Introduction: Cochlear implant (CI) surgery allows hearing reestablishment among individuals with severe to profound hearing loss. However, only few patients will need a surgical reassessment. Objectives: To verify th...Introduction: Cochlear implant (CI) surgery allows hearing reestablishment among individuals with severe to profound hearing loss. However, only few patients will need a surgical reassessment. Objectives: To verify the incidence of surgical reassessment among adult patients;to verify the reasons that led the second surgery to be performed;to verify the efficacy—and audiological outcomes—of revisional surgery. Method: A longitudinal retrospective cohort study was carried out with the review of medical records, of adult patients, with bilateral severe to profound sensorineural hearing loss who underwent to revisional surgery, from 2004 to 2016 at a CI Center, in Brazil. Results: One hundred fifty-eight CI surgeries were performed among 137 adult patients. Fourteen revisional surgeries were performed among 10 patients: five surgeries were due by displacement of the internal unit;one because of having excessive subcutaneous tissue;one due to non-progression of the electrodes during the initial surgery, one late tympanic membrane perforation, one late facial palsy and, one due to a suture dehiscence in the surgical incision with exposure of the internal unit. Conclusions: The incidence of surgical reassessment among adult CI patients was 8.9%. All implanted patients that underwent a new surgical approach maintained an improved auditory threshold after revisional CI surgery.展开更多
BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and...BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.展开更多
Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to...Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.展开更多
BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to...BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.展开更多
This study aims to revise the Belief in a Just World Scale(BJWS)for Chinese college students and test its reliability and validity(construct validity,convergent and divergent validity).Two samples of 546 and 595 colle...This study aims to revise the Belief in a Just World Scale(BJWS)for Chinese college students and test its reliability and validity(construct validity,convergent and divergent validity).Two samples of 546 and 595 college students were selected,respectively,using stratified cluster random sampling.Item analysis,exploratory factor analysis(EFA),confirmatory factor analysis(CFA),reliability analysis and convergent and divergent validity tests were carried out.The results showed that the 13 items of the BJWS have good item discrimination.The corrected item–total correlation in the general belief in a just world subscale was found to range from 0.464 to 0.655,and that in the personal belief in a just world subscale was 0.553 to 0.715.The internal consistency coefficients of the revised version of the BJWS and its subscales are good.The EFA and CFA results show that the structure and items of the revised scale are the same as those of the original scale.Belief in a just world was found to have significant positive correlations with gratitude and empathy,and has a significant negative correlation with anxiety,thereby exhibiting good convergent and divergent validity.Therefore,the Chinese revised version of the BJWS has good reliability and validity.展开更多
The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 20...The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 2018 on Musculoskeletal Infection.A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review(2023)on diagnosing,managing,and treating periprosthetic knee infections.However,a significant lack of literature exists concerning the optimal duration for the antibiotic holiday,calling for more research before establishing any clinical guidelines.展开更多
Discoveries of many coal seams at depths by drilling carried by Geological Survey of Pakistan in Sor Range and Harnai Gochina, extended the coal seams at depth which is challenge for mine owners to exploit feasibly. B...Discoveries of many coal seams at depths by drilling carried by Geological Survey of Pakistan in Sor Range and Harnai Gochina, extended the coal seams at depth which is challenge for mine owners to exploit feasibly. Bed to bed gypsum samplings (and their chemical analyses) of huge gypsum deposits from Sulaiman foldbelt is a base for industrialist and also planers to develop cement and gypsum industries to increase export and foreign exchange for the development of area and Pakistan. Low and high grade sedimentary iron deposits, silica sand and uranium host rocks and their extensions in Sulaiman and Kirthar foldbelts are presented. Anomalies of a few base metals arise as a result of geochemical exploration carried at part of Loralai District of Balochistan. Theropod dinosaurs were frequent in India, while Poripuchian titanosaurs (Sauropoda, Dinosauria) were frequent in Pakistan. Besides some ichnotaxa, many