Type Of Repair Research Articles

Finite element analyses of lateral condyle fracture fixation in paediatrics regarding configuration of Kirschner-wire

BackgroundThis study aimed to discover the most stable outcome among different Kirschner-wire (K-wire) configurations for fixation of a lateral condyle fracture (Milch type II) in different loads of stress by using finite element analyses (FEA).MethodsThe right humerus of a 6-year-old boy with a lateral condyle fracture (Milch type II), was modelled with a computer aided engineering. Using FEA, peak von Mises stress and stiffness were evaluated first for a single K-wire fixation by varying the angle (0, 5, 10, 15, 20, 25, 30 degrees). Then, based on the single K-wire result, assessment of peak von Mises stress and stiffness were evaluated via FEA for two- or three-wire fixation under various configurations (two convergent, two parallel, three divergent).ResultsSingle K-wire fixation by 5 and 25 degrees had the lowest peak von Mises stress. The fracture site showed higher stiffness at 0, 5 and 15 degrees. Considering the collected results and clinical situation, 5 degree K-wire was selected for the FEA of multiple K-wire fixation. For multiple K-wire fixation, three divergent (5–20-35 degrees) K-wires showed better stability, both in peak von Mises stress and stiffness, than any two-K-wire configurations. Among two K-wire fixations, two divergent (5–50 degrees) K-wires provided the lowest von Mises stress in varus and valgus while two divergent (5–65 degrees) K-wires showed better results in flexion, extension, internal and external rotation, and both configurations showed similar results in stiffness.ConclusionsWe successfully created a paediatric lateral condyle fracture (Milch type II) model which was used to conduct FEA on different K-wire configurations to achieve stability of the fracture. Our results show that an initial K-wire inserted at 5 degrees, followed by the insertion of a second divergent wire at either 45 or 60 degrees provides the most stability in two K-wire fixations in this type of fracture repair.

Analysis of promising varieties and forms of raspberries of the repair type of fruiting by a complex of signs in the conditions of the Orenburg region

Today, it is important to study the interaction of the genotype of red raspberry plants and climatic conditions. The study included 12 varieties and forms of primocane raspberry selection of the Kokino base station of Federal Horticultural Center for Breeding, Agrotechnology and Nursery and the Orenburg branch of the Federal Horticultural Research Center for Breeding, Agrotechnology and Nursery. The following signs were studied: the number of berries on the lateral, the average weight of the berry, productivity, the content of sugars, soluble solids, ascorbic acid in berries. It was found that the genotype of the variety and form has the greatest influence on the average weight of berries (97.6 %), productivity (79.7 %), soluble dry substances (76.0 %), and the number of berries on the lateral, the content of sugars and ascorbic acid is 60.0-53.0 %. A positive correlation was found between the average weight of berries and productivity (R=0.85). According to the results of clustering, it was revealed that at the level of 20 standard units, two groups are distinguished (in the first - 7 varieties and forms, in the second – 5). The varieties and forms included in the first group had the maximum productivity and average weight of berries in the climatic conditions of the Orenburg region. When comparing the average values of traits using the t - Student criterion, it was revealed that the average berry weight and productivity from the bush had statistical differences between the first and second clusters (t = 4.78 and 4.91 at p<0.01, respectively). Based on the data obtained, it was revealed that more significant differences in Euclidean distances are noted for the varieties Gerakl – 0.64, Jar ptica – 0.59, Arisha – 0.57, Oranjevoe chudo – 0.46, 1-80 – 0.43, which realized their productivity potential in different years of cultivation and are of interest both for cultivation in the conditions of the Orenburg region and for their further use in breeding.

Comparison of Robotic, Laparoscopic, and Open Unilateral Repair of Non-recurrent Inguinal Hernia.

