Simultaneous cholecystectomy for asymptomatic gallstones during elective colorectal cancer surgery

BACKGROUND

Asymptomatic gallstones are commonly detected using preoperative imaging in patients with colorectal cancer (CRC), but its management remains a topic of debate.

METHODS

Clinicopathologic characteristics of patients who had asymptomatic gallstones presenting during the colorectal procedure were retrospectively reviewed. Medical records, including postoperative morbidity, mortality, and long-term gallstone-related diseases, were assessed.

RESULTS

Of 134 patients with CRC having asymptomatic gallstones, 89 underwent elective colorectal surgery only (observation group), and 45 underwent elective colorectal surgery with simultaneous cholecystectomy (cholecystectomy group). After propensity score matching (PSM), the complications were similar in the 2 groups. During the follow-up period, biliary complications were noted in 11 patients (12.4%) in the observation group within 2 years after the initial CRC surgery, but no case was found in the cholecystectomy group. After PSM, the incidence of long-term biliary complications remained significantly higher in the observation group than in the cholecystectomy group (26.5% vs 0.0%; P < .01). Multivariable logistic regression analysis identified female gender, old age (≥65 years old), and small multiple gallstones as independent risk factors for the development of long-term gallstone-related diseases in patients from the observation group.

CONCLUSION

Simultaneous prophylactic cholecystectomy during prepared, elective CRC surgery did not increase postoperative morbidity or mortality but decreased the risk of subsequent gallstone-related complications. Hence, simultaneous cholecystectomy might be a preferred therapeutic option for patients with CRC having asymptomatic gallstones in cases of elective surgery, especially for older patients (≥65 years old), female patients, and those with small multiple calculi.

Simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction: initial experience

BACKGROUND

Simultaneous transcatheter mitral valve in valve (VIV) replacement and aortic valve replacement experience is limited. We report our initial experience with simultaneous transapical transcatheter aortic and mitral valve replacement in patients with severe valve dysfunction.

METHODS

A total of 8 patients had simultaneous transcatheter heart valve implants for severe mitral bioprosthesis failure (VIV), with a second valve procedure that included native aortic regurgitation (n = 3) or degenerated bioprostheses in the aortic position (n = 5). All patients were treated with a self-expandable J-valve transcatheter valve, using the transapical approach.

RESULTS

The mean age of the patients was 73.1 ± 6.2 years. The mean Society of Thoracic Surgeons score was 13.8 ± 6.3%. Device success was 100% according to Valve Academic Research Consortium-2 criteria. No other procedure-associated complications occurred, including left ventricular outflow tract obstruction and valve migration. The mean hospital lengths of stay after the procedure were 11.5 ± 8.0 days. No deaths occurred at 30 days. At a median follow-up period of 28.7 ± 22.3 months, no patients died. All patients were in New York Heart Association functional classes I-II. Echocardiographic parameters at follow-up showed a normofunctioning J valve in the mitral position and a mean max mitral flow velocity of 2.0 ± 0.5 m/s; the J valve in the aortic position was also normofunctioning, and the mean max aortic flow velocity was 2.3 ± 0.5 m/s.

CONCLUSION

Simultaneous transapical transcatheter aortic and mitral valve replacement using the self-expandable J valve appears to be a feasible and effective alternative to redo surgery.

Simultaneous Co-surgeon Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstructions: Feasibility and Clinical Outcomes

BACKGROUND

A co-surgeon model is known to be favorable in microvascular breast reconstruction, but simultaneous co-surgeon deep inferior epigastric perforator (DIEP) flap cases have not been well-studied. The authors hypothesize that performing two simultaneous co-surgeon bilateral DIEP flap reconstructions results in non-inferior clinical outcomes and may improve patient access to care.

METHODS

A single-institution, retrospective cohort study was performed utilizing record review to identify all cases of co-surgeon free-flap breast reconstructions over a 38-month period. Patients who underwent simultaneous bilateral DIEP flap breast reconstructions with the same two co-surgeons were identified. The control group consisted of subjects who underwent non-simultaneous reconstruction by the same co-surgeons within the same, preceding, or following month of those in the study group. Primary outcome variables were 90-day postoperative complications, while secondary outcomes were operating time, ischemia time, and length of stay. Descriptive statistics, univariate and multivariable regression analyses were performed.

RESULTS

Overall, 137 subjects were identified and 64 met the inclusion criteria (n = 28 study, n = 36 control). There were no statistically significant differences between groups in body mass index, radiation, trainee experience, flap perforator number, immediate/delayed reconstruction, or length of stay. There were also no statistically significant differences in complications, including flap loss, anastomosis revision, take-back to the operating room, or re-admission. Operative time was longer in the simultaneous DIEP group (540.5 vs. 443.5 min, p < 0.01), but ischemia time was shorter in the simultaneous group (64.0 vs. 80.5 min, p < 0.01).

CONCLUSIONS

A simultaneous co-surgeon approach to bilateral DIEP flap reconstruction may improve access to care and does not result in a higher complication rate compared with non-simultaneous bilateral DIEP flaps.

Does a simultaneous ventral/dorsal approach provide better reduction quality in treating acetabular fracture involving both columns with displaced posterior wall?

INTRODUCTION

Various surgical techniques have been proposed to manage acetabular fractures involving both columns with posterior wall displacement. However, the optimal surgical approach to achieve satisfactory reduction quality remains controversial.

MATERIALS AND METHODS

This retrospective study evaluated 34 patients with fractures who were treated at a single medical institution. The patients were divided into two groups according to the ventral/dorsal surgical approach employed: simultaneous (SI) and sequential (SE). Perioperative parameters, as well as radiological and functional outcomes, were analyzed and compared between the two groups.

RESULTS

The SI and SE groups comprised 9 and 23 out of the 34 patients, respectively. The SI group exhibited a significantly shorter surgical time and lower estimated blood loss than the SE group (p = 0.04 and 0.03, respectively). The quality of reductions of the anterior and posterior columns was similar between the two groups; however, superior reduction in the fracture gap of the posterior wall was observed in the SI group, as revealed by axial and coronal computed tomography scans.

CONCLUSIONS

A simultaneous ventral and dorsal approach through the pararectus and the modified Gibson approach confer clinical advantages in reducing the fracture gap, surgical time, and intraoperative blood loss when managing acetabular fractures involving both columns and a displaced posterior wall. Therefore, these surgical approaches may be considered to be optimal for achieving satisfactory reduction quality in such fractures.

Bilateral Total Ankle Arthroplasty

Patients with bilateral ankle arthritis have higher rates of primary and secondary/inflammatory arthritis and a more debilitating condition than those with unilateral pathology. The limited bilateral total ankle arthroplasty (TAA) literature supports both 1-surgeon and 2-surgeon team bilateral TAAs as safe and effective with comparable improvements in patient-reported outcome measures (PROMs), complications, reoperations, and prosthesis survival as unilateral TAA and staged bilateral TAA. Additional benefits of bilateral arthroplasty supported in the hip and knee literature include cost reduction, noninferior and even superior perioperative complication profiles, improved PROM and satisfaction, shorter recovery time, early rehabilitation, and less time away from employment.

In-Hospital Complications and Costs of Simultaneous Bilateral Total Hip Arthroplasty: The Case for Selection and Potential Cost Savings

Background

Published comparisons between bilateral and unilateral total hip arthroplasty (THA) remain controversial regarding the potential risks and benefits. Our objectives were to compare (1) postoperative complications and (2) resource utilization of patients having simultaneous bilateral THA with patients having unilateral procedures.

Methods

The Nationwide Inpatient Sample was used to identify patients undergoing primary elective THA from January 2016 to December 2019. Complications and costs were compared between unilateral and simultaneous bilateral patients. Binary logistic regression analysis controlling demographics, comorbidities, and the primary diagnosis was performed to compare the cohorts of unilateral and bilateral patients.

