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Mismatch Repair01:36

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Organisms are capable of detecting and fixing nucleotide mismatches that occur during DNA replication. This sophisticated process requires identifying the new strand and replacing the erroneous bases with correct nucleotides. Mismatch repair is coordinated by many proteins in both prokaryotes and eukaryotes.
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In order to be passed through generations, genomic DNA must be undamaged and error-free. However, every day, DNA in a cell undergoes several thousand to a million damaging events by natural causes and external factors. Ionizing radiation such as UV rays, free radicals produced during cellular respiration, and hydrolytic damage from metabolic reactions can alter the structure of DNA. Damages caused include single-base alteration, base dimerization, chain breaks, and cross-linkage.
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One of the common DNA damages is the chemical alteration of single bases by alkylation, oxidation, or deamination. The altered bases cause mispairing and strand breakage during replication. This type of damage causes minimal change to the DNA double helix structure and can be repaired by the base excision repair (BER) pathways. BER corrects damaged DNA sequences by removing the damaged base and restoring the original base sequence using the complementary strand as a template.
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Proofreading and DNA Repair Assay Using Single Nucleotide Extension and MALDI-TOF Mass Spectrometry Analysis
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The Weekend Effect in AAA Repair.

Thomas F X O'Donnell1, Chun Li1, Nicholas J Swerdlow1

  • 1Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.

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Weekend surgery for abdominal aortic aneurysms (AAA) did not increase mortality for ruptured or symptomatic cases. However, weekend transfers of ruptured AAA patients showed higher mortality, indicating a need to improve weekend transfer protocols.

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Area of Science:

  • Vascular Surgery
  • Health Services Research
  • Patient Outcomes

Background:

  • Conflicting evidence exists regarding surgical outcomes based on the day of the week.
  • The impact of weekend surgery on abdominal aortic aneurysm (AAA) repair outcomes requires clarification.

Purpose of the Study:

  • To investigate the association between the day of the week and perioperative mortality in patients undergoing abdominal aortic aneurysm (AAA) repair.
  • To compare outcomes for elective, symptomatic, and ruptured AAA repairs performed on weekdays versus weekends.

Main Methods:

  • Analysis of 38,498 patients undergoing AAA repair (endovascular aneurysm repair and open repair) from the Vascular Quality Initiative (2009-2017).
  • Utilized mixed-effects logistic regression to compare adjusted perioperative mortality rates based on the day of repair.
  • Examined outcomes for elective, symptomatic, and ruptured AAA repairs, including patient transfers.

Main Results:

  • No significant difference in adjusted mortality for ruptured or symptomatic AAA repair between weekdays and weekends.
  • Patients with ruptured AAA transferred over the weekend had higher adjusted mortality compared to those transferred during the week (28% vs 21%).
  • Symptomatic AAA repair on the weekend was associated with higher adjusted mortality than delaying surgery until a weekday (7.9% vs 3.1%). Elective AAA repair showed no day-of-week variation.

Conclusions:

  • No weekend effect was observed for ruptured or symptomatic abdominal aortic aneurysm (AAA) repair mortality.
  • Higher mortality in weekend transfers of ruptured AAA patients suggests potential issues with weekend transfer care coordination.
  • Improvements in weekend transfer processes for ruptured AAA patients are recommended to mitigate outcome disparities.