There is a paucity of data comparing open, robotic, and laparoscopic approaches on unilateral, non-recurrent inguinal hernias. Our study presents a large, retrospective triple-arm outcome analysis between robotic, laparoscopic, and open unilateral, non-recurrent inguinal hernia repairs at a single institution. 706 patients who underwent elective, non-recurrent inguinal hernia repair performed by 8 general surgeons at a single institution from 2016 to 2019 were reviewed retrospectively. Patient baseline characteristics, operative times, resident involvement, and postoperative outcomes were analyzed for all repair types. A cost analysis of the different procedures was performed. There were 305 laparoscopic repairs, 207 robotic repairs, and 194 open repairs. Open and laparoscopic repairs were performed on patients who were older (p =< .001) and with a higher Charlson Comorbidity Index (p =< .001). Patient BMI was higher in minimally invasive repair than open repair (P = .021). There were no significant differences in complication rates on pairwise analysis. Robotic and open repairs had significantly longer operative times than laparoscopic repairs (P < .001). There was less resident involvement in robotic repair than with the other approaches (P < .001). Resident involvement was associated with shorter OR times (P = .001) and no significant difference in postoperative complications. There was a trend over the study period toward faster operative times and more robotic repair. Robotic repair is the most expensive repair, followed by laparoscopic and open repairs. All 3 repair techniques can be performed without significant differences in outcomes. The technique utilized should be based on surgeon preference and patient characteristics.

Long-term outcomes of a new anatomy-based method for finding the medial cut end during late canalicular repair

Locating the medial cut end during late repair of canalicular lacerations can be challenging. The aim of this study was to evaluate the effectiveness and long-term outcomes of a new anatomy-based method for solving the problem of locating the medial cut end. This retrospective interventional study included 85 eyes of 85 consecutive adult patients with unilateral inferior canalicular lacerations who underwent late primary (≥2 days after injury) or secondary (≥6 months after initial treatment) surgery. Before surgery, the lacerations were classified as lateral, central, or medial according to the 'distance from the punctum to the distal end' of the lacerated inferior canaliculus. The time spent to locate the proximal lacerated end (TSL) was recorded. All patients were followed up for ≥1 year to evaluate the lacrimal passage patency and the distance between the superior and inferior punctum (DBSIP, to assess cosmesis). There were 16 (18.82%) lateral-type, 55 (64.71%) central-type, and 14 (16.47%) medial-type canalicular lacerations. The TSL was 3.48±1.05 (range 0.9-6.8) min for all patients and differed significantly among the three types of canalicular lacerations (P<0.001). Lacrimal irrigation showed patent lacrimal passages in 69 patients (81.18%) at 3 months and a further 4 patients (4.71%) at 6 months, residual stenosis without obstruction in 5 patients (5.88%), and obstruction in 7 patients (8.24%). The postoperative DBSIP on the affected side was shorter than the preoperative DBSIP (2.66±0.66vs. 3.09±1.72mm, P=0.006) and comparable to that on the unaffected side (2.78±0.40mm). Our new anatomy-based method is efficient and achieves good long-term outcomes for all types of late canalicular repair.

OC-046 SURGICAL ASPECTS AND EARLY MORBIDITY OF RECURRENT INGUINAL HERNIAS DURING OPEN REOPERATION

Abstract Background Inguinal hernia recurrences (IHR) are relatively common and have higher complexity and complication risk at reoperation when compared with primary inguinal hernias (PIH). This study aims to further characterize the patterns of recurrence and early complications observed by type of hernia repair at the index surgery. Methods After REB approval, a review of charts from patients undergoing elective first reoperation for IHR from 2013–2017 was performed. First operations were classified as: childhood repair, laparoscopic repair, open tissue repair, open mesh repair and Shouldice repair. Early complication included hematoma, infection and seroma. Statistical analyses were completed. Results A total of 1281 patients underwent 1340 surgeries for IHR in the study period (4.9% of all inguinal hernias operated). There wa an increased proportion of males, direct type hernias and wound infection in IHR group (p&amp;lt;.001) when compared with PIH repairs. During surgical procedure, the length of surgery was longer, scarring of tissues heavier, nerve identification lower in patients with previous open mesh and Shouldice repairs, in comparison to other groups (childhood, laparoscopic and open repair - p&amp;lt;.001). Conclusion Recurrent inguinal hernia repairs present higher complexity than PIH repairs and incurr in higher chances of early postoperative complications. The type of PIH repair technique influences surgical difficulties encountered in the open reoperation, with open mesh and Shouldice techniques being associated with higher surgical difficulty. This information may help in surgical planning, according with the anticipated leverl of procedure difficulty.