Results

Nine thousand nine hundred fifty-five Bilateral procedures and 785,609 unilateral procedures were identified. Patients with bilateral procedures were at increased risk for many medical complications including gastrointestinal complications (OR: 4.1; 95% CI: 2.4-6.9, P < .01), postoperative blood transfusions (OR: 3.6; 95% CI: 3.3-3.9, P < .01), and pulmonary embolisms (OR: 3.2; 95% CI: 2.0-5.1, P < .01). Patients with bilateral procedures were also at increased risk for joint complications, including periprosthetic fractures (OR: 7.4; 95% CI: 5.2-10.5, P < .01) and other mechanical complications (OR: 27.0; 95% CI: 23-30, P < .01). These patients also incurred higher index hospitalization costs ($25,347 vs $16,757, P < .001) and were discharged more commonly to a rehabilitation facility (17.8% vs 13.4%, P < .001).

Conclusions

Bilateral THA are at increased risk of developing postoperative complications despite being younger and having fewer comorbidities on average when compared with unilateral patients. While bilateral patients had a higher index hospitalization cost, the overall cost of one episode of care is lower than two separate hospitalizations.

The Safety and Outcomes of Simultaneous Open Rhinoplasty, Alar Reduction, and Upper Lip-Lift through One Surgery

Background

The safety and outcomes of performing a simultaneous Alar reduction, Lip lift, and Open rhinoplasty Surgery (ALOS) through independent incisions have not been reported in any study, therefore, we aimed to evaluate the safety and outcomes of this combination procedure.

Methods

This retrospective review study was conducted on all cases of simultaneous ALOS, lip-lift, and alar reduction performed from 2018-2022, at Facial Plastic Surgery Clinic, New York, USA. Alar reduction involved complete through-and-through resection of alar wedge, and the type of lip lift technique was bullhorn design with excision of skin and Superficial Musculo-Aponeurotic System. Primary open rhinoplasty with inverted V-columellar incision was performed. The follow up period ranged between 4 months to 2 years, but all of patients were followed up at 6 days, one, and two months post-operatively.

Results

Fifty one cases were enrolled. We reviewed criteria of complications including infection, vascular events (such as necrosis, or partial ischemia), and poor scarring, fortunately, we did not have any infection or vascular issues. In 2 cases, columellar scar was "less than optimal", but in all other cases, this scar was "not perceivable" based on the patient survey. In 4 cases, the lip lift procedure scar was considered "less than optimal" showed slight indentation of white scar of lip lift in 9/44 cases. Additionally, all columellar and alar incisions had nearly invisible scarring.

Conclusion

In primary rhinoplasty cases, without any other surgeries or previous trauma in the oronasal region, performing concomitant lip lift, open rhinoplasty, and alar wedge resection is safe and does not negatively affect vascularity or scarring.

Image-free handheld robotic-assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes

PURPOSE

The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent simultaneous bilateral total knee arthroplasty (SB-TKA) using either robotic-assisted TKA (RA-TKA) or conventional TKA (C-TKA).

METHODS

Included were the patients who underwent SB-TKA between January 2018 and January 2020 and had a minimum follow-up of 2 years. Of 151 patients included, 117 patients were operated using an image-free handheld robotic sculpting system (RA-TKA group) and 34 patients operated using conventional instrumentation (C-TKA group). The key outcomes noted were multiple patient-reported outcomes (PROs), adverse events, and radiological outcomes. Two investigators independently measured the radiological outcomes on pre- and post-operative radiographs in coronal plane (medial proximal tibial angle [MPTA] and anatomic lateral distal femoral angle [aLDFA]) and sagittal plane (posterior tibial slope [PTS] and posterior condylar offset [PCO]). The chi-square test was used to examine categorical variables. Student's t test was used to analyze the continuous variables.

RESULTS

Patients in both groups were similar in baseline characteristics (gender, body mass index, incidence of comorbidities, and length of hospital stay) except that RA-TKA group patients younger (66.7 ± 8.9 vs 70.4 ± 10.5, P = 0.037) than C-TKA group. The operative time was longer in RA-TKA group as compared to C-TKA (189.3 ± 37.1 vs 175.0 ± 28.2, P = 0.040). The final PROs at each were similar between the two groups (P > 0.05). The values of PROs at final follow-up in RA-TKA compared to C-TKA were VAS pain (0.4 ± 0.9 vs 0.4 ± 0.5), KOOS-JR (89.3 ± 5.8 vs 87.1 ± 5.3), and physical (55.9 ± 2.8 vs 55.4 ± 3.2), mental (61.1 ± 4.4 vs 60.2 ± 4.7) component of VR-12 scores, and KSS satisfaction (37.5 ± 1.1 vs 37.1 ± 2.2) (all P > 0.50 or non-significant [n.s.]). While one patient in RA-TKA required revision of femoral component for peri-prosthetic fracture, none of the patient in conventional group were revised (0.85% vs 0%, P = n.s.). The proportion of patients with outliers in RA-TKA group was lower for aLDFA (2.6% vs 22.1%, P < 0.01) and PTS (0% vs 35%, P < 0.01).

CONCLUSION

This comparative study in patients undergoing SB-TKA found reduction of outliers in femoral and tibial implant positioning with RA-TKA as compared to C-TKA. There were no differences in both groups for pain, function, and satisfaction at a minimum of 2 years of follow-up.

LEVEL OF EVIDENCE

III Therapeutic Study.

Simultaneous Approaches

BACKGROUND

Given that low physical activity levels and poor dietary intake are co-occurring risk factors for chronic disease, there is a need for interventions that target both health behaviors, either sequentially or simultaneously. Little is known about participant characteristics that are associated with better or worse response to sequential and simultaneous interventions.

METHOD

The 12-month Counseling Advice for Lifestyle Management (CALM) randomized trial (N = 150; Mage = 55.3 years) targeted these two behaviors either via a sequential approach - dietary advice first then exercise advice added ("Diet-First") or exercise advice first then dietary advice added ("Exercise-First") - or via a simultaneous approach. The objective was to examine demographic, clinical, and psychosocial moderators of intervention effects on 12-month change in (1) moderate-to-vigorous physical activity (MVPA), (2) fruit/vegetable intake, (3) caloric intake from saturated fat, and (4) weight. Hierarchical regressions first compared Diet-First to Exercise-First, followed by comparisons of these arms combined ("sequential") to the simultaneous arm.

RESULTS

Older age, higher baseline BMI, and lower social support were associated with higher MVPA in Exercise-First vs. Diet-First, while lower tangible support was associated with higher fruit/vegetable intake in Exercise-First but not in Diet-First. Poor sleep was associated with higher levels of MVPA in the sequential arm than in the simultaneous arm. Lower vitality was associated with greater weight loss in the sequential arm than in the simultaneous arm, while the opposite was true for those who were not married.

CONCLUSION

Identifying moderators of treatment response can allow the behavioral medicine field to enhance intervention efficacy by matching participant subgroups to their best-fitting interventions.

TRIAL REGISTRATION

NCT00131105.

Bilateral simultaneous cochlear implantation is a safe method of hearing rehabilitation in adults

PURPOSE

Bilateral cochlear implantation is an effective treatment for patients with bilateral profound hearing loss. In contrast to children, adults mostly choose a sequential surgery. This study addresses whether simultaneous bilateral CI is associated with higher rates of complications compared to sequential implantation.

METHODS

169 bilateral CI surgeries were analyzed retrospectively. 34 of the patients were implanted simultaneously (group 1), whereas 135 patients were implanted sequentially (group 2). The duration of surgery, the incidence of minor and major complications and the duration of hospitalization of both groups were compared.

RESULTS

In group 1, the total operating room time was significantly shorter. The incidences of minor and major surgical complications showed no statistically significant differences. A fatal non-surgical complication in group 1 was particularly extensively reappraised without evidence of a causal relationship to the chosen mode of care. The duration of hospitalization was 0.7 days longer than in unilateral implantation but 2.8 days shorter than the combined two hospital stays in group 2.

