Bilateral Group Research Articles

Identity Shift: from Javanese Islam to Shari’ah-Centric Muslims in the Trah, a kinship-based social organisation

This article explores how Javanese identity has shifted away from Javanese Islam (kejawen) to a more shari’ah-centric identity. This shift is evident within the trah, a Javanese bilateral decent group or social organisation consisting of generations of children, grandchildren and great-grandchildren, including spouses and subsequent descendants. Long-term observations were conducted in this research through participation in various trah activities and in-depth interviews with trah members. The research found that initially, the trah members were kejawen, namely Javanese who identify as Muslims, but who adhere to Javanese beliefs and ritual practices that have been acculturated into Islamic teachings. Kejawen have a high appreciation of Javanese art and culture as part of their identity. However, trah members began to identify with shari’ah-centric piety, having internalised various aspects of a shari’ah lifestyle that is deemed more Islamic. This shift in identity occurred during the Indonesian political Reformation era which brought freedom of expression. This freedom was manipulated by Islamic activists to fortify political positions and engender a shari’ah-centric identity. The trah has provided a platform for its members – generations of children, grandchildren and great-grandchildren – to adopt this shari’ah-centric piety.

Cerebral protection in aortic arch surgery: systematic review and meta-analysis.

Consensus regarding optimal cerebral protection strategy in aortic arch surgery is lacking. We therefore performed a systematic review and meta-analysis to assess outcome differences between unilateral antegrade cerebral perfusion (ACP), bilateral ACP, retrograde cerebral perfusion (RCP) and deep hypothermic circulatory arrest (DHCA). A systematic literature search was performed in Embase, Medline, Web of Science, Cochrane and Google Scholar for all papers published till February 2021 reporting on early clinical outcome after aortic arch surgery utilizing either unilateral, bilateral ACP, RCP or DHCA. The primary outcome was operative mortality. Other key secondary endpoints were occurrence of postoperative disabling stroke, paraplegia, renal and respiratory failure. Pooled outcome risks were estimated using random-effects models. A total of 222 studies were included with a total of 43 720 patients. Pooled postoperative mortality in unilateral ACP group was 6.6% [95% confidence interval (CI) 5.3–8.1%], 9.1% (95% CI 7.9–10.4%), 7.8% (95% CI 5.6–10.7%), 9.2% (95% CI 6.7–12.7%) in bilateral ACP, RCP and DHCA groups, respectively. The incidence of postoperative disabling stroke was 4.8% (95% CI 3.8–6.1%) in the unilateral ACP group, 7.3% (95% CI 6.2–8.5%) in bilateral ACP, 6.4% (95% CI 4.4–9.1%) in RCP and 6.3% (95% CI 4.4–9.1%) in DHCA subgroups. The present meta-analysis summarizes the clinical outcomes of different cerebral protection techniques that have been used in clinical practice over the last decades. These outcomes may be used in advanced microsimulation model. These findings need to be placed in the context of the underlying aortic disease, the extent of the aortic disease and other comorbidities.Prospero registration number: CRD42021246372METC: MEC-2019-0825

Bilateral Nephrectomy Impairs Cerebral Oxygen Delivery After Acute Hemodilution Anemia in Rats

HypothesisWe hypothesize that renal sensing of hypoxia is essential for activation of cardiovascular responses needed to maintain cerebral oxygen delivery during acute anemia and that bilateral nephrectomy will negatively affect brain oxygen delivery during acute hemodilutional anemia.MethodsAll experiments were approved by the Animal Care and Use Committee at St. Michael’s Hospital and conducted in accordance with ARRIVE‐2 guidelines. Sham or bilateral nephrectomy (n=5) were performed on isoflurane anesthetized Sprague‐Dawley rats prior to performing acute hemodilution (50% estimated blood volume) 1:1 with 6% hydroxyethyl starch. Heart rate (HR), mean arterial pressure (MAP) and rectal temperature were monitored continuously. Arterial blood gases and cooximetry samples were measured before and after hemodilution. Continuous measurements of brain microvascular oxygen tension (PbrO2) were measured via a phosphorescence quenching method using an intravascular oxygen probe, Oxyphor PdG4, and an OxyLED phosphorometer. Data were tested for normality and analysis performed by two‐way ANOVA with p<0.05 taken to be significant.ResultsBilateral nephrectomy resulted in a reduction in baseline HR (p<0.004). Hemodilution resulted in a comparable reduction in hemoglobin concentration in both groups (Sham: 5.1±0.3 g/dL; Nephrectomy: 4.2±0.4 g/dL) with no differences in arterial PaO2 or PaCO2. After hemodilution, HR increased significantly in both groups (p<0.05). MAP tended to be lower in the bilateral nephrectomy group and decreased transiently in both groups following hemodilution (p<0.01). Brain microvascular pO2 (PbrO2)was not significantly different between nephrectomy and sham at baseline. Post‐hemodilution the PbrO2 was significantly lower in nephrectomised rats (11.5±5.1 mmHg) compared to sham operated rats (25.4±11.3 mmHg) (p=0.031).ConclusionsWe observed that bilateral nephrectomy resulted in changes in baseline physiology, including a lower HR. Hemodilution resulted in a comparable reduction in hemoglobin concentration, without difference in PaO2 or PaCO2. MAP decreased more profoundly immediately after hemodilution in nephrectomised animals, and recovered with time. Nephrectomy resulted in a significant drop in brain microvascular pO2 (PbrO2) immediately after hemodilution. This was not observed in sham controls. These data suggest that the kidney serves an important sensing role during acute anemia which supports cardiovascular responses and preserves the adequacy of brain tissue oxygen delivery. Hypoxia sensing by the kidney, and other integrative systemic mechanisms, may be central to these findings.

