Cu/TiO2 adsorbents modified by air plasma for adsorption-oxidation of H2S.

In this study, non-thermal plasma (NTP) was employed to modify the Cu/TiO2 adsorbent to efficiently purify H2S in low-temperature and micro-oxygen environments. The effects of Cu loading amounts and atmospheres of NTP treatment on the adsorption-oxidation performance of the adsorbents were investigated. The NTP modification successfully boosted the H2S removal capacity to varying degrees, and the optimized adsorbent treated by air plasma (Cu/TiO2-Air) attained the best H2S breakthrough capacity of 113.29 mg H2S/gadsorbent, which was almost 5 times higher than that of the adsorbent without NTP modification. Further studies demonstrated that the superior performance of Cu/TiO2-Air was attributed to increased mesoporous volume, more exposure of active sites (CuO) and functional groups (amino groups and hydroxyl groups), enhanced Ti-O-Cu interaction, and the favorable ratio of active oxygen species. Additionally, the X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS) results indicated the main reason for the deactivation was the consumption of the active components (CuO) and the agglomeration of reaction products (CuS and SO42-) occupying the active sites on the surface and the inner pores of the adsorbents.

LC-MS/MS and GC-MS/MS Cross-Checking Analysis Method for 426 Pesticide Residues in Agricultural Products: A Method Validation and Measurement of Uncertainty.

A method was developed to analyze residual pesticides in various vegetables using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-tandem mass spectrometry (GC-MS/MS). A method can analyze over 200 individual compounds, selectively separate peaks within 30 min, and meet various criteria such as those by the Codex Alimentarius Commission (CODEX). Most compounds showed recovery rates between 70 and 120%, and a relative standard deviation was within 20%. Measurement uncertainty, considering various influencing factors such as instrument precision, method sensitivity, experimental conditions, sample handling, and analytical procedures, was meticulously calculated. The expanded uncertainties of cross-checking 33 available pesticides ranged from 10.1 to 26.2 µg/kg at a confidence level of approximately 95%. Risk assessment of detected pesticides in agricultural products indicated a safety range of 0.00003-2.87240%. The developed method effectively analyzes diverse compounds simultaneously, contributing to agricultural product safety.

Bidirectional associations between sleep and cannabis and alcohol (co-)use in daily life.

BACKGROUND: Poor sleep is common in the context of cannabis use, but experimental and daily-life studies provide mixed evidence for whether cannabis use helps or disturbs same-night sleep. Despite a high prevalence of co-use of alcohol and cannabis, most studies of cannabis use and sleep do not consider alcohol use. We sought to add to this literature by examining associations between cannabis and sleep in the context of alcohol co-use and to examine these associations bidirectionally using ecological momentary assessment. METHODS: Participants were 88 adults reporting cannabis use at least 3×/week and simultaneous alcohol and cannabis use at least 2×/week. For 14 days, participants completed morning surveys assessing hours slept and perceived sleep quality from the night before. In morning surveys, random surveys, and substance-specific surveys, participants also reported on alcohol and cannabis craving, use, and amounts. RESULTS: Primary results from multilevel models demonstrated that cannabis use was not independently associated with sleep (duration or quality). However, cannabis use attenuated alcohol's negative effects on sleep quality. CONCLUSIONS: Results question the utility of cannabis use to improve sleep but highlight the attenuated negative effects of alcohol as a potential reinforcer of alcohol-cannabis co-use. Future work should continue to consider polysubstance use and integrate additional self-report and objective measures of sleep health to further clarify how cannabis use affects sleep.

Simultaneous or sequential kidney-liver transplantation in primary hyperoxaluria.

