Simultaneous Procedure Research Articles

Comparison of Postoperative Infection Rates After Office-based Oculoplastic Procedures Using Sterile and Clean Gloves.

To compare postoperative infection (PI) rates using sterile and clean-boxed gloves in office-based oculoplastic procedures. Prospective, comparative study of patients undergoing oculoplastic procedures by a single surgeon (RS) in an office-based procedure room between October 2018 and September 2020. Participants included were 18 years or older. Excluded were patients on oral antibiotics within 2 weeks before the procedure, had a follow-up period of less than 1 week, had a contaminated wound, had complex reconstructions, or had multiple simultaneous procedures performed. Oculoplastic procedures were performed using either sterile or clean-boxed gloves. The main outcome measure was the frequency of postoperative infection. Three thousand one hundred twenty-nine patients, 1,815 (58%) of whom were women, with a mean age of 60 (18-102) years were included. One thousand five hundred seventy procedures were performed with sterile gloves, while 1,559 were performed with clean-boxed gloves. The patients in the 2 groups were similar in age, gender, and number of high-risk individuals. One patient in the sterile glove group who underwent upper blepharoplasty (0.064%) and one patient (0.064%) in the clean-boxed glove group who had an external levator advancement blepharoptosis repair developed PI. Neither patient had risk factors for infection, and both infections resolved after 1 week of oral amoxicillin-clavulanate 875/125 mg twice daily. In minimally complex in-office oculoplastic procedures, using sterile versus clean-boxed gloves resulted in similar low infection rates in this large cohort. The healthcare benefits may not outweigh the costs of using sterile gloves universally for office-based oculoplastic procedures.

Simultaneous Femoral Osteotomy and Primary Total Knee Arthroplasty in Patient with Severe Extra-articular Deformity : A Case Report

Correction of an extra-articular deformity of the femur and tibia during total knee arthroplasty (TKA) in advanced knee osteoarthritis (OA) is a technically demanding procedure. The challenge is in the implications of the femoral and tibial realignment osteotomy in both coronal and sagittal planes either as step-by-step or simultaneous procedure. We herein describe an unusual case of knee OA characterized by fixed severe varus knee deformity, tibio-femoral bowing, and lower limb internal rotation. The patient underwent distal femoral osteotomy correction accompanied by TKA to restore mechanical and rotational alignment at the same time. A standard primary posterior stabilized (PS) implant was used. The procedure successfully provided stability, restored alignment and delivered good functional outcome. This case highlights the arthroplasty surgeon’s challenges, especially those who work in limited facilities.

Fabrication of novel PCL/PGS fibrous scaffold containing HA and GO through simultaneous electrospinning-electrospray technique

Herein, poly(caprolactone)/poly (glycerol sebacate) (PCL/PGS) fibrous structures incorporating hydroxyapatite (HA) and graphene oxide (GO) nanofillers were prepared through two procedures, including electrospinning and simultaneous electrospinning/electrospray procedures. Accordingly, introducing nanofillers into the structures through the simultaneous method led to improving the mechanical strength from 3.69 to 4.95 MPa. The electrospray nanofillers caused improvement of the amorphous regions (up to 83.4%) and increased the degradation rate. Furthermore, the filler-filled electrospun/electrospray sample illustrated the highest cell viability of 94.81 ± 0.5%. The results implied that the simultaneous procedure is promising for fabricating filler-loaded membranes as bone tissue scaffolds.

Concurrent optimization of topological configuration and continuous fiber path for composite structures — A unified level set approach

This study proposes a novel topology optimization approach for design of continuous steering fiber path for composite structures using a level set method. The radial basis function (RBF) is employed to construct the level set function (LSF). Fiber orientations are parameterized by LSF and fiber paths can be determined instinctively for the inherent advantages of the level set approach. Besides, the fast-marching method is employed to extrapolate the primary fiber paths to the secondary fiber paths, which can avoid the manufacturing drawbacks such as gaps and overlaps to a large extent. A detection and filtering technique is proposed here to alleviate the orientation disorder at the intersection of the diffusion surfaces. Two design schemes are developed to optimize both structural topology and fiber path. In a sequential procedure, topology optimization is conducted first with isotropic materials; and then fiber paths are optimized on the basis of fixed topological boundary. In a simultaneous optimization procedure, structural boundaries and fiber paths are optimized alternately through two inner loops. In this study, three numerical examples are presented to demonstrate the effectiveness of the proposed methods, and the results show that optimization of fiber path is beneficial to improvement of structural performance. In general, the simultaneous optimization scheme exhibits better optimal outcome in comparison with the sequential optimization scheme.

