Difference In Time Research Articles

Development and evaluation of vesicourethral anastomosis bench-top model for measurement of traction force on urethra in robotic surgery.

In vesicourethral anastomosis (VUA), which is part of robot-assisted radical prostatectomy, surgeons must proceed carefully to avoid urethral damage. We developed and evaluated a VUA bench-top model that can measure the traction force on the urethra during robotic surgery. The VUA model included the urethra, bladder, pelvic bones, and a small force sensor that was capable of measuring the traction force on the urethra. Eight skilled and eight novice urologists performed a VUA task in robotic surgery. The skilled surgeons assessed the model's realism and usefulness as a training tool using a 5-point Likert scale. The evaluation items [task time, maximum force, force volume, and length of time that specific excessive forces were applied to the urethra (2, 3, 4, and ≥ 5 N)] were compared between the skilled and novice surgeons using the Mann-Whitney U test. Measurements were conducted in four directions with respect to the maximum force on the urethra: 11-1, 2-4, 5-7, and 8-10 o'clock. The quality of the model was scored 3.7 to 4.9 points for all 16 items in 4 domains except for "Usefulness compared with animal models." There were differences in the task time and almost all force parameters between the skilled and novice surgeons. We developed a relatively high-quality VUA bench-top model that measures traction force on the urethra, and we have revealed differences in the forces of action on the urethra in two groups of surgeons with different skill levels.

Are bone targeted agents still useful in times of immunotherapy? The SAKK 80/19 BTA pilot study

BackgroundPatients with bone metastases from solid tumors often have additional treatment with bone targeted agents (BTAs) to avoid symptomatic skeletal events (SSEs) such as clinically significant pathological fracture leading toradiation therapy or surgery to the bone, spinal cord compression, or hypercalcemia. The absolute value of BTA treatment in the era of immunotherapy (IO) is unknown. MethodsPatients with bone metastases treated with immunotherapy within the Alpine Tumor Immunology Registry were compared based on whether they received an additional BTA such as denosumab or zoledronic acid. The primary endpoint was time to first SSE. Continuous data were summarized as median and range, categorical data using frequency counts and percentages. Kaplan-Meier estimates were used to describe and visualize the effect of categorical variables. ResultsOne hundred and ninety-seven patients with bone metastases and treatment with immunotherapy such as nivolumab (48 %), pembrolizumab (40 %), atezolizumab (12 %), ipilimumab (9 %) and other immunotherapy (5 %) were included. The most frequent tumor types were lung cancer (50 %), malignant melanoma (11 %), renal cell cancer (10 %) and bladder cancer (9 %), respectively. One hundred and twenty-two patients (62 %) received a BTA treatment (91 % denosumab). The median treatment duration of a BTA was 178 days (min: 1 day, max: 2010 days). Out of the 197 patients, 47 (24 %) experienced at least one SSE, 100 (51 %) had bone pain. Ten of the 122 patients (8 %) receiving a BTA developed osteonecrosis of the jaw (ONJ). The percentage of patients without an SSE at fixed time points was higher if treated with a BTA (e.g., at 6 months, 92 % [95 % CI: 84 % - 96 %] versus 88 % [95 % CI: 77 % - 94 %]), but no significant difference in time to first SSE (HR 0.69; 95 % CI 0.34–1.39, log-rank p = 0.29) or time to first bone pain (HR: 0.85; 95 % CI: 0.51–1.43, p = 0.54) between these two groups could be detected. There were differences in OS between patients treated with a BTA and patients not treated with a BTA (HR: 1.46; 95 % CI: 1.01–2.10, p = 0.043). ConclusionNo significant difference in time to first SSE or bone pain was observed between patients who have received a BTA or not when treated with immunotherapy. Based on these retrospective results the indication of BTAs to reduce SSEs in cancer patients under treatment with immunotherapy needs further evaluation.