bone taxa such as 1 titanosauriform, 14 titanosaurian sauropod (including one new titanosaur), and 3 theropod dinosaurs are established from Pakistan. Among these 12 titanosaur species and 3 theropod species are named in about 10 km<sup>2</sup> area of Vitakri dome and 2 titanosaur species are named in about a few hundred square meter area of Mari Bohri (Kachi Bohri) which is about 10 km westward from Vitakri dome. Pakistan is a unique country which discoverd 14 diversified titanosaurs in a short area and also in a short period (67 - 66 million years ago/Ma). About 400 bones found from a few meter thick upper part of upper shale horizon of latest Maastrichtian Vitakri Formation which is base for titanosaur taxa. Cranial material is in low fraction (but include significant diverse snouts), caudal vertebrae are prominent, the cervicals, dorsals and sacrals have significant numbers, forelimb and hind limb bones have balanced fraction. Humeri, femora and tibiae are most common. To know the position of Pakistani titanosaurs among titanosaurs and sauropods, there is a need to extend list of characters for phylogenetic analyses. This broad feature list should include main characters of titanosaurs from Pakistan and also from global world.展开更多
Founded in 1963,China National Institute of Standardization(CNIS)mainly focuses on the research into the standardization development strategies,fundamental theories,principles and methods as well as standards systems....Founded in 1963,China National Institute of Standardization(CNIS)mainly focuses on the research into the standardization development strategies,fundamental theories,principles and methods as well as standards systems.It also carries out the standardization scientific research,experimental verification,test and evaluation,standards development,revision and promotion,and transformation and application of science&technology achievements.CNIS has played an active role as a public welfare research institute,providing technical support for the work of State Administration for Market Regulation(SAMR),other ministries and local governments.展开更多
On May 6th,2024,National Medical Products Administration issued Announcement on the Establishment of Cosmetics Standardization Technical Committee(No.53 of 2024).According to the announcement,National Medical Products...On May 6th,2024,National Medical Products Administration issued Announcement on the Establishment of Cosmetics Standardization Technical Committee(No.53 of 2024).According to the announcement,National Medical Products Administration is about to establish Cosmetics Standardization Technical Committee,aiming at furthering implementing Regulations on Supervision and Administration of Cosmetics,and promoting the formulation and revision of the cosmetics standard(including toothpaste).展开更多
Healthcare security and privacy breaches are occurring in the United States (US), and increased substantially during the pandemic. This paper reviews the National Institute of Standards and Technology (NIST) publicati...Healthcare security and privacy breaches are occurring in the United States (US), and increased substantially during the pandemic. This paper reviews the National Institute of Standards and Technology (NIST) publication base as an effective solution. The NIST Special Publication 800-66 Revision 1 was an essential standard in US healthcare, which was withdrawn in February 2024 and superseded by SP 800-66 Revision 2. This review investigates the academic papers concerning the application of the NIST SP 800-66 Revision 1 standard in the US healthcare literature. A systematic review method was used in this study to determine current knowledge gaps of the SP 800-66 Revision 1. Some limitations were employed in the search to enforce validity. A total of eleven articles were found eligible for the study. Consequently, this study suggests the necessity for additional academic papers pertaining to SP 800-66 Revision 2 in the US healthcare literature. In turn, it will enhance awareness of safeguarding electronic protected health information (ePHI), help to mitigate potential future risks, and eventually reduce breaches.展开更多
BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplas...BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplasty(TKA),but rarely after a unicompartimental knee arthroplasty(UKA).In the context of UKA metallosis,surgeons often opt for revision using a TKA.However,in this paper,the authors successfully treated UKA revising the metal back only.CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA,ten(90.9%)were treated revising using though a TKA.Only one case was managed through a uni-on-uni revision,reporting high knee function.Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation.At 18 mo following surgical debridment and uni-on-uni revision surgery,our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.CONCLUSION Our study highlights that in case of metallosis after UKA,the treatment may be based on surgical debridement and just revising the mobilized components.展开更多
BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the com...BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.展开更多
Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficient...Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.展开更多
Taxonomic studies of the Odorrana versabilis group have been consistently disorganized,and they have often been incorrectly associated with an abandoned subgenus or genus Bamburana in existing literature.In this study...Taxonomic studies of the Odorrana versabilis group have been consistently disorganized,and they have often been incorrectly associated with an abandoned subgenus or genus Bamburana in existing literature.In this study,we conducted an integrative taxonomic analysis using molecular phylogenetic analysis of two mitochondrial gene fragments(16S rRNA and CO1)and morphological examination of 41 specimens collected during herpetological surveys in southern China.Our results confirmed the monophyly of O.versabilis group which exhibited distinct morphological traits.We also identified a cryptic lineage sister with O.exiliversabilis.Additionally,our study revealed that O.trankieni was nested within O.nasuta.Consequently,we redefined the morphological characteristics of the O.versabilis group,described a new species in this group,O.confusa sp.nov.,and proposed that O.trankieni be considered a junior synonym of O.nasuta.One of the most significant findings of this study was the observation of distinct morphological changes in adult males across all species within the O.versabilis group between the non-breeding and breeding seasons.This study contributes to research on various aspects of Asian amphibian fauna,including taxonomy,ecology,evolution,and physiology.展开更多
BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications w...BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.展开更多
BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-...BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.展开更多
BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt(VPS)catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.AIM To ide...BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt(VPS)catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.AIM To identify the demographics,clinical presentation,clinical findings,and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter,clinically presented with or without trans-oral extrusion.METHODS An online search was performed for the extraction/retrieval of the published/available literature pertaining to the above-mentioned VPS complication.Manuscripts were searched from PubMed,PMC(PubMed Central),ResearchGate,and Google Scholar databases using various terminology relating to the VPS complications.The first case of migration of a VPS catheter into the stomach was reported in the year 1980,and the data were retrieved from 1980 to December 2022.Cases were categorized into two groups;Group A:Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same,and Group B:Cases who had migration of the distal VPS catheter into the stomach,but presented without trans-oral extrusion.RESULTS A total of n=46 cases(n=27;58.69%male,and n=19;41.3%females)were recruited for the systematic review.Group A included n=32,and Group B n=14 cases.Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the(n=22)cases.Approximately sixty percent(n=27)of them were children≤5 years of age at the time of the diagnosis of the complication mentioned above.In seventy-two percent(n=33)cases,this complication was detected within 24 mo after the VPS insertion/last shunt revision.Clinical diagnosis was evident for the entire group A cases.Various diagnostic modalities were used to confirm the diagnosis for Group B cases.Various surgical procedures were offered for the management of the complication in n=43 cases of both Groups.In two instances,intra-gastric migration of the distal VPS catheter was detected during the autopsy.This review documented four deaths.CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups.It was more frequently reported in children,although also reported in adults and older people.A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without transoral extrusion.展开更多
BACKGROUND The popularity of uncemented stems in revision total hip arthroplasty(THA)has increased in the last decade.AIM To assess the outcomes of both cemented and uncemented stems after mid-term follow up.METHODS T...BACKGROUND The popularity of uncemented stems in revision total hip arthroplasty(THA)has increased in the last decade.AIM To assess the outcomes of both cemented and uncemented stems after mid-term follow up.METHODS This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines.Articles were chosen irrespective of country of origin or language utilized for the article full texts.This paper included studies that reviewed revision THA for both cemented or uncemented long stems.RESULTS Three eligible studies were included in the meta-analysis.Analysis was conducted by using Review Manager version 