Towards single cell ICP-MS normalized quantitative experiments using certified selenized yeast

In the search for a normalized procedure to replicate and compare single cell-inductively coupled plasma-mass spectrometry (SC-ICP-MS) experiments, SELM-1, a certified reference material containing selenium enriched yeast cells has been used. Selenium concentrations (both, intra- and extracellular) have been measured using either sequential or simultaneous procedures. Regarding quantitative results, the sequential procedure involving cell washing followed by freeze drying of the washed material and intracellular Se quantification using SC-ICP-MS provided best results. In this case, intracellular Se accounted for 1304 ± 48 mg kg−1 (corresponding to 64% of the certified Se content). The average mass of Se per yeast cell was 41.6 fg Se with a dispersion of 1.6–279 fg Se/cell. In the isolated extracellular Se fraction, the Se concentration accounted for 412 ± 48 mg kg−1 (about 21% of the total Se). Thus, the sequential procedure provided a total Se recovery of about 85% with respect to the certified value. The direct dilution and simultaneous measurement of intra- and extracellular Se by SC-ICP-MS provided results of 1024 ± 42 mg kg−1 for intracellular and 316 ± 30 mg kg−1 for extracellular Se representing a total recovery of about 66%. In both cases, an initial thorough characterization of the cell density per solid weighed material was conducted by flow cytometry and the cell integrity ensured using confocal microscopy. These results clearly demonstrated that with appropriate sample preparation, SC-ICP-MS is a unique tool, which is capable of providing quantitative information about intracellular and extracellular Se. In addition, SELM-1 seems the ideal tool to enable data normalization at the single cell level to replicate, benchmark, and improve new SC-ICP-MS studies by using the same material for data validation.

Investment and Information Acquisition

We study the interaction between productive investment and persuasion activities in a principal–agent setting with strategic disclosure. In an attempt to persuade the principal, the agent diverts substantial resources from productive activities to information acquisition for persuasion, even though productive activities are more efficient and raise the chances of success in persuasion. The equilibrium outcomes of simultaneous and sequential allocation procedures are the same, because the value of learning and experimentation through information acquisition is dominated by the value of productive investment. We show that an increase in cost of an investment project leads to a lower productive investment. (JEL D21, D82, D83, D86, G31)

Office-Based Carpal Tunnel Release Using Ultrasound Guidance in a Community Setting: Long-Term Results.

Objectives: To report the safety and effectiveness of office-based carpal tunnel release (CTR) using ultrasound (US) guidance in a general community population.Methods: This was a prospective single-center study that evaluated patients treated with CTR using US guidance between March 2019 and August 2020 for whom one-year data were available. Procedures were performed in an office-based procedure room using local anesthesia. Main outcomes of this study included complications, Boston Carpal Tunnel Questionnaire scores (BCTQ-SSS, BCTQ-FSS) and Quick Disabilities of the Shoulder and Hand (QDASH) scores.Results: Among 88 patients (123 hands) aged 30 to 89 years with available one-year data, 29 patients had simultaneous bilateral procedures. No intraoperative complications were reported. Statistically significant and clinically important improvements in BCTQ-SSS, BCTQ-FSS and QDASH scores occurred within two weeks and persisted through one year of follow-up (p < 0.001). Outcomes were similar for simultaneous bilateral releases. During follow-up, one patient developed complex regional pain syndrome that was successfully treated and subsequently had CTR using US guidance on the contralateral hand. No other complications were observed during one-year follow-up.Conclusion: Office-based CTR using US guidance is safe, effective and provides sustained clinical improvements at one-year follow-up in a community population. Simultaneous bilateral procedures were well-tolerated and resulted in similar clinical improvements.