BJS-02 LONG-TERM REOPERATION RATE FOLLOWING PRIMARY VENTRAL HERNIA REPAIR: A REGISTER-BASED STUDY

Abstract Aim The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair. Methods The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010–2019. Reoperation was defined as repeat repair after primary repair. Results Altogether 30,253 umbilical hernia repairs and 7407 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.284 (95% confidence interval (CI) 0.106–0.760) after open onlay mesh repair, 0.476 (CI 0.359–0.629) after open interstitial mesh repair, 0.368 (CI 0.230–0.590) after open sublay mesh repair, 0.446 (CI 0.167–1.194) after open intraperitoneal onlay mesh repair, 0.931 (CI 0.639–1.357) after laparoscopic repair, and 0.939 (CI 0.502–1.757) after other (unknown) techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged ≤49 years (HR 1.669, CI 1.391–2.002), for women (HR 1.390, CI 1.178–1.641), and for patients with liver cirrhosis (HR 2.546, CI 1.050–6.174). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age ≤49 years (HR 2.079, CI 1.380–3.134). Conclusions All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.

OC-037 HERNIA DEFECT CLOSURE IN POLYPROPYLENE BASED LAPAROSCOPIC HERNIOPLASTY TO AVOID SEROMA FORMATION AND HERNIA RECURRENCE: A PROSPECTIVE COHORT STUDY

Abstract Aim This is a Prospective Cohort study, to assess a preventive effect, through closing hernia defect in laparoscopic mesh hernioplasty with polypropylene based best hands-on surgical method. The study could provide promising outcomes with diminishing seroma formation and recurrence rate. Methods The study were conducted from April 2017 to until date. The study persuaded with nearly 328 cases from Tertiary Care Centre who underwent laparoscopic trans-abdominal and extraperitoneal patch plasty (TAPP) (TEPP). Hernia defect closure were performed through this polypropylene mesh and deployment using sutures to all patients. The primary outcomes regarding seroma formation, recurrence of hernia, Pre-operative status and post-operative complications was all observed and recorded. Results About 328 indirect and direct hernia defects were recruited and indulged for study. All the defect closure operations by polypropylene mesh hernioplasty for all types of hernia repair exhibited high success rate, without hernia reccurrence and minimal seroma formation. Conclusions The closure of Hernia defect in laparoscopic polypropylene mesh hernioplasty explicated to be secure and effective technique and would significantly decrease post-operative incidence of seroma formation without increasing hernia recurrence risks, chronic and acute pain. The approach can be recommended for scrotal or larger hernia repair as well.

Predictors of mitral valve hemodynamics after mitral valve repair for degenerative mitral regurgitation: a subanalysis of the CAMRA randomized trial

Abstract Introduction Intra-operative predictors of mid-to-late mitral valve dysfunction after surgical repair of mitral regurgitation (MR) caused by prolapse remain poorly characterized. This study aims to evaluate the effect of annuloplasty prosthesis size on post-operative MV hemodynamics at rest and during exercise, and to identify perioperative predictors of MV dysfunction. Methods 104 patients were randomly assigned to resection and preservation for surgical treatment of posterior leaflet prolapse in the Canadian Mitral Research Alliance CardioLink-2 study. Echocardiograms were performed at baseline and 1 year postoperatively. Intraoperative TEE was performed to assess immediate MV gradients. Exercise TTE was performed 1 year after repair. Linear regression analysis was used to identify associations between MV indices (rest and peak exercise gradients) at 12 months, and perioperative echocardiographic and clinical factors. Results Mean age of participants was 65±10 years, and 83% were male. Larger annuloplasty size was associated with lower transmitral gradients at rest and during peak exercise. In multivariable analysis, annuloplasty size ≥34mm was associated with lower mean and peak rest and exercise gradients at 12 months, after adjustment for repair type, age, sex, and BSA (p&amp;lt;0.001). Higher pre-operative pulmonary artery pressures were associated with reduced functional capacity post-operatively. Intra-operative TEE gradients predict resting and exercise MV hemodynamics at 1 year. Conclusion Annuloplasty size ≥34mm is associated with improved MV hemodynamics at rest and during peak exercise 1 year post MV repair. MV repair prior to onset of pulmonary hypertension confers favourable post operative functional capacity. Finally, intra-operative TEE can be used to identify patients at risk of mitral valve dysfunction within 1 year of repair. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The Heart and StrokeFoundation of Ontario (GIA 16-00014666)

End-to-end anastomosis as a superior repair type to prevent recurrence of arteriovenous fistula aneurysms and improve patency outcomes.