CONCLUSION

In the synopsis of all considered complications and complication-relevant factors, equivalence of simultaneous and sequential cochlear implantation in adults in terms of safety was found. However, potential side effects related to longer surgical time in simultaneous surgery must be considered individually. Careful patient selection with special consideration to existing comorbidities and preoperative anesthesiologic evaluation is essential.

Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm

With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally. We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.

The effects of alcohol and marijuana co-use patterns on intimate partner aggression perpetration

Alcohol and marijuana are two of the most widely used substances in the U.S, with rates of alcohol and marijuana co-use increasing in recent years. Despite this increase, little is known about the effects of alcohol and marijuana co-use patterns (e.g., simultaneous, concurrent) on intimate partner aggression (IPA) perpetration. The purpose of the current study was to examine differences in IPA among simultaneous and concurrent alcohol and marijuana use groups and an alcohol-only group. Participants were 496 individuals (57% identifying as a woman) recruited nationally in April 2020 via Qualtrics Research Services who reported being in a current relationship and recently consuming alcohol. Individuals completed an online survey that included demographics, measures of COVID-19 stress, alcohol and marijuana use, and physical and psychological IPA perpetration. Based on survey responses, individuals were categorized as belonging to the alcohol use only group (n = 300), the concurrent alcohol and marijuana use group (n = 129), or the regular simultaneous alcohol and marijuana use group (n = 67). Due to inclusion criteria, there was no marijuana use only group. Individuals with regular simultaneous or concurrent alcohol and marijuana co-use reported more frequent physical and psychological IPA perpetration compared to those who only used alcohol. Neither physical nor psychological IPA perpetration frequency differed between individuals who reported regular simultaneous versus concurrent alcohol and marijuana co-use. Results suggest that alcohol and marijuana co-use in general, and not the specific pattern of use, is associated with an increased likelihood of IPA perpetration.

STAGED VERSUS SIMULTANEOUS APPROACH IN COMPLEX BILATERAL TOTAL KNEE REPLACEMENT: EXPERIENCE FROM TERTIARY INSTITUTION IN NIGERIA

Background

Bilateral end-stage knee osteoarthritis is a common presentation. The decision facing both patient and surgeon is whether to undertake the replacement of both knees in one sitting i.e. simultaneous bilateral total knee replacement (SMTKR) or to undertake this as a staged bilateral total knee replacement (STTKR). The decision is made harder by the presence of severe coronal and sagittal plane deformities and associated bone loss. We present our results of treating such patients with a focus on a trilogy of cost, complication and functional outcome following SMTKR.

Methodology

A retrospective review of 31 patients who presented with bilateral knee arthritis. 19 underwent SMTKR and 12 underwent STTKR. Data on the trilogy of complication, cost and functional outcome were collected and analysed.

Results

Our cohort of patients was overwhelmingly female in both groups at overall F/M = 30/1. Patients in the SMTKR group were slightly younger at a mean of 65 years compared to 69 years in the STTKR group. Mean Oxford Knee Score (OKS) improved significantly in all groups, mean of 54 in SMTKR and 56 in the STTKR groups. There was one fatality in the STTKR from upper GI bleeding and 1 revision for bone graft failure. The overall cost is less with SMTKR.

Summary

SMTKR is a safe and effective undertaking in properly selected patients with bilateral end-stage knee arthritis with severe deformities. Significant experience is however needed to successfully tackle complex deformities and such procedures should be undertaken by experienced arthroplasty surgeons.

Design of coil holder for the improved maneuvering in concurrent TMS-MRI

BACKGROUND

Concurrent transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI) is time-consuming because of the limited space in the MRI bore and the sophisticated placement and orientation of the TMS coil to elicit the desired brain activities and behaviors.

OBJECTIVE

We developed a TMS coil holder capable of quick adjustment of the TMS coil position and orientation. The holder can also hold an MRI receiver coil array.

METHODS

A holder with one controlling knob, two omni-direction rotation joints, and two in-plane rotation joints was developed.

RESULTS

Different TMS coil positions and orientations can be arranged and fixed in seconds. The holder can also accommodate two TMS coils to allow for multi-coil TMS-MRI.

CONCLUSION

Our development significantly improves the workflow of the concurrent TMS-MRI in new neuroscience studies and clinical applications.

An exceptional challenging case: Anterior shoulder dislocation with ipsilateral humeral shaft fracture complicated with an upper extremity compartment syndrome

INTRODUCTION

Combination of shoulder dislocation with ipsilateral shaft humeral fracture is extremely rare and the occurrence of upper extremity compartment syndrome as a complication is even rarer.

CASE PRESENTATION

A 36-year-old male, sustained a road traffic accident as a pedestrian struck by a vehicle. He was diagnosed with an anterior dislocation of the right shoulder with an ipsilateral open transverse fracture of the middle third of the humeral shaft. He was treated with closed reduction and Hackethal bundle nailing. The next day, the patient developed acute compartment syndrome and underwent multiple fasciotomy.

DISCUSSION

This particular combination represents a great surgical challenge in orthopedics and there is no clear consensus until now regarding its management. We review the mechanism and the appropriate treatment of this injury.

CONCLUSION

We think it is critical to emphasize the original character of our case, because it is probably the first report to describe this special injury associated with upper extremity compartment syndrome.

Transformation of algal-dissolved organic matter via sunlight-induced photochemical and microbial processes: interactions between two processes

Algal-dissolved organic matter (ADOM) is an important fraction of dissolved organic carbon (DOC) in eutrophic water. Although ADOM is known to be readily transformed by microbes, the role of sunlight-induced photochemical process and the interactions between two processes on ADOM transformation remains unclear. In this study, three types of treatments for ADOM, including photochemical process under natural solar light (L treatment), microbial process (M treatment), and the simultaneous photochemical plus microbial process (L&M), were performed for 18 days. Our results showed that M treatment was more effective for the loss of DOC, chromophoric DOM (CDOM) at short wavelengths (a₂₅₄ and a₂₈₀), than L treatment, while L treatment was more effective for the transformation of a₃₅₀ and the fluorescent components of the ubiquitous humic-like component and the tryptophan-like component. Comparison in the decay kinetics of DOC and CDOM in the three treatments showed that the simultaneous photochemical and biological processes exhibited an inhibitory effect on DOC decay rate but not the percentage of labile DOC fraction. Higher relative abundance of protein-like substances was found after L&M treatment, while the relative abundance of humic-like substance and aromaticity increased after M treatment, and the low molecular-weight compounds were produced after L treatment. Our results emphasized the importance of photochemistry in processing ADOM to mediate the chemodiversity in natural water.

Simultaneous contralateral prophylactic mastectomy compared to unilateral nipple-sparing mastectomy for breast cancer surgical treatment: Are complications higher?

BACKGROUND

This study compared post-operative reconstructive complications and oncologic treatment between patients who underwent unilateral versus bilateral nipple sparing mastectomy (NSM) with implant based reconstruction (IBR).

METHODS

Patients diagnosed with unilateral breast cancer who underwent NSM with IBR between 2010 and 2019 were reviewed. Patient demographics, surgical details, adjuvant therapy and postoperative complications were analyzed.

RESULTS

A total of 434 NSM with IBR were performed in 269 patients, 24% unilateral, and 76% bilateral. The bilateral group received a direct implant significantly more frequently and were younger compared to unilateral (p < 0.001). The unilateral group received post-mastectomy radiation therapy at significantly higher rate (p < 0.001) with no difference in receipt of adjuvant chemotherapy. Overall, 11% of mastectomies developed a 30-day complication requiring reoperation and that extended to 13% at 120 days. There was no difference regarding the incidence of complications requiring reoperation (p = 0.84) or complications type between the two groups (p = 0.29).