BACKGROUND: Primary hyperoxaluria type 1 is responsible for pediatric kidney failure in 1 to 2% of cases. Novel therapies based on RNA interference are changing the natural history of the disease. However, for those who do progress to kidney failure, and for patients living in countries that cannot afford these expensive therapies, liver-kidney transplantation may remain the only efficient therapy. METHODS: The aim of the study was to evaluate the outcome of patients with primary hyperoxaluria type 1 who received simultaneous or sequential liver-kidney transplantation. We retrospectively evaluated 10 patients, five of whom received a simultaneous transplantation, and five underwent sequential transplantation, with a median postponement of the kidney transplantation of 8 months (range 4-20). Among the patients, 5 were from medium-low income countries. RESULTS: Median follow up was 3.2 years (range 1.6-11). Median estimated glomerular filtration rate at 6 and 12 months was 81.2 (range: 45.7-108.8) and 79.3 ml/min/1.73m2 (range 54.7-112.1) in patients who underwent simultaneous transplantation, and 45.7 (range 34.5-86.7) and 38.3 ml/min/1.73m2 (range 29.9-77.5) in those with sequential transplantation (p:NS). Biopsies performed at 6 and 12 months showed precipitation of calcium oxalate crystals in 7 patients, demonstrating the recurrence of deposition despite the delay between liver and kidney transplantation. No differences in kidney function or in post-transplant renal oxalate precipitation were observed between patients that underwent bilateral nephrectomy and those who did not. As of their most recent follow up, none of the patients has lost their kidney graft. CONCLUSIONS: Our study shows that by adapting the transplant strategy to individual cases, patients with primary hyperoxaluria type 1 can be successfully treated.

Feasibility study of dual-accelerated simultaneous multi-slice imaging in diffusion tensor imaging of glioma.

Objective: To explore the value of dual-accelerated simultaneous multi-slice (SMS) imaging in diffusion tensor imaging (DTI) of glioma. Methods: Thirty-four patients with glioma who underwent magnetic resonance imaging (MRI) in our hospital from January 2022 to March 2023 were randomly selected. The results of dual-accelerated SMS-DTI and conventional DTI were retrospectively analyzed. All patients were scanned using a uMR790 3.0T MRI scanner, and the scanning technicians followed a predefined sequence to ensure consistency in scan parameters. The images were subjectively evaluated using a Likert 5-point scoring system. Objective evaluation was performed by measuring the required values of the images with b-value = 1000 s/mm2, primarily measuring the signal intensity in the tumor region and the contralateral normal brain white matter region. The standard deviation values were used to calculate the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the same encoding direction as the background noise. The number of generated fiber pathways, fractional anisotropy (FA), and mean diffusivity (MD) were measured and analyzed using post-processing software. The relative FA (rFA) and relative MD (rMD) were calculated. Results: The results of conventional DTI and SMS-accelerated DTI were compared. In terms of subjective evaluation, including overall image quality, tumor edge clarity, and magnetic sensitivity artifacts, both techniques showed no significant differences, indicating comparable diagnostic performance in anatomical visualization. In terms of objective evaluation and quantitative parameter measurement, there were statistically significant differences in SNR and CNR values, with slightly lower values in the dual-accelerated SMS-DTI compared with conventional DTI, a significant reduction in scanning time can be achieved through a slight loss in image quality. The number of fiber pathways and the rFA and rMD values did not show typical differences between the two techniques. The correlation between these measures was highly similar, with no significant differences observed. Conclusion: The application of dual-accelerated simultaneous multi-slice imaging in DTI of glioma is feasible.

Evaluation of the clinical effect of 4D digital strabismus and amblyopia visual function correction system combined with traditional comprehensive treatment methods on anisometropic amblyopia.

