Enhanced activation of persulfate by modified red mud biochar for degradation of dye pollutant: Resource utilization and non-radical activation.

The substantial development of the dyeing and printing industry has resulted in an increased discharge of dye wastewater containing a large amount of recalcitrant organic pollutants. Furthermore, the landfill disposal of red mud has led to significant environmental pollution such as soil erosion and groundwater contamination. Therefore, this study aimed to promote the resource utilization of red mud by preparing advanced oxidation catalyst, resulting in effective treatment of dye wastewater, and the primary reaction mechanism was revealed. In this study, biochar-loading red mud (RBC) was applied to activate persulfate (PDS) for the degradation of acid orange 7 (AO7) with the initial concentration of 50 mg L-1. The maximum removal rate of 2.45 mg L·min-1 was achieved in 20 min and corresponding with the removal ratio of 98.0% under the PDS concentration of 20 mM (4.76 g L-1). Eventually, the removal ratio of 99.2% was attained within 60 min. The high catalytic efficiency was probably ascribed to the singlet oxygen (1O2) dominant non-radical pathway and RBC-mediated electron transfer mechanism. It was found that Fe(II), specific surface areas and functional groups on the catalyst were highly related to its catalytic efficiency and passivation. RBC had better reusability due to the loading of biochar and the reduction of zero-valent iron. The non-radical pathway mechanism and electron transfer mechanism were proposed for the activation of PDS, and non-radical pathway played a dominant role. Besides, the degradation pathways and toxicity assessment were analyzed. This research proposed a new electron transfer mechanism for activation process of PDS, which can provide a theoretical support for further studies. Overall, this study demonstrated that catalysts synthesized from red mud and biomass exhibit highly efficient activation in degrading the model pollutant AO7 through PDS activation. The catalyst displayed promising reusability and practical applicability, offering potential advancements in both the resource utilization and reduction of red mud.

Advances in Neuroimaging and Multiple Post-Processing Techniques for Epileptogenic Zone Detection of Drug-Resistant Epilepsy.

Among the approximately 20 million patients with drug-resistant epilepsy (DRE) worldwide, the vast majority can benefit from surgery to minimize seizure reduction and neurological impairment. Precise preoperative localization of epileptogenic zone (EZ) and complete resection of the lesions can influence the postoperative prognosis. However, precise localization of EZ is difficult, and the structural and functional alterations in the brain caused by DRE vary by etiology. Neuroimaging has emerged as an approach to identify the seizure-inducing structural and functional changes in the brain, and magnetic resonance imaging (MRI) and positron emission tomography (PET) have become routine noninvasive imaging tools for preoperative evaluation of DRE in many epilepsy treatment centers. Multimodal neuroimaging offers unique advantages in detecting EZ, especially in improving the detection rate of patients with negative MRI or PET findings. This approach can characterize the brain imaging characteristics of patients with DRE caused by different etiologies, serving as a bridge between clinical and pathological findings and providing a basis for individualized clinical treatment plans. In addition to the integration of multimodal imaging modalities and the development of special scanning sequences and image post-processing techniques for early and precise localization of EZ, the application of deep machine learning for extracting image features and deep learning-based artificial intelligence have gradually improved diagnostic efficiency and accuracy. These improvements can provide clinical assistance for precisely outlining the scope of EZ and indicating the relationship between EZ and functional brain areas, thereby enabling standardized and precise surgery and ensuring good prognosis. However, most existing studies have limitations imposed by factors such as their small sample sizes or hypothesis-based study designs. Therefore, we believe that the application of neuroimaging and post-processing techniques in DRE requires further development and that more efficient and accurate imaging techniques are urgently needed in clinical practice. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.

CircRRAS2 promotes myogenic differentiation of bovine MuSCs and is a novel regulatory molecule of muscle development.