CONCLUSION

These findings support the oncologic and reconstructive equivalence to support patient choice in CPM.

Comparison of simultaneous vs sequential pars plana vitrectomy and cataract surgery

BACKGROUND

To compare the clinical outcomes of patients undergoing sequential pars plana vitrectomy (PPV) followed by cataract extraction surgery (CE) [PPV/CE], simultaneous PPV and CE (PPV + CE), and sequential CE followed by PPV [CE/PPV].

METHODS

A retrospective observational cohort study of 427 eyes of 404 patients who underwent either sequential or simultaneous PPV and CE surgery between March 2016 and May 2021. Pre-operative and post-operative assessments (up to 2 years of follow-up visits) of uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SEQ), and refractive prediction error (RPE) was done. Main outcome measures were both visual (UCVA, CDVA) and refractive (RPE, SEQ).

RESULTS

There was a statistically significant difference in CDVA of the PPV/CE, PPV + CE, CE/PPV groups (logMAR 0.34 ± 0.40, 0.65 ± 0.61, and 0.55 ± 0.60, respectively) at one month postoperatively (POM1) (P < 0.001), and at the POM12 visits (logMAR 0.25 ± 0.34, 0.53 ± 0.68, and 0.44 ± 0.48; P = 0.04). In the subgroup analysis of patients with a diagnosis of either epiretinal membrane or vitreous opacities, there was no statistically significant difference in SEQ (P = 0.09) and RPE (P = 0.13) at the combined 1 month and 3 month visits.

CONCLUSION

Simultaneous PPV and cataract surgery demonstrated similar improvements in visual acuity and refractive outcomes, as well as comparable intraoperative and postoperative complication profiles to sequential surgery.

Comparing workload and performance during demanding push force and mental tasks

BACKGROUND

The effects of performing occupational tasks that demand physical and mental efforts in combined and simultaneous approaches are unknown, especially when pushing force is analyzed as a physical effort and solving arithmetic problems as a mental effort.

OBJECTIVE

In this study, physical and mental demands were simulated in a lab environment to assess the workload.

METHODS

Using a push force dynamometer, the maximum push force strength of each participant was recorded, and the physical demand was simulated exerting the push force in low, medium, and high levels. Mental demands were simulated solving arithmetic tasks in low, medium, and high levels. Two experimental conditions were defined: (1) task with combined physical and mental workload (performing physical demands first and mental demands after) and (2) task in a simultaneous way (performing both demands at the same time. NASA-TLX Traditional and RAW were applied to assess the workload.

RESULTS

The time to complete the tasks was significantly longer in the combined than the simultaneous approach, and performance was significantly higher in the combined than the simultaneous tasks.

CONCLUSION

The combined approach obtained better results than simultaneous and Traditional NASA-TLX presented a significantly higher level of global workload index than RAW.

Bilateral simultaneous asymmetric hip fracture without major trauma in an elderly patient: a case report

BACKGROUND

Simultaneous bilateral hip fractures without major trauma in the elderly are rare and usually symmetrical. To the best of our knowledge, only two cases of bilateral simultaneous asymmetric hip fracture in the elderly without major trauma have been reported.

CASE PRESENTATION

We present the case of a 90-year-old Japanese man with simultaneous bilateral asymmetric hip fractures with trochanteric fracture on the right side and greater trochanteric fracture on the left side. He complained of dyspnea at midnight and was referred to our emergency department. He was admitted to the internal medicine department for bacterial pneumonia treatment. On the 8th day of hospitalization, he was referred to our orthopedic surgery department for hip pain and was found to have fractures of both hips. Computed tomography findings showed that the left femoral neck fracture was an old fracture, while the left greater trochanteric fracture and the right trochanteric fracture were fresh fractures. He was surgically treated through open reduction and internal fixation with an intramedullary nail on the right and hemiarthroplasty on the left in supine position, performed during the same surgical sessions on the 12th day of hospitalization.

CONCLUSIONS

We report a new form of simultaneous bilateral asymmetric hip fracture in the elderly. The fracture types of the case were femoral trochanteric fracture and greater trochanteric fracture of the femur, which were different from the fracture types in the previously reported two cases. Clinicians should be aware of the possibility of simultaneous bilateral hip fractures, especially in the elderly.

Cognitive-motor multitasking in older adults: a randomized controlled study on the effects of individual differences on training success

Background

Multitasking is an essential part of our everyday life, but performance declines typically in older age. Many studies have investigated the beneficial effects of cognitive, motor and combined cognitive-motor training on multitasking performance in older adults. Previous work, however, has not regarded interindividual differences in cognitive functioning and motor fitness that may affect training benefits. The current study aims to identify whether different training programs may have differential effects on multitasking performance depending on the initial level of cognitive functioning and motor fitness.

Methods

We conduct a 12-week single-blinded randomized controlled trial. A total of N = 150 healthy older adults are assigned to either a single cognitive, a single motor, or a simultaneous cognitive-motor training. Participants are trained twice per week for 45 min. A comprehensive test battery assesses cognitive functions, motor and cardiovascular fitness, and realistic multitasking during walking and driving in two virtual environments. We evaluate how multitasking performance is related not only to the training program, but also to participants’ initial levels of cognitive functioning and motor fitness.

Discussion

We expect that multitasking performance in participants with lower initial competence in either one or both domains (cognitive functioning, motor fitness) benefits more from single-task training (cognitive training and/or motor training). In contrast, multitasking performance in participants with higher competence in both domains should benefit more from multitask training (simultaneous cognitive-motor training). The results may help to identify whether tailored training is favorable over standardized one-size-fits all training approaches to improve multitasking in older adults. In addition, our findings will advance the understanding of factors that influence training effects on multitasking.

Trial registration

DRKS (German Clinical Trials Register), DRKS00022407. Registered 26/08/2020 - Retrospectively registered at https://www.drks.de/drks_web/setLocale_EN.do

Clinical analysis of subxiphoid single-port thoracoscopic surgery for simultaneous bilateral lung lesion resection

OBJECTIVE

To investigate the efficacy and safety of simultaneous subxiphoid single-port thoracoscopic resection of bilateral lung lesions.

METHODS

This retrospective study analyzed the clinical data of 72 patients who underwent resection of bilateral lung lesions at the Department of Thoracic Surgery in the First Affiliated Hospital of University of Science and Technology of China between August 2020 and January 2022. Surgery-related parameters were compared between patients who underwent subxiphoid single-port thoracoscopy (subxiphoid group, 36 patients) and patients who underwent intercostal single-port thoracoscopy (intercostal group, 36 patients).

RESULTS

Compared to the intercostal group, the subxiphoid group exhibited significantly better postoperative catheterization time (P = 0.013), postoperative thoracic drainage, postoperative visual analog scale pain scores at 24 and 48 h, and incision pain and numbness at 1 and 3 months after surgery (all P < 0.05). There were no significant differences in operation time, intraoperative blood loss, or postoperative complications between the two groups (all P > 0.05). There were no cases of perioperative mortality, conversion to thoracotomy, or serious complications in either group.

CONCLUSION

Subxiphoid single-port thoracoscopic surgery for simultaneous resection of bilateral lung lesions is safe and effective, reduces postoperative acute and chronic pain, decreases trauma, allows faster recovery, and is more consistent with the concept of minimally invasive surgery than bilateral intercostal single-port thoracoscopy. Thus, this subxiphoid single-port thoracoscopic surgery approach should be considered for clinical application.

