Comparison of safety and efficiency between sequential simultaneous bilateral and staged bilateral total knee arthroplasty at a high-volume center: a retrospective cohort study.

The treatment strategy remains controversial for bilateral end-stage osteoarthritis, particularly with regard to patient safety. The aim of this study was to compare the safety and clinical results of sequential simultaneous bilateral total knee arthroplasty (ssBTKA) and staged bilateral total knee arthroplasty (staBTKA). Patients who underwent either simultaneous (n=168) or staged (n=63) bilateral total knee arthroplasty in a single center between February 2017 and April 2021 were identified retrospectively. Data related to age, gender, body mass index, ASA score, comorbidities, operative time, transfusion rate, length of stay, knee range of motion (ROM), Knee Society Score (KSS), complications, and mortality rates were evaluated. Mean follow-up duration was 39.0±14.7 months. Preoperative characteristics were similar among cohorts. Transfused units were significantly higher in the ssBTKA group (p<0.001). Operative time and length of stay were significantly higher in the staBTKA group (respectively, p<0.001 and p=0.004). Complication rates (except superficial infection rate which was significantly higher in the staBTKA group), revision rates, mortality rates and functional outcomes were statistically similar between the groups (p>0.05). Presence of preoperative coronary artery disease comorbidity was significantly associated with increased postoperative myocardial infarction risk (p=0.001). ssBTKA provided similar functional results, shorter cumulative hospital stay and shorter operative time without increasing complications and mortality rates compared to staBTKA procedure. For patients with pre-existing coronary artery disease, a more cautious approach should be preferred to decrease complications.

Frequency of silent myocardial ischemia in type 2 diabetic patients and the relation with poor glycemic control.

The aim of the study was to investigate the frequency of silent myocardial ischemia in type 2 diabetic patients without any clinical or laboratory findings of myocardial ischemia and to examine the related factors for silent myocardial ischemia. A total of 116 type 2 diabetic patients (82 women) with a disease duration of 5-20 years were included in the study. All patients underwent stress and resting myocardial perfusion single-photon emission computed tomographic (SPECT) study with (99m)Tc-MIBI. Coronary angiography was performed in patients with ischemia established at myocardial perfusion SPECT. Ischemia was determined in 18 (15.5%) patients by myocardial perfusion SPECT. Coronary angiography performed in 17 of these patients confirmed coronary stenosis >50% in 11 patients. Thus, the prevalence of silent myocardial ischemia was 9.6%. Significant relations were found between silent myocardial ischemia and male sex, high HbA(1C) level and retinopathy. Type 2 diabetic patients (especially men) with poorly controlled diabetes mellitus or retinopathy should be screened for silent myocardial ischemia.

Repeated exposure to social stress has long-term effects on indirect markers of dopaminergic activity in brain regions associated with motivated behavior.

The visible burrow system (VBS) is a chronic social stress paradigm in which a dominance hierarchy forms among male rats housed with females. Males in the VBS undergo behavioral and physiological changes thought to be manifestations of chronic social stress. Since it is unclear whether chronic social stress affects motivation and reward behavior, brain areas related to these regions were examined. Long-term effects of a single or repeated VBS exposure on mesolimbic subregions were investigated by exposing rats to the VBS either once (one cycle of VBS housing and recovery) or repeatedly (three cycles). Behavior in the VBS was observed and rats were classified as dominants or subordinates. Subordinates were further sub-classified on the basis of stress hormone (corticosterone) response to an acute stressor (i.e. restraint stress). Normal responders were categorized as stress-responsive subordinates (SRS) and animals with a blunted hypothalamic-pituitary-adrenal axis response were designated as non-responsive subordinates (NRS). Controls males were pair-housed with a single female during VBS periods and alone during recovery. Lowered enkephalin-mRNA levels were observed in the nucleus accumbens (Acb) after single VBS exposure in SRS and repeated VBS exposure both subordinate groups (i.e. SRS + NRS) compared with controls. Decreased dopamine transporter density was detected after single VBS exposure in the dorsolateral caudate putamen (DLCPu) of NRS and after repeated VBS exposure in the Acb of NRS compared with controls. Dopamine D2 receptor density was elevated after single VBS exposure in the Acb of both subordinate groups (SRS + NRS) and after repeated VBS exposure in the DLCPu, dorsomedial CPu, and Acb of NRS compared with controls. No changes in dopamine D1 receptor binding were observed in any group. These results suggest that long-term changes in dopamine activity in mesolimbic structures persist after repeated exposures to chronic social stress and may provide insight into the neurochemical basis of depressive illness and subsequent comorbidity with drug abuse vulnerability.

Angiotensin converting enzyme gene polymorphism and glomerular filtration rate changes in type 2 diabetic patients.

It has been suggested that an insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin-converting enzyme (ACE) gene may be associated with diabetic nephropathy The aim of this study was to investigate whether an association exists between ACE I/D polymorphism and glomerular filtration rate (GFR) in type 2 diabetes mellitus. A total of 128 type 2 diabetic patients were included in the study with the following ACE genotype distribution: DD 40, ID 58,11 30. I/D polymorphism was determined by polymerase chain reaction (PCR). Mean GFR was not statistically different according to ACE genotype (DD: 89.9 +/- 28.1 ml/min, ID: 99.5 +/- 25.1 ml/min, II: 96.6 +/- 19.6 ml/min). There was no significant difference in genotype distribution in normo-, micro- and macroalbuminuric patients (DD:ID:II [%], normo- 35:46:19, micro-28:55:17, macro- 31:55:14). ACE I/D polymorphism does not seem to be associated with GFR in type 2 diabetic patients.

Scintigraphic evaluation of the Eustachian tube functions.

Eustachian tube (ET) dysfunction is one of the most important factors in the etiology of middle ear disease. There are several methods to assess the functions of ET which show the anatomic patency of the tube. However, functional patency of ET should be evaluated as well. For this reason, we used a scintigraphic method at 42 patients who had otitis media with effusion (study group) and traumatic perforation of the ear drum (control group) at 32 and 10 of them, respectively. After instillation of 100 microCi (100 microliters) Technetium 99m-macro-aggregated albumin (Tc99m-MAA) into the middle ear, 60 images were taken at 15 second intervals. Both groups were investigated as to whether there was radioactivity passage through ET and, the arrival time of the radioactivity to ET and to nasopharynx were calculated if the passage occurred. Radioactivity passage rates in the study and control groups were 5 (16%) and 10 (100%), respectively. The difference between both groups was statistically very significant (Chi-square, p < 0.001). Scintigraphy is a feasible tool for the assessment of ET functions. Scintigraphic methods should be improved and be used as a tubal function test in the future.

Evaluation of growth in children using quantitative bone scintigraphy.

Our aim was to assess the value of quantitative bone scintigraphy for evaluating long-bone growth and to establish the normal uptake patterns of the growth plate in children. Subjects (180 girls, 154 boys) of normal weight and height, aged 2-20 years, were investigated using skeletal scintigraphy. Regions of interest were outlined over posterior images of the distal femoral growth plate and femoral diaphysis. The average number of counts per fixel in each region of interest was determined. The ratio of uptake in the distal femoral growth plate to that in the femoral diaphysis (GP:D ratio) was calculated for all subjects, and its relationship with age was determined. Peak GP:D ratios in girls and boys were reached at ages 11 and 13 years, respectively (8.26 in girls and 8.18 in boys), corresponding to the periods of most rapid growth. Our findings suggest that determining the scintigraphic GP:D ratio may be useful for evaluating growth and development in children if normal standard GP:D ratios are established.