Parametric bootstrap procedures for three-factor ANOVA and multiple comparison procedures with unequal group variances

The issue of unmet equal variance assumption in multi-factor ANOVA has been addressed in the literature with several methods, and parametric bootstrap (PB) has been found in the one-way and two-way cases to outperform other methods. We extend previously developed PB procedures for one- and two-way ANOVA, and illustrate with a three-way ANOVA model with unequal group variances (heteANOVA model). We develop a framework for working with these models, analogous to usual multi-factor ANOVA procedures, where F-tests and Tukey’s simultaneous multiple comparison procedures are replaced by PB procedures. Using simulation, we compare these methods to F-tests for each step in model selection, as well as to Tukey’s test for multiple comparison procedures (MCP). The results of our simulations indicate that the PB methods outperform F-tests and Tukey’s test in terms of Type I error when data are unbalanced.

ROLE OF BONE MARROW ASPIRATION AND MARROW BIOPSY IN HAEMATOLOGICAL DISORDERS

Background: Bone marrow aspiration and bone marrow trephine biopsy are the two procedures done for the diagnosis of both hematological and non-hematological disorders and are complimentary to each other. To studyAim and Objective: the essential haematological evaluation of cases where bone marrow aspiration and bone marrow biopsy is indicated and to correlate the ndings of bone marrow aspiration and bone marrow biopsy in diagnosing various haematological disorders. The study wasMaterial and Methods: done on 86 patients in the age group 10-80 years. All had undergone simultaneous bone marrow aspiration and bone marrow biopsy procedures in the department of Clinical Haematology in a tertiary hospital. Standard methods were followed for bone marrow aspiration and biopsy procedure and for staining and evaluation of cellular aspirate. The Male to Female ratio of 1.4:1; 60% of patients belonged to 20-Observation &amp; Results: 60years group. Bone marrow and aspiration yield high diagnostic evaluation in megaloblastic anaemia (89.47%) against aspirates (10.52%) with p value of 0.00086 while in aplastc anaemia the aspirate evaluation shows better diagnostic yield (p value of 0.285). A combinationConclusion: of bone marrow aspiration and bone marrow biopsy give a better morphology of the cells and with good picture of the architecture and pattern of distribution of the cells. There is high diagnostic yield in evaluation of anemia.

Robot-assisted nephroureterectomy for upper tract urothelial carcinoma—feasibility and complications: a single center experience

Background Robot-assisted nephroureterectomy (RANU) is the primary treatment for upper tract urothelial carcinoma (UTUC) at our hospital for patients with clinical stage less than T2, and for patients with invasive tumours, but unfit for major surgery. Objective To assess peri-operative conditions and outcomes of RANU at our unit, and to evaluate the safety of the procedure. Methods The medical records of all 166 patients undergoing RANU for suspected UTUC and followed for more than three months in a large university hospital in Sweden were reviewed retrospectively. After the exclusion of twenty patients because of previous cystectomy, simultaneous surgical procedure, or other tumour types than UTUC in the pathological report, 146 patients remained for the analyses. The primary endpoint was complication rate according to Clavien-Dindo at 90 days. Secondary endpoints were perioperative bleeding, violation of oncological surgical principles, hospital stay, and re-admission within 90 days. Results The median age was 75 [(Inter Quartile Range) IQR 70–80] years and 57% of the patients had an ASA score above 2. According to Clavien-Dindo, one patient had a grade 3 complication, and no patient had a grade 4–5 complication. The median blood loss was 50 (IQR 20–100) ml and the median hospital stay was 6 (IQR 5–7) days. Twelve patients were re-admitted to the hospital within 90 days (eight with urinary tract infection/haematuria, one with hematoma, and three with other diseases). Conclusion Robot-assisted nephroureterectomy is a safe procedure for patients with upper tract urothelial carcinoma, with a low risk of major surgical complications.

Symmetry following unilateral two-stage prosthetic breast reconstruction: Is there an optimal time for managing the contralateral breast?