Enhanced Method for Evaluating Remodeling Floor Plans for Apartment Complexes with an Emphasis on Efficiency and Accuracy

A social issue in Korea has recently emerged regarding the structural performance and living environment improvement of aged apartment houses (i.e., 20 or more years old). The available methods to improve the issues related to aged apartment houses are remodeling and reconstruction, and there is a trend to recommend environmentally friendly remodeling. During the initial design stage of a typical remodeling project, several floor plan drafts are prepared and undergo several revisions to produce the final floor plan. As such, this study aims to develop a program capable of promptly offering quantitative structural guides during the initial design stage, thereby reducing the duration and workforce required to complete the final floor plan. The developed program was utilized to conduct a structural evaluation of five existing apartment complexes in Korea. Subsequently, to validate the usability of the developed program, the accuracy and time efficiency of its evaluation results were compared to those using commercial structural analysis software. While the calculated structural indices showed a variance within 5% between the two programs, there were considerable differences in processing time, at 35 min vs. 8-16 h per building. Therefore, the program developed in this study will be beneficial during the initial design stage, and it will significantly reduce the time, effort, and cost necessary for decision-making in a remodeling project while maintaining accuracy in structural assessment.

First Reported Series of Cerebral Angiography Performed at an Outpatient Center: Safety and Satisfaction Results.

Ambulatory surgery centers (ASCs) are increasingly common venues for same-day neurosurgical procedures, allowing for cost-effective, high-quality patient care. We present the first and largest series of patients undergoing diagnostic cerebral angiography at an ASC to demonstrate the effectiveness, safety, and efficiency of outpatient endovascular care. We retrospectively reviewed data for consecutive patients who underwent diagnostic cerebral angiography at our ASC between January 1, 2024, and May 29, 2024. Data collected included vascular access approach, procedural duration, turnover time, and periprocedural complications. Using a standardized 2-week postprocedural survey, patients were asked to provide comments and rate their subjective satisfaction from a 1 to 5 scale, with "5" being completely satisfied. All cases were performed with a physician team comprising 1 attending neuroendovascular neurosurgery and 1 neuroendovascular fellow present. Fentanyl and midazolam were administered for conscious sedation in all cases. Among the 67 patients included in this series, the mean procedural duration was 29.4 ± 8.6 minutes. The mean turnover time was 13.7 ± 3.6 minutes. Between transradial (46 of 67 [68.7%]) and transfemoral (21 of 67 [31.3%]) access site approaches, there were no statistically significant differences in mean procedural duration (29.4 ± 8.0 vs 29.2 ± 9.9 minutes, respectively; P = .72) or turnover time (14.0 ± 3.9 vs 12.9 ± 2.8 minutes, respectively; P = .4). No complications occurred periprocedurally or within the 2-week follow-up period. A total of 48 (71.6%) of 67 patients responded to the postprocedural survey, all of whom unanimously reported a score of "5." We found that diagnostic cerebral angiography performed at our ASC was safe and effective for patient care. In addition, all survey respondents (71.6% of those provided the survey) reported highest levels of satisfaction. The integration of neuroendovascular procedures into ASCs potentially offers a cost-effective and highly efficient option in an evolving economic landscape.

Local differences in robustness to ocean acidification.

Ocean acidification (OA) caused by increased atmospheric carbon dioxide is affecting marine systems a globally and is more extreme in coastal waters. A wealth of research to determine how species will be affected by OA, now and in the future, is emerging. Most studies are discrete and generally do not include the full life cycle of animals. Studies that include the potential for adaptation responses of animals from areas with different environmental conditions and the most vulnerable life stages are needed. Therefore, we conducted experiments with the widely-distributed blue mussel, Mytilus edulis, from populations regularly exposed to different OA conditions. Mussels experienced experimental conditions prior to spawning, through embryonic and larval development, a highly vulnerable stage. Survivorship to metamorphosis of larvae from all populations was negatively affected by extreme OA conditions (pH 7.3, Ωar, 0.39, pCO2 2479.74), but, surprisingly, responses to Mid OA (pH 7.6, Ωar 0.77, pCO21167.13) and Low OA (pH 7.9, Ωar 1.53, pCO2 514.50) varied among populations. Two populations were robust and showed no effect of OA on survivorship in this range. One population displayed the expected negative effect on survivorship with increased OA. Unexpectedly survivorship in the fourth population was highest under Mid OA conditions. There were also significant differences in development time among populations that were unaffected by OA. These results suggest that adaptation to OA may already be present in some populations and emphasizes the importance of testing animals from different populations to see the potential for adaptation to OA.

Stable isotope and fatty acid variation of a planktivorous fish among and within large lakes.

