Conversion hip arthroplasty for failed nailing of intertrochanteric fracture: Reflections on some important aspects

In this editorial,I present my comments on the article by Solarino et al.Conversion hip arthroplasty,which is an optional salvage procedure performed following unsuccessful fixation of intertrochanteric femur fractures in elderly pati-ents,entails more complex processes and higher rates of operative complications than primary arthroplasty.Hence,it is important to consider the appropriateness of the primary treatment choice,as well as the adequacy of nailing fixation for intertrochanteric fractures.This article briefly analyzes the possible factors contributing to the nailing failure of intertrochanteric fractures and attempts to find corresponding countermeasures to prevent fixation failures.It also analyzes the choice of treatment between nailing fixation and primary arthroplasty for intertrochanteric fractures.

Failed medial patellofemoral ligament reconstruction:Causes and surgical strategies

Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.

Bicanalicular versus monocanalicular intubation after failed probing in congenital nasolacrimal duct obstruction

AIM：To investigate the clinical outcomes of different intubation techniques in the cases of failed primary probing.METHODS： This retrospective study was performed on338 patients with the diagnosis of congenital nasolacrimal duct obstruction with age 1-4y that had failed primary probing.Intubation was performed under light sedation in operating room and the stent was left 3mo in place.Clinical outcome was investigated 3mo after tube removal.RESULTS： Bicanalicular intubation method had higher complete and relative success rates compared to monocanalicular intubation（P =0.00）.In addition,Monoka intubation had better outcomes compared to Masterka technique（P =0.046）.No difference was found between genders but the higher the age,the better the outcomes with bicanalicular technique rather than monocanalicular.CONCLUSION： Overall success rate of bicanalicular intubation is superior to monocanalicular technique especially in older ages.Also,based upon our clinical outcomes,Masterka intubation is not recommended in cases of failed probing.

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

Retrieval strategy for failed satellite on tether’s optimal balance swing angle

A retrieval control strategy for failed satellite,which is connected to a servicing spacecraft by a tether,is studied.The Lagrange analytical mechanics based dynamics modeling for the system composed of a servicing spacecraft,a tether and a failed satellite,is presented under the earth center inertia coordinate system,then model simplification is conducted under the assumption that the failed satellite’s mass is far smaller than the servicing spacecraft’s,meanwhile the tether’s length is far smaller than the size of the servicing spacecraft’s orbit.Analysis shows that the retrieval process is intrinsically unstable as the Coriolis force functions is a negative damping.A retrieval strategy based on only the tether’s tension is designed,resulting in the fastest retrieval speed.In the proposed strategy,firstly,the tether’s swing angle amplitude is adjusted to 45?by deploying/retrieving the tether;then the tether swings freely with fixed length until it reaches negative maximum angle–45?;finally,the tether is retrieved by the pre-assigned exponential law.For simplicity,only the coplanar situation,that the tether swings in the plane of the servicing spacecraft’s orbit,is studied.Numerical simulation verifies the effectiveness of the strategy proposed.

Management of chronic dacryocystitis cases after failed external dacryocystorhinostomy using endoscopic technique with a novel lacrimal ostium stent

AIM: To demonstrate the outcomes of endoscopic endonasal dacryocystorhinostomy(En-DCR) with an novel lacrimal ostium stent(LOS) which was performed in patients with recurrent epiphora after failed external dacryocystorhinostomy(Ex-DCR) and analyze the causes of failed Ex-DCR.METHODS: From September 2015 and December 2017, the clinic data of 29 cases suffered from recurrent epiphora after failed Ex-DCR was reviewed.The LOS were implanted into the ostium at the end of the revisional surgery.The causes of failed Ex-DCR were analyzed before revisional surgeries.Outcome of revisional surgeries with the new device were evaluated as well.RESULTS: The major causes of failure of the external approach were synechiae formation in the nasal ostium(29/29), followed by inadequate removal of the bony wall(21/29), nasal synechiae formation between lateral wall of nose and middle turbinate(11/29), and the bone opening was not in good location(7/29).The rate of success after revisional surgery was 82.76%.Re-obstruction of the ostiums were found in 5 failed cases.CONCLUSION: Endoscopic approach with a novel LOS may be an effective procedure to manage recurrent epiphora after previous failed Ex-DCR surgery.Synechiae formation in the nasal ostium and inadequate removal of the bony wall were the major causes of failure of Ex-DCR.