Simultaneous Comparison of Subxiphoid and Intercostal Wound Pain in the Same Patients Following Thoracoscopic Surgery.

There is a lack of data comparing postoperative pain after subxiphoid and intercostal video-assisted thoracoscopic surgery (VATS). Pain is an individual’s subjective experience and, therefore, difficult to compare between different individuals subjected to either procedure. This study assessed reported pain at six postoperative time points in the same patients receiving both subxiphoid and intercostal incisions for thoracic disease. Data from 44 patients who received simultaneous combined intercostal and subxiphoid VATS were retrospectively analyzed from August 2019 to July 2021. All patients received the same length of subxiphoid and intercostal incisions with or without drain placements. A numerical pain rating scale was administered on postoperative days (POD)-1, POD-2, POD-Discharge, POD-30, POD-90, and POD-180. Bilateral uniportal VATS was performed in 11 patients, and unilateral multiportal VATS was performed in 33 patients. In the unilateral VATS group, there were no differences in pain reported for both incisions in the early postoperative period. However, in the bilateral VATS group, subxiphoid wounds resulted in significantly higher pain scores on POD-1, POD-2, and POD-Discharge (p = 0.0003, 0.001, and 0.03, respectively). Higher late (3 and 6 months) postoperative pain was associated with intercostal incisions in both groups, as previously reported, whereas higher early (day 1, 2, and discharge) postoperative pain was more associated with subxiphoid incisions than intercostal incisions in the bilateral VATS group.

Effective brain network analysis in unilateral and bilateral upper limb exercise training in subjects with stroke

Knowing the patterns of brain activation that occur and networks involved under different interventions is important for motor recovery in subjects with stroke. This study aimed to study the patterns of brain activation and networks in two interventions, affected upper limb side and bilateral exercise training, using concurrent functional near-infrared spectroscopy (fNIRS) imaging. Thirty-two patients in the early subacute stage were randomly divided into two groups: unilateral and bilateral groups. The patients in the unilateral group underwent isokinetic muscle strength training on the affected upper limb side and patients in the bilateral group underwent bilateral upper limb training. Oxyhemoglobin and deoxyhemoglobin concentration changes (ΔHbO2 and ΔHbR, respectively) were recorded in the ipsilateral and contralateral prefrontal cortex (IPFC and CPFC, respectively) and ipsilateral and contralateral motor cortex (IMC and CMC, respectively) by fNIRS equipment in the resting state and training conditions. The phase information of a 0.01-0.08Hz fNIRS signal was extracted by the wavelet transform method. Dynamic Bayesian inference was adopted to calculate the coupling strength and direction of effective connectivity. The network threshold was determined by surrogate signal method, the global (weighted clustering coefficient, global efficiency, and small-worldness) and local (degree, betweenness centrality, and local efficiency) network metrics were calculated. The degree of cerebral lateralization was also compared between the two groups. The results of covariance analysis showed that, compared with bilateral training, the coupling effect of CMC→IMC was significantly enhanced (p=0.03); also, the local efficiency of the IMC (p=0.01), IPFC (p<0.001), and CPFC (p=0.006) and the hemispheric autonomy index of IPFC (p=0.007) were significantly increased in unilateral training. In addition, there was a significant positive correlation between the coupling intensity of the inter-hemispheric motor area and the shifted local efficiency. The results indicated that unilateral upper limb training could more effectively promote the interaction and balance of bilateral motor hemispheres and help brain reorganization in the IMC and prefrontal cortex in stroke patients. The method provided in this study could be used to evaluate dynamic brain activation and network reorganization under different interventions, thus improving the strategy of rehabilitation intervention in a timely manner and resulting in better motor recovery.