PURPOSE: The objective of this study was to evaluate the clinical efficacy of a 4D digital strabismus and amblyopia visual function correction system (4D-DSAAVFCS) in combination with conventional modalities compared with conventional modalities alone in children with anisometropic amblyopia. METHODS: This nonrandomized controlled study collected data on best-corrected visual acuity (BCVA), simultaneous vision, fusion vision, near stereoscopic vision, the amplitude of P100 wave (graphic evoked visual potentials), and the latency of P100 wave from both eyes at the beginning of the treatment and one year later. The Mann‒Whitney U test was used to compare BCVA contrasts in different subgroups, and the independent samples t test was used to compare the amplitude and latency of P100 wave contrasts in different subgroups. The basic cure rate, simultaneous vision recovery rate, fusion vision recovery rate, and near stereoscopic vision recovery rate contrasts in different subgroups were compared via the chi-square test. RESULTS: This study included 393 children (217 boys and 176 girls) aged 3 to 12 years with anisometropic amblyopia who were treated at the Aier Eye Hospital of Wuhan University from January 2020 to December 2022. The children were divided into two groups, the 4D group (263 cases) and the traditional group (130 cases), on the basis of the treatment modality. The children in the traditional group received treatment through the conventional method of occlusion and regular training. Meanwhile, the children in the 4D group received treatment through the traditional method and the 4D-DSAAVFCS. The 4D group was divided into two age groups: 3 ~ 6 years (161 cases) and 6 ~ 12 years (102 cases). The basic cure rate of the 4D group was significantly better than that of the traditional group (χ2 = 4.318, P < 0.05). There were no statistically significant differences in the BCVA, the latency of P100 wave, or the amplitude of P100 wave between the 4D group and the traditional group before treatment (U=-0.117, t=-0.05, all P > 0.05 ). After one year of treatment, a statistically significant difference was observed between the 4D group and the conventional group in terms of BCVA, the latency of P100 wave, and the amplitude of P100 wave (U=-1.243, t=-0.853, t=-1.546, all P < 0.05). These results suggest that the therapeutic effect was greater in the 4D group than in the conventional group. The recovery rates of simultaneous vision, convergent fusion, divergent fusion, and near stereoscopic vision were significantly greater in the 4D group than in the conventional group (χ2 = 4.344, 4.726, 5.123, and 2.036, respectively; all P < 0.05). Additionally, the basic cure rate of children aged 3 ~ 6 years in the 4D group was significantly greater than that of children aged 6 ~ 12 years (χ2 = 2.365, P < 0.05). In this study, BCVA was significantly lower in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (U = -1.267, P < 0.05). Similarly, the amplitude of P100 wave was also significantly greater in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (t = -1877, P < 0.05). The latency of P100 wave was lower in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (t=-0.998, P < 0.05). Additionally, the recovery rate of near stereoscopic vision was significantly greater in the 3 ~ 6-year-old group than in the 6 ~ 12-year-old group (χ2 = 4.534, P < 0.05). CONCLUSION: The combination of the traditional method with the 4D-DSAAVFCS was more effective than the traditional method alone in treating amblyopic children. This approach was particularly helpful in improving the visual acuity of the children and restoring their optic nerve conduction function, simultaneous vision, fusion vision, and near stereoscopic vision. The combination of the traditional method and the 4D-DSAAVFCS is more effective for younger children.

Pattern recognition of multiple metal ions using fluorescent Perylenyl nanoaggregates and application in food traceability.

Metal ions (MIs) identification is essential for the safety assessment, traceability and authentication of food. Most current approaches for detecting MIs are difficult to reconcile the simplicity, sensitivity and stability simultaneously. In this work, we proposed a novel strategy for discriminating MIs based on fluorescent supramolecular nanoaggregates (SNAs). In the presence of MI, perylene diimide derivatives (PDI)-based SNAs could be formed through the multiple non-covalent interactions between them including electrostatic, coordination and π-π interactions. With the assistance of discriminant analysis (LDA), different MIs (Hg2+, Ag+, Cd2+, Fe3+, Cr3+, Fe2+, Zn2+, Cu2+ and Pb2+) were successfully identified at three different concentration levels. It featured good quantitative sensing abilities in buffer solutions and practical samples. Furthermore, a water-quality evaluation model was successfully constructed for the distinction of different sources of drinking water, and the fluorescence array sensor technology was applied for the first time to the geographical traceability of apples.