5.3.We computed the risk ratio as a measure of the treatment effect,taking into account heterogeneity.We used random-effect models.There were no significant differences found for intraoperative periprosthetic fractures[risk ratio(RR)=1.25;95%confidence interval(CI):0.29-5.32;P=0.76],aseptic loosening(RR=2.15,95%CI:0.81-5.70;P=0.13),dislocation rate(RR=0.50;95%CI:0.10-2.47;P=0.39),or infection rate(RR=0.99,95%CI:0.82-1.19;P=0.89),between the uncemented and the cemented long stems for revision THA after mid-term follow-up.CONCLUSION This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA.In summary,there were no significant differences in the dislocation rate,aseptic loosening,intraoperative periprosthetic fracture and infection rate between the two cohorts.展开更多
Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on...Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on-site high-speed rail emergency disposal,basic principles for revising the regulations on railway technical management(RRTM)are proposed and suggestions and evaluation methods according to the main clauses are put forward.Findings–Basic principles for revising the RRTM are proposed,namely“to meet the actual needs of on-site high-speed railway emergency disposal,standardize the emergency disposal process,improve the efficiency of emergency disposal and keep the consistency between provisions of emergency disposal”.Existing provisions related to emergency disposal efficiency,scenarios,safety and service quality are made up for the deficiencies.To make up for the deficiencies of the existing provisions related to emergency disposal efficiency,improvement of emergency disposal scenarios and guarantee of emergency disposal safety and quality,this paper puts forward suggestions on revising 15 emergency disposal provisions of the RRTM with regard to earthquake monitoring and warning,in-station foreign body invasion warning,air conditioning failure of EMU trains and forced parking of trains in sections.A fuzzy comprehensive evaluation model based on the analytic hierarchy process(AHP)is constructed to evaluate the proposed revision scheme and suggestions,which has been highly recognized by experts.Originality/value–This study implements the goal of high-quality railway development.展开更多
文摘Introduction: Cochlear implant (CI) surgery allows hearing reestablishment among individuals with severe to profound hearing loss. However, only few patients will need a surgical reassessment. Objectives: To verify the incidence of surgical reassessment among adult patients;to verify the reasons that led the second surgery to be performed;to verify the efficacy—and audiological outcomes—of revisional surgery. Method: A longitudinal retrospective cohort study was carried out with the review of medical records, of adult patients, with bilateral severe to profound sensorineural hearing loss who underwent to revisional surgery, from 2004 to 2016 at a CI Center, in Brazil. Results: One hundred fifty-eight CI surgeries were performed among 137 adult patients. Fourteen revisional surgeries were performed among 10 patients: five surgeries were due by displacement of the internal unit;one because of having excessive subcutaneous tissue;one due to non-progression of the electrodes during the initial surgery, one late tympanic membrane perforation, one late facial palsy and, one due to a suture dehiscence in the surgical incision with exposure of the internal unit. Conclusions: The incidence of surgical reassessment among adult CI patients was 8.9%. All implanted patients that underwent a new surgical approach maintained an improved auditory threshold after revisional CI surgery.
基金Supported by National Natural Science Foundation of China,No.82004386and Guangdong Basic and Applied Basic Research Foundation,No.2022A1515011700.
文摘BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.
文摘Total hip arthroplasty(THA)is one of the most successful elective operations in orthopedic surgery for improving pain and functional disability in patients with end-stage joint disease.However,dislocation continues to be a troublesome complication after THA,as it is a leading cause of revision and is associated with substantial social,health,and economic costs.It is a relatively rare,usually early occurrence that depends on both the patients’characteristics and the surgical aspects.The most recent and important finding is the special attention to be given preoperatively to spinopelvic mobility,which is closely related to the incidence of dislocation.Consequently,clinical and radiographic assessment of the lumbar spine is mandatory to identify an altered pelvic tilt that could suggest a different positioning of the cup.Lumbar spinal fusion is currently considered a risk factor for dislocation and revision regardless of whether it is performed prior to or after THA.Surgical options for its treatment and prevention include the use of prostheses with large diameter of femoral head size,dual mobility constructs,constrained liners,and modular neck stems.