Is Right Unilateral Transversus Abdominis Plane (TAP) Block Successful in Postoperative Analgesia in Laparoscopic Cholecystectomy?

Background Transversus abdominis plane (TAP) block is used for postoperative analgesia in laparoscopic cholecystectomy. In laparoscopic cholecystectomy, the incisions are located mainly on the upper right side of the abdomen. Aims We aim to determine the efficacy of less-invasive ultrasound-guided right unilateral oblique subcostal TAP block in laparoscopic cholecystectomy on postoperative analgesia by comparing patients undergoing bilateral TAP block and a control group. Methods Ninety patients were equally divided into control, unilateral, and bilateral TAP block groups. TAP blocks were conducted before anesthesia. No block was applied to the control group. Patients' demographics and postoperative pain, satisfaction, and nausea-vomiting scores and tramadol/ondansetron doses were evaluated. Results There was no significant difference in the verbal numerical rating scale for pain scores at rest and during coughing (VNRS-R and VNRS-C) between unilateral and bilateral TAP block groups at postoperative 1 hour, 2 hour, 4 hour, 8 hour, 12 hour, and 24 hours. In addition, VNRS-R and VNRS-C scores were significantly higher in the control group than in the other two groups. Tramadol consumption in the control group was significantly higher than in the unilateral and bilateral TAP block groups (p ≤ 0.01), while no significant difference was identified between unilateral and bilateral TAP block groups (p=0.303). Nausea-vomiting scores and ondansetron consumption did not differ significantly between all the groups. Patient satisfaction was significantly higher in unilateral and bilateral groups (p < 0.01, p < 0.01) than in the control group, while there was no significant difference between unilateral and bilateral TAP block groups (p=0.793). Conclusions Right unilateral TAP block provides postoperative analgesia as effective as bilateral TAP block in laparoscopic cholecystectomy.

Comparison of 3 Different Minimally Invasive Surgical Techniques for Lumbar Spinal Stenosis

Operations for lumbar spinal stenosis is the most often performed surgical procedure in the adult lumbar spine. This study reports the clinical outcome of the 3 most commonly used minimally invasive posterior decompression techniques. To compare the effectiveness of 3 minimally invasive posterior decompression techniques for lumbar spinal stenosis. This randomized clinical trial used a parallel group design and included patients with symptomatic and radiologically verified lumbar spinal stenosis without degenerative spondylolisthesis. Patients were enrolled between February 2014 and October 2018 at the orthopedic and neurosurgical departments of 16 Norwegian public hospitals. Statistical analysis was performed in the period from May to June 2021. Patients were randomized to undergo 1 of the 3 minimally invasive posterior decompression techniques: unilateral laminotomy with crossover, bilateral laminotomy, and spinous process osteotomy. Primary outcome was change in disability measured with Oswestry Disability Index (ODI; range 0-100), presented as mean change from baseline to 2-year follow-up and proportions of patients classified as success (>30% reduction in ODI). Secondary outcomes were mean change in quality of life, disease-specific symptom severity measured with Zurich Claudication Questionnaire (ZCQ), back pain and leg pain on a 10-point numeric rating score (NRS), patient perceived benefit of the surgical procedure, duration of the surgical procedure, blood loss, perioperative complications, number of reoperations, and length of hospital stay. In total, 437 patients were included with a median (IQR) age of 68 (62-73) years and 230 men (53%). Of the included patients, 146 were randomized to unilateral laminotomy with crossover, 142 to bilateral laminotomy, and 149 to spinous process osteotomy. The unilateral laminotomy with crossover group had a mean change of -17.9 ODI points (95% CI, -20.8 to -14.9), the bilateral laminotomy group had a mean change of -19.7 ODI points (95% CI, -22.7 to -16.8), and the spinous process osteotomy group had a mean change of -19.9 ODI points (95% CI, -22.8 to -17.0). There were no significant differences in primary or secondary outcomes among the 3 surgical procedures, except a longer duration of the surgical procedure in the bilateral laminotomy group. No differences in clinical outcomes or complication rates were found among the 3 minimally invasive posterior decompression techniques used to treat patients with lumbar spinal stenosis. ClinicalTrials.gov Identifier: NCT02007083.

Effect of Temporal Artery Biopsy Length and Laterality on Diagnostic Yield.

Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Temporal artery biopsy (TAB) remains the gold standard for diagnosis in the United States; however, practices vary in the length of artery obtained and whether bilateral simultaneous biopsies are obtained. Retrospective chart review of all TABs performed at the Johns Hopkins Wilmer Eye Institute between July 1, 2007, and September 30, 2017. Five hundred eighty-six patients underwent TAB to evaluate for GCA. Of 404 unilateral biopsies, 68 (16.8%) were positive. Of 182 patients with bilateral biopsies, 25 (13.7%) had biopsies that were positive and 5 patients (2.7%) had biopsies that were discordant, meaning only 1 side was positive. There was no significant difference in the average postfixation length of positive and negative TAB specimens (positive mean length 1.38 ± 0.61 cm, negative mean length 1.39 ± 0.62 cm, P = 0.9). There is no significant association between greater length of biopsy and a positive TAB result in our data. Although the rate of positive results was not higher in the bilateral group compared with the unilateral group, 2.7% of bilateral biopsies were discordant, similar to previously published rates. Overall, this suggests that initial bilateral biopsy may increase diagnostic yield, albeit by a small amount.

Comparison between Traditional Chinese Medicine Constitution and Blood Biochemical Markers Associated with Left and Right Mammary Hyperplasia in Rural Areas of Southwest China.

Background Hyperplasia of mammary glands (HMG) is the breast disease with the highest clinical incidence. Many traditional Chinese medicine (TCM) doctors suggest that the treatment of HMG should be based on the left and right breast pain difference. However, these views are based on case reports, and an objective basis has not been established for treatment according to left-side and right-side differences. Methods We enrolled 150 patients who met the clinical diagnostic criteria of HMG. The incidence bias was determined according to the score difference between bilateral breast pain and mass in patients with HMG. A left group, right group, and bilateral group were included, and TCM constitution was investigated in each group. Blood biochemical indicators were measured for 120 fasting patients. We conducted a network pharmacology study of the key herb qingpi and chenpi, which are used by TCM doctors to treat different lateral HMG. Results In patients with biased onset of HMG, the results showed that the frequency and constitution score of stagnant blood in the L group were higher than those of the R group, and the frequency and constitution score of phlegm-dampness in the R group were higher than those of the L group. Both the L and R groups had high proportion of stagnant Qi. The results indicated that the concentration of coagulation factor VIII (FVIII) was higher in the L group than that in the R group, and the concentration of lipoprotein a (Lp-α) was higher in the R group than that in the L group. The results showed that sinensetin and neohesperidin contained in qingpi might interfere with platelet activation, thrombogenesis, prolactin signaling pathway, and atherosclerosis process, in removing “blood stasis” and eventually treating the left-leaning group of HMG patients. Sitosterol and citromitin contained in chenpi could regulate lipid metabolism by interfering with regulation of lipolysis in adipocytes, salivary secretion, estrogen signaling pathway, and thyroid hormone signaling pathway. Chenpi could eliminate “phlegm turbidity” and treat HMG patients in the right-leaning group. Conclusions We preliminarily confirmed that the clinical pathogenesis of HMG is not a left-right equilibrium and TCM constitution, coagulation function, and lipid metabolism may be used as the objective basis for the difference between the left and right in HMG pathogenesis. For left-sided HMG patients, the doctor can consider qingpi, herb of activating blood and removing stasis, to treat HMG. However, for right-sided HMG, we think doctors should apply herb of activating Qi and eliminating phlegm, such as chenpi.

Unilateral vs. Bilateral Radiotherapy for Oropharyngeal Carcinoma: Impact on Long Term Symptom Burden