Covalent organic frameworks functionalized electrodes for simultaneous removal of UO22+ and ReO4- with fast kinetics and high capacities by electro-adsorption

The recovery of radioactive ions from high salinity low-level radioactive wastewater (LLRW) is important for the sustainable utilization of nuclear energy. Previous work primarily focuses on developing adsorbents that remove individual types of ions via physicochemical adsorption. Here, we report a new strategy for the simultaneous recovery of uranium (UO₂²⁺) and rhenium (ReO₄^-) as a non-radioactive surrogate of technetium from LLRW via electro-adsorption. Carboxyl functionalized covalent organic frameworks (COF-1) and cationic covalent organic frameworks (COF-2) were prepared as cathode and anode materials, respectively. The adsorption capacities were 411 mg U/g for COF-1 and 984 mg Re/g for COF-2 under 1.2 direct-current (DC) volts, 2.5 and 2.1 times higher than the capacities of the same adsorbents obtained by physicochemical adsorption. We also found that the electro-adsorption of uranium and rhenium follows pseudo-second-order kinetics with the adsorption rates of 0.45 and 1.05 g/mg/h at pH 7.0 and 298.15 K, again two times faster than those measured in physicochemical adsorption. Therefore, electro-adsorption improves both adsorption capacity and kinetics by maximizing the utility of available active sites in adsorbents and facilitating ion migration towards the adsorbents. The adsorption efficiencies for uranium and rhenium reached 65.9% and 89.2%, respectively, after electro-adsorption for 2 h. The high efficiencies can be maintained after five adsorption-desorption cycles. Furthermore, the electrodes showed high selectivity for uranium(VI) and rhenium(VII) and excellent salt resistance even in 1 mol/L NaCl solution. XPS studies revealed that covalent bonds were formed between uranium(VI) and carboxyl groups on COF-1, and rhenium(VII) was bound to cationic COF-2 through electrostatic interaction. Our asymmetric electrodes design can be extended to simultaneously and efficiently remove other types of radioactive or heavy metal ions from wastewater.

Bilateral hip arthroscopy for treating femoroacetabular impingement: a systematic review

PURPOSE

Femoroacetabular impingement (FAI) is a hip disorder which can often present bilaterally. The purpose of this systematic review was to explore the current practices for bilateral hip arthroscopy in treating FAI as they relate to outcomes and complications.

METHODS

This review has been conducted according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The electronic databases PubMed, MEDLINE, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 18th, 2020. The Methodological Index for Non-randomized Studies (MINORS) was used to assess study quality. Data are presented descriptively.

RESULTS

Overall, 19 studies were identified, comprising 957 patients (48.6% male) with a mean age of 27.9 ± 7.1 years and a mean follow-up of 31.7 ± 20.8 months. The majority of patients were treated with a staged bilateral hip arthroscopy (78.5%) with a mean duration between surgeries of 7.1 ± 4.0 months. Significant preoperative-to-postoperative improvements for clinical outcomes such as pain, hip function, and health-related daily living as well as radiographic outcomes were reported in six studies for staged procedures (p < 0.05) and three studies for simultaneous procedures (p < 0.02). Significant improvements in patient-reported outcomes (e.g., HOS-ADL, Pain, HOS-SS, mHHS, and NAHS) were found in favor of those undergoing a shorter delay between surgeries in three studies (i.e., < 3, 10 or 17 months) (p < 0.05) compared to those who had delayed surgeries (i.e., > 3, 10, or 17 months). The overall complication rate was 10.1% (97/957).

CONCLUSIONS

Bilateral surgery for FAI yields improved outcomes postoperatively and complication rates similar to unilateral surgery. The overall complication rate was 10.1% with the most common complication being revision surgery. Staged bilateral surgery is more commonly performed than simultaneous surgery. Clinicians should consider preoperative imaging, clinical history, and patient values when deciding between staged and simultaneous procedures for bilateral FAI surgery. Future studies are required to determine the optimal indications for simultaneous versus staged procedures, as well as the ideal timing between surgeries for the latter.

LEVEL OF EVIDENCE

Level IV.

Real-time and simultaneous assay of monophenolase and diphenolase activity in tyrosinase catalyzed cascade reactions by combination of three-way calibration and excitation-emission matrix fluorescence

A real-time assay for multiple enzyme activities in cascade reactions is required for research on metabolism and bioengineering. Tyrosinase has the bifunctional activity of monophenolase and diphenolase. A combined strategy of three-way calibration with excitation-emission matrix (EEM) fluorescence was developed for real-time and simultaneous determination of monophenolase and diphenolase activity with tyrosine as a substrate. Mathematical separation and second-order advantage were utilized to solve spectral overlapping and uncalibrated interferents during complex dynamic enzymatic processes. Kinetic evolution profiles of EEM were monitored to stack a fusion three-way data array together with static samples. Using a parallel factor analysis (PARAFAC) algorithm, pseudo-univariate calibration curves with limits of detection (LODs) of 3.00 μM and 0.85 μM were established to simultaneously and real-time measure tyrosine and DOPA. Progress curves for tyrosine consumption by monophenolase and DOPA consumption by diphenolase were obtained using the law of mass conservation to calculate the initial velocity. The LODs for monophenolase and diphenolase were 0.0232 U⋅mL^-1 and 0.0316 U⋅mL^-1. The method achieved real-time and simultaneous assays of multiple enzyme activities in cascade reactions. It showed potential application in the metabolic pathway and biochemical industry.

Clinical outcomes following colorectal resection of colorectal cancer with simultaneous hepatic and pulmonary metastases at the time of diagnosis

PURPOSE

There are no established treatment strategies for patients with hepatic and pulmonary metastases at the time of primary colorectal cancer (CRC) diagnosis. This study assessed patients undergoing complete resection of primary CRC and hepatic and pulmonary metastases, to evaluate long-term outcomes and clarify clinicopathological factors associated with failure of complete resection.

METHODS

This retrospective analysis enrolled patients at Shizuoka Cancer Center between 2002 and 2018 who underwent colorectal resection with curative intent for primary CRC with hepatic and pulmonary metastases. The curative resection (CR) group comprised patients who underwent complete resection of the primary tumor and metastatic lesions, and the non-curative resection (Non-CR) group consisted of those in whom resection of the metastatic lesions was not performed. Univariate and multivariate analyses were conducted to determine clinicopathological factors associated with non-curative resection.

RESULTS

Of 26 total patients, the CR and Non-CR groups consisted of 14 (54%) and 12 patients (46%), respectively. In the CR group, the 3-year overall and relapse-free survival rates were 92.9% and 28.6%, respectively. Multivariate analysis showed that pathological stage T4 (odds ratio 8.58, 95% confidence interval 1.13-65.20, p = 0.04) was independently associated with non-curative resection.

CONCLUSION

The percentage of patients undergoing complete resection of primary CRC and metastatic lesions was 56%, and the 3-year OS rate was 92.9%. Resection of primary CRC and metastatic lesions was considered to be appropriate in this population, and pathological stage T4 tumor was associated with incomplete resection of metastatic tumors.

A Rare Case of Simultaneous Fracture Neck of Femur on One Side and Contralateral Intertrochanteric Fracture Femur in a 41-Year-Old Female - A Case Report

Introduction

Simultaneous fractures in the neck of femur on the one side and contralateral intertrochanteric fracture of the femur with only trivial injury are among rarest injuries. Fracture neck of femur or intertrochanteric fracture either isolated or in combination such as simultaneous bilateral fracture neck of femur and simultaneous bilateral intertrochanteric fractures are relatively commonly reported in literature. Herein, we report a very rare case of a young female with chronic kidney disease who presented with simultaneous fractures neck of femur on the one side and contralateral intertrochanteric fracture of femur after a fall from standing height.

Case Report

A 41-year-old female with chronic kidney disease from the past 5 years presented to us with severe pain at both hip and inability to stand after a fall from standing height. Clinical examination and investigations were done. She suffered fracture neck of femur on the right side and intertrochanteric fracture femur on the left side. Single stage fixation of both these fractures by two different methods was done successfully after optimization of her medical condition with multidisciplinary approach. She was advised weight bearing according to fixation method used and progress of fracture union. She regained her preoperative walking status gradually in 6 months.