Aquatic food webs are spatially complex, potentially contributing to intraspecific variability in production pathway reliance of intermediate trophic level consumers. Variation in trophic reliance may be described by well-established trophic indicators, like stable isotope ratios (δ13C, δ15N), along with emerging trophic indicators, such as fatty acid composition. We evaluated stable isotope ratios and fatty acid profiles of European smelt (Osmerus eperlanus) among and within distinct regions of three large Swedish lakes (Hjälmaren, Mälaren, Vättern) which differed in trophic status. We expected that smelts in more oligotrophic lakes and regions would be characterized by distinct stable isotope signatures and fatty acid profiles, with particularly high polyunsaturated fatty acid (PUFA) relative levels. However, we acknowledge that frequent movement of smelts among regions may serve to spatially integrate their diet and lead to limited within-lake variation in stable isotope ratios and fatty acid composition. As expected, in comparison with more productive lakes (i.e., Hjälmaren and Mälaren), smelts from ultra-oligotrophic Vättern were characterized by low δ15N, high δ13C and high percent of a dominant PUFA, docosahexaenoic acid (DHA). Smelts from different regions of the morphometrically complex Mälaren displayed differential stable isotope ratios and fatty acid relative concentrations, which were consistent with within-lake differences in productivity and water residence times, suggesting that smelts in this lake forage locally within distinct regions. Finally, at the individual smelt level there were particularly strong and consistent associations between a well-established trophic indicator (δ13C) and percent DHA, suggesting that the relative concentration of this fatty acid may be a useful additional trophic indicator for smelt.

Comparison of dynamic compression system versus multiple cancellous screws in the treatment of femoral neck fractures in young adults

IntroductionFemoral neck fractures have posed a significant global healthcare challenge and had notable impacts on the quality of life. Current treatment strategies for femoral neck fractures in young individuals have varied, emphasizing the need for optimal fixation methods. This study compared the clinical and radiological outcomes of the dynamic compression system (DCS) and multiple cancellous screws (MCS) methods.MethodsThis retrospective study included a total of 275 young adults with fresh femoral neck fractures treated with DCS and MCS. A matching analysis with a 1:1 ratio based on age, gender, fracture classification, and reduction quality was conducted. Demographic data were recorded, and comparisons were made according to follow-up time (FUT), hospitalization period, operation duration, femoral neck shortening, caput-collum-diaphysis (CCD) angle, Harris Hip Score (HHS), and post-operative complications.ResultsA total of 42 fractures were matched with a median age of 42 years (range, 22–48). In the DCS group, vertical neck shortening (median 1.92) was significantly lower than that in the MCS group (median 4.53) (P < 0.05). In the DCS group, horizontal femoral neck shortening, resultant femoral neck shortening, the amount of change in CCD angle, and HHS were 0.57 mm (0.43, 4.74 mm), 1.82 mm (0.40, 3.53 mm), 0.13° (-0.78°, 1.80°), and 91 (85–93), respectively. They were all non-significant than 1.00 mm (0.56, 6.23 mm), 2.74 mm (1.59, 6.71 mm), -0.18° (-1.11°,1.85°), and 91 (75, 93) in the MCS group, respectively (P > 0.05). There was no statistical difference in FUT, hospitalization period, operation time, and post-operative complications at the latest follow-up (P > 0.05). There were no complications such as pulmonary embolism, deep vein thrombosis, and incision infection reported.ConclusionDCS and MCS demonstrated effectiveness in treating femoral neck fractures in young adults. The DCS implant provides additional stability in the vertical axis. A prospective randomized controlled study with a large sample size was needed to validate these findings.

Assessment of the therapeutic potential of Hsp70 activator against prion diseases using in vitro and in vivo models