<h3>Purpose/Objective(s)</h3> Bilateral neck radiotherapy (RT) is often required for oropharyngeal carcinoma (OPC) patients while unilateral neck RT is only used for selected small well-lateralized primary tonsillar tumors with no/minimal ipsilateral nodal disease. Our purpose is to compare long-term symptom burden following unilateral vs bilateral RT in patients with oropharyngeal carcinoma (OPC). <h3>Materials/Methods</h3> A retrospective review was conducted for patients with T1-3 N0-2b (AJCC 7th edition) tonsillar cancer treated with IMRT from 2011 to 2017. Patient-reported symptom burden was collected in routine practice using the MD Anderson Symptom Inventory (MDASI) at baseline, RT-end (3 weeks pre or post final RT fraction), 3 weeks – 3 months, 3 – 6 months, 6 – 12 months, 12 - 24 months, and 24 - 36 months post RT. Within each period, the latest record was chosen if there were multiple records available for one patient. MDASI symptom scores (ranging from 0 = "not present" to 10 = "as bad as you can imagine") were compared between unilateral vs bilateral RT groups at each time point using Wilcoxon Rank-Sum tests and linear mixed effect model. <h3>Results</h3> A total of 256 patients were eligible, of whom MDASI scores were available in 125 including 22 (18%) with unilateral and 103 (82%) with bilateral neck RT. Median age was 59 years, and 95 (76%) were male. The differences in "Dry Mouth" scores from baseline to 6 months and from baseline to 36 months were significantly better (lower) in the unilateral RT group on mixed effect model analysis [mean 2.11 (95% CI: 1.056 – 3.17) vs 3.72 (95% CI: 3.15 – 4.29), p = 0.004] and [mean 1.43 (95% CI: 0.44 - 2.42) vs 2.62 (95% CI: 2.1 - 3.13), p = 0.04] respectively; these differences meet a conventional threshold for clinical importance. MDASI change scores in other domains were similar between the two groups (all p > 0.05). Mean MDASI raw scores were highest at RT-end for all domains with improvement by 2 years for most symptoms. The unilateral RT group had significantly better (lower) raw MDASI scores in "Dry Mouth" at baseline (mean 0.3 vs 1.4, p = 0.045) and 6 months post RT (mean 2.6 vs 5.4, p <0.001). "Swallowing" raw scores were also statistically and clinically significantly better (lower) in the unilateral RT group at 6 months post-RT (mean 2.1 vs 3.5, p = 0.047). <h3>Conclusion</h3> Patients receiving unilateral RT fare better with "Dry mouth" by 6-month and 36-month and possibly with "Swallowing" by 6-month post RT compared to patients receiving bilateral RT.

2,7-substituted fluorenone-based liquid crystal trimers: twist-bend nematic phase induced by outer thioether linkage

ABSTRACT 2,7-Substituted fluorenone has a planar and slightly bent aromatic structure and is used as a building block for organic liquid crystals (LCs). Herein, we report for the first time the synthesis, phase-transition behaviour, and mesophase structure of fluorenone-incorporated LC trimers that exhibit an emerging helical twist-bend nematic (NTB) phase. The LC trimers possess a central 2,7-ether-substituted fluorenone and bilateral cyanobiphenyl groups linked via odd alkylene C n H2n spacers (n = 7 or 9) with either ether or thioether outer linkages; these are abbreviated CBOnOFlnOnOCB and CBSnOFlnOnSCB, respectively. The CBOnOFlnOnOCB trimers having only ether linkages display only the conventional nematic (N) phase, whereas the outer thioether-linked CBSnOFlnOnSCB trimers form an NTB phase below the temperature range of the N phase. Furthermore, the phase-transition behaviour of these fluorenone-based LC trimers is compared with that of the corresponding all-biphenyl-based motif trimer analogues, CBOnOBOnOCB and CBSnOBOnSCB.

Effects of Bilateral and Unilateral Eccentric Exercise on Muscle Damage and Muscular Physiological Indices in Healthy Men

PURPOSE: This study aimed to determine the effects of bilateral and unilateral eccentric exercises on muscle damage and muscular physiological indices in healthy men.METHODS: Using a randomized crossover design, nine adult males without musculoskeletal disorders were divided into a bilateral eccentric exercise group (BEG, n=9) and a unilateral eccentric exercise group (UEG, n=9). Bilateral and unilateral eccentric exercises involved five sets of six repetitions of the rhythm metronome speed eccentric contraction 3 seconds at 110% one repetition maximum (1RM) using bilateral of BEG and the dominant and non-dominant of UEG separated by four weeks, respectively. Muscle damage (flexed and extended ROM, CIR, and VAS) and muscular physiological indices (muscle activity, muscle fatigue, and muscle tone) were measured before, immediately after (0 hour), 24, 48, 72, and 96 hours following bilateral and unilateral eccentric exercises.RESULTS: The flexed ROM, CIR, VAS, muscle activity, and muscle tone were significantly increased after both bilateral and unilateral eccentric exercises (p&lt;.05, respectively). Extended ROM and muscle activity significantly decreased after both bilateral and unilateral eccentric exercises (p&lt;.05, respectively). However, there was no significant interaction between side (S) and time and side (T×S).CONCLUSIONS: These results showed that there was no difference in muscle damage and physiological indices after measuring and setting the 1RM muscle strength separated by bilateral and unilateral eccentric exercises.

Comparison of Unilateral Versus Bilateral Lateral Rectus Recession for Small Angle Intermittent Exotropia: Outcomes and Surgical Dose-Responses.