Within-episode relations among simultaneous alcohol and cannabis use and continued drinking: The role of momentary subjective responses, craving, and drinking context.

BACKGROUND: Simultaneous alcohol and cannabis use is associated with riskier daily drinking. However, little research has tested momentary mechanisms through which simultaneous use predicts continued drinking during acute drinking episodes. The current study tested whether simultaneous use moments predicted within-episode increases in subjective responses, craving, and continued drinking, and whether these relations were potentiated in social versus solitary settings. METHODS: Emerging adults who co-use alcohol and cannabis (N = 85) completed 21 days of ecological momentary assessment with event-contingent reports during drinking episodes. Three-level multilevel models tested whether simultaneous (vs. alcohol-only) use moments indirectly predicted subsequent, continued drinking through subjective responses (i.e., high-arousal positive/stimulant, high-arousal negative/aggression, low-arousal positive/relaxation, low-arousal negative/impairment) and alcohol craving, and whether relations differed by social versus solitary contexts. RESULTS: Within drinking episodes, simultaneous (vs. alcohol-only) use moments were associated with increased stimulation, which was indirectly associated with continued drinking through increased alcohol craving. Additionally, the relation between simultaneous (vs. alcohol-only) use and stimulating effects was potentiated during solitary drinking moments, whereas the relation between stimulating effects and craving was potentiated during social drinking moments. However, stimulating effects were higher in social contexts across all moments. Finally, simultaneous (vs. alcohol-only) use moments were associated with increased relaxation, which was indirectly associated with a lower likelihood of continued drinking through lesser craving. CONCLUSIONS: Simultaneous use predicted both continued within-episode drinking and cessation of drinking, with acute subjective effects and craving as mechanisms, dependent upon context. Just-in-time interventions should consider targeting affect, craving, and context in event-specific interventions.

Pediatric Huntington Disease Brains Have Distinct Morphologic and Metabolic Traits: the RAREST-JHD Study.

BACKGROUND: Pediatric-onset Huntington's disease (POHD) exhibits a phenotype different from adult-onset HD (AOHD), with hypokinetic movement disorders (eg, rigidity, bradykinesia, and dystonia) rather than chorea typical of AOHD. OBJECTIVES: The aim was to identify pathophysiology-based biomarkers specific to POHD (≥60 CAG repeats). METHODS: Simultaneous hybrid imaging using [18F]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography plus magnetic resonance imaging (FDG-PET/MRI) and clinical assessment using standardized Huntington's disease (HD) scales were employed. Exploratory longitudinal analyses were also performed. RESULTS: Striatal volume loss was remarkable and more severe in POHD (n = 5) than in AOHD (n = 14). Widespread, significantly altered glucose metabolism occurred in several different POHD cortical areas and thalamus, but not AOHD cortex, consistent with differences in clinical progression. CONCLUSIONS: POHD patients' brains exhibited distinct morphologic and metabolic traits compared to AOHD patients' brains, with longitudinal changes mirroring clinical progression. Hybrid FDG-PET/MRI highlighted a variable regional brain dysfunction in vivo, as a biological consequence of highly expanded CAG repeats. Findings provide further evidence that POHD is a distinct disease from AOHD.

Dual-Channel fluorescent detection of Biothiols: A novel probe for Distinguishing Cysteine, Homocysteine, Glutathione, and N-Acetylcysteine in cellular environments.