IntroductionPrion diseases are deadly neurodegenerative disorders in both animals and humans, causing the destruction of neural tissue and inducing behavioral manifestations. Heat shock proteins (Hsps), act as molecular chaperones by supporting the appropriate folding of proteins and eliminating the misfolded proteins as well as playing a vital role in cell signaling transduction, cell cycle, and apoptosis control. SW02 is a potent activator of Hsp 70 kDa (Hsp70).MethodsIn the current study, the protective effects of SW02 against prion protein 106-126 (PrP106-126)-induced neurotoxicity in human neuroblastoma cells (SH-SY5Y) were investigated. In addition, the therapeutic effects of SW02 in ME7 scrapie-infected mice were evaluated.ResultsThe results showed that SW02 treatment significantly increased Hsp70 mRNA expression levels and Hsp70 ATPase activity (p &amp;lt; 0.01). SW02 also significantly inhibited cytotoxicity and apoptosis induced by PrP106-126 (p &amp;lt; 0.01) and promoted neurite extension. In vivo, intraperitoneal administration of SW02 did not show a statistically significant difference in survival time (p = 0.16); however, the SW02-treated group exhibited a longer survival time of 223.6 ± 6.0 days compared with the untreated control group survival time of 217.6 ± 5.4 days. In addition, SW02 reduced the PrPSc accumulation in ME7 scrapie-infected mice at 5 months post-injection (p &amp;lt; 0.05). A significant difference was not observed in GFAP expression, an astrocyte marker, between the treated and untreated groups.ConclusionIn conclusion, the potential therapeutic role of the Hsp70 activator SW02 was determined in the present study and may be a novel and effective drug to mitigate the pathologies of prion diseases and other neurodegenerative diseases. Further studies using a combination of two pharmacological activators of Hsp70 are required to maximize the effectiveness of each intervention.

Comparative analysis of the safety and effectiveness of Nirmatrelvir-Ritonavir and Azvudine in older patients with COVID-19: a retrospective study from a tertiary hospital in China

Introduction: Numerous studies have explored the treatment outcomes of Nirmatrelvir-Ritonavir and Azvudine in older patients with COVID-19. However, direct comparisons between these two drugs are still relatively limited. This study aims to compare the safety and effectiveness of these two drugs in Chinese older patients with early infection to provide strategies for clinical treatment.Methods: Older COVID-19 patients (age ≥65) hospitalized during the winter 2022 epidemic in China were included and divided into Nirmatrelvir-Ritonavir and Azvudine. Demographics, medication information, laboratory parameters, and treatment outcomes were collected. All-cause 28-day mortality, delta cycle threshold (ΔCt), nucleic acid negative conversion time, and incidence of adverse events were defined as outcomes. Propensity score matching (PSM), Kaplan-Meier, Cox proportional hazards model, subgroup analysis, and nomograms were selected to evaluate the outcomes.Results: A total of 1,508 older COVID-19 patients were screened. Based on the inclusion and exclusion criteria, 1,075 patients were eligible for the study. After PSM, the final number of older COVID-19 patients included in the study was 375, and there were no significant differences in demographic characteristics between the two groups (p &amp;gt; 0.05). Compared to the Azvudine group, the Nirmatrelvir-Ritonavir group showed a higher incidence of multiple adverse events (12.8% vs 5.2%, p = 0.009). The incidence of adverse events related to abnormal renal function was higher in the Nirmatrelvir-Ritonavir group compared to the Azvudine group (13.6% vs 7.2%, p = 0.045). There were no significant differences between the two groups in terms of all-cause 28-day mortality (HR = 1.020, 95% CI: 0.542 - 1.921, p = 0.951), whereas there were significant differences in nucleic acid negative conversion time (HR = 1.659, 95% CI: 1.166 - 2.360, p = 0.005) and ΔCt values (HR = 1.442, 95% CI: 1.084 - 1.918, p = 0.012).Conclusion: Azvudine and Nirmatrelvir-Ritonavir have comparable effectiveness in reducing mortality risk. Azvudine may perform better in nucleic acid negative conversion time and virus clearance and shows slightly better safety in older patients. Further studies with a larger sample size were needed to validate the result.

Unveiling the impact of three-dimensional (3D) technology on rhinoplasty: a systematic review and meta-analysis.

This study aimed to investigate the impact of three-dimensional technology(3D) on preoperative evaluation for rhinoplasty. A systematic search was conducted on EMBASE, MEDLINE, and Web of Science. Studies that utilized 3D technology in preoperative assessment for rhinoplasty were included. Primary outcome was surgeon and patient satisfaction. Secondary outcomes included nasal function, cost-efficiency, reoperation rate, precision, and surgical time. Twelve studies (595 patients) were included. Surgeons reported higher satisfaction with 3D approaches based on precision and postoperative results. Patients expressed satisfaction with the 3D approaches due to better understanding of the procedure and the ability to discuss with the surgeons on planning the procedure and participating in postoperative design. The 3D approaches demonstrated higher surgeon satisfaction (mean difference -0.13, 95%CI -0.20 to -0.06, p=0.0002), particularly in revision cases, and provided higher precision compared with the 2D approaches. However, 3D technology was more expensive and not cost-efficient. There were no significant differences in reoperation rate (OR 0.16, 95% CI 0.02 to 1.36, p=0.09) and surgical time. Postoperative nasal function showed inconsistent results. Three-dimensional technology offered higher surgeon satisfaction and increased precision compared with 2D imaging. However, 3D imaging was expensive and not cost-efficient. Reoperation rate and surgical time were comparable, while postoperative nasal function outcomes showed inconsistent results.