To compare the surgical outcomes of unilateral lateral rectus recession to bilateral lateral rectus recession for small angle intermittent exotropia. This was a retrospective cohort study of pediatric patients with an intermittent exotropia between 16 and 20 prism diopters (PD) who underwent unilateral lateral rectus recession or bilateral lateral rectus recession at a single tertiary care pediatric hospital. The primary outcome was success (exotropia < 10 PD of esotropia < 5 PD, no decrease in stereopsis > 0.6 log arcsec, and no reoperation) at 12 months postoperatively. Secondary outcomes included survival analysis of time to surgical failure, surgical dose-response, and improvement in central fusion or stereopsis. At 12 months, successful outcomes were achieved in 13 of 27 patients (46%) in the bilateral lateral rectus recession group and 19 of 28 patients (70%) in the unilateral lateral rectus recession group, which was not a statistically significant difference (P = .10). Survival analysis showed a trend toward a higher rate of failure in the bilateral lateral rectus recession group compared to the unilateral lateral rectus recession group (P = .04). The mean surgical dose-response was 1.7 PD/mm at 1 week and 1.0 PD/mm at 12 months for the bilateral lateral rectus recession group, and 2.0 PD/mm at 1 week postoperatively and 1.4 PD/mm at 12 months postoperatively for the unilateral lateral rectus recession group. There were no cases of long-term postoperative lateral incomitance in either group. Unilateral lateral rectus recession and bilateral lateral rectus recession have similar success rates for small angle intermittent exotropia after at least 12 months of follow-up. Randomized controlled trials in surgical management of intermittent exotropia should consider unilateral lateral rectus recession as a treatment arm. [J Pediatr Ophthalmol Strabismus. 2022;59(5):350-355.].

Comparison between Digital Casts and Cone Beam Computed Tomography for Measuring Maxillary Transverse Dimensions in Patients with Impacted Canines.

Cone beam computed tomography (CBTCT) scans (n = 45) and digital dental casts (n = 45) were both used to measure the maxillary transverse dimensions in patients with impacted maxillary canines. The objectives were to explore the associations of these dimensions with the impaction and patient characteristics, and to compare the measurements between these techniques. The maxillary width was measured on scans and casts at the Walaridge, and the intermolar width and interpremolar width levels were measured at the first and second premolars (measured from the buccal grooves and the palatal cuspids, and the palatal and lingual amelocemental junctions). Two examiners independently compared the measurements between the control quadrants (without impaction) and the case quadrants (with impaction) in patients with unilateral impactions, and between the unilateral and bilateral impaction groups. The interclass correlation coefficient (ICC) was calculated to assess the interexaminer reliability and paired or independent Student’s t-tests and ANOVAs were used for comparisons. The ICCs were 0.887 and 0.919, globally, for the measurements on the CBCT scans and casts, respectively, which indicates the excellent interexaminer reliability. On the CBCT scans, statistically significant differences were found between the case and control quadrants in the transverse measurements at the lingual level on the upper first molars, and at the WALA ridge level on the upper second premolars (p < 0.05) in the unilateral impaction group. Significant differences were found between the case quadrants in the unilateral versus the bilateral groups at the WALA ridge on the second premolars in casts (p < 0.05), and at the lingual point on the first molars on the CBCT scans (p < 0.05). No statistically significant differences in the transverse measurements were observed between the impacted buccal and palatal canines on either the casts or CBCT scans. To the best of our knowledge, this is the first study to compare the transverse measurements between digital models and CBCT scans.

Bilateral and concomitant pathology’ surgeries do not affect the outcomes of mini-open distal linear metatarsal osteotomy (Bosch osteotomy) with manipulation for hallux valgus deformity

BackgroundBosch osteotomy for hallux valgus (HV) deformity has advantages of reduction both the operating time and surgical dissection, and may be performed bilaterally and with fewer complications than other surgical procedures as well as early weight-bearing. However, there are few reports on the effects of bilateral simultaneous surgery, simultaneous surgery on concomitant pathologies, and the preoperative HV angle on the postoperative results. The present assessed the factors that might affect the improvement in clinical outcomes following mini-open Bosch osteotomy with manipulation to treat HV deformity. MethodsSeventy patients with 110 feet were included. They were divided into groups as follows: unilateral and bilateral simultaneous surgery groups, Bosch osteotomy alone and simultaneous surgeries for concomitant pathologies groups, and preoperative HV angle< 40° and ≥ 40° groups. Subjective clinical outcome scores using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and the HV and intermetatarsal first and second metatarsal (M1M2) angles according to the anteroposterior (A-P) view of the weighted foot X-ray were assessed preoperatively and at 12 months after surgery. ResultsThe mean HV angle, M1M2 angle and all subscales of the SAFE-Q score showed significant improvement at 12 months after surgery, regardless of simultaneous bilateral surgery, simultaneous surgery for concomitant pathologies, or the preoperative HV angle. On comparing the groups, there were no significant differences in the HV angle at 12 months after surgery. Significant inferiority at 12 months after surgery was found in the intermetatarsal angle in the simultaneous surgery for concomitant pathologies group and in all subscales of the SAFE-Q score in the HV angle ≥ 40° group. ConclusionMini-open Bosch osteotomy with manipulation for HV deformity demonstrated good results in both radiological assessments and subjective clinical scores at 12 months after surgery, even for simultaneous bilateral surgery, simultaneous concomitant pathologies’ surgery, and severe HV deformity. Level of EvidencePrognostic Level III, retrospective cohort study.