文摘BACKGROUND In recent years,there has been an increase in the number of total hip arthroplasty procedures in the younger patient population.This active group has higher expectations of their prosthesis in comparison to the older population,and there is a greater physical demand for the prosthesis.Short femoral stems were in-troduced to retain proximal bone stock and joint biomechanics and became more common to implant in this specific population.Currently,the long-term survival and functional outcomes of various short stems are still being investigated in different clinics.AIM To determine the 5-year survival of the Optimys hip stem.METHODS This was a prospective multicenter cohort study of 500 patients conducted in two hospitals in the Netherlands.All patients received the Optimys short stem(Mathys Ltd,Bettlach,Switzerland).The primary outcome measure was survival of the hip stem,with revision as the endpoint.The secondary outcome measurements included patient-reported outcome measures(PROMs).Kaplan-Meier analysis was used to calculate the 5-year survival rate.Log-minus-log transformation was performed to calculate the 95%confidence interval(95%CI).Mixed model analyses were performed to assess the course of the PROMs during the 1st 2 years after surgery.Analyses were modeled separately for the 1st and 2nd years to calculate the yearly change in PROMs during both follow-up periods with accompanying 95%CIs.RESULTS The mean age of the total 500 patients was 62.3 years(standard deviation:10.6)and 202 were male(40%).At a median follow-up of 5.5 years(interquartile range:4.5-6.7),7 patients were deceased and 6 revisions were registered,for infection(n=3),subsidence(n=2)and malposition(n=1).This resulted in an overall 5-year survival of 98.8%(95%CI:97.3-99.5).If infection was left out as reason for revision,a stem survival of 99.4%(95%CI:98.1-99.8)was seen.Baseline questionnaires were completed by 471 patients(94%),317 patients(63%)completed the 1-year follow-up questionnaires and 233 patients(47%)completed the 2-year follow-up.Both outcome measures significantly improved across all domains in the 1st year after the operation(P<0.03 for all domains).In the 2nd year after surgery,no significant changes were observed in any domain in comparison to the 1-year follow-up.CONCLUSION The Optimys stem has a 5-year survival of 98.8%.Patient-reported outcome measures increased significantly in the 1st postoperative year with stabilization at the 2-year follow-up.
基金Key Project of Party Building and Ideological and Political Education Research from University of Science and Technology Liaoning for the Year 2023(2023KDDJ-X01)awarded to Zhe Yu.
文摘This study aims to revise the Belief in a Just World Scale(BJWS)for Chinese college students and test its reliability and validity(construct validity,convergent and divergent validity).Two samples of 546 and 595 college students were selected,respectively,using stratified cluster random sampling.Item analysis,exploratory factor analysis(EFA),confirmatory factor analysis(CFA),reliability analysis and convergent and divergent validity tests were carried out.The results showed that the 13 items of the BJWS have good item discrimination.The corrected item–total correlation in the general belief in a just world subscale was found to range from 0.464 to 0.655,and that in the personal belief in a just world subscale was 0.553 to 0.715.The internal consistency coefficients of the revised version of the BJWS and its subscales are good.The EFA and CFA results show that the structure and items of the revised scale are the same as those of the original scale.Belief in a just world was found to have significant positive correlations with gratitude and empathy,and has a significant negative correlation with anxiety,thereby exhibiting good convergent and divergent validity.Therefore,the Chinese revised version of the BJWS has good reliability and validity.
文摘The practice of implementing an antibiotic holiday before the second stage of hip or knee arthroplasty is currently controversial due to limited evidence for this approach,as per the International Consensus Meeting 2018 on Musculoskeletal Infection.A greater understanding of this issue could augment the quality of Alrayes and Sukeik’s mini-review(2023)on diagnosing,managing,and treating periprosthetic knee infections.However,a significant lack of literature exists concerning the optimal duration for the antibiotic holiday,calling for more research before establishing any clinical guidelines.
文摘Discoveries of many coal seams at depths by drilling carried by Geological Survey of Pakistan in Sor Range and Harnai Gochina, extended the coal seams at depth which is challenge for mine owners to exploit feasibly. Bed to bed gypsum samplings (and their chemical analyses) of huge gypsum deposits from Sulaiman foldbelt is a base for industrialist and also planers to develop cement and gypsum industries to increase export and foreign exchange for the development of area and Pakistan. Low and high grade sedimentary iron deposits, silica sand and uranium host rocks and their extensions in Sulaiman and Kirthar foldbelts are presented. Anomalies of a few base metals arise as a result of geochemical exploration carried at part of Loralai District of Balochistan. Theropod dinosaurs were frequent in India, while Poripuchian titanosaurs (Sauropoda, Dinosauria) were frequent in Pakistan. Besides some ichnotaxa, many bone taxa such as 1 titanosauriform, 14 titanosaurian sauropod (including one new titanosaur), and 3 theropod dinosaurs are established from Pakistan. Among these 12 titanosaur species and 3 theropod species are named in about 10 km<sup>2</sup> area of Vitakri dome and 2 titanosaur species are named in about a few hundred square meter area of Mari Bohri (Kachi Bohri) which is about 10 km westward from Vitakri dome. Pakistan is a unique country which discoverd 14 diversified titanosaurs in a short area and also in a short period (67 - 66 million years ago/Ma). About 400 bones found from a few meter thick upper part of upper shale horizon of latest Maastrichtian Vitakri Formation which is base for titanosaur taxa. Cranial material is in low fraction (but include significant diverse snouts), caudal vertebrae are prominent, the cervicals, dorsals and sacrals have significant numbers, forelimb and hind limb bones have balanced fraction. Humeri, femora and tibiae are most common. To know the position of Pakistani titanosaurs among titanosaurs and sauropods, there is a need to extend list of characters for phylogenetic analyses. This broad feature list should include main characters of titanosaurs from Pakistan and also from global world.