Biothiols, including cysteine (Cys), homocysteine (Hcy), glutathione (GSH), and N-acetylcysteine (NAC), possess similar chemical structures and properties but play crucial, distinct roles in biological cells and blood serum. Imbalances in the concentrations of these biothiols are associated with various diseases, highlighting the importance of precise discrimination, especially between Cys and other biothiols. Owing to the similarity of the chemical properties of Cys, Hcy, GSH, and NAC, developing an effective methodology to differentiate these thiol compounds is challenging. In this study, we designed and synthesized a novel dual-channel fluorescent probe, hereafter referred to as CNTC, by integrating coumarin and acrylonitrile. This probe enabled the simultaneous discrimination of Cys from Hcy, GSH, and NAC, producing distinct fluorescent signals: blue for Cys and green for Hcy, GSH, and NAC. CNTC exhibited rapid response kinetics (within 30 min) and impressive detection limits of 0.31, 0.11, 0.029, and 0.032 µM for Cys, Hcy, GSH, and NAC, respectively. Furthermore, CNTC was successfully applied in the fluorescence imaging of both exogenous and endogenous Cys, Hcy, GSH, and NAC in living cells. The remarkable analytical and bioimaging capabilities of CNTCin vivo establish it as a promising tool for elucidating the pathophysiological roles of biothiols, particularly Cys, Hcy, GSH, and NAC.

Application of Ti4+ embedded functional composite materials in simultaneous enrichment of glycopeptides and phosphopeptides.

Glycosylation and phosphorylation of proteins represent crucial forms of post-translational modifications (PTMs), playing pivotal roles in various biological processes. Research indicates a strong correlation between the development of type 2 diabetes (T2D) and abnormal protein translation in the body. Therefore, studying glycosylation and phosphorylation at the molecular level can be used for monitoring disease progression and refining research methodologies. In this study, the material is modified and functionally engineered by utilizing graphene oxide (GO) as the substrate, and incorporating titanium ions (Ti4+) into chondroitin sulfate. The composite was successfully applied to the selective enrichment of glycopeptides and phosphopeptides by utilizing the bifunctionality of hydrophilic interaction chromatography and metal ion chelation chromatography. This approach allowed for the capture of 57 glycopeptides and 2 phosphopeptides from normal human serum, and 141 glycopeptides and 10 phosphopeptides from T2D serum, respectively. This approach effectively tackles the challenges of detecting low-abundance glycopeptides and phosphopeptides in complex environments, enabling the successful capture from serum samples. The design and application of this material provide new insights into the development of PTMs and their connection to the study of T2D diabetes.

Single-Breath Simultaneous Measurement of DLNO and DLCO as Predictor of the Emphysema Component in COPD - A Retrospective Observational Study.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterized by heterogeneous abnormalities of the airways and lung parenchyma that cause different clinical presentations. The assessment of the prevailing pathogenetic components underlying COPD is not usually pursued in daily practice, also due to technological limitations and cost. Aim: To assess non-invasively the lung emphysema component of COPD by the simultaneous measurement of DLNO and DLCO via a single-breath (sDLNO and sDLCO). Methods: COPD patients aged ≥40 years of both genders were recruited consecutively and labelled by computed tomography as "with significant" emphysema (>10% of CT lung volume) or "with negligible" emphysema otherwise. Current lung function tests such as sDLNO, sDLCO and Vc (the lung capillary blood volume) were measured. All possible subsets of independent spirometric and diffusive parameters were tested as predictors of emphysema, and their predicted power compared to each parameter alone by ROC analysis and area under the curve (AUC). Results: Thirty-one patients with "significant emphysema" were compared to thirty-one with "negligible emphysema". FEV1 and FEV1/FVC seemed to be the best spirometric predictors (AUC 0.80 and 0.81, respectively), while sDLCO and Vc had the highest predicted power among diffusive parameters (AUC 0.92 and 0.94, respectively). sDLCO and Vc values were the parameters most correlated to the extent of CT emphysema. Six subsets of independent predictors were identified and included at least one spirometric and one diffusive parameter. According to goodness-to-fit scores (AIC, BIC, log-likelihood and pseudo R2), RV coupled with sDLCO or Vc proved the best predictors of emphysema. Conclusion: When investigating the parenchymal destructive component due to emphysema occurring in COPD, sDLNO, sDLCO and Vc do enhance the predictive power of current spirometric measures substantially. sDLNO, sDLCO and Vc contribute to phenotype of the main pathogenetic components of COPD easily and with high sensitivity. Organizational problems, radiation exposure, time and costs could be reduced, while personalized and precision medicine could be noticeably implemented.