Adjuvant Chemotherapy Might Be Recommended to Patients With Positive Margin After Gastrectomy: A 20-Year Retrospective Analysis in a Single Center.

BackgroundMargin positivity after gastric cancer resection is associated with poorer outcomes. However, the prognostic factors and the choice of postoperative adjuvant treatment of patients with positive margin (PM) after gastrectomy are still being debated.MethodsA single-center, retrospective analysis was conducted for patients with PM after gastrectomy from the China National Cancer Center Gastric Cancer Database (NCCGCDB) from 1998 to 2018. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS).ResultsA total of 449 patients were included in the study, including 192 (42.8%) in the proximal PM group (PPM), 205 (45.7%) in the distal PM group (DPM), and 52 (11.6%) in the bilateral PM group (BPM). The 3- and 5-year OS rates for the PM patients investigated were 47.5% and 39.3%, respectively, and the 3- and 5-year RFS rates were 60.0% and 53.6%, respectively. Multivariate Cox regression analysis proved total gastrectomy (hazard ratio (HR): 1.783, 95%CI: 1.133–2.805, p = 0.012), pT4 (HR: 5.264, 95%CI: 1.493–18.565, p = 0.01), pN2 (HR: 2.263, 95%CI: 1.164–4.397, p = 0.016), pN3 (HR: 2.327, 95%CI: 1.233–4.393, p = 0.009), and combined resection (HR: 1.952, 95%CI: 1.256–3.034, p = 0.003) to be independent risk factors of OS, and pT3 (HR: 9.257, 95%CI: 1.152–74.386, p = 0.036) and pT4 (HR: 11.361, 95%CI: 1.469–87.847, p = 0.020) to be independent risk factors for RFS. Adjuvant chemotherapy prolonged OS in the PPM group (p = 0.032) and prolonged RFS in the PPM group (p < 0.001) and the DPM group (p = 0.035) compared with surgery alone.ConclusionsAdvanced pathologic stage was associated with poor prognosis, and postoperative adjuvant chemotherapy might be recommended in PM patients after gastrectomy. Still, further prospective trials are warranted to verify and support our conclusions.

Effect of Unilateral or Bilateral Weight Training Using Dumbbells for Eight Weeks on Body Composition and Physical Fitness in Adult Males

본 연구는 8주간 덤벨을 이용한 유니레터럴 또는 바이레터럴 웨이트 트레이닝이 성인 남성의 신체조성과 기초체력에 미치는 영향에 대해서 조사하였다. 본 연구에는 건강한 성인 남성 20명이 참여하였으며, 유니레터럴군(n=10) 과 바이레터럴군(n=10)으로 무작위 분류되었다. 유니레터럴군은 한 팔을 가지고, 바이레터럴군은 양 팔을 이용하여 8주간 주 3회 웨이트 트레이닝(덤벨 프레스, 덤벨 스쿼트, 덤벨 데드리프트)을 수행하였다. 신체조성은 체지방량과 근육량, 팔과 다리 둘레(우측 및 좌측)가 각각 측정되었다. 기초체력은 악력(우측 및 좌측), 평형성(우측 및좌측), 제자리 멀리뛰기가 각각 측정되었다. 통계 분석은 반복측정 분산분석(repeated measure ANOVA)이 사용되었다. 연구 결과, 신체조성에서 체지방량(P=0.002)과 근육량(P=0.001), 팔 둘레(우측: P=0.002; 좌측: P=0.001) 와 다리 둘레(우측: P=0.001; 좌측: P=0.002) 모두 시기와 집단 간 유의한 상호작용 효과가 있는 것으로 나타났다. 그리고 기초체력에서는 악력에서만 시기와 집단 간 유의한 상호작용 효과가 있었다(우측과 좌측 모두: P<0.001). 우측 및 좌측 평형성과 제자리멀리뛰기에서는 시기와 집단 간 유의한 상호작용 효과가 없었다(P> 0.05). 결론적으로 8주간 덤벨을 이용한 유니레터럴 웨이트 트레이닝은 바이레터럴 웨이트 트레이닝보다 성인 남성의 신체조성과 함께 기초체력을 향상시키는 데 있어서 더 효과적인 것으로 나타났다.This study aims to investigate the effect of unilateral or bilateral weight training using dumbbells for eight weeks on body composition and physical fitness in adult males. The study enrolled 20 healthy adult male participants who were randomly assigned to the unilateral (n=10) or bilateral (n=10) groups. The unilateral group used a single arm while the bilateral group used both arms to perform weight training using dumbbells (press, squat, and deadlift) three times a week for eight weeks. For body composition assessment, fat mass, muscle mass, and arm and leg circumference (right and left) were measured. For physical fitness assessment, hand-grip strength (right and left), balance (right and left), and the standing long jump were measured. The repeated measures ANOVA was used for statistical analysis. The study results revealed significant interaction effects between time and group on all body composition variables, including fat mass (P=0.002), muscle mass (P=0.001), arm circumference (right: P=0.002; left: P=0.001), and leg circumference (right: P=0.001; left: P=0.002). For physical fitness, a significant interaction effect between time and group was identified only in hand-grip strength (both right and left: P<0.001). There were no significant interaction effects between time and group for right and left balance and the standing long jump (P>0.05). In conclusion, eight-week unilateral weight training using dumbbells was more effective than bilateral weight training in improving physical fitness and body composition in adult males.