文摘Founded in 1963,China National Institute of Standardization(CNIS)mainly focuses on the research into the standardization development strategies,fundamental theories,principles and methods as well as standards systems.It also carries out the standardization scientific research,experimental verification,test and evaluation,standards development,revision and promotion,and transformation and application of science&technology achievements.CNIS has played an active role as a public welfare research institute,providing technical support for the work of State Administration for Market Regulation(SAMR),other ministries and local governments.
文摘On May 6th,2024,National Medical Products Administration issued Announcement on the Establishment of Cosmetics Standardization Technical Committee(No.53 of 2024).According to the announcement,National Medical Products Administration is about to establish Cosmetics Standardization Technical Committee,aiming at furthering implementing Regulations on Supervision and Administration of Cosmetics,and promoting the formulation and revision of the cosmetics standard(including toothpaste).
文摘Healthcare security and privacy breaches are occurring in the United States (US), and increased substantially during the pandemic. This paper reviews the National Institute of Standards and Technology (NIST) publication base as an effective solution. The NIST Special Publication 800-66 Revision 1 was an essential standard in US healthcare, which was withdrawn in February 2024 and superseded by SP 800-66 Revision 2. This review investigates the academic papers concerning the application of the NIST SP 800-66 Revision 1 standard in the US healthcare literature. A systematic review method was used in this study to determine current knowledge gaps of the SP 800-66 Revision 1. Some limitations were employed in the search to enforce validity. A total of eleven articles were found eligible for the study. Consequently, this study suggests the necessity for additional academic papers pertaining to SP 800-66 Revision 2 in the US healthcare literature. In turn, it will enhance awareness of safeguarding electronic protected health information (ePHI), help to mitigate potential future risks, and eventually reduce breaches.
文摘BACKGROUND Metallosis is the result of metallic wear debris in the soft tissues and is associated to both local and systemic inflammatory response.Metallosis has been reported after total hip and total knee arthroplasty(TKA),but rarely after a unicompartimental knee arthroplasty(UKA).In the context of UKA metallosis,surgeons often opt for revision using a TKA.However,in this paper,the authors successfully treated UKA revising the metal back only.CASE SUMMARY Prior to treat our patient we conducted a literature research through which we identified eleven cases of metallosis after UKA,ten(90.9%)were treated revising using though a TKA.Only one case was managed through a uni-on-uni revision,reporting high knee function.Our patient complained worsening pain and function after a snap occurred at 16 mo after UKA implantation.At 18 mo following surgical debridment and uni-on-uni revision surgery,our patient exhibited a relevant improvement in Oxford Knee Score and a reduction of metal ion levels in the blood.CONCLUSION Our study highlights that in case of metallosis after UKA,the treatment may be based on surgical debridement and just revising the mobilized components.