Arteriovenous fistulae (AVF) complicated by aneurysms are repaired through several mechanisms. Little is known about risk factors for aneurysm recurrence or the efficacy of subsequent repair of recurring aneurysms. About 291 patients underwent AVF aneurysm repair between 2009 and 2019 at a large urban medical center. Patients who underwent staged repair, had a primary graft with pseudoaneurysm, were status-post kidney transplant, or using other dialysis access at the time of repair were excluded. One hundred sixty-two patients were included in the study, of which 52 developed a secondary aneurysm. Chi-square and t-test analyses were used to compare demographics. Multivariate logistic regression was used to examine independent risk factors for aneurysm recurrence. Of the 52 patients with recurrent aneurysms, 41 were repaired again. Patency was examined for each group 1 year postoperatively. Patients without secondary aneurysms were more likely to have a Charlson Comorbidity Index score ⩾5 (p = 0.045). Males were 2.8 times more likely to develop a secondary aneurysm compared to females (p = 0.023). Patients who underwent elective compared to emergent or urgent surgery for primary aneurysms were significantly less likely to recur (OR = 0.222; p = 0.016). Primary aneurysms repaired by end-to-end anastomosis, compared to aneurysmorrhaphy or graft, were significantly less likely to recur (OR = 0.239; p = 0.041). Among patients with secondary aneurysms, those repaired via end-to-end anastomosis had a significantly higher primary patency rate 1 year postoperatively (p = 0.024). Secondary aneurysm repairs exhibited 1-year primary and secondary patency rates of 51.2% and 82.9%, respectively. End-to-end anastomosis reduces risk of recurrence and demonstrates superior patency rates when repairing recurrent aneurysms. It remains unclear why some patients are prone to aneurysm recurrence, however continued attempts to repair existing vascular access are proven to be successful.

Visualizing Dunhuang: The Lo Archive Photographs of the Mogao and Yulin Caves

Visualizing Dunhuang: The Lo Archive Photographs of the Mogao and Yulin Caves

VEGFA from osteoblasts is not required for lamellar bone formation following tibial loading.

The relationship between osteogenesis and angiogenesis is complex. Normal bone development requires angiogenesis, mediated by vascular endothelial growth factor A (VEGFA). Studies have demonstrated through systemic inhibition or genetic modification that VEGFA is indispensable for several types of bone repair, presumably via its role in supporting angiogenesis. But a direct role for VEGFA within osteoblasts, in the absence of angiogenesis, has also been suggested. To address the question of whether VEGFA from osteoblasts supports bone formation directly, we applied anabolic loading to induce lamellar bone formation in mice, a process shown to be independent of angiogenesis. We hypothesized that VEGFA from osteoblasts is required for lamellar bone formation. To test this hypothesis, we applied axial tibial compression to inducible Cre/LoxP mice from three lines. Vegfafl/fl mice were crossed with Ubiquitin C (UBC), Osterix (Osx) and Dentin-Matrix Protein 1 (DMP1) Cre-ERT2 mice to target all cells, (pre)osteoblast-lineage cells, and mature osteoblasts and osteocytes, respectively. Genotype effects were determined by comparing control (Vegfafl/fl) and Cre+ (VegfaΔ) mice for each line. At 5months of age tamoxifen was injected for 5days followed by a 3-week clearance prior to loading. Female and male mice (N=100) were loaded for 5days to peak forces to engender -3100με peak compressive strain and processed for dynamic histomorphometry (day 12). Percent MS/BS increased 20-70% as a result of loading, with no effect of genotype in Osx or Dmp1 lines. In contrast, the UBC groups had a significant decrease in relative periosteal BFR/BS in VegfaΔ vs. Vegfafl/fl mice. The UBC line did not have any cortical bone phenotype in non-loaded femurs. In summary, dynamic histomorphometry data confirmed that tibial loading induces lamellar bone formation. Contrary to our hypothesis, there was no decrease in loading-induced bone formation in the Osx or Dmp1 lines in the absence of VEGFA. There was a decrease in bone formation in the UBC line where all cells were targeted. This result indicates that VEGFA from a non-osteoblast cell source supports loading-induced lamellar bone formation, although osteoblast/osteocyte VEGFA is dispensable. These findings support a paracrine model whereby non-osteoblast VEGFA supports lamellar bone formation, independent of angiogenesis.

Meniscus Repair in Pediatric Athletes.

Meniscus tears are common in the pediatric population, typically occur after noncontact injuries, and can be diagnosed clinically with MRI confirmation. Surgery should be offered to patients with loss of range of motion, persistent symptoms, or displaced/complex tears. Given poor long-term outcomes reported after meniscectomy, repair should be attempted when possible as pediatric menisci are well vascularized and have better outcomes after repair than their adult counterparts. The location of the tear is an important determining factor when deciding on the type of repair to use. Pediatric meniscus repair techniques will be discussed noting differences between pediatric and adult procedures. Further studies are needed to explore the role of biologics and define postoperative protocols.