Conclusion

Simultaneous fractures in the neck of femur on the one side and intertrochanteric fracture of the femur on the other side are very rare presentation and can happen in patients with primary or secondary bone disease. Multidisciplinary team effort is needed for overall effective management and prompt surgical treatment can help achieve favorable outcome.

Does age increase perioperative complications for single-stage bilateral total hip arthroplasty?

The potential of post-operative complication may exclude elderly patients from undergoing single-staged bilateral total hip arthroplasty (SSBTHA). This study retrospective compared perioperative complications between SSBTHA patients <70 (N = 157) and ≥70 (N = 56) years of age. Patients ≥70 had significantly lower body mass index (p = 0.029) and had a higher ASA classification (p = 0.041) compared to patients <70. No differences in post-operative complications or transfusion rates were found between age groups. However, patients ≥70 were less likely to be discharged home. While SSBTHA can safely be performed in patients ≥70, the risk of transfusion may suggest pre-operative hemoglobin screenings, especially for patients ≥70.

Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment

BACKGROUND

Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment.

METHODS

In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger.

DISCUSSION

This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide.

TRIAL REGISTRATION

Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.

Simultaneous determination of dihydroxybenzene isomers in cosmetics by synthesis of nitrogen-doped nickel carbide spheres and construction of ultrasensitive electrochemical sensor

N-doped nickel carbide spheres (N-NiCSs) were synthesised for the first time by controlling the type of surfactant, surfactant-to-Ni molar ratio, reaction temperature, and reaction time. The morphology, composition, and electrochemical behaviour of the synthesised spheres revealed that the spheres presented a large specific surface area, abundant pores, and good conductivity, with excellent electrocatalytic performance. A glassy carbon electrode-modified with N-NiCSs was used for the simultaneous identification of hydroquinone (HQ), catechol (CC), and resorcinol (RS) utilising differential pulse voltammetry. The oxidation peaks of HQ, CC, and RS were observed at 9.8, 119, and 470 mV, respectively (vs. SCE). Under optimal conditions, the oxidation peak currents of HQ, CC, and RS were linear in the concentration ranges of 0.005-100 μM, 0.05-200 μM, and 5-500 μM, respectively. The detection limits of HQ, CC, and RS were 0.00152 μM, 0.015 μM, and 0.24 μM (S/N = 3), respectively. The sensitivities of HQ, CC, and RS were 4.635, 2.069, and 0.985 μA μM^-1 cm^-2 (S/N = 3), respectively. The fabricated sensor was successfully used to detect HQ, CC, and RS in hair dye, whitening cream, and local tap water samples. Moreover, the sensor presented a good repeatability, reproducibility, and stability during cosmetic testing and a relatively wide linear range, an ultralow detection limit, and an ultrahigh sensitivity.

Biotreatment potential of co-contaminants hexavalent chromium and polychlorinated biphenyls in industrial wastewater: Individual and simultaneous prospects

Co-existence of polychlorinated biphenyls (PCBs) and hexavalent chromium (Cr(VI)) in the environment due to effluent from industries has aggravated the pollution problem. Both contaminants can alter chemical interactions, processes and impair enzymatic activities in the ecosystem that results in negative impacts on aquatic and terrestrial life. Previously, research has been performed for the fate and transfer of these contaminants individually, but simultaneous removal approaches have not received much attention. Cr(VI) exists in a highly toxic form in the environment once released, whereas location of chlorine atoms in the ring determines PCBs toxicity. Lower chlorinated compounds are easily degradable whereas as high chlorinated compounds require sequential strategy for transformation. Microorganisms can develop different mechanism to detoxify both pollutants. However, occurrence of multiple contaminants in single system can alter the bioremediation efficiency of bacteria. Use of metal resistance bacterial for the degradation of organic compounds has been widely used bioaugmentation strategy. Along with that use of sorbents/bio sorbents, biosurfactants and phytoremediation approaches have already been well reported. Bioremediation strategy with dual potential to detoxify the Cr(VI) and PCBs would be a probable option for simultaneous biotreatment. Application of bioreactors and biofilms covered organic particles can be utilized as efficient bioaugmentation approach. In this review, biotreatment systems and bacterial oxidative and reductive enzymes/processes are explained and possible biotransformation pathway has been purposed for bioremediation of co-contaminated waters.

Cardiac Lipoma Extirpation with Chronic Lung Abscess Excision: A Case Report of Simultaneous Video-Assisted Thoracoscopic Surgery Procedures

This study examined a rarely seen benign heart tumor that was found incidentally on a chest X-ray. Radiological images were taken of a 42-year-old patient with no symptoms of a heart condition, showing a thick-walled left lung cavity that appeared after prior inflammation and concomitant enlargement of the cardiac shadow. A large subepicardial lipoma in combination with a chronic abscess on the left lung was revealed on chest computed tomography. The treatment consisted of simultaneous surgical removal of both the lung and heart lesions using video-assisted thoracoscopic surgery.

A rare case report of simultaneous occurrence of a pediatric pleuropulmonary blastoma and an intralobar pulmonary sequestration

We are presenting a rare case with the simultaneous occurrence of pleuropulmonary blastoma and an intra lobar pulmonary sequestration. Although there have been cases reported previously with pleuropulmonary blastoma associated with congenital pulmonary malformations, the association with an intra lobar pulmonary sequestration is very rare. The patient, a female, 6-month-old child arrived at our pediatric service with the clinic of cough, respiratory distress, and fever after being treated for 2 weeks for left lung bronchopneumonia according clinical signs and radiographic description but without clinical improvements. Contrast enhanced CT images showed the simultaneous presence of 2 different lesions in the left lung, a heterogeneous mass in the superior lobe without delineation with mediastinal structure compatible with a pleuropulmonary blastoma and a consolidation in the inferior lobe with bronchogram present and a systemic vessel feeding compatible with an intra lobar pulmonary sequestration, both confirmed by histologic examinations after the surgical intervention. Although it is very rare, the simultaneous presence of these distinct embryogenic lesions may occur and radiologist should be aware as the imaging diagnosis may be very helpful for the further management of the patient.

Concurrent TMS-fMRI for causal network perturbation and proof of target engagement

The experimental manipulation of neural activity by neurostimulation techniques overcomes the inherent limitations of correlative recordings, enabling the researcher to investigate causal brain-behavior relationships. But only when stimulation and recordings are combined, the direct impact of the stimulation on neural activity can be evaluated. In humans, this can be achieved non-invasively through the concurrent combination of transcranial magnetic stimulation (TMS) with functional magnetic resonance imaging (fMRI). Concurrent TMS-fMRI allows the assessment of the neurovascular responses evoked by TMS with excellent spatial resolution and full-brain coverage. This enables the functional mapping of both local and remote network effects of TMS in cortical as well as deep subcortical structures, offering unique opportunities for basic research and clinical applications. The purpose of this review is to introduce the reader to this powerful tool. We will introduce the technical challenges and state-of-the art solutions and provide a comprehensive overview of the existing literature and the available experimental approaches. We will highlight the unique insights that can be gained from concurrent TMS-fMRI, including the state-dependent assessment of neural responsiveness and inter-regional effective connectivity, the demonstration of functional target engagement, and the systematic evaluation of stimulation parameters. We will also discuss how concurrent TMS-fMRI during a behavioral task can help to link behavioral TMS effects to changes in neural network activity and to identify peripheral co-stimulation confounds. Finally, we will review the use of concurrent TMS-fMRI for developing TMS treatments of psychiatric and neurological disorders and suggest future improvements for further advancing the application of concurrent TMS-fMRI.

Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience

OBJECTIVES

The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management.

METHODS

From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection.

RESULTS

Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031).

CONCLUSIONS

When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.

