliznyakMichael Zaliznyak More articles by this author , Aurash Naser-TavakolianAurash Naser-Tavakolian More articles by this author , Peris CastanedaPeris Castaneda More articles by this author , and Andrew FreedmanAndrew Freedman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As surgical training has become increasingly subspecialized, residents have been encouraged to pursue additional fellowship training. We sought to better understand current attitudes regarding expectations for competency for non-fellowship trained graduates in sub-specialty procedures and how this has affected teaching practices during residency training. We chose to study hypospadias as a model as it is a signature procedure for pediatric urologists that is both technically challenging and at the same time quite common. METHODS: We created a survey tool utilizing the well-established Zwisch scale to assess the level of autonomy afforded to trainees by survey respondents during various types of hypospadias repair as well as elicited attitudes regarding post-training expectations. Our survey was distributed via email to the Society of Pediatric Urology membership. We also collected respondent demographic data such as geographic location, years in practice, and practice setting. RESULTS: 178 of 761 (23%) unique recipients completed the survey. We excluded 6 respondents who are retired or do not perform hypospadias repair. 170 of 172 (98%) included respondents felt that trainees should not perform hypospadias repair independently in practice without additional fellowship training. Among pediatric urologists who train residents, trainee autonomy as measured by the Zwisch scale was limited to an assistant role for the vast majority of trainees and decreased as the severity of the hypospadias increased (Figure 1). CONCLUSIONS: Urology residents for the most part are not being afforded a level of autonomy in hypospadias cases during training that would suggest competency for independence following graduation. Additionally, there is consensus that contemporary graduates are not expected to be competent to perform hypospadias repair in independent practice without additional fellowship training. This raises the question if there are other common sub-specialty procedures in urology where residents are not expected to achieve competence, and if so, how should we as educators, be forthcoming about the limitations of urology residency training to set appropriate trainee and employer expectations? Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e225 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John M. Masterson More articles by this author Michael Zaliznyak More articles by this author Aurash Naser-Tavakolian More articles by this author Peris Castaneda More articles by this author Andrew Freedman More articles by this author Expand All Advertisement PDF downloadLoading ...

Формирование организационно-технологического механизма повышения технологичности производства работ при капитальном ремонте зданий

Introduction. Modern methods of executing total building renovation are based on the principles of flow and scientific methods of labour organisation, developed with due regard for the specific features of certain types of repair and construction works technologies. The following labour-intensiveness and duration of work, material-intensiveness, cost and production cost of constructions are considered as the main indicators of work production technology in the course of overhaul repair. Each of these indicators has corresponding reserves, which are identified and used to improve the manufacturability of production of each type of work, as well as on the building as a whole. Materials and methods. The article is based on the method of assessing the effectiveness of various options to reduce the duration of work, which directly affects the change in technological parameters. A ranking among contractors has been carried out to identify the reserves for increasing labour productivity, as well as to identify bona fide contractors for customers. Results. The developed methodology of evaluation of manufacturability of overhaul works allows contractors to justify for customers the proposals on reduction of terms and cost of overhaul works. The use of the developed organizational and technological mechanism in practice of interaction of all participants of capital repair process will allow not only to achieve the highest indicators, but also will serve as a basis for actualization of normative documents on total building renovation. Conclusions. The method of efficiency estimation of different variants of work time reduction and related changes of technological parameters according to Wald, Savage and Hurwitz criteria allowed to establish the most preferable construction-technological solution. The developed rating assessment of contractors will, on the basis of achieved results, enable to reveal reserves of increasing labour productivity in the course of repair-construction works and to encourage these organizations to be more preferable in carrying out competitive procedures of selecting contractors by the customer. The identified reserves of reducing the duration of overhaul works are used as a basis for the formation of measures to improve the manufacturability of works.

Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age

Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4–17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370–554) compared to controls (626; 95% CI: 576–676), although there was no statistically significant difference in the sports index (187; 95% CI: 156–220 versus 220; 95% CI: 203–237). A lower mean weight-for-age and height-for-age, additional urogenital (r = − 0.20, p = 0.04) or anorectal malformation (r = − 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found. Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors.Trial registration: German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021.What is Known:• Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity.What is New:• Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers.• Physical activity was associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.

Finite Element Analysis of Different Osseocartilaginous Reconstruction Techniques in Animal Model Knees.

Lesions of the articular cartilage are frequent in all age populations and lead to functional impairment. Multiple surgical techniques have failed to provide an effective method for cartilage repair. The aim of our research was to evaluate the effect of two different compression forces on three types of cartilage repair using finite element analysis (FEA). Initially, an in vivo study was performed on sheep. The in vivo study was prepared as following: Case 0-control group, without cartilage lesion; Case 1-cartilage lesion treated with macro-porous collagen implants; Case 2-cartilage lesion treated with collagen implants impregnated with bone marrow concentrate (BMC); Case 3-cartilage lesion treated with collagen implants impregnated with adipose-derived stem cells (ASC). Using the computed tomography (CT) data, virtual femur-cartilage-tibia joints were created for each Case. The study showed better results in bone changes when using porous collagen implants impregnated with BMC or ASC stem cells for the treatment of osseocartilaginous defects compared with untreated macro-porous implant. After 7 months postoperative, the presence of un-resorbed collagen influences the von Mises stress distribution, total deformation, and displacement on the Z axis. The BMC treatment was superior to ASC cells in bone tissue morphology, resembling the biomechanics of the control group in all FEA simulations.

A prospective cohort study of assisted bladder emptying following primary cloacal repair: The Children's National experience

Although the combination of bladder dysfunction and upper tract anomalies puts patient with cloaca at risk for renal disease, the rarity of this condition makes it difficult to study empirically. As a high-volume center, we uniquely capture bladder function outcomes following our growing number of cloacal repairs. 1) Describe the rates of incomplete bladder emptying following primary cloacal repair (at 2-3 months after repair and last follow up), and 2) identify clinical factors associated with assisted bladder emptying. We performed a prospective cohort study of patients undergoing primary cloaca repair by our Children's National Colorectal Center team between 2020 and 2021. The primary outcome was assisted bladder emptying at 2-3 months postoperatively and last visit. Covariables included preoperative characteristics (cloacagram measurements), ARM complexity (moderate=common channel [CC] <3-cm, severe=CC≥3-cm), vesicoureteral reflux (VUR) status, sacral ratio (good ≥0.7, intermediate 0.7-0.4, poor ≤0.4), spinal cord status, means of preoperative bladder emptying, and operative details (age at repair, repair type, & concomitant laparotomy). Eighteen participants were eligible. A majority had moderate cloaca (78%), VUR (67%), spinal cord abnormalities (89%), and good sacral ratios (56%). Preoperatively, 10 patients were diapered for urine and 8 had assisted bladder emptying. Surgical repairs were performed at a median age of 8 months (range 4-46). Nine (50%) patients underwent urogenital separation (UGS), eight (44%) total urogenital mobilization, and 1 (6%) perineal sparing posterior sagittal anorectoplasty with introitoplasty. Exploratory laparotomy was performed in 7 (39%) patients. At 2-3 months, 7 patients were voiding and 11 required assisted bladder emptying. Median length of long-term follow up was 12 months (range 5-25), and 8 patients were voiding and 10 required assisted bladder emptying. Postoperative need for assisted bladder emptying was significantly associated with assisted bladder emptying preoperatively, a shorter urethra and increasing common channel length, UGS and exploratory laparotomy. Spinal cord imaging findings were not associated. Bladder emptying following cloaca repair is likely a result of congenital function and surgical effects. Indeed, increasingly cloaca complexity requiring UGS and laparotomy was associated with both pre- and post-operative assisted bladder emptying. The lack of association with spinal cord imaging may reflect a divergence between anatomy and function. Approximately half of patients required assisted bladder emptying in this study. Associated factors included urethral and common channel length, the need for assisted bladder emptying preoperatively, the type of surgical approach and additional laparotomy. Being diapered with seemingly normal voiding prior to surgery did not guarantee normal bladder function postoperatively.

Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair

The use of caudal anesthesia at the time of hypospadias repair remains controversial as some prior studies have reported increased postoperative complication rates associated with caudal nerve block. However, these results have been called into question due to confounding factors and heterogeneous study groups. Given the importance of identifying true risk factors associated with increased hypospadias complication rate, we examined our experience with caudal anesthesia limiting our analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated with increased postoperative complications. We retrospectively reviewed our institutional hypospadias database from June 2007 to January 2021. All boys who underwent single-stage distal hypospadias repair with either caudal or penile block with minimum 1 month follow up were included. Records were reviewed to determine the type of local anesthesia, type of hypospadias repair, all complications, and time to complication. Association between any complication and local anesthesia type was evaluated by univariate and multivariate logistic regression analysis controlling for age at surgery and type of repair. A sub-analysis was performed for complications occurring ≤30 days. Overall, 1008 boys, 832 (82.5%) who received caudal and 176 (17.5%) penile block, were included. Median age at surgery was 8.1 months and median follow up was 13 months. Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation. Median time to complication was 10.59 months and was significantly shorter in the caudal group (8.45 vs. 25.2 months). Caudal anesthesia was associated with higher likelihood of complication on univariate analysis; however, this was not true on multivariate analysis when controlling for age and type of repair. Caudal anesthesia was not associated with increased likelihood of complication within 30 days. Since the association between caudal anesthesia and hypospadias complications was first suggested, several studies have tried to answer this question with variable results. Our findings add to the evidence that there is no association between caudal anesthesia and increased hypospadias complications in either the short or long term. The major strengths of our study are a large, homogenous study population, robust follow up and inclusion of data from 14 surgeons over 14 years. Limitations include the study's retrospective nature as well as lack of standardized follow up protocol throughout the study period. After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair.

Comparative Study between Lichtenstein versus Lichtenstein Combined with Mesh Plug in Management of Inguinal Hernia

Inguinal hernioplasty is an ordinary operation all over the world. Many types of repair are present. Aim of the surgeon is to improve the outcome and decrease the recurrence. We evaluated the addition of a mesh plug with the usual repair as a

Residency graduates should not be expected to perform hypospadias repair without fellowship training: Results from a survey of SPU membership

Trainee autonomy has eroded over time as surgery has become more subspecialized and as attending oversight has increased, causing many trainees to seek additional fellowship training beyond residency. Less clear is whether there are cases that attendings view as "fellowship-level" or "privileged" cases in which resident-level trainees should not have high levels of autonomy due to complexity or high-stakes outcomes. We sought to better understand current attitudes and practices with regards to trainee autonomy in hypospadias repair as it represents a high complexity procedure within pediatric urology. We administered a RedCap survey to the SPU membership, asking respondents to describe the level of autonomy afforded to trainees in various types of hypospadias repair (distal, midshaft, proximal, perineal) as measured by the Zwisch scale. The Zwisch scale describes the role of the attending in the attending-trainee relationship in a low-to-high trainee autonomy fashion: show and tell; active help; passive help; supervision only. 177 of 761 (23%) unique recipients completed our survey and 174 of 177 (98%) of respondents felt that trainees should not perform hypospadias repair independently in practice without additional fellowship training. Among pediatric urologists who train residents, trainee autonomy as measured by the Zwisch scale decreased as the type of hypospadias repair moved from distal to proximal. There was near unanimous agreement among respondents that urology trainees should not perform hypospadias repair in practice without additional pediatric urology fellowship training, and that current practice affords little trainee autonomy in hypospadias repair at the resident level. These findings introduce a new wrinkle into the issue of trainee autonomy: cases in which trainees perhaps should not have autonomy. Concurrently, the concern with such findings is that this intentional lack of autonomy may extend to other urologic procedures that one would expect trainees to be able to perform independently. Urology trainees are not expected to be able to perform hypospadias in practice without additional training. This raises the question that there may be other such procedures in urology, and if so, should we as instructors, be forthcoming about the limitations of urology residency training to set appropriate trainee expectations?