Incidence and risk factors for secondary failure after acute obstetric sphincter injury repair - an audit of 239 women.

The rate of secondary failure after obstetric sphincter injury repair is unknown, with the literature reporting rates ranging from 0.1% to 53%. We aimed to perform an audit to identify the rate and risk factors for failure of sphincter repair in a cohort of postpartum women using endoanal ultrasound (EAUS) and manometry, assessing the risk factors and impact of these events. Prospective data were collected within a 2year period from patients who attended the perineal clinic at Eastern Health. Variables of primary repair and presence of postpartum complications were recorded and subsequently analysed. Of 239 patients with obstetric anal sphincter injury (OASI) included, 100 (41.8%) had EUAS evidence of sphincter defects. Only 20% with secondary repair failure were symptomatic with faecal or flatal incontinence at a mean follow-up of 23.4months postpartum. Patients with secondary repair failure had lower anal resting (p= 0.006) and maximum squeeze pressures compared with patients with intact repairs (p< 0.001). In terms of variables that were investigated, namely location, operator hierarchy, type of repair and material used, none had a statistically significant correlation with secondary repair failure of OASI. Postpartum complications had an overall incidence of 12.7%, and those with any complication were found to have an increased rate of secondary failure of repair (p= 0.157). Using EAUS to confirm secondary failure of repair, incidence was 41.4% in this cohort. There were no identifiable modifiable variables that reduced the risk of secondary failure of repair. Further prospective research with increased sample size and longer follow-up periods is required to assess the validity of the findings.

Decoy Exosomes Offer Protection Against Chemotherapy-Induced Toxicity.

Cancer patients often face severe organ toxicity caused by chemotherapy. Among these, chemotherapy-induced hepatotoxicity and cardiotoxicity are the main causes of death of cancer patients. Chemotherapy-induced cardiotoxicity even creates a new discipline termed "cardio-oncology". Therefore, relieving toxicities induced by chemotherapy has become a key issue for improving the survival and quality of life in cancer patients. In this work, mesenchymal stem cell exosomes with the "G-C" abundant tetrahedral DNA nanostructure (TDN) are modified to form a decoy exosome (Exo-TDN). Exo-TDN reduces DOX-induced hepatotoxicity as the "G-C" base pairs scavenge DOX. Furthermore, Exo-TDN with cardiomyopathic peptide (Exo-TDN-PCM) is engineered for specific targeting to cardiomyocytes. Injection of Exo-TDN-PCM significantly reduces DOX-induced cardiotoxicity. Interestingly, Exo-TDN-PCM can also promote macrophage polarization into the M2 type for tissue repair. In addition, those decoy exosomes do not affect the anticancer effects of DOX. This decoy exosome strategy serves as a promising therapy to reduce chemo-induced toxicity.

Recent advances in smart‐responsive hydrogels for tissue repairing

AbstractThe rapid development of biomedical materials and tissue engineering technology has played an increasingly important role in the process of tissue repair in recent years. Smart‐responsive hydrogels are three‐dimensional network structures formed by cross‐linking of hydrophilic polymers. In addition to having conventional hydrogels that approximate the natural extracellular matrix structure and serve as delivery vehicles for functional molecules (drugs and proteins). More importantly, smart‐responsive hydrogels can achieve relevant changes in material morphology or properties under the conditions of changes in physical, chemical, and biological factors, thereby achieving controlled functional molecules release. It is more urgent to design and build smart‐responsive hydrogels to achieve precise tissue repair with the introduction of the concept of precision medicine and drug delivery. In this review, we highlight different types of smart‐responsive hydrogels and their mechanisms of response to different stimuli and discuss their potential for application in different types of tissue repair, such as chronic wound repair, damaged heart tissue repair, brain nerve tissue repair, and other fields. Finally, we present the prospects of smart‐responsive hydrogels in tissue repair. In general, the current progress in the application of smart‐responsive hydrogels in tissue repair lays the foundation for future applications in other diseases.