Murexide-derived in vitro electrochemical sensor for the simultaneous determination of neurochemicals

This work highlights the protocol employed for the simultaneous electroanalysis of tryptamine, serotonin and dopamine using a conducting poly-murexide-based electrode. To date, this is the first-of-its-kind report of simultaneous electrochemical determination of these three targets. Features of the developed electrode were identified by employing FE-SEM analysis. Under optimized conditions, the analytes underwent an irreversible electro-oxidation at the modified electrode surface, with a linear range of 0.5-40 μΜ, 0.4-40.4 μΜ and 0.5-40 μΜ for dopamine, serotonin and tryptamine, respectively. The electrolytic medium employed for the sensing was a phosphate-buffered solution with pH 7. The specificity of the developed electrode was also satisfactory in the presence of other biomolecules including L-phenylalanine, L-serine, glucose and ascorbic acid. Thus, the developed murexide-derived conducting-polymer-based electrode was used for the simultaneous sensing of the neurochemicals dopamine, serotonin and tryptamine. Electroanalysis was also demonstrated for these targets in human serum.

Simultaneous Uniportal video-assisted thoracic surgery of bilateral pulmonary nodules

Background

Surgical resection is an appropriate treatment option for synchronous bilateral pulmonary nodules with ground-glass opacities. The applicability of simultaneous uniportal video-assisted thoracic surgery is not fully understood. We evaluated the feasibility and safety of performing such surgeries at our hospital.

Methods

Clinical data of 35 patients who underwent simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery at our hospital were reviewed retrospectively.

Results

Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery was performed for 35 patients (15 men, 20 women); 97 nodules were operated on, and the average nodule diameter was 11.4 mm (range, 1–38 mm). Computerized tomography showed that most nodules had ground-glass opacity (52/97, 53.6%); solid nodules (24/97, 24.7%) and nodules with mixed ground-glass opacity (21/97, 21.7%) were noted. Surgical resection included lobar-sublobar resection (11/35, 31.4%) and sublobar-sublobar resection (24/35, 68.6%). Wound infection and postoperative 30-day mortality were not observed. Pneumonia was the major postoperative complication, with a higher incidence in the lobar-sublobar group (6/10, 60%) than in the sublobar-sublobar group (4/25, 16%; P = 0.016). Pneumonia did not correlate with operative time (mean, 262.3 ± 108.1 vs. 261.9 ± 87.5 min, P = 0.991), duration of chest drainage (mean, 7.0 ± 4.0 vs 5.4 ± 2.1 days, P = 0.124), and postoperative hospital stay (mean, 10.2 ± 3.6 vs 10.2 ± 6.4 days, P = 0.978). The mean follow-up time was 8 (range, 3–22) months. Recurrence of primary lung cancer or mortality was not noted at the final follow-up.

Conclusions

Simultaneous bilateral pulmonary resection with uniportal video-assisted thoracic surgery is feasible and safe for appropriate patients. Simultaneous lobar-sublobar pulmonary resection for bilateral nodules can increase the risk of developing pneumonia.

Corticospinal excitability enhancement with simultaneous transcranial near-infrared stimulation and anodal direct current stimulation of motor cortex

OBJECTIVES

Non-invasive brain stimulation (NIBS) is beneficial to many neurological and psychiatric disorders by modulating neuroplasticity and cortical excitability. However, recent studies evidence that single type of NIBS such as transcranial direct current stimulation (tDCS) does not have meaningful clinical therapeutic responses due to their small effect size. Transcranial near-infrared stimulation (tNIRS) is a novel form of NIBS. Both tNIRS and tDCS implement its therapeutic effects by modulating cortical excitability but with different mechanisms. We hypothesized that simultaneous tNIRS and tDCS is superior to single stimulation, leading to a greater cortical excitability.

METHODS

Sixteen healthy subjects participated in a double-blind, sham-controlled, cross-over designed study. Motor evoked potentials (MEPs) were used to measure motor cortex excitability. The changes of MEP were calculated and compared in the sham condition, tDCS stimulation condition, tNIRS condition and the simultaneous tNIRS and anodal tDCS condition.

RESULTS

tDCS alone and tNIRS alone both elicited higher MEP after stimulation, while the MEP amplitude in the simultaneous tNIRS and tDCS condition was significantly higher than either tNIRS alone or tDCS alone. The enhancement lasted up to at least 30 minutes after stimulation, indicating simultaneous 820 nm tNIRS with 2 mA anodal tDCS have a synergistic effect on cortical plasticity.

CONCLUSIONS

Simultaneous application of tNIRS with tDCS produces a stronger cortical excitability effect.

SIGNIFICANCE

The simultaneous tNIRS and tDCS is a promising technology with exciting potential as a means of treatment, neuro-enhancement, or neuro-protection.

Safety and outcome of simultaneous bilateral unicompartmental knee arthroplasty: A systematic review

Purpose

Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes.

Methods

The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications.

Results

Ten articles were included with 765 simultaneous BUKA. Overall complication rate was 7.0%, survivorship was 97.6% at mean 17 months follow-up. No differences were reported between simultaneous and staged BUKA.

Conclusion

Simultaneous BUKA is as safe as staged BUKA, it is associated with decreased length of stay and operative time, although it has an increased rate of blood transfusion.

Simultaneous robotic-assisted resection of colorectal cancer and synchronous liver metastases: a systematic review

Simultaneous resections of primary colorectal cancer (CRC) and synchronous colorectal liver metastases (CRLM) have emerged as safe and efficient procedures for selected patients. Besides the traditional open approach for simultaneous resections, similar outcomes have been reported for minimally invasive approaches. Over the past years, a number of studies have sought to evaluate the safety and efficacy of simultaneous robotic-assisted resections (SRAR) for patients with synchronous CRC and CRLM. The objective of this systematic review is to evaluate the safety, technical feasibility and outcomes of SRAR of the primary CRC and CRLM. A comprehensive review of the literature was undertaken. Nine studies comprising a total of 29 patients (16 males) who underwent SRAR were considered eligible for inclusion. The primary tumor site was the rectum in 22 (76%) patients and the colon in 7 (24%) patients. A minor liver resection was performed in the majority of the cases (n = 24; 82%). The median operative time and estimated blood loss were 399.5 min (range 300-682) and 274 ml (range 10-780 ml), respectively. No cases of conversion to open were reported. The median LOS was 7 days (range 2-28 days). All patients reportedly underwent R0 resection. Overall and major morbidity rates were 38% and 7%, respectively, while no perioperative deaths were reported. Despite the limited number of studies, SRAR seems to be a safe and efficient minimally invasive approach for highly selected patients always implemented in the context of multidisciplinary patient management.

Glass chemical transition: An unknown thermal transition observed in cellulose acetate butyrate

Cellulose acetate butyrate (CAB) belongs to cellulose esters, an important category of polymers, that are derived from the most abundant organic substance on earth (cellulose). As most cellulose esters, CAB is believed to exhibit a melting point. In this study, carefully selected experiments were performed, in order to test if the endothermic peak, observed in the Differential Scanning Calorimetry (DSC) scan of CAB, is a melting point. It was found that it is not a melting peak but a chemically induced transition (appearing as glass transition) occurring simultaneously with mass loss (decomposition and vaporization). For this phenomenon, the term "glass chemical transition" is proposed. Various literature misinterpretations/confusions are clarified and the potential consequences of this discovery are shortly discussed. Based on literature data and the presented results, it seems almost certain that secondary cellulose esters exhibit this behavior. It is likely, that other polymers, also exhibit this peculiar thermal transition.

The impact of unilateral, simultaneous, or sequential cochlear implantation on pediatric language outcomes

OBJECTIVES

The purpose of this study was to determine the impact of unilateral versus bilateral cochlear implantation on receptive and expressive spoken language outcomes. Secondary aims were to investigate factors timing of first and second implant placement and reliance on government funded health plans on language outcome.