Achieving breast symmetry following unilateral mastectomy remains a challenge. Contralateral procedures are usually necessary to achieve breast symmetry. Controversy exists regarding whether these symmetry procedures should be performed at the time of the initial reconstruction or on a delayed basis. The study included 105 patients who had unilateral mastectomy, of which 55 had a simultaneous (immediate) contralateral symmetry procedure and 50 had a delayed contralateral symmetry procedure. Outcomes were compared and assessed for each cohort based on demographics, complications, and patient satisfaction. The delayed cohort required more procedures (3.4vs. 1.8, p < 0.0001) but shorter overall hospitalization length (2.8vs. 4.1 days, p < 0.0001). The two cohorts experienced a similar rate of revision (38.3% vs. 49.3%, p=0.17) The delayed cohort required a contralateral balancing procedure after completion of reconstruction more often than the immediate cohort (p=0.021). Overall reconstruction-specific complication rates were similar in both cohorts. The 36-Item Short-Form Health Survey (SF-36), a validated questionnaire for quality-of-life assessment, was administered 3 months after surgery and demonstrated that both cohorts reported similar outcomes when comparing their satisfaction with treatment. The results of this study demonstrate that immediate contralateral symmetry operations can be performed safely without increased morbidity. A new algorithm is presented.

V02-11 NEPHROSTOMY BALLOON &amp; SHEATH SUPRAPUBIC TUBE PLACEMENT: A MINIMALLY INVASIVE APPROACH TO LARGE CALIBER SUPRAPUBIC TUBE PLACEMENT

You have accessJournal of UrologyCME1 May 2022V02-11 NEPHROSTOMY BALLOON & SHEATH SUPRAPUBIC TUBE PLACEMENT: A MINIMALLY INVASIVE APPROACH TO LARGE CALIBER SUPRAPUBIC TUBE PLACEMENT Kevin Flynn, Charles Schlaepfer, Faizan Khawaja, and Bradley Erickson Kevin FlynnKevin Flynn More articles by this author , Charles SchlaepferCharles Schlaepfer More articles by this author , Faizan KhawajaFaizan Khawaja More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002528.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Suprapubic tubes (SPT) are a vital tool in the management of complex urologic voiding conditions. There are numerous methods of SPT placement, each with pros/cons: peel-away kits are easy to place, but often have small caliber SPTs i.e., 12 or 14 Fr, prone to kinking, that require serial upsizing to achieve the desired caliber; open SPT placements permit an initial large caliber SPT but are more invasive, particularly in obese patients. This video demonstrates a minimally invasive technique for SPT placement in patients with preserved urethral access to the bladder that safely allows for initial, precise placement of large caliber (≥20F) catheters using the Nephromax© nephrostomy balloon and sheath (NBS-SPT). METHODS: Technique: A 6” 17G Tuohy© spinal needle is placed percutaneously 3 cm above the pubis (generally in the abdominal crease), 1-2 cm off midline towards the side the patient prefers to keep the drainage bag. The needle is angled to enter the bladder dome in the midline, which is visualized cystoscopically with a full bladder. (NOTE: This angling decreases catheter kinking). The stylette is removed and a stiff wire is advanced. A 2 cm horizontal skin incision is made. A 24 Fr NBS is advanced into the bladder under vision and inflated to 18 ATM. The balloon is then deflated/removed and the SPT is passed through the sheath into the bladder. Once inflated, the sheath removed and the SPT is secured to the skin. Study: A 10-year retrospective review of NBS-SPT placements at a single institution was performed, analyzing patient characteristics, surgical details, and surgical outcomes. RESULTS: NBS-SPT was attempted 65 times over the study period. Indications included acquired/congenital neurogenic bladder (48%) and urinary retention (25%). A simultaneous additional procedure (e.g. cytolitholapaxy, bladder neck incision) was performed in 31% of NBS-SPTs. Median BMI was 29.5 (IQR: 25-33.9) and 34% had prior abdominal procedures. Median operative time (NBS-SPT only) was 16 minutes (IQR 14-20). All procedures were successful in placing a catheter ≥20 Fr. 30-day Clavien I/II complication rate was 18% (hematuria n=3; cellulitis n=4; early SPT exchange for clogging n=5). A Clavien IIIb complication occurred in one patient with hematuria requiring fulguration. First SPT exchange in clinic was successful in 95%, with two patients requiring replacement under anesthesia. CONCLUSIONS: NBS-SPT is a safe and efficient minimally invasive technique for initial, precise placement of large caliber SPT in patients with urethral bladder access. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e114 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Flynn More articles by this author Charles Schlaepfer More articles by this author Faizan Khawaja More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Incidence of Recurrent Instability After Medial Retinacular Repair, Quadriceps Tendon Femoral Ligament Reconstruction, and the Roux Goldthwait Patellar Tendon Transfer for Patellar Instability