Anterior Thoracic Discectomy and Fusion for Symptomatic Ventral Bone Spur Associated Type I Cerebrospinal Fluid Leak: A Technical Report and Operative Video.

Technical Report. Cerebrospinal fluid (CSF) leak secondary to anterior osteophytes at the cervico-thoracic junction is a rare cause of intracranial hypotension. In this article we describe a technique for anterior repair of spontaneous ventral cerebrospinal fluid leaks in the upper thoracic spine. In this technical report and operative video, we describe a 23-year-old male who presented with positional headaches and bilateral subdural hematoma. Dynamic CT myelography demonstrated a high flow ventral cerebrospinal fluid leak associated with a ventral osteophyte at the level of the T1-T2 disc space. Targeted blood patch provided only temporary improvement in symptoms. An anterior approach was chosen to remove the offending spur and micro-surgically repair the dural defect. The patient had complete resolution of his preoperative symptoms after primary repair. In select cases, an anterior approach to the upper thoracic spine is effective to repair Type 1 cerebrospinal fluid leaks.

Single-Center Retrospective Analysis of Acute Type A Aortic Dissection Outcome and Reoperation Focusing on Extended Versus Limited Initial Repair.

The optimal management strategy for acute aortic type A dissection remains controversial. Whether a limited primary (index) repair would increase the need for late aortic reintervention is still an open debate. A total of 393 consecutive adult patients with acute type A aortic dissection who underwent cardiac surgery were analyzed. Our research hypothesis was whether limited aortic index repair (i.e., isolated aorta ascending replacement without an open distal anastomosis with and without a concomitant aortic valve replacement, including hemiarch replacement procedure) is associated with a higher incidence of late aortic reoperation compared with extended repair (i.e., any other surgical procedure that goes beyond that limited approach). Type of the initial repair had no statically significant relationship with in-hospital mortality with a P-value of 0.12, however in multivariable analysis, cross-clamp time had a statistically significant relation with mortality (P = 0.4). From the patients who survived until discharge (N = 311), 40 patients needed a reoperation on the aorta; the mean interval until reoperation was 4.5 years. The relationship between the type of the initial repair and the need for reoperation didn't reach a statically significant value (P = 0.9). In-hospitable mortality after the second operation was 10% (N = 4). We reached two conclusions. 1) An extended prophylactic repair in the initial operation of an acute type A aortic dissection might not lead to a lower incidence of reoperations on the aorta and could increase in-hospital mortality by increasing cross-clamp time, and 2) Reoperation on the aorta could be done safely with acceptable mortality outcomes.

The Fisher Subunit Anatomical Approach for Cleft Lip Revisions

Introduction: Many techniques exist to reapproximate a cleft lip but can leave unsatisfactory results with non-anatomic scars and a short upper lip. Because of this, the need for cleft lip revision often arises years after the initial repair. Many revisions focus on adjacent tissue transfers and realignment of landmarks, but in the senior authors’ experience, entirely re-creating the defect and utilizing the Fisher repair for revision has led to aesthetically pleasing results and less noticeable scars. Materials and Methods: A database was collected that included all cleft lip revisions performed at a large, comprehensive children’s hospital from October 2018 to July 2021. Inclusion criteria included any cleft patient with a cleft lip revision performed by two craniofacial surgeons regardless of previous repair history. Data collected included sex, characteristics of the cleft lip (laterality and complete or incomplete defect), age at initial repair, type of initial repair, any previous revisions, age at index revision, type of revision with any additional tissue rearrangement, and any nose repair. Results: Sixty-five patients were included in the study for analysis. The type of initial repair was known in sixty-four cases (98%), and fifty-four were Millard repairs (83%). Twenty-two patients (33%) had a previous revision prior to their index revision. The average revision age was 9.6 years. Sixty patients (92%) underwent the Fisher repair technique for their index revision and forty-six patients (70%) underwent some form of nasal revision. In follow-up, all patients demonstrated an improvement in lip aesthetics. Conclusion: The necessity for cleft lip revision derives from suboptimal results of initial treatment. Here we have demonstrated a large subset of patients that have undergone cleft lip revision using the Fisher technique. In the senior surgeons’ experience, the Fisher repair technique in the setting of cleft lip revision is an ideal way to address the shortcomings of historical repair techniques.

Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions. The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

Biochemical characterization of the RNA-binding and RNA-DNA strand exchange activities of the human RAD52 protein.

RAD52 is a single-stranded DNA (ssDNA) binding protein that functions in the repair of DNA double-strand breaks (DSBs) by promoting the annealing of complementary DNA strands. RAD52 may also play an important role in an RNA transcript-dependent type of DSB repair, in which it reportedly binds to RNA and mediates the RNA-DNA strand exchange reaction. However, the mechanistic details of these functions are still unclear. In the present study, we utilized the domain fragments of RAD52 to biochemically characterize the single-stranded RNA (ssRNA) binding and RNA-DNA strand exchange activities of RAD52. We found that the N-terminal half of RAD52 is primarily responsible for both activities. By contrast, significant differences were observed for the roles of the C-terminal half in RNA-DNA and DNA-DNA strand exchange reactions. The C-terminal fragment stimulated the inverse RNA-DNA strand exchange activity displayed by the N-terminal fragment in trans, whereas the trans stimulatory effect by the C-terminal fragment was not observed in the inverse DNA-DNA or forward RNA-DNA strand exchange reactions. These results suggest the specific function of the C-terminal half of RAD52 in RNA-templated DSB repair.

Vascular Surgery Role in Vascular Trauma: 11-Year Analysis of Peripheral Vascular Trauma Management at a Level-1 Trauma Center

Vascular surgeons are increasingly relied upon in the management of complex peripheral vascular trauma. The degree however that vascular surgery (VS) is involved in vascular trauma care is not well established. We hypothesize that VS consultation is required in a high portion of complex lower extremity vascular trauma. A single-center retrospective review of all consecutive patients who sustained traumatic arterial injury of the lower extremity requiring open operative repair at a level-1 trauma center (from February 2009 to May 2020) was performed. Patients who underwent surgical repair were stratified by the service that performed the operation (VS versus trauma surgery [TS]). Secondary outcomes assessed included location of arterial injury, type of repair, and clinical outcomes. A total of 111 patients underwent operative repair of lower extremity arterial injury (mean age 34.5±15.5years, 89% male). The most common vessels requiring intervention were the superficial femoral artery (n=42, 38%), popliteal artery (n=35, 31.5%), and tibial vessels (n=19, 17.1%). The most common intervention required in patients was an autologous bypass (n=85, 76.5%), followed by ligation (n=9, 8.1%) and primary repair (n=6, 5.4%). Most interventions overall required VS involvement (n=95, 86%). VS performed a higher proportion of autologous graft procedures compared to TS (n=79, 92.9% vs. n=6, 7.1%). VS case load overall was likewise predominantly autologous grafts (n=79/95, 83.2%). TS operated on a higher proportion of injuries to the tibial vessels (44% vs. 13%, P=0.01), whereas VS intervened more frequently on popliteal injuries (36% vs. 6%, P=0.02). With regard to the method of arterial repair, TS was more likely to perform ligation (38% vs. 3 %, P<0.001) or primary repair (13% vs. 3%, P=0.04) compared to VS. However, VS was more likely to perform repair with autologous graft (83% vs. 38%, P<0.001). There were no significant differences in rates of mortality, limb loss, transfusions requirement, fasciotomy, deep venous thrombosis, hematoma formation, or length of stay between groups. Although, surgical site infections were more common in the TS group (38% vs. 15%, P=0.04). Vascular surgeons play a large role in managing complex lower extremity vascular trauma. In particular, VS remains integral for the management of more difficult injuries (e.g., popliteal injuries) and is more likely to provide more complex repairs (e.g., autologous grafts).