Assessment of the competitive advantages of composite materials in building structures

The article presents the results of a study of the domestic market of building composite materials. An increase in research work and the development of the production of composite materials were noted. The authors revealed an increase in the activity of their use in certain types of construction. However, certain difficulties in making decisions at the stage of design and engineering development due to the high cost of composite materials are also identified and described. Therefore, the authors of this study focused on the significant competitive advantages of the studied innovations for the construction industry. The authors also proposed a new fundamental approach to conducting an economic assessment of the effectiveness of the use of innovative building materials using composites as an example. The advantages and various effects arising from the use of composite materials are revealed. As proof, the article provides a calculation of the economic effect achieved in the case of setting the value of the investment project planning horizon equal to the normative average service life of the structure. The effect is achieved in the process of long-term operation due to the increase in the period between repairs and the absence of costs for certain types of construction, repair and maintenance work. An assessment of the import dependence of the construction industry by type of activity "production of composite materials" was carried out. The authors note a shortage of personnel, dependence on imported equipment for the production of composites, and a shortage of their own raw materials. However, the situation in the composite industry is not critical. Thus, an increase in demand from consumers of products, the development and support of new import-substituting manufacturers, the development of a raw material base with the support of the state can solve this problem

Biomechanical analysis of stability of joint depression calcaneal fractures: Fixation with locking compression plate alone compared with addition of supplemental oblique screw

PurposeThe standard treatment of calcaneus fractures is a lateral plate and screw construct. Patients at our institution have been treated with a lateral locking plate combined with one retrograde screw inserted in the oblique plane to allow immediate weight bearing. The purpose of this study was to determine whether addition of a oblique screw to a lateral plate construct increases stability. MethodsA Sanders 2B fracture (AO/OTA 83-C2) was created in 8 pairs (16 total specimens) of cadaveric feet. All were repaired using a lateral locking plate/screws construct. One specimen in each pair was chosen randomly to receive an additional oblique screw. The specimens were tested with cyclic load of up to 800 N. Movement at the fracture sites and subsidence of the talus were tracked with a three-dimensional video analysis system. ResultsTalar subsidence was not significantly affected by the presence of the additional oblique screw (p = 0.22). The sustentaculum fragment in the case of the screw repair moved 0.39 mm while the same fragment without the additional screw repair displaced 0.12 mm (p < 0.01). Two repairs with and one repair without the additional screw failed during longer-term cyclic loading. ConclusionThe two repair types were not statistically different in regards to talar subsidence. While statistical significance resulted in the comparison of sustentaculum fragment movement, the amount of movement did not reach a level of clinical relevance. This study demonstrated immediate stability and durability of the additional screw construct with high volume weight bearing loads.

Surgical Interventions for Lumbosacral Plexus Injuries: A Systematic Review.

Background:Nerve reconstruction techniques for lumbosacral plexus (LSP) injuries vary. There are no clear treatment guidelines available, and summative evaluations of the literature discussing these surgeries are lacking. For these reasons, this investigation aimed to systematically review and consolidate all available literature discussing surgical interventions for LSP injuries and cohesively present patient-reported and objective postoperative outcomes.Methods:The authors conducted a systematic review using PubMed, Embase, Web of Science, ProQuest Dissertations and Theses Global (via Proquest.com), and ClinicalTrials.gov databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. After title and abstract screening, identified articles were read in full and selected for inclusion based on prespecified criteria.Results:Our literature search identified 8683 potential citations, and after duplicate removal, abstract screening, and full-text review, 62 studies remained meeting inclusion and exclusion criteria. Outcomes were extracted according to the location of injury and type of surgical repair. Injuries were classified into isolated femoral nerve injuries, isolated obturator nerve injuries, isolated sciatic nerve injuries, and multilevel LSP injuries. Surgical treatment was further classified into exploration with neurolysis, direct repair, nerve grafting, and nerve transfer surgery.Conclusions:Although results vary based on the location of the injury and the surgical technique used, nerve grafts and transfers demonstrated reasonable success in improving functional and pain outcomes. Overall, isolated femoral and obturator nerve injuries had the best outcomes reported with surgical treatment. Furthermore, incomplete sciatic nerve and multilevel LSP injuries had more reported surgical options and better outcomes than complete sciatic nerve injuries.