文摘BACKGROUND Transoral outlet reduction(TORe)is a minimally invasive endoscopic revision of Roux-en-Y gastric bypass(RYGB)for weight recurrence;however,little has been published on its clinical implementation in the community setting.AIM To characterize the safety and efficacy of TORe in the community setting for adults with weight recurrence after RYGB.METHODS This is a retrospective cohort study of argon plasma coagulation and purse-string suturing for gastric outlet reduction in consecutive adults with weight recurrence after RYGB at a single community center from September 2020 to September 2022.Patients were provided longitudinal nutritional support via virtual visits.The primary outcome was total body weight loss(TBWL)at twelve months from TORe.Secondary outcomes included TBWL at three months and six months;excess weight loss(EWL)at three,six,and twelve months;twelve-month TBWL by obesity class;predictors of twelve-month TBWL;rates of post-TORe stenosis;and serious adverse events(SAE).Outcomes were reported with descriptive statistics.RESULTS Two hundred eighty-four adults(91.9%female,age 51.3 years,body mass index 39.3 kg/m^(2))underwent TORe an average of 13.3 years after RYGB.Median pre-and post-TORe outlet diameter was 35 mm and 8 mm,respectively.TBWL was 11.7%±4.6%at three months,14.3%±6.3%at six months,and 17.3%±7.9%at twelve months.EWL was 38.4%±28.2%at three months,46.5%±35.4%at six months,and 53.5%±39.2%at twelve months.The number of follow-up visits attended was the strongest predictor of TBWL at twelve months(R^(2)=0.0139,P=0.0005).Outlet stenosis occurred in 11 patients(3.9%)and was successfully managed with endoscopic dilation.There was one instance of post-procedural nausea requiring overnight observation(SAE rate 0.4%).CONCLUSION When performed by an experienced endoscopist and combined with longitudinal nutritional support,purse-string TORe is safe and effective in the community setting for adults with weight recurrence after RYGB.
文摘Periprosthetic joint infection(PJI)following total knee arthroplasty is one of the most catastrophic and costly complications that carries significant patient wellness as well as economic burdens.The road to efficiently diagnosing and treating PJI is challenging,as there is still no gold standard method to reach the diagnosis as early as desired.There are also international controversies with respect to the best approach to manage PJI cases.In this review,we highlight recent advances in managing PJI following knee arthroplasty surgery and discuss in depth the two-stage revision method.
基金This work was supported by DFGP Project of Fauna of Guangdong-202115Nanling National Park Construction Project(No.ZD22-ZC016AG)2022 Wildlife Monitoring Projects of the Guangdong Forestry Bureau,and the National Animal Collection Resource Center,China.
文摘Taxonomic studies of the Odorrana versabilis group have been consistently disorganized,and they have often been incorrectly associated with an abandoned subgenus or genus Bamburana in existing literature.In this study,we conducted an integrative taxonomic analysis using molecular phylogenetic analysis of two mitochondrial gene fragments(16S rRNA and CO1)and morphological examination of 41 specimens collected during herpetological surveys in southern China.Our results confirmed the monophyly of O.versabilis group which exhibited distinct morphological traits.We also identified a cryptic lineage sister with O.exiliversabilis.Additionally,our study revealed that O.trankieni was nested within O.nasuta.Consequently,we redefined the morphological characteristics of the O.versabilis group,described a new species in this group,O.confusa sp.nov.,and proposed that O.trankieni be considered a junior synonym of O.nasuta.One of the most significant findings of this study was the observation of distinct morphological changes in adult males across all species within the O.versabilis group between the non-breeding and breeding seasons.This study contributes to research on various aspects of Asian amphibian fauna,including taxonomy,ecology,evolution,and physiology.
基金Supported by the General Cultivation Project of Xi'an Health Commission,No.2021ms08.
文摘BACKGROUND Periprosthetic joint infection(PJI) and periprosthetic fracture(PPF) are among the most serious complications following total knee arthroplasty. Herein, we present one patient with these two complications with details on the characteristics, treatment strategy, and outcome.CASE SUMMARY A 69-year-old female patient who suffered from PJI and PPF following total knee arthroplasty was treated by a two-stage revision surgery. After thorough foreign material removal and debridement, we used a plate that was covered with antibiotic-loaded bone cement to link with a hand-made cement spacer to occupy the joint space and fix the fracture. Although the infection was cured, the fracture did not heal and caused bone defect due to the long interval between debridement and revision. In the revision surgery, a cemented stem and cortical allogenic splints were used to reconstruct the fracture and bone defect. At the final followup 27 mo after revision, the patient was satisfied with postoperative knee functions with satisfactory range of motion(104°) and Hospital for Special Surgery knee score(82 points). The radiographs showed no loosening of the prosthesis and that the bone grafts healed well with the femur.CONCLUSION Our two-stage revision surgery has proved to be successful and may be considered in other patients with PJI and PPF.