The proliferation and myogenic differentiation of muscle stem cells (MuSCs) are important factors affecting muscle development and beef quality. There is increasing evidence that circRNAs can regulate myogenesis. We found a novel circRNA, named circRRAS2 that is significantly upregulated in the differentiation phase of bovine MuSCs. Here, we aimed to determine its roles in the proliferation and myogenic differentiation of these cells. The results showed that circRRAS2 was expressed in several bovine tissues. CircRRAS2 inhibited MuSCs proliferation and promoted myoblast differentiation. In addition, chromatin isolation by using RNA purification and mass spectrometry in differentiated muscle cells identified 52 RNA-binding proteins that could potentially bind to circRRAS2, in order to regulate their differentiation. The results suggest that circRRAS2 could be a specific regulator of myogenesis in bovine muscle.HighlightsCircRRAS2 expression is higher in DM cells than in GM cells.CircRRAS2 could significantly inhibit the proliferation and apoptosis of bovine MuSCs.CircRRAS2 promotes the differentiation of bovine MuSCs into myotubes.CircRRAS2 may exert regulatory effects through multiple RNA binding proteins.

The influence of different nitrate concentrations on aerobic sludge granulation and the role of extracellular polymeric substances.

This study investigated the influence of nitrate on aerobic granular sludge (AGS) granulation. The introduction of nitrate at 5, 15 and 20 mg L-1 promoted AGS granulation, and the promoting effect was positively correlated with nitrate concentrations. Meanwhile, exogenous nitrate significantly increased denitrification rate in the AGS system. However, granular disintegration appeared at a long-term addition of nitrate. An in-deep analysis showed that nitrate stimulated the secretion of extracellular polymeric substances (EPS), especially the content of proteins, which might be the main reason for the AGS granulation. However, the rapid and excessive increase in EPS might cause granular disintegration, as excessive EPS blocked the transmission of substrates, leading to the increase of dead cells in the granules. Besides, nitrate also altered the hydrophobicity of EPS and the content of α-helix, 3-turned helix and polymeric chain that favored aggregation, which also affected AGS granulation. From the microbial community level, nitrate induced the enrichment of denitrifying bacteria, including those that also functioned as EPS producers, such as Micropruina and Flavobacterium, resulting in the rapid increase of functional enzymes associated with amino acid synthesis, thereby promoting the secretion of proteins in EPS. Conversely, disintegration caused by mass transfer blockage might lead to the loss of EPS producing bacteria and subsequent decrease in EPS content, further accelerating granular disintegration.

The acceleration of aerobic sludge granulation by alternating organic loading rate: Performance and mechanism.

As a highly promising treatment technology for wastewater, long start-up time is one of the bottlenecks hindering the widespread application of aerobic granular sludge (AGS). This study focused on exploring the possibility of alternating organic loading rate (OLR) in promoting AGS granulation. Under alternating OLR (3.6-14.4 kgCOD/m3·d), AGS granulation was significantly accelerated. The mean granule size under alternating load reached 234.6 µm at 17 d, while under constant OLR (7.2 kgCOD/m3·d), the mean granule size was only 179.2 µm. Moreover, the granule size maintained continuous growth even when the alternating OLR was changed to constant OLR. Alternating load significantly increased the content of extracellular polymeric substances (EPS), especially proteins (PN) in tightly bound EPS (TB-EPS), which was likely the main reason for accelerating AGS granulation. Moreover, alternating load reduced the hydrophilicity of EPS and promoted the content of proteins secondary structures that favored aggregation in TB-EPS, which were also beneficial for granulation. Microbial community results showed that alternating load might promote the enrichment of EPS producing bacteria, such as Thauera, Brevundimonas and Shinella. Meanwhile, the content of enzymes that regulated amino acids metabolism also increased under alternating load, which might be related to the increase of PN in EPS. These results further demonstrated that alternating load promoted granulation through EPS.

Acid-modified red mud biochar for the degradation of tetracycline: Synergistic effect of adsorption and nonradical activation.

In this study, a novel acid-modified red mud biochar catalyst (MMBC) was synthesized by industrial waste red mud (RM) and peanut shell (PSL) to activate peroxodisulfate (PDS) for the degradation of TC. Meanwhile, MMBC exhibited remarkable adsorption capacity, reaching a 60% removal ratio of TC within 60 min (equilibrium adsorption capacity = 12 mg/g). After adding PDS, MMBC/PDS system achieved a 93.8% removal ratio of TC within 60 min. Quenching experiments and electron paramagnetic resonance (EPR) results showed that 1O2 played a dominant role in the degradation of TC and O2•- was the mainly precursor for the production of 1O2 in the MMBC/PDS system. X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared spectroscopy (FTIR) analysis showed that the surface Fe(II), -OH and -COOH provided the active sites for the activation of PDS by MMBC. In addition, acid modification optimised the surface structure of the catalyst and enhanced the conversion of Fe (mainly Fe(III) to Fe(II)), thereby improving the adsorption and catalytic efficiency of MMBC. This study confirmed that modified red mud biochar is an efficient composite with both adsorption and catalysis, providing new ideas for the practical treatment of antibiotic wastewater and the resource utilization of red mud.