Formalization of decision-making procedures regarding the extension of the operation term of railway rolling stock in the conditions of post-war development of Ukraine

Summary: Today, the vast majority of the railway transport fleet in Ukraine has reached the end of its service life, set by the manufacturer. One of the ways to solve the problem of aging rolling stock, along with the purchase of new wagons and locomotives, remains the extension of the service life of passenger wagons due to the restoration of their resource during appropriate repairs. However, the extension of the service life of rolling stock in Ukraine is regulated by a large number of documents (more than a dozen). Since information is scattered in various sources, the need to consider many criteria regarding the possibility of extending the service life of various types of railway rolling stock units creates certain difficulties in perceiving information and takes time to make a decision on the appointment of the necessary type of repair. One of the solutions to the problem of decentralization of the regulatory framework, along with its change, is its formalization for further development of automated decision-making systems in this area. The paper proposes the classification of passenger wagons of locomotive traction (as the most difficult case) by type and place of production from the point of view of the issue of continuing operation beyond the period established by the manufacturer. An algorithm has been developed for the exact calculation of the difference between dates (construction, repair history, and the maximum period of operation), ensuring compliance with regulatory documents, and based on it, software that allows to determine the existence of grounds for extending the term as quickly as possible in the conditions of technical diagnostics using a smartphone operation of the load-bearing structures of locomotive traction passenger wagons and calculate the type of repair that must be scheduled according to the calendar period

Predictors of mitral valve haemodynamics after mitral valve repair for degenerative mitral regurgitation

ObjectiveIntraoperative predictors of functional mitral valve (MV) stenosis after surgical repair of mitral regurgitation (MR) caused by prolapse remain poorly characterised. This study evaluated the effect of annuloplasty size on...

Differences in Surgical Practice Patterns of Vaginal Native Tissue Repair for Pelvic Organ Prolapse Between Urologists and Gynecologists.

Surgeon specialty training may influence the combination of transvaginal procedures for pelvic organ prolapse (POP) repair. Isolated transvaginal anterior compartment repair (AR) without concurrent apical suspension (ApS) is a known risk factor for POP recurrence. Our primary aim was to compare the prevalence of isolated AR between urologists versus gynecologists. Our secondary aim was to compare associated postoperative complications. We queried the American College of Surgeons National Surgical Quality Improvement Program for vaginal POP repair procedures (Current Procedural Terminology codes 57240, 57260, 57265, 57268, 57282, 57283) over a 5-year period by designated surgical specialty. We analyzed the relationships between specialty, vaginal repair type, operative details, and 30-day postoperative complications. Between January 2015 and December 2019, we included 16,093 women who underwent transvaginal POP repair, 90% performed by gynecologists and 10% by urologists. Urologists were more likely to perform an isolated AR without concurrent ApS (56% vs 47%, P < 0.0001). Gynecologists performed more isolated ApS (11% vs 9%) and combined AR with ApS (43% vs 35%, P < 0.0001). Overall, concurrent urethral sling placement was performed in 27% of cases, regardless of POP repair type, with no difference between specialties (P > 0.05). There were no differences in 30-day reoperations, readmissions, surgical site infections, urinary tract infections, or hospital stay lengths between specialties (P > 0.05). Urologists perform a minority of vaginal POP repairs and were more likely to perform isolated AR than gynecologists. The absence of concurrent ApS may increase the likelihood of prolapse recurrence. Immediate complication rates for each procedure did not differ.