Simultaneous Photocatalytic CO 2 Reduction and H 2 O Oxidation under Non-sacrificial Ambient Conditions.

The utilization of CO2, H2O, and solar energy is regarded as a sustainable route for converting CO2 into chemical feedstocks, paving the way for carbon neutrality and reclamation. However, the simultaneous photocatalytic CO2 reduction and H2O oxidation under non-sacrificial ambient conditions is still a significant challenge. Researchers have carried out extensive exploration and achieved dramatic developments in this area. In this review, we first primarily elucidate the principles of two half-reactions in the photocatalytic conversion of CO2 with H2O, i.e., CO2 reduction by the photo-generated electrons and protons, and H2O oxidation by the photo-generated holes without sacrificial agents. Subsequently, the strategies to promote two half-reactions are summarized, including the vacancy/facet/morphology design, adjacent redox site construction, and Z-scheme heterojunction development. Finally, we present the advanced in situ characterizations and future perspectives in this field. This review aims to provide fresh insights into effectively simultaneous photocatalytic CO2 reduction and H2O oxidation under non-sacrificial ambient conditions.

The impacts of roller compaction on the quality attributes of simultaneously compressed micro and minitablets.

The challenges of developing good quality low dose minitablets was assessed by systematically studying the effects of ibuprofen (IBU, a model compound) particle sizes (6-58 µm D50) and concentrations (0.1-3 %w/w), roller compaction forces (3-7 kN/cm), and the minitablet size. A novel compression approach, where three minitablet sizes (1.2, 1.5, and 2 mm) were simultaneously produced in a single compression run was used. Roller compacted ribbons, granules, minitablets were characterized for physico-mechanical properties and minitablets were also characterized for stratified content uniformity and weight uniformity. The results showed that roll force was the more dominant factor to ribbon solid fraction or tensile strength and granule size enlargement. Minitablets obtained from the granules had good weight uniformity; all but one batch met the criteria. The precise control of tooling lengths across the various sizes was found profoundly important for achieving expected weights, solid fraction, and tensile strength of the simultaneously produced minitablets. The roller compaction process considerably improved the CU variability of the minitablets as compared to the direct compression process. Smaller particle size and higher concentration of IBU, increased roller compaction force, and larger minitablet size improved the potency and content uniformity; however, only the minitablet size was a statistically significant factor in this study. As a product strategic design criterion, a threshold of 25 minitablets in a dosage unit would ensure robust downstream filling and weight verification operations as well as dose accuracy and uniformity (would pass stage 1 criteria). This study results demonstrated feasibility of the novel simultaneous compression approach and the roller compaction process in developing good quality minitablets.

Simultaneous treatment of large hiatal hernias during Roux-en-Y gastric bypass: technical considerations and outcome.

Roux-en-Y gastric bypass (RYGB) is the preferred surgical option for patients with proven gastroesophageal reflux disease and obesity grade ≥ II (BMI ≥ 35 kg/m2). Data on simultaneous treatment of larger hiatal hernias during RYGB are scarce. From 2012 until 2022, data from all consecutive patients undergoing gastric bypass procedures were collected and retrospectively analyzed. The characteristics and surgical outcomes of patients undergoing RYGB alone (RYGBa) versus RYGB with simultaneous treatment of a large hiatal hernia (RYGB-HH) were compared. Out of 573 patients who received RYGB, we identified 12 simultaneously treated for large hiatal hernia. The characteristics of RYGB-HH versus RYGBa patients were higher age (55 vs. 44 years; p = 0.004) and lower BMI (39.2 vs. 46.9 kg/m2; p = 0.001). Duration of surgery in the RYGB-HH group was longer (144 min vs. 98 min; p < 0.001), while complications > Clavien-Dindo II were similar compared to the RYGBa group (8.3 vs. 9.4%, p = 0.56). Length of stay did not differ among the groups (4 vs. 5.5 days, p = 0.051). At a median follow-up of 12 months, there was no clinical recurrence of hiatal hernia in the RYGB-HH group. Simultaneous treatment of large hiatal hernias during Roux-en-Y gastric bypass surgery prolongs operation time but seems feasible and safe in the hands of experienced surgeons.