Association between aesthetic satisfaction and chronic postsurgical pain in breast cancer patients treated with one stage prosthesis implantation

This study retrospectively studied the incidence of chronic post-surgical pain (CPSP) following single-stage implant-based breast reconstruction (IBBR) and evaluated the possible risk factors. This was a retrospective cohort study, involving all patients undergoing single-stage IBBR between January and December 2019. The follow-up was completed between January and March 2021. The scores for satisfaction (SS) were based on the BREAST-Q, while the pain burden index (PBI) was used to assess the degree of CPSP. The questionnaires were completed by 159 patients. CPSP occurred in 48.43% of the patients, 2.52% of them being severe cases. Significant predictors for the development of CPSP in the univariate analysis included severe acute postoperative pain (PP), a history of preoperative chronic pain, psychological disorders, SS with the reconstructed breasts, and whether there were any regrets about having had the reconstruction. Multivariate analysis identified severe acute PP (odds ratio (OR) = 2.80, 95% confidence interval (CI) = 1.16–6.79, p = 0.023), a history of preoperative chronic pain (OR = 3.39, 95% CI = 1.42–8.10, p = 0.006), and the SS (OR = 0.86, 95% CI = 0.75–0.99, p = 0.034) as being independently associated with the development of CPSP. In subgroup analysis, the PBI of the patients in the SS < 12 group (p < 0.001), the bilateral group (p < 0.01), and the severe acute PP group (p < 0.005) was significantly higher than the PBI of those in the control groups. This study demonstrated a significant incidence of CPSP following single-stage IBBR, and the patients with lower SS of their reconstructed breasts developed more CPSP. Lower SS, bilateral procedures, and severe acute PP were predictors of higher PBI.Trial registration: Registered in Chictr.org.cn registry system on 24 February 2020 (ChiCTR2000030139).

A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms.

Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs).Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use.Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P < 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P < 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P > 0.05).Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.

Bilateral versus unilateral radioactive stent insertion for hilar cholangiocarcinoma.

Radioactive stent insertion (RSI) is widely used for patients with obstructive hilar cholangiocarcinoma (HC) to increase the stent patency and overall survival (OS). However, one controversy of treating HC patients is determining whether to use unilateral or bilateral stenting. General knowledge on unilateral and bilateral RSI efficacy is still lacking. To evaluate the clinical efficacy and long-term prognoses of unilateral and bilateral RSI in HC patients. Between January 2016 and December 2020, all HC patients who received unilateral and bilateral RSI at our hospital were selected for this study. We compared the treatment efficacy and long-term prognosis of patients undergoing these two procedures. Overall, 65 HC patients received either unilateral (n = 33) or bilateral (n = 32) RSI. There were no significant differences in the technical (both 100%) and functional (97.0% vs. 90.6%, p = 0.584) success rates between the 2 groups. Stent re-obstruction occurred in 6 and 9 patients in the unilateral and bilateral groups, respectively (p = 0.341). Median stent patency was 214 and 233 days in the unilateral and bilateral groups, respectively (p = 0.650). Median OS was 240 and 281 days in the unilateral and bilateral groups, respectively (p = 0.068). Lastly, the total complication rate was significantly lower in the unilateral group, as compared to the bilateral group (12.1% vs. 34.4%, p = 0.033). Unilateral and bilateral RSI provided comparable clinical efficacy and long-term prognoses of HC patients. However, unilateral stenting exhibited a markedly lower complication rate.