Management of patients with a failed kidney transplant: Dialysis reinitiation, immunosuppression weaning, and transplantectomy

The number of patients reinitiating dialysis after a failed transplant increases over time and has more than doubled between the year 1988 and 2010 （an increase from 2463 to 5588）. More importantly, patients returning to dialysis have been shown to have a greater thanthree-fold increase in the annual adjusted mortality rates compared with those with a functioning graft. Continuation of immunosuppression to preserve residual graft function has been implicated to be a contributing factor, seemingly due to immunosuppression-ass-ociated cardiovascular and infectious complications and malignancy risk, among others. Nonetheless, maintenance low-dose immunosuppression has been suggested to confer survival beneft in patients returning to peritoneal dialysis. Whether early vs late reinitiation of dialysis or whether transplantectomy has an impact on patient survival remains poorly defined. Consensus guidelines for the management of a failed allograft are lacking. In this article, we present a literature overview on the ideal timing of dialysis reinitiation after graft loss, the management of immunosuppression after graft failure, and the risks and benefits of transplantectomy. The authors’ perspectives on the management of this special patient population are also discussed.

Edna: a Failed Life Mediator Contrasting with Madame Ratignolle and Madame Reisz

The Awakening is about the heroine Edna Pontellier awakes and tries to reset her relation with the world in New Orleans,a place the family chose to spend the summer, where there also are influences working their way to awake Edna. Among them, theeffects from Madame Ratignolle and Madame Reisz are of great importance in the process of Edna's awakening and to her final sui-cide. This dissertation will see how Edna is affected by and distinguished from them, and get the conclusion that Edna fails being alife mediator by contrasting with the two women.

Failed Reconciliation in The Narrow Road to the Deep North

The Narrow Road to the Deep North,a novel composed by Richard Flanagan,a well-known Australian contemporary nov⁃elist,depicts a grand political picture of Australia,from the lens of individual’s psyche.The domination of the official history en⁃courages forgetting as a way to deal with the painful history,the Burma camp in the novel,while the minorities,who rise up,fighting against the imposed official history by constructing the counter memory,are trapped in the identity confusion.Literature is used by both the perpetrators and the survivors as means to pursuing for reconciliation but both failed for the perpetrators use it as a way of forgetting which contributes to the prevailing unforgiveness in the novel,and further contributes the victims’failed reconciliation.

Transient global amnesia after epiduroscopy in a failed back surgery syndrome patient: Case report

Epiduroscopy (EDS) allows diagnosis and treatment of spinal nerve root pathology by a fiberoptic device inserted percutaneously in the epidural space. Transient global amnesia syndrome (TGA) is defined by an abrupt onset of an anterograde and retrograde amnesia that lasts up to 24 h, although mild subclinical neuropsychological deficits, with concomitant vegetative symptoms, can last for days after the episode. To our knowledge no cases of TGA in association with EDS have been recognized. We present a case of a 54-year-old man who was admitted for EDS, having experienced two times the failed surgery for spinal and left leg pain. During the EDS, 10 ml of non-ionic contrast media (CM) was injected to confirm the inside lesions. The epidural adhesions were gently broken down and drugs were injected around any inflamed nerve roots. Immediately after EDS, the patient experienced a TGA with loss of memory for the recent procedure and an impaired ability to retain new information. There were no signs of confusion or altered conscious level or seizure activities and neurological examination was normal. At 24 h a cranial computerized tomography (cCT) without CM showed “abnormal contrast enhancement at subarachnoid liquoral spaces levels”, then at 72 h cCT control was normal. The patient was discharged on the seventh day with perioperative lacunar amnesia persisting at this time. Herein, we sought a possible relationship between neurotoxic effect of CM and TGA in a patient emotionally stressed, even if the CM dose was given as a normal clinical range.

Point-of-care ultrasound identifi cation of yolk stalk sign in a case of failed fi rst trimester pregnancy

Emergency physicians are often the first providersto encounter patients with complications in earlypregnancy. Point-of-care （POC） pelvic ultrasound isbeing increasingly used in the evaluation of emergencydepartment （ED） patients with first trimester symptoms.[1]While the initial aim of POC ultrasound in this settingis to confirm an intrauterine pregnancy, a secondarygoal is to differentiate between a normal and abnormalpregnancy. There exist a number of sonographic featuresto suggest a pregnancy is non-viable.

Have Phase Ⅲ clinical trials of Compound Danshen Dripping Pill'tragically failed'?