Background:For skeletally immature patients with recurrent patellofemoral instability, numerous soft tissue procedures have been described to stabilize the patella while protecting the physis, with varied success rates and no clear superiority of a given procedure. Cases characterized by habitual instability or severe patellofemoral dysmorphology often warrant multiple simultaneous procedures to correct both proximal and distal malalignment.Hypothesis/Purpose:To determine the incidence of recurrent instability and post-operative complications in a series of patients treated with (1) quadriceps tendon femoral ligament reconstruction (QTFLR) and medial retinacular repair (MRR), or (2) QTFLR and Roux-Goldthwait patellar tendon transfer (RG) with or without MMR; and to compare these outcomes to those for isolated MRR.Methods:Eligible participants were retrospectively identified from surgeon records based on diagnosis of patellar instability, surgical treatment with MRR, QTFLR, RG, or a combination of these procedures, and minimum follow-up of 6 months. The medical records of included participants were reviewed to collect demographic data and document post-operative complications and recurrent instability. The presence of skeletal immaturity, patella alta, trochlear dysplasia, and elevated TT-TG were determined from radiographs and MRI. Statistical analysis included independent t-tests, rank sum procedure, and Chi-square analysis for univariate analysis, and stepwise binary logistic regression analysis to determine predictors of recurrent instability and complications.Results:Seventy patients (41 females, 29 males) were included with a mean age of 16.4 years and mean follow-up of 3.5 years. The QTFLR + MRR group (n=11) had 36.3% incidence of recurrent instability (dislocation in 3, subluxation in 1) and 9.1% incidence of complications. The QTFLR + RG ± MRR group (n=13) had 23.1% incidence of recurrent instability (no dislocations, subluxation in 3) and 7.7% incidence of complications. The isolated MRR group (n=46) had a 23.9% incidence of recurrent instability (dislocation in 7, subluxation in 4) and 15.2% incidence of complications. There was a significantly higher presence of trochlear dysplasia (p<0.001) and elevated TT-TG (p=0.004) in the combination procedure group compared to the isolated MRR group. Elevated TT-TG and skeletal immaturity were significantly associated with post-operative subluxation in the isolated MRR group. No other factors were predictive of recurrent instability or post-operative complications for any groups.Conclusion:The incidence of recurrent instability after combined soft tissue procedures for patellar instability ranged from 23-36%, similar to the incidence of recurrent instability of 24% for isolated MRR despite the combined procedure group having a higher presence of trochlear dysplasia and elevated TT-TG distance.

Kidney Re-Transplantation after Simultaneous Heart and Kidney Transplant: Case Study and Literature Review

The kidney is one of most frequent transplants to be performed in multi-organ transplantation. A simultaneous heart and kidney transplant (SHKT) is the best-known treatment method in patients with severe heart failure and end-stage renal disease (ESRD). Here, the authors describe the case of a kidney re-transplantation after SHKT, which is in accordance with the majority of studies, and proves the safety of simultaneous procedures. The article highlights the complex care required after the transplant, followed by the multi-factor qualification for re-transplantation. In conclusion, the case shows that SHKT provides long-term favorable outcomes and enables a repeated kidney transplantation with satisfactory one-year follow-up results.

Robot-Assisted Right Colectomy with Sequential Wedge Resection of Segments 4 and 5 of The Liver and Cholecystectomy for Colon Cancer with Metastasis to The Liver

The liver is the most common place for colon adenocarcinoma metastasis because of portal circulation. The surgical intervention for patients with colon adenocarcinoma with synchronous metastasis to the liver has been debated. Studies have shown that the simultaneous resection of a colorectal adenocarcinoma with a liver metastasis has similar outcomes compared to the traditional staged approach when looking at morbidity, mortality, and long-term oncologic effects. There has also been a shift to less invasive procedures when performing abdominal surgery. However, the laparoscopic method that has increasingly been used for the simultaneous procedure is technically challenging and therefore not widely adopted. The technical limitations hindering the simultaneous method could be overcome by utilizing a robotic approach. The aim of this report is to demonstrate the effectiveness of a robotic approach for colon adenocarcinoma with synchronous liver metastases.