Electrotaxis of alveolar epithelial cells in direct-current electric fields.

PURPOSE: This study aims to elucidate the electrotaxis response of alveolar epithelial cells (AECs) in direct-current electric fields (EFs), explore the impact of EFs on the cell fate of AECs, and lay the foundation for future exploitation of EFs for the treatment of acute lung injury. METHODS: AECs were extracted from rat lung tissues using magnetic-activated cell sorting. To elucidate the electrotaxis responses of AECs, different voltages of EFs (0, 50, 100, and 200 mV/mm) were applied to two types of AECs, respectively. Cell migrations were recorded and trajectories were pooled to better demonstrate cellular activities through graphs. Cell directionality was calculated as the cosine value of the angle formed by the EF vector and cell migration. To further demonstrate the impact of EFs on the pulmonary tissue, the human bronchial epithelial cells transformed with Ad12-SV40 2B (BEAS-2B cells) were obtained and experimented under the same conditions as AECs. To determine the influence on cell fate, cells underwent electric stimulation were collected to perform Western blot analysis. RESULTS: The successful separation and culturing of AECs were confirmed through immunofluorescence staining. Compared with the control, AECs in EFs demonstrated a significant directionality in a voltage-dependent way. In general, type Ⅰ alveolar epithelial cells migrated faster than type Ⅱ alveolar epithelial cells, and under EFs, these two types of cells exhibited different response threshold. For type Ⅱ alveolar epithelial cells, only EFs at 200 mV/mm resulted a significant difference to the velocity, whereas for, EFs at both 100 mV/mm and 200 mV/mm gave rise to a significant difference. Western blotting suggested that EFs led to an increased expression of a AKT and myeloid leukemia 1 and a decreased expression of Bcl-2-associated X protein and Bcl-2-like protein 11. CONCLUSION: EFs could guide and accelerate the directional migration of AECs and exert antiapoptotic effects, which indicated that EFs are important biophysical signals in the re-epithelialization of alveolar epithelium in lung injury.

CircUBE2Q2 promotes differentiation of cattle muscle stem cells and is a potential regulatory molecule of skeletal muscle development.

BACKGROUND: The growth and development of muscle stem cells (MuSCs) are significant events known to affect muscle plasticity, disease, meat production, and meat quality, which involves the types and functions of mRNA and non-coding RNA. Here, MuSCs were cultured from Guangxi fetal cattle. RNA sequencing was used to analyze the RNA expression of mRNA and non-coding RNAs during the cell proliferation and differentiation phases. RESULTS: Two thousand one hundred forty-eight mRNAs and 888 non-coding RNAs were differentially expressed between cell proliferation and differentiation phases, including 113 miRNAs, 662 lncRNAs, and 113 circRNAs. RT-qPCR verified the differential expression levels of mRNAs and non-coding RNAs, and the differentially expressed circUBE2Q2 was subsequently characterized. Expression profile analysis revealed that circUBE2Q2 was abundant in muscle tissues and intramuscular fat. The expression of cricUBE2Q2 was also significantly upregulated during MuSCs myogenic differentiation and SVFs adipogenic differentiation and decreased with age in cattle muscle tissue. Finally, the molecular mechanism of circUBE2Q2 regulating MuSCs function that affects skeletal muscle development was investigated. The results showed that circUBE2Q2 could serve as a sponge for miR-133a, significantly promoting differentiation and apoptosis of cultured MuSCs, and inhibiting proliferation of MuSCs. CONCLUSIONS: CircUBE2Q2 is associated with muscle growth and development and induces MuSCs myogenic differentiation through sponging miR-133a. This study will provide new clues for the mechanisms by which mRNAs and non-coding RNAs regulate skeletal muscle growth and development, affecting muscle quality and diseases.

Broadband transparent and high-Q resonant polarization meta-grating enabled by a non-local geometric-phase metasurface.