A retrospective analysis of simultaneous bilateral uniportal thoracoscopic surgeries for multiple primary bilateral pulmonary nodules.

BACKGROUND: There are no standard treatment options for bilateral multiple pulmonary nodules requiring resection. This study aimed to summarize the experience of simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the treatment of bilateral multiple primary pulmonary nodules. METHODS: The clinical data of 65 cases of simultaneous bilateral uniportal thoracoscopic surgery for bilateral multiple primary pulmonary nodules treated were retrospectively analyzed. These cases were treated within The Ninth Medical Center of PLA General Hospital between January 2018 and November 2020. Parameters related to the surgery, perioperative aspects, surgical techniques, pathology results, and postoperative complications were examined. RESULTS: All surgeries were conducted through uniportal video-assisted thoracoscopic surgery, with no instances of intraoperative conversion to thoracotomy. Fifty-three patients further underwent CT-guided Hookwire localization for the localization of pulmonary nodules. A total of 189 nodules were resected using multiple surgical procedures, with a malignancy rate of 86.2%. The average operation time was 226 ± 77.4 min, the average thoracic drainage duration was 3.1 ± 1.5 days, the average 24 h pleural drainage was 385.9 ± 157.4 mL, the average postoperative hospital stay was 8.6 ± 2.4 days, and the average blood loss was 77.2 ± 33.8 mL. Post-surgery, all patients were transferred to the ward safely within 12 h. 15.38% of patients have prolonged drainage time, and 12.31% of patients experience complications such as lung infection, arrhythmia, and venous thrombosis. CONCLUSION: The selected cases undergoing simultaneous bilateral uniportal video-assisted thoracoscopic surgery for the management of bilateral multiple primary pulmonary nodules demonstrated favorable outcomes. Our observations indicate the safety and feasibility of this procedure, providing an individualized and precise treatment approach for affected patients.

Robot-assisted cervical esophagectomy with simultaneous transhiatal abdominal procedure for thoracic esophageal carcinoma.

BACKGROUND: Minimally invasive robot-assisted cervical esophagectomy has been sporadically reported as a novel thoracic esophagectomy technique for patients with thoracic esophageal carcinoma. Most reports indicate that the abdominal component of robot-assisted cervical esophagectomy is performed sequentially after the cervical phase. However, if the cervical and abdominal phases are performed simultaneously using a nerve integrity monitoring system with no administration of muscle relaxants, there are two major advantages: a reduced risk of recurrent nerve palsy and a shorter operative time. We herein report our experience performing novel robot-assisted transcervical esophagectomy with a simultaneous transhiatal abdominal approach using a nerve integrity monitoring system. METHODS: Thirty cases of robot-assisted cervical esophagectomy performed from 2023 to April 2024 were reviewed. The operative and short-term surgical outcomes of this procedure were compared with those of robot-assisted cervical esophagectomy using a sequential abdominal approach, and the feasibility and efficacy of the simultaneous procedure were analyzed. RESULTS: All patients successfully underwent robot-assisted cervical esophagectomy with no intraoperative adverse events. There were no differences in the patients' demographic or operative data between the two groups. There was no difference in the mean operation time for the cervical procedure (p = 0.23). However, there was a significant difference in the total time for the whole procedure (sequential group: 453.8 ± 26.8 min, simultaneous group: 291.2 ± 36.1 min; p < 0.01). There were no differences in postoperative surgical complications between the groups. There was also no difference in the total number of surgically harvested mediastinal lymph nodes (p = 0.33). CONCLUSIONS: Robot-assisted transcervical esophagectomy, a new technique for thoracic esophageal cancer, was safe and feasible under intraoperative management using nerve integrity monitoring without muscle relaxants. This procedure facilitates intraoperative monitoring of recurrent laryngeal nerve activity, significantly shortening the total operative time.