Suitability of salivary leucocytes to assess DNA repair ability in human biomonitoring studies by the challenge-comet assay

The challenge-comet assay is a simple but effective approach that provides a quantitative and functional determination of DNA repair ability, and allows to monitor the kinetics of repair process. Peripheral blood mononuclear cells (PBMC) are the cells most frequently employed in human biomonitoring studies using the challenge-comet assay, but having a validated alternative of non-invasive biomatrix would be highly convenient for certain population groups and circumstances. The objective of this study was to validate the use of salivary leucocytes in the challenge-comet assay. Leucocytes were isolated from saliva samples and challenged (either in fresh or after cryopreservation) with three genotoxic agents acting by different action mechanisms: bleomycin, methyl methanesulfonate, and ultraviolet radiation. Comet assay was performed just after treatment and at other three additional time points, in order to study repair kinetics. The results obtained demonstrated that saliva leucocytes were as suitable as PBMC for assessing DNA damage of different nature that was efficiently repaired over the evaluated time points, even after 5 months of cryopreservation (after a 24 h stimulation with PHA). Furthermore, a new parameter to determine the efficacy of the repair process, independent of the initial amount of damage induced, is proposed, and recommendations to perform the challenge-comet assay with salivary leucocytes depending on the type of DNA repair to be assessed are suggested. Validation studies are needed to verify whether the method is reproducible and results reliable and comparable among laboratories and studies.

3. Assessment of in vitro dural repair techniques with a hydrostatic pressure device

<h3>BACKGROUND CONTEXT</h3> Incidental durotomies are a relatively infrequent occurrence during lumbar spine surgery and are generally benign, without significant adverse consequences. Treatment with direct repair, with or without augmentation, is generally very effective and further cerebrospinal fluid (CSF) leak is uncommon. The strength and stability of a dural repair is dependent on several factors, including patient age, quality of dural tissue, the size and location of the durotomy, and the manner in which the repair is performed. There is limited in vitro evidence comparing the strength of different dural repair techniques and the resulting likelihood of recurrent CSF leak. <h3>PURPOSE</h3> To compare the strength and stability of various dural repair techniques in an in vitro human cadaveric durotomy model. <h3>STUDY DESIGN/SETTING</h3> An in vitro testing device was created to apply controlled, hydrostatic pressure to evaluate the integrity of a surgically-created durotomy. <h3>PATIENT SAMPLE</h3> Sixteen human cadaveric specimens. <h3>OUTCOME MEASURES</h3> The hydrostatic pressure required to cause a leak at the site of the dural repair. <h3>METHODS</h3> Complete human cadavers were placed in the prone position and the dura in the thoracic and lumbar spines was exposed through a midline incision and subsequent laminectomies. The dura was clamped 8 cm proximal and distal to the level of the durotomy and clamped with reliable, water-tight plastic rings. A 16-gauge plastic catheter was introduced into the lateral aspect of the dura and sutured in a water-tight fashion to serve as the source for instilling saline into the dura. The catheter was attached to a hydrostatic pressure measuring column to assess the intradural pressure. Linear durotomies of either 1 cm or 6 cm in length were made with a 15 blade in both the thoracic and lumbar spines of each cadaver. A dural repair was performed with either a 6-0 prolene or 2-0 silk suture. Repair technique were either multiple, simple interrupted sutures or a simple running repair with knots at the respective margins of the durotomy. An analysis of variant analysis (ANOVA) was employed to assess differences in leak rates with respect to applied hydrostatic pressure. <h3>RESULTS</h3> Eight repair groups (thoracic vs lumbar / 6-0 prolene vs 2-0 silk / running vs multiple interrupted) were studied for each of the 1 cm and 6 cm durotomies. There were no significant differences noted in the frequency or extent of spinal fluid leak at different hydrostatic pressures with respect to either suture type employed or suture technique performed. There was a slight difference in the mean applied hydrostatic pressure applied to create a fluid leak in the 6 cm durotomy (16 cm H2O) compared to the 1 cm durotomy (12 cm H2O) but this did not reach statistical significance. <h3>CONCLUSIONS</h3> In this in vitro study of the integrity of the repair of experimentally created durotomies, no significant difference was noted with respect to different suture type or technique of repair. Larger durotomies had a slight, not significant trend for recurrent leak at lower applied hydrostatic pressures. In general, expansion of the repaired dura with controlled delivery of intrathecal fluid, simulating an in vivo, intraoperative Valsalva maneuver, did not reveal significant differences in varying repair types. While this in vitro study does not directly replicate an in vivo scenario, the results do reinforce the necessity of a meticulous water tight suture repair to adequately treat incidental durotomies and thus avoid the troublesome consequences of a recurrent CSF leak. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.