Spatial wavefront control and high-Q spectral filtering are both of great importance for various optical applications, such as eye-tracking for eyewear, planar optical modulators, and optical sensing. However, it is a great challenge to simultaneously satisfy these two functionalities in a metasurface due to the inevitable conflicts of local and non-local modes, where local modes of a single meta-atom manipulate the wavefront in a broadband range, while non-local collective modes of extended meta-atoms only support high-Q resonances at certain characteristic wavelengths. Here, we demonstrate a low-contrast dielectric non-local meta-grating that provides both spatial and spectral control of light in a broadband range of 700-1600 nm, offering elaborate wavefront shaping only for narrow-band resonances. Such counterintuitive functionality is supported by spatially tailored dark modes (quasi-bound states in the continuum) encoding with spatially varying geometric phases, while low-contrast dielectric provides broadband non-resonant transmission. Moreover, a broadband transparent polarization meta-grating with two resonance wavelengths is presented. Non-local geometric-phase metasurfaces open an exciting avenue for wavefront shaping and spectral manipulation, and may have potential applications in sensing, lasing, and spectral filtering.

Sensitivity enhancement of far-detuned RF field sensing based on Rydberg atoms dressed by a near-resonant RF field.

Rydberg-atom electrometers promise traceable standards for RF electrometry by enabling stable and uniform measurement. In this Letter, we propose an approach to increase the sensitivity of the Rydberg-atom electrometer for far-detuned RF field sensing. The key physical mechanism is the addition of a new ingredient-a local RF field near-resonant with a Rydberg transition-so that the far-detuned field can be detected by the shift of an Autler-Townes (AT) splitting peak, which can be dozens of times larger than the AC Stark shift of the electromagnetic induced transparency (EIT) signal without the near-resonant field. The method enables us to measure far-detuned fields with higher sensitivities, including sub-GHz RF fields (even DC electric fields) which are rarely involved in the existing sensitivity enhancement methods.

Use of Cementless Metaphyseal Fixation in Revision Total Knee Arthroplasty in the United States.

BACKGROUND: Fixation options for revision total knee arthroplasty (rTKA) have expanded and now include cementless metaphyseal fixation. The utilization rates of these implants in the United States are not well known. The purpose of this study was to analyze trends in cementless metaphyseal fixation for rTKA within the American Joint Replacement Registry (AJRR). METHODS: The AJRR was queried for the years 2015-2019 to identify all rTKA with implant data. Trends in the use of cementless sleeves, metaphyseal cones, and any cementless metaphyseal fixation (sleeves + cones) were examined over the study period using logistic regression analysis. RESULTS: Twenty thousand two hundred and eighty rTKA were analyzed. Cementless metaphyseal fixation was used in 16% of rTKA and significantly increased over the study period (14% to 19%, P < .0001). Cementless metaphyseal fixation was more frequently utilized during revision for aseptic loosening than other diagnoses (OR 1.014, 95% CI 1.001-1.027). Cementless sleeve utilization decreased over time (11% to 9%, P = .004), driven by decreased use on the femur (4% to 2%, P < .0001). The use of cones increased significantly over time (3% to 9%, P < .0001), driven by increased use on the tibia (2% to 9%, P < .0001). Cones were 22 times more likely to be utilized on the tibia relative to the femur (P < .0001) and were more likely to be used in revisions for infection (OR 1.103, 95% CI 1.089-1.117) and aseptic loosening (OR 1.764, 95% CI 1.728-1.800). CONCLUSION: Cementless metaphyseal fixation has grown in popularity yet, still comprised only 16% of rTKA over a 5-year period. Most of the increase was due to the utilization of tibial metaphyseal cones.

Can Abnormal Spinopelvic Relationships be Identified by Anteroposterior Pelvic Radiographs?