Sphincter-Preserving Fistulectomy Is an Effective Minimally Invasive Technique for Complex Anal Fistulas.

BackgroundThe optimal treatment of complex anal fistulas remains unclear, though many different sphincter-preserving procedures have been described. A minimally invasive technique with a better outcome is desired. The purpose of this study was to present a new technique—sphincter-preserving fistulectomy (SPF) and its clinical outcomes.Materials and MethodsA retrospective study was performed to compare the efficacy and outcomes of SPF with ligation of the intersphincteric fistula tract (LIFT) in the management of complex anal fistulas in regards to postoperative pain, complications, wound healing time, recurrence, overall success rate, fecal continence function, and quality of life. Continence function was evaluated using the Wexner incontinence scale and anal manometry. The fecal incontinence quality of life (FIQL) scale was used to assess patients' quality of life.ResultsFrom June 2020 to July 2021, 41 patients with 43 SPF procedures and 35 patients with 35 LIFT procedures were included. Postoperative pain was comparable between two groups. The morbidity rate and the mean wound healing time in the SPF group were lower than those in the LIFT group (2.3% vs. 48.6%, p < 0.001; 1.4 ± 0.3 vs. 1.7 ± 0.4 months, p = 0.001). At a mean follow-up duration of 11.4 ± 3.5 months in the SPF group and 10.7 ± 4.3 months in the LIFT group, SPF achieved a better overall success rate than LIFT (97.7% vs. 77.1%, p = 0.014). Three patients in the SPF group and 4 patients in the LIFT group who all underwent a simultaneous fistulotomy procedure complained new incontinence of flatus. There was no statistical difference between the two groups in regards to the Wexner scores (p = 0.790), the maximum resting anal canal pressure (p = 0.641), the maximum squeeze pressure (p = 0.289), and the FIQL scores including lifestyle (p = 0.188), coping (p = 0.188), depression (p = 0.850), and embarrassment (p = 0.910).ConclusionsSPF is a novel, safe, and effective minimally invasive technique for the management of complex anal fistulas, with a promising success rate and negligible impairment on continence. Future prospective studies are needed to evaluate the long-term outcomes of SPF.

Comparing the bond strength of fiber post cementation in the root canal using pre- and co-curing procedures with the same self-etching bonding system

Background/purposeSelf-etching bonding systems are widely used in fiber post cementation. However, no clear guidelines are established for choosing pre- or co-curing procedures. We investigated the bond strength of fiber post cementation using pre-/co-curing methods in self-etching bonding systems and compared them with those of a self-adhesive system. Materials and methodsPost spaces were prepared in 30 single-rooted premolars/canines, and the fiber posts were cemented in three ways (10 specimens per group): using a self-etching bonding system with either a pre-curing or simultaneous co-curing procedure (RelyX™ Ultimate; groups SE-pre and SE-co, respectively) and using a self-adhesive system (RelyX™ Unicem 2, group SA). Each specimen was embedded and sliced perpendicularly to the long axis into three 2.5-mm-thick sections. Microphotographs of the coronal and apical surfaces of each section were acquired, and push-out tests (1 mm/min) were performed. One-way analysis of variance was conducted on the data, followed by Tukey's honestly significant difference post hoc test. ResultsThe bond strength in the whole root was not significantly different among the three groups. When independently evaluating each portion, group SE-co exhibited significantly lower coronal bond strength. The bond strength varied among root regions only in group SE-pre; the apical region had a significantly lower value. ConclusionNo cementation method is superior in all portions. Regarding pre-curing methods, clinicians must caution the fit between the post and post space, which may be affected by the pre-polymerized bond layer. The co-curing method used in a larger coronal cement space contributes to the poor bond strength.