Compound Danshen Dripping Pill (CDDP) is the traditional Chinese medicine that has been widely used in China for the treatment of diseases such as coronary heart disease, stenocardia, and myocardial ischemia. The application of the pills was submitted to the USA Food and Drug Administration (FDA) in 1997. It was also the first TCM to enter phase III clinical trials by the FDA. However, news about the failure of the phase III clinical trials of CDDP was recently reported.

Belsey Mark IV Repair for Recurrent Hiatal Hernia and Failed Fundoplication: An Analysis of Outcomes in 206 Patients

Background: With the increasing number of laparoscopic fundoplications, many more patients with a failed primary antireflux operation are being referred for complex redo procedures. The objective of this study was to evaluate our results of redo antireflux surgery using the Belsey Mark IV (BMIV) Repair. Methods: A retrospective analysis of the patients who underwent BMIV repair following a failed fundoplication was performed. The primary endpoint was failure of the redo procedure and recurrent hiatal hernia. Secondary endpoints were assessment of the functional results of the redo fundoplication and quality of life with a Dysphagia Score, and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL) questionnaire. Results: 206 patients underwent surgery for failed primary fundoplication. Most patients had one prior antireflux surgery 148/206 (71.8%). The most common primary failed fundoplication was the Nissen procedure (189/206, 91.7%). The median time from the prior operation to the redo operation was 34 months. Median follow-up was 25.6 months. The Dysphagia score decreased from 3.6 ± 0.5 preoperatively to 1.0 ± 0.4 postoperatively (p < 0.0001). At the time of follow-up, the Median GERD-HRQL score was 4 (range 0 - 9), classified as excellent, compared to a preoperative Median GERD-HRQL score of 43 (range 41 - 50) which was classified as poor. (p < 0.0001). There was no recurrence of the hiatal hernia. Conclusion: Complete takedown and reestablishment of the normal anatomy, recognition of a short esophagus, and proper placement of the wrap are essential components of a redo antireflux procedure. The BMIV repair as the choice of reopertaive procedure results in excellent symptom relief, significant improvement in quality of life, and is associated with excellent medium-term durability in terms of recurrence of the hiatal hernia.

Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.

Lessons learned from the TIMI trials in rescue interventions for elderly patients after failed fibrinolytic therapy:look beyond the TIMI flow

In ST-segment elevation myocardial infarction (STEMI), acute reperfusion of the infarct-related artery (IRA)is the main goal in the early minutes after the patient seeks medical attention. Fibrinolytic therapy (FT) and/or primary coronary intervention (PCI) were proven to be effective in opening the IRA.

A Method for Forecasting Failures of Sucker Rod-pumped Wells

An exact forecast of the failures of a sucker rod-pumped well in a production area means much for an oilfield’s operation budget, operational arrangement and production plan. In this paper, according to the characteristics of failed sucker rod-pumped well randomness and strong outburst, with the gray GM (1,1) forecast model and the Markov forecast model combined, gray GM (1,1) forecast model is utilized to handle the primary data of an oilfield, and Markov forecast model is utilized to calculate the state transfer probability of forecast value. Then, the gray Markov forecast model considering the influence of randomness factors is formed. Field results prove that the calculation precision of this method is higher and the practicability is greater.

一种设计Fail-Stop协议的新方法

如何设计出满足安全需求的安全协议是一项非常重要的课题,目前尚无有效的方法。Fail-Stop协议在遭遇干扰其正常运行的主动攻击时完全停止。本文提出了一种设计Fail-Stop协议的新方法,分析了这种方法的正确性;分析了SSL协议早期版本的安全缺陷,并使用本方法对其进行了改进。

椭圆曲线离散对数问题上的Fail-stop数字签名方案

提出了一种基于椭圆曲线离散对数问题的Fail-stop签名方案,保证了签名者的安全性。提出了一次性签名方案,给出了多重消息签名方案,并且这两种方案都具有Fail-stop的性质。

增强型fail-stop签名方案的安全性分析

本文介绍一种可证明的安全签名方案:fail-stop签名方案。它是一种安全性增强的一次签名方案,该方案仅给一则消息签名时是安全的,它不能同时给两则消息同时签名,必须一次一签,密钥使用过后必须扔掉,可以进行任意次的验证,有较高的安全性和实用性。本文对fail-stop签名系统的安全性进行了分析和评估,提出了一种伪造证明算法,签名者能够以高概率证明签名的真伪。