Effect of residual dental follicle after removal of impacted mandibular third molar on the periodontal health of adjacent second molar

Objective: To investigate whether residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars affect the periodontal health of adjacent mandibular second molars, in order to provide clinical reference for the management of residual dental follicles after third molar extraction. Methods: A total of 82 patients who underwent bilateral impacted mandibular third molar extraction at the Department of Oral Surgery, School and Hospital of Stomatology Wuhan University, from November 1, 2020, to November 30, 2022, were included in the study. Using a self-controlled method, each patient's bilateral mandibular third molars were randomly divided into two groups: Group A underwent third molar extraction with thorough removal of residual dental follicle tissue, while Group B underwent third molar extraction without any treatment of the remaining dental follicle tissue. Operation time and adverse reactions were recorded. Clinical and radiographic examinations were performed at 6-month follow-up to evaluate the periodontal parameters and alveolar bone height of the bilateral mandibular second molars, and differences between the two groups were compared. Results: All patients had successful bilateral mandibular third molar extractions, and no serious complications occurred intraoperatively or postoperatively. There were no statistically significant differences in surgical time, postoperative pain, or facial swelling between the two groups (P>0.05). At the 6-month follow-up, the probing depth on the distal aspect of the mandibular second molars in Group A [2.67 (2.00, 3.67) mm] was significantly less than that in Group B [4.00 (3.00, 5.00) mm] (Z=-6.55, P<0.001). The clinical attachment loss on the distal aspect of the mandibular second molars in Group A [1.00 (0.00, 3.00) mm] was less than that in Group B [3.00 (2.00, 5.00) mm] (Z=-5.99, P<0.001). The distance from the alveolar crest to the cementoenamel junction on the distal aspect of the mandibular second molars in Group A [(1.86±1.34) mm] was less than that in Group B [(3.04±1.89) mm] (t=6.87,P<0.001). In patients aged≥20 years, the probability of recovery of alveolar bone height to normal level on the distal aspect of the mandibular second molars in Group A [42.3% (11/26)] was significantly higher than that in Group B [0 (0/26)] (P<0.01), while there was no statistically significant difference between Group A [63.3% (19/30)] and Group B [46.7% (14/20)] in patients aged<20 years (P>0.05). Conclusions: Residual dental follicles in the alveolar socket after extraction of impacted mandibular third molars adversely affect the periodontal health of adjacent teeth. Thorough removal of residual dental follicles during impacted mandibular third molar extraction is beneficial for the postoperative recovery of alveolar bone height of the distal aspect of the mandibular second molars, especially in patients aged≥20 years.

Outcomes and adverse events for spinal synovial cysts surgical treatment: a systematic review and meta-analysis.

Spinal synovial cysts (SSCs) are a rare cause of nerve root and spinal cord compression. Surgical excision of SSCs remains the mainstay of treatment in the presence of unremitting symptoms or neurological deficits, but the choice of the surgical approach remains controversial. The goal of this study was to compare clinical outcomes and adverse events associated with traditional approaches (interlaminar or laminectomy/hemilaminectomy) and minimally invasive approaches (microsurgical tubular approaches or endoscopic approaches) for SSCs. Studies reporting surgical management of SSCs were searched in three online databases (PubMed, the Cochrane Library, and Web of Science). This meta-analysis was reported following the PRISMA Statement. It was registered at the International Prospective Register of Systematic Reviews (CRD42021288992). The Cochrane Collaboration's Risk of Bias in Nonrandomised Studies-of Interventions (ROBINS-I) was used to evaluate bias. Extracted research data were statistically analyzed using Stata 16 and SPSS statistics 25. A total of 22 related relevant studies were included. Meta-analysis revealed no statistically significant difference in dural tear, residual cyst, recurrence, reoperation, and operation time between minimally invasive approaches and traditional approaches (p > 0.05), but minimally invasive approaches had a good functional improvement (p = 0.004). Postoperative length of hospital stays and intraoperative bleeding in traditional approaches were also higher than in minimally invasive approaches (p < 0.05). Based on the available evidence, minimally invasive approaches may be better than traditional approaches in the treatment of SSCs. Minimally invasive approaches had the advantages of improving clinical satisfaction, with a similar complication rate to traditional approaches. Moreover, endoscopic and microsurgical tubular approaches had similar outcomes.

Abbreviated MRI in the evaluation of dizziness: report turnaround times and impact on length of stay compared to CT, CTA, and conventional MRI.

Neuroimaging is often used in the emergency department (ED) to evaluate for posterior circulation strokes in patients with dizziness, commonly with CT/CTA due to speed and availability. Although MRI offers more sensitive evaluation, it is less commonly used, in part due to slower turnaround times. We assess the potential for abbreviated MRI to improve reporting times and impact on length of stay (LOS) compared to conventional MRI (as well as CT/CTA) in the evaluation of acute dizziness. We performed a retrospective analysis of length of stay via LASSO regression for patients presenting to the ED with dizziness and discharged directly from the ED over 4 years (1/1/2018-12/31/2021), controlling for numerous patient-level and logistical factors. We additionally assessed turnaround time between order and final report for various imaging modalities. 14,204 patients were included in our analysis. Turnaround time for abbreviated MRI was significantly lower than for conventional MRI (4.40h vs. 6.14h, p < 0.001) with decreased impact on LOS (0.58h vs. 2.02h). Abbreviated MRI studies had longer turnaround time (4.40h vs. 1.41h, p < 0.001) and was associated with greater impact on ED LOS than non-contrast CT head (0.58h vs. 0.00h), however there was no significant difference in turnaround time compared to CTA head and neck (4.40h vs. 3.86h, p = 0.06) with similar effect on LOS (0.58h vs. 0.53h). Ordering both CTA and conventional MRI was associated with a greater-than-linear increase in LOS (additional 0.37h); the same trend was not seen combining CTA and abbreviated MRI (additional 0.00h). In the acute settings where MRI is available, abbreviated MRI protocols may improve turnaround times and LOS compared to conventional MRI protocols. Since recent guidelines recommend MRI over CT in the evaluation of dizziness, implementation of abbreviated MRI protocols has the potential to facilitate rapid access to preferred imaging, while minimizing impact on ED workflows.

Player Activity and Load Profiling with Hidden Markov Models: A Novel Application in Rugby League

ABSTRACT Player movement in rugby league is complex, being spatiotemporal and multifaceted. Modeling this complexity to provide robust measures of player activity and load has proved difficult, with important aspects of player movement yet to be considered. These include the influence of time-varying covariates on player activity and the combination of different dimensions of player movement. Few studies have simultaneously categorized player activity into different activity states and investigated factors influencing the transition between states, or compared player activity and load profiles between matches and training. This study applied hidden Markov models (HMMs)—a data-driven, multivariate approach—to rugby league training and match GPS data to i) demonstrate how HMMs can combine multiple variables in a data-driven way to effectively categorize player movement states, ii) investigate the influence of two time-varying covariates, score difference and elapsed match time on player activity states, and iii) compare player activity and load profiles within and between training and match modalities. HMMs were fitted to player GPS, accelerometer and heart rate data of one English Super League team across 60 training sessions and 35 matches. Distinct activity states were detected for both matches and training, with transitions between states in matches influenced by score difference and elapsed time and clear differences in activity and load profiles between training and matches. HMMs can model the complexity of player movement to effectively profile player activity and load in rugby league and have the potential to facilitate new research across several sports.

The Efficacy of Local Antibiotic Delivery Systems Therapy in the Management of Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis.

We aim to evaluate the efficacy of local antibiotic delivery systems in patients with diabetic foot osteomyelitis (DFO). The Web of Science, PubMed, and Embase databases were searched for relevant publications until March 2024. All studies evaluating the efficacy of local antibiotic delivery systems in patients with DFO were included. We calculated pooled risk ratio (RR) with 95% CIs for binary outcomes and mean difference (MD) for continuous outcomes. The Cochrane's risk of bias tool and methodological index for non-randomized studies (MINORS) assessment were used to evaluate the quality of studies. A total of 9 studies with 491 patients were included in this analysis. The overall healing rate in antibiotic group was 0.85 (95% CI: 0.67, 0.97). Healing rates were significantly higher in the antibiotic group compared to the control group (RR: 1.18, 95% CI: 1.01, 1.38). Furthermore, recurrence rates and amputation rates have no significantly difference between the antibiotic group and the control group (RR: 0.30, 95% CI: 0.04, 2.12 and RR: 0.22, 95% CI:0.03, 1.91), along with no significantly difference in healing time and hospital stays(MD: -7.87, 95% CI: -20.81, 5.07 and MD:-2.33, 95% CI:-5.17, 0.50). No obvious publication bias was observed in the funnel plot (Egger's test, P = .99). Our meta-analysis found that diabetic foot osteomyelitis patients treated with local antibiotic delivery systems had better healing rates than the control group. However, no significant differences were found in healing time, recurrence, hospital stays, or amputation rates. Larger randomized controlled trials are necessary in the future.