Laparoscopic simultaneous inguinal hernia repair and appendectomy in children: A multicenter study

BackgroundInguinal hernias (IHs) are sometimes encountered incidentally in children during laparoscopic appendectomy. This study aims to evaluate the efficacy and outcomes of laparoscopic simultaneous inguinal hernia repair and appendectomy in children. MethodsA multicentric study was performed in patients with AA and concurrent IH who received laparoscopic simultaneous inguinal hernia repair and appendectomy (study group), compared with patients who underwent two–stage laparoscopic procedures (control group) between September 2012 and January 2020. Intraoperative data, postoperative complications, and clinical outcomes were prospectively collected and retrospectively analyzed. Results189 patients with AA and concurrent IH (117 children in the study group, and 72 children in the control group) were enrolled. No significant differences in preoperative characteristics were identified between the two groups. Patients in the study group had a shorter total operative time and hospital stay than those in the control group (43.2 ± 8.1 vs 53.9 ± 7.3 min, p < 0.001; 1.5 ± 0.8 vs 2.2 ± 0.9 days, p = 0.023). The study group incurred lower costs than the control group (9198.7 ± 587.6 vs 14,392.5 ± 628.6 RMB, p < 0.001). During follow–up (range 1.5–6.0 years), three children in the study group and two children in the control group experienced wound infection. One child in the study group had recurrent IH. ConclusionsLaparoscopic simultaneous procedures do not increase the incidence of wound infection or recurrent IH. Moreover, they avoid repeat anesthesia and hospitalization. Therefore, this approach is safe, feasible and cost-effective for children with AA and concurrent IH. Level of evidenceLevel III.

Inhospital Complications and Costs of Simultaneous Bilateral Total Knee Arthroplasty: The Case for Selection and Potential Cost Savings

BackgroundPublished comparisons between bilateral and unilateral total knee arthroplasties (TKAs) remain biased, as most patients undergoing bilateral TKA are prescreened and healthier than average patients having unilateral procedures. Our objectives were to compare postoperative complications and resource utilization of patients having simultaneous bilateral TKAs with similar patients having unilateral procedures. MethodsThe Nationwide Inpatient Sample (NIS) database was used to identify patients undergoing primary elective TKA from 2002 to 2011. A total of 4,445,263 patients were identified. Of these, 190,783 (4%) were having same-day bilateral procedures. Patients with staged bilateral TKA during the same hospitalization were excluded. Complications and costs were compared to a matched cohort of patients having unilateral procedures. This cohort was matched based on age, gender, and 30 comorbid-defined elements in the NIS. ResultsA total of 172,366 (90%) simultaneous bilateral procedures were matched 1:1 to patients with unilateral procedures for the adjusted analysis. Patients with bilateral procedures were at an increased risk for many complications including postoperative anemia (OR: 2.3; 95% CI: 2.2-2.3, P < .001), cardiac (OR: 2.1; 95% CI: 2.0-2.3, P < .001), and inhospital mortality (OR: 3.3; 95% CI: 2.6-4.3). These patients also incurred in higher hospital costs ($19,343 vs $12,852, P < .001) and were discharged more commonly to a rehabilitation facility (70% vs 32%, P < .001). ConclusionPatients undergoing simultaneous bilateral TKA are at an increased risk of developing important postoperative complications and mortality compared with unilateral cases. These data highlight the importance of patient selection and optimization for bilateral TKA and potential cost savings.

Radiation-induced graft polymerization of N-isopropyl acrylamide onto microcrystalline cellulose: Assessing the efficiency of the peroxidation method

This article reports on the development of an experimental protocol based on the radiation-induced graft polymerization of a temperature-responsive polymer onto cellulose (MCC). MCC was selected as a model substrate, in view of modifying cellulose nanocrystals (CNCs). Two different grafting methods, by pre-irradiation or simultaneous procedure, were performed to assess their efficiency and identify key experimental steps. The Fenton reaction was successfully applied to radiation-peroxidized MCC. The effects of radiation dose, reaction temperature, monomer concentration and reaction time were studied in various combinations to control the polymerization of N-isopropyl acrylamide (NIPAM). The amount of poly(NIPAM) grafted on MCC was determined by elemental analysis. Grafted MCC samples were characterized by infrared spectroscopy, thermogravimetry, scanning electron microscopy and X-ray diffraction to compare their features with the unmodified substrate. This experimental approach was then applied to CNCs. The grafting and purification protocols for the modified CNCs were adapted accordingly. Preliminary characterization shows the presence of the poly(NIPAM) grafts onto the CNCs and evidences the temperature-reponsiveness of the obtained material.