文摘BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.
文摘BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt(VPS)catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.AIM To identify the demographics,clinical presentation,clinical findings,and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter,clinically presented with or without trans-oral extrusion.METHODS An online search was performed for the extraction/retrieval of the published/available literature pertaining to the above-mentioned VPS complication.Manuscripts were searched from PubMed,PMC(PubMed Central),ResearchGate,and Google Scholar databases using various terminology relating to the VPS complications.The first case of migration of a VPS catheter into the stomach was reported in the year 1980,and the data were retrieved from 1980 to December 2022.Cases were categorized into two groups;Group A:Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same,and Group B:Cases who had migration of the distal VPS catheter into the stomach,but presented without trans-oral extrusion.RESULTS A total of n=46 cases(n=27;58.69%male,and n=19;41.3%females)were recruited for the systematic review.Group A included n=32,and Group B n=14 cases.Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the(n=22)cases.Approximately sixty percent(n=27)of them were children≤5 years of age at the time of the diagnosis of the complication mentioned above.In seventy-two percent(n=33)cases,this complication was detected within 24 mo after the VPS insertion/last shunt revision.Clinical diagnosis was evident for the entire group A cases.Various diagnostic modalities were used to confirm the diagnosis for Group B cases.Various surgical procedures were offered for the management of the complication in n=43 cases of both Groups.In two instances,intra-gastric migration of the distal VPS catheter was detected during the autopsy.This review documented four deaths.CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups.It was more frequently reported in children,although also reported in adults and older people.A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without transoral extrusion.
文摘BACKGROUND The popularity of uncemented stems in revision total hip arthroplasty(THA)has increased in the last decade.AIM To assess the outcomes of both cemented and uncemented stems after mid-term follow up.METHODS This study was performed following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement and the Cochrane Handbook for systematic reviews and meta-analysis guidelines.Articles were chosen irrespective of country of origin or language utilized for the article full texts.This paper included studies that reviewed revision THA for both cemented or uncemented long stems.RESULTS Three eligible studies were included in the meta-analysis.Analysis was conducted by using Review Manager version 5.3.We computed the risk ratio as a measure of the treatment effect,taking into account heterogeneity.We used random-effect models.There were no significant differences found for intraoperative periprosthetic fractures[risk ratio(RR)=1.25;95%confidence interval(CI):0.29-5.32;P=0.76],aseptic loosening(RR=2.15,95%CI:0.81-5.70;P=0.13),dislocation rate(RR=0.50;95%CI:0.10-2.47;P=0.39),or infection rate(RR=0.99,95%CI:0.82-1.19;P=0.89),between the uncemented and the cemented long stems for revision THA after mid-term follow-up.CONCLUSION This study has evaluated the mid-term outcomes of both cemented and uncemented stems at first-time revision THA.In summary,there were no significant differences in the dislocation rate,aseptic loosening,intraoperative periprosthetic fracture and infection rate between the two cohorts.
基金funded by Foundation of China Academy of Railway Sciences(No:AYF22Y143).
文摘Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on-site high-speed rail emergency disposal,basic principles for revising the regulations on railway technical management(RRTM)are proposed and suggestions and evaluation methods according to the main clauses are put forward.Findings–Basic principles for revising the RRTM are proposed,namely“to meet the actual needs of on-site high-speed railway emergency disposal,standardize the emergency disposal process,improve the efficiency of emergency disposal and keep the consistency between provisions of emergency disposal”.Existing provisions related to emergency disposal efficiency,scenarios,safety and service quality are made up for the deficiencies.To make up for the deficiencies of the existing provisions related to emergency disposal efficiency,improvement of emergency disposal scenarios and guarantee of emergency disposal safety and quality,this paper puts forward suggestions on revising 15 emergency disposal provisions of the RRTM with regard to earthquake monitoring and warning,in-station foreign body invasion warning,air conditioning failure of EMU trains and forced parking of trains in sections.A fuzzy comprehensive evaluation model based on the analytic hierarchy process(AHP)is constructed to evaluate the proposed revision scheme and suggestions,which has been highly recognized by experts.Originality/value–This study implements the goal of high-quality railway development.