Impact of Thoracic Duct Resection on Long-Term Survival After Esophagectomy: Individual Patient Data Meta-analysis.

Radical esophagectomy, including thoracic duct resection (TDR), has been proposed to improve regional lymphadenectomy and possibly reduce the risk of locoregional recurrence. However, because of its impact on immunoregulation, some authors have expressed concerns about its possible detrimental effect on long-term survival. The purpose of this review was to assess the influence of TDR on long-term survival. PubMed, MEDLINE, Scopus, and Web of Science databases were searched through 15 March 2024. Overall survival (OS), cancer specific survival (CSS), and disease-free survival (DFS) were primary outcomes. Restricted mean survival time difference (RMSTD), risk ratio (RR), standardized mean difference (SMD), and 95% confidence intervals (CI) were used as pooled effect size measures. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology was employed to evaluate the certainty of evidence. The analysis included six studies with 5756 patients undergoing transthoracic esophagectomy. TDR was reported in 49.1%. Patients' ages ranged from 27 to 79 years and 86% were males. At 4-year follow-up, the multivariate meta-analysis showed similar results for the comparison noTDR versus TDR in term of OS [- 0.8 months, 95% confidence interval (CI) - 3.1, 1.3], CSS (0.1 months, 95% CI - 0.9, 1.2), and DFS (1.5 months, 95% CI - 2.6, 5.5). TDR was associated with a significantly higher number of harvested mediastinal lymph nodes (SMD 0.57, 95% CI 0.01-1.13) and higher risk of postoperative chylothorax (RR = 1.32; 95% CI 1.04-2.23). Anastomotic leak and pulmonary complications were comparable. TDR seems not to improve long-term OS, CSS, and DFS regardless of tumor stage. Routine TDR should not be routinely recommended during esophagectomy.

A hierarchal model for bacterial cell inactivation in solution by direct and indirect treatment using cold atmospheric plasmas

Cold atmospheric plasma devices have shown promise for a variety of plasma medical applications, including wound healing and bacterial inactivation often performed in liquids. In the latter application, plasma-produced reactive oxygen and nitrogen species (RONS) interact with and damage bacterial cells, though the exact mechanism by which cell damage occurs is unclear. Computational models can help elucidate relationships between plasma-produced RONS and cell killing by enabling direct comparison between dissimilar plasma devices and by examining the effects of changing operating parameters in these devices. In biological applications, computational models of plasma-liquid interactions would be most effective in design and optimization of plasma devices if there is a corresponding prediction of the biological outcome. In this work, we propose a hierarchal model for planktonic bacterial cell inactivation by plasma produced RONS in liquid. A previously developed reaction mechanism for plasma induced modification of cysteine was extended to provide a basis for cell killing by plasma-produced RONS. Results from the model are compared to literature values to provide proof of concept. Differences in time to bacterial inactivation as a function of plasma operating parameters including gas composition and plasma source configuration are discussed. Results indicate that optimizing gas-phase reactive nitrogen species production may be key in the design of plasma devices for disinfection.

Evaluation of Porcine-Derived Collagen Membranes for Soft Tissue Augmentation in the Oral Cavity: An In Vivo Study.

The use of porcine-derived collagen membranes (PDCM) to improve intraoral soft tissue rehabilitation remains under investigation. Different degrees of crosslinking have yielded differences in resorption time and inflammation surrounding collagen membranes. The aim of this study was to evaluate the in vivo performance of bilayered PDCMs with varying degrees of crosslinking for the regeneration of oral soft tissue defects. Bilateral split-thickness oral mucosa defects were created in mandibles of beagles (n=17) and assigned to one of the following: bilayer PDCM (high crosslinking porcine dermis in sheet form-H-xlink) and (low crosslinking porcine dermis in sheet form-L-xlink), bilayer PDCM (non-crosslinked predicate collagen membrane in spongy form-Ctrl), or negative control (Sham) and compared with positive control (unoperated). Animals were euthanized after 4-, 8-, or 12-weeks of healing to evaluate soft tissue regeneration and remodeling through histomorphometric analyses. H-xlink membranes presented delayed healing with a poorly developed epithelial layer (analogous to the sham group) across time points. Relative to Ctrl at 8 and 12 weeks, defects treated with H-xlink presented no difference in semiquantitative scores (P > 0.05), while L-xlink exhibited greater healing (P = 0.042, P = 0.043, at 8 and 12 weeks, respectively). Relative to positive control, L-xlink exhibited similar healing at 8 weeks and greater healing at 12 weeks (P = 0.037) with a well-developed epithelial layer. Overall, groups treated with L-xlink presented with greater healing relative to the positive control after 12 weeks of healing and may serve as an alternative to autologous grafts for intraoral soft tissue regeneration.

Comparison of biportal endoscopic and microscopic tubular paraspinal approach for foraminal and extraforaminal lumbar disc herniation.

Foraminal and extraforaminal lumbar disc herniation (FELDH) is an important pathological condition that can lead to lumbar radiculopathy. The paraspinal muscle-splitting approach introduced by Reulen and Wiltse is a reasonable surgical technique. Minimally invasive procedures using a tubular retractor system have also been introduced. However, surgical treatment is considered more challenging for FELDH than for central or subarticular lumbar disc herniations (LDHs). Some researchers have proposed uniportal extraforaminal endoscopic lumbar discectomy through a posterolateral approach as an alternative for FELDH, but heterogeneous clinical results have been reported. Recently, the biportal endoscopic (BE) paraspinal approach has been suggested as an alternative. The aim of this study was to compare the clinical outcomes of BE and microscopic tubular (MT) paraspinal approaches for decompressive foraminotomy and lumbar discectomy (paraLD) in patients with FELDH. Ninety-one consecutive patients with unilateral lumbar radiculopathy and FELDH underwent paraLD. Demographic and perioperative data were collected. Clinical outcomes were evaluated using the visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI) for spinal disability, and the modified Macnab criteria for patient satisfaction. Postoperative complications and reoperation rates were also evaluated. In total, 76 patients were included in the final analysis. Among them, 43 underwent BE paraLD (group A) and the remaining 33 underwent MT paraLD (group B). The demographic and preoperative data were not statistically different between the groups. All patients showed significant improvements in VAS back, VAS leg, and ODI scores compared with baseline values (p < 0.05). The improvement in VAS back scores was significantly better in group A than in group B on postoperative day 2 (p < 0.001). However, all clinical parameters were comparable between the two groups after postoperative year 1 (p > 0.05). According to the modified Macnab criteria, 86.1% and 72.7% of the patients had excellent or good outcomes in groups A and B, respectively. No intergroup differences were observed (p = 0.367). In addition, there were no differences in the total operation time or amount of surgical drainage. Postoperative complications were not significantly different between the two groups (p = 0.301); however, reoperation rates were significantly higher in group B (p = 0.035). BE paraLD is an effective treatment for FELDH and is an alternative to MT paraLD. In particular, BE paraLD has advantages of early improvement in postoperative back pain and low reoperation rates.

The effect of irrigation solution temperature and novel heat-treated rotary files on apical debris extrusion and canal preparation time.

This study aimed to compare apical debris extrusion and canal preparation time with ProTaper Gold (PTG) and ProTaper Ultimate (PTU) files at different temperatures. Mesio-buccal roots of 60 mandibular first molars were distributed into six groups depending on the file type (PTG, PTU) and irrigation solution temperature (20, 37, 45°C). During instrumentation, extruded debris were collected and weighed to measure the mass in milligrams. The canal preparation time was recorded in seconds. ANOVA followed by Bonferroni post-hoc tests were used for analysis. The amount of debris extrusion was significantly higher in PTU, which was affected by the irrigation solution temperature (p < 0.05). The difference in canal preparation time was not significant between the two file systems, however, it was significant between the different temperatures (p = 0.001). Both file systems had shorter canal preparation times at 20°C. The irrigation solution temperature could influence the debris extrusion and time of canal preparation.