METHODS

This was a retrospective chart review of spoken language users with bilateral severe-to-profound hearing loss. A total of 204 children were included, 105 in the bilateral group and 99 in the unilateral group. Multiple regression analyses were completed to investigate factors that influence language outcomes at age 5.

RESULTS

Recipients who received bilateral CIs performed significantly higher on measures of receptive and expressive language than those with unilateral implants.

DISCUSSION

This study demonstrates that bilateral implantation has a significant impact on receptive and expressive aspects of language development, and should be strongly considered as standard practice for children with bilateral severe to profound hearing loss.

CONCLUSION

These results indicate that families should be counseled that language outcomes are better with bilateral cochlear implantation than unilateral implantation. Cochlear implant teams should continue to consider the impact of socioeconomic status on outcomes and explore new methods to reduce the impacts and barriers of poverty to language development.

A meta-analysis of clinical and radiological outcomes in simultaneous bilateral unicompartmental knee arthroplasty

BACKGROUND

The most common pattern seen in bilateral knee osteoarthritis involves only the medial compartment in both knees. In such cases, bilateral Unicompartmental Knee Arthroplasty (UKA) would be a suitable surgery, this can be done simultaneously in one surgery or in stages with a period of time between each UKA. Simultaneous bilateral UKA in appropriately selected patients have the potential advantages of a lower cost, a shorter hospital stay, and a shorter overall recovery process. Despite this, there are concerns that operating on both knees in one surgery may increase the risk of complications, revisions and mortality.

METHODS

A PRISMA systematic review and meta-analysis was conducted using three databases (MEDLINE, EMBASE, and Scopus) to identify all studies which investigated either clinical or radiological outcomes in simultaneous bilateral UKA.

RESULTS

All sixteen studies included found that simultaneous bilateral UKA improved clinical and radiological outcomes. Eight studies compared clinical or radiological outcomes between simultaneous and staged bilateral UKA. Simultaneous bilateral UKA was found to have a significantly shorter length of operation, length of hospital stay, and a lower treatment cost (P < 0.001). Our meta-analysis found no statistically significant difference in the all-cause complication rate between simultaneous and staged bilateral UKA (P = 0.36). Only one study compared radiological outcomes between simultaneous and staged bilateral UKA which found no significant difference.

CONCLUSION

Our review suggests that simultaneous bilateral UKA is comparable to staged bilateral UKA in terms of clinical and radiological outcomes and has the potential to be increasingly adopted in clinical practice due to its superior cost-effectiveness.

Tibial tuberosity avulsion-fracture associated with complete distal rupture of the patellar tendon: A case report and review of literature

BACKGROUND

Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases.

CASE SUMMARY

We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications.

CONCLUSION

This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.

A dual luminescent sensor coordination polymer for simultaneous determination of ascorbic acid and tryptophan

Simultaneous high sensitivity detection of biomolecules is important for research in medicine, living cells and environmental samples. In this work, a water stable coordination polymer, [Cd₂(bptc)(4,4'-bpy)(H₂O)₃]ˑH₂O 1 (H₄bptc = 2,3,3',4'-biphenyl tetracarboxylic acid, 4,4'-bpy = 4,4'-bipyridine), was designed and successfully synthesized as a luminescent sensor for simultaneous recognition of Ascorbic Acid (AA) and L-Tryptophan (L-Trp) based on luminescent -OFF and -ON, respectively. Importantly, the proposed sensing system showed an excellent performance with high K_SV values of 4.85 × 10⁴ M^-1, 9.60 × 10⁷ M^-1 and low limit of detection (LOD) of 0.28 nM, 63 nM, respectively. In addition, the probable mechanisms are also discussed. The luminescent quenching behavior by AA can be mainly attributed to the static resonance energy transfer between complex 1 and the analytes. Whereas the enhancing effect of L-Trp comes from the intrinsic strong luminescence for L-Trp itself and photo-competitive mechanism between CP 1 sensor and L-Trp, supposedly. In addition, the repeatability of both systems were also investigated.

[Clinical analysis of 12 cases of acute myeloid leukemia complicated with synchronous primary solid tumor]

Objective: To explore the clinical characteristics of acute myeloid leukemia (AML) complicated with simultaneous multiple primary cancer (SMPC). Methods: The data of 12 AML patients with SMPC hospitalized in the Affiliated Cancer Hospital of Zhengzhou University, the First Affiliated Hospital of Nanyang Medical College, the Xinhua District Hospital of Pingdingshan City and the First People's Hospital of Pingdingshan City from March 2014 to July 2019 were analyzed retrospectively, and their clinical features, treatment and prognosis were summarized. Results: Among the 12 patients, there were 6 males and 6 females, with a median age of 58 years (39-70 years). AML classification: according to French-American-British (FAB) classification, the 12 AML patients were classified as M₀ 1, M₁ 1, M_2a 5, M_2b 1, M₃ 2, M₅ 2; according to National Comprehensive Cancer Network (NCCN) prognosis stratified, low risk group 1 case, medium risk group 4 cases, high risk group 7 cases; classification of solid tumors: 3 cases of lung cancer, 1 case of breast cancer, 2 cases of gastric cancer, 3 cases of esophageal cancer, 1 case of rectal neuroendocrine tumor, 1 case of invasive hydatidiform mole and 1 case of sigmoid colon cancer. The median time interval for the diagnosis of two primary malignant tumors was 4 (from 2.6 to 5.6) months. Results of gene mutation detection: AML prognostic gene detection results: a total of 12 kinds of gene abnormalities including ASXL1, JAK2, TET2, U2AF1, ABCB1, FLT3-ITD, RUNX1, SETBPIT, TET2 (single nucleotide polymorphism, SNP), p53, IKZF1 and IDH2 were detected, and solid tumor related genes were detected: a total of 4 kinds of gene abnormalities including Her-2, EGFR, K-RAS and MSI were detected. Survival: among the 12 patients, 1 case was lost during follow-up, 2 cases were still in treatment, 3 cases ended treatment and the condition was stable, 6 cases died. The median overall survival of 12 patients was 12.5 (from 3.8 to 48.0) months. Conclusions: It is not clear whether there is a certain correlation between the simultaneous occurrence of AML and solid tumors. Patients with AML and synchronous solid tumors are not unusual. Both tumors should be treated aggressively at the same time.

Complication rates of bilateral total hip versus unilateral total hip arthroplasty are similar

Objective

Utilize a nationwide database to identify and compare the differences between patient demographics and clinical outcomes for patients undergoing simultaneous bilateral total hip arthroplasty (THA) and unilateral THA.

Methods

A nationwide administrative claims database was utilized; In-hospital, 90-day, and 1-year post-discharge rates of local and systemic complications were collected and compared with multivariate logistic regression.

Results

Incidence of prosthetic joint infection was significantly lower in the bilateral cohort. Length of stay was significantly shorter in the unilateral THA cohort.

Conclusion

Surgeons should consider simultaneous bilateral THA a safe and effective procedure for low risk patients with appropriate comorbidities.

Hydrogen production from macroalgae by simultaneous dark fermentation and microbial electrolysis cell

Hydrogen production from Saccharina Japonica by simultaneous dark fermentation (DF) and microbial electrolysis cell (MEC), called sDFMEC, was studied. In the novel sDFMEC process, substrates were converted to H₂ and volatile fatty acids (VFAs) by DF in the bulk phase, and VFAs are simultaneously oxidized by the exoelectrogens in the microbial film on anode electrode with further production of H₂ at the cathode. The sDFMEC process was compared with DF and a combined process of DF and MEC in series (DF-MEC) in terms of H₂ production. The overall H₂ production from S. Japonica in sDFMEC process was higher (438.7 ± 13.3 mL/g-TS), than DF (54.6 ± 0.8 mL/g-TS) and DF-MEC (403.5 ± 7.9 mL/g-TS) process, respectively, which is approximately 3-times higher than those reported in the literature.