BACKGROUND: Abnormal spinopelvic relationships may place patients at an increased risk for instability after primary total hip arthroplasty. The purpose of this study was to determine if radiographic markers on a standing anteroposterior (AP) pelvis radiograph could identify patients with sagittal spinopelvic imbalance or spinal stiffness. METHODS: Patients undergoing primary total hip arthroplasty at a single institution from 2017 to 2020 with standing AP pelvis radiographs and sitting/standing lateral radiographs were identified. AP pelvis radiographs were assessed for the following: lumbosacral hardware, spine osteophytes, disc space narrowing, scoliosis>5°, pelvic obliquity>5°, and overlap of the sacrococcygeal junction/pubic symphysis. Patients with spinopelvic imbalance and/or spinopelvic stiffness were identified. Univariate and multivariate analyses were performed. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: Four hundred eighty-six patients were included. Prevalence of isolated sagittal spinopelvic imbalance and isolated spinopelvic stiffness was 12% and 21%, respectively; 11% of patients had sagittal imbalance and stiffness. Overlap of the sacrococcygeal junction/pubic symphysis (OR = 10.2, 95% CI = 5.3-19.8) and presence of lumbosacral hardware (OR = 4.4, 95% CI = 2.0-9.4) were markers of an increased risk of combined sagittal imbalance and stiffness. Seventy-nine percent of patients with overlap of the sacrococcygeal junction and pubic symphysis and 82% of patients with lumbosacral hardware had an abnormal spinopelvic relationship. CONCLUSION: Isolated sagittal imbalance and stiffness were difficult to predict on standing AP pelvis radiographs. Overlap of the sacrococcygeal junction/pubic symphysis and presence of lumbosacral hardware associated with a higher risk of combined sagittal imbalance/stiffness and were present in ≥79% of patients with an abnormal spinopelvic relationship. LEVEL OF EVIDENCE: IV; retrospective cohort study.

Recent Increases in Outpatient Total Hip Arthroplasty Have Not Increased Early Complications.

BACKGROUND: Outpatient total hip arthroplasty (THA) has increased in recent years. Recent regulatory changes may allow and incentivize outpatient THA in more patients; however, there are concerns regarding safety. The purpose of this study is to assess early complications in outpatient THA compared to longer hospitalization. METHODS: We identified patients undergoing primary THA in the National Surgical Quality Improvement Program database between 2015 and 2018. Patients were stratified by length of stay (LOS): 0 days (LOS 0), 1-2 days, and ≥3 days. Thirty-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Multivariate analysis was performed. RESULTS: In total, 4813 (4%) patients underwent outpatient THA, 84,627 (64%) had LOS of 1-2 days, and 42,293 (32%) had LOS ≥3 days. LOS 0 patients were younger, had lower body mass index, and less medical comorbidities compared to those with postsurgical hospitalization. Any complication was experienced in 3.2% of the LOS 0 group, 5.3% of the LOS 1-2 group, and 15.6% for the LOS ≥3 group (P < .0001). Readmission rates were 1.6%, 2.6%, and 4.7% for the 3 groups, respectively (P < .0001). After controlling for confounding variables, patients with LOS 1-2 days had higher odds for any complication (odds ratio 1.56 [1.32-1.83) and readmission (odds ratio 1.41 [1.12-1.78]) compared to LOS 0 days. Patients with LOS ≥3 days had higher odds for complications compared to LOS 0 or 1-2 days. CONCLUSION: Outpatient THA had lower odds for readmission or complications compared to LOS 1-2 days. Despite increased outpatient surgery, many patients had postsurgical hospitalization and, due to patient factors, this remains an integral patient of post-THA care.

Clustering-Driven DGS-Based Micro-Doppler Feature Extraction for Automatic Dynamic Hand Gesture Recognition.

We propose in this work a dynamic group sparsity (DGS) based time-frequency feature extraction method for dynamic hand gesture recognition (HGR) using millimeter-wave radar sensors. Micro-Doppler signatures of hand gestures show both sparse and structured characteristics in time-frequency domain, but previous study only focus on sparsity. We firstly introduce the structured prior when modeling the micro-Doppler signatures in this work to further enhance the features of hand gestures. The time-frequency distributions of dynamic hand gestures are first modeled using a dynamic group sparse model. A DGS-Subspace Pursuit (DGS-SP) algorithm is then utilized to extract the corresponding features. Finally, the support vector machine (SVM) classifier is employed to realize the dynamic HGR based on the extracted group sparse micro-Doppler features. The experiment shows that the proposed method achieved 3.3% recognition accuracy improvement over the sparsity-based method and has a better recognition accuracy than CNN based method in small dataset.

Application of biochar activated persulfate in the treatment of typical azo pigment wastewater.

With the increase of the azo pigment wastewater, it is necessary to seek an efficient and sustainable treatment method to address issues of damaging water ecosystems and human health. In this work, organic representing azo dye Acid Orange 7 (AO7), heavy metal representing hexavalent chromium (Cr(VI)), and inorganic representing ammonia nitrogen (NH4+-N) were selected to roughly simulate the azo pigment