Functional and Radiological Outcome of Simultaneous Bilateral Total Knee Replacement in a Tertiary Care Centre : A Quasi-prospective Study.

Introduction: Osteoarthritis (OA) is the most frequent joint disease with a prevalence of 5313 per 100,000 persons in India. OA of the knee is a major contributor to mobility impairment, particularly among women. In these patients, total knee replacement (TKR) is widely accepted as the gold standard treatment for pain relief and restoration of function. Now, patients have the option of undergoing either a simultaneous bilateral TKR or a staged TKR. The former has shown significant advantages such as shorter rehabilitation, cost efficacy and shorter hospital stay. This study aimed to assess the functional and radiological outcome of simultaneous bilateral TKR in a tertiary care centre. Materials and Methods: 30 adult patients above the age of 55 years with severe OA knee who underwent simultaneous bilateral TKR between 2022-2023 were included in this prospective study. Preoperatively, they were assessed with radiographs including full length scannograms. Mean Anatomical Axis, Mean Mechanical Axis and Mechanical Axis Deviation (Varus) were calculated based on the scannograms by a single observer. The same observer administered the oxford knee score (OKS) preoperatively to all patients. Regular clinical and radiological follow up was done. After 1 year follow up, the same observer administered the Oxford Knee Score (OKS) to the operated knee. Results: With a female preponderance among the study subjects (56.7%), the majority of the cases in our cohort were characterised as Grade IV Kellgren-Lawrence radiological grade of Osteoarthritis (76.66%) and were found to have tricompartmental involvement (70%). The mean anatomical axis for the right and left lower limb were 4.56±5.17 and 9.68±1.72 respectively. The mean mechanical axis deviation (Varus) for the right and left lower limb were 31.6±15.1 and 52.0±13.9 respectively. Preoperatively, mean mechanical axis for the right and left lower limb were 9.95±4.31 and 14.2 ±0.67 respectively. Postoperatively, mechanical axis was restored to near-normal values (3-5 degrees). Significant improvement in mean OKS from a preoperative value of 18.30 ± 3.46 to postoperative value of 33.50 ± 5.32 was noted at 1 year. Conclusion: Treatment of severe bilateral OA knee with simultaneous single staged bilateral TKR ensures good functional outcome , early mobility with minimal complications.

Ergodic Rate Analysis of Simultaneous Transmitting and Reflecting Reconfigurable Intelligent Surface-Assisted Rate-Splitting Multiple Access Systems Based on Discrete Phase Shifts.

In this paper, we combine simultaneous transmitting and reflecting reconfigurable intelligent surface (STAR-RIS) with rate-splitting multiple access (RSMA) technology and investigate the ergodic rate performance of an STAR-assisted RSMA system. Considering the discrete phase shifts of the STAR-RIS in practice, the downlink performance of STAR-RIS-assisted RSMA with discrete phase shifts is compared to that with continuous phase shifts. Firstly, the cumulative distribution function of signal-to-interference-plus-noise ratio (SINR) of users is analyzed. Then, the total ergodic rate of the system and its approximate closed-form solution are, respectively, derived based on the cumulative distribution function of users. The simulation results validate the effectiveness of the theoretical analysis, showing good agreement between the derived theoretical ergodic rate and the corresponding simulations. Although the system performance with discrete phase shifts is inferior to that with continuous phase shifts due to quantization errors, the performance of the continuous phase shift system is well approximated when the quantization bit of the phase shift system reaches 3 in the simulations. Additionally, the impact of the number of STAR-RIS elements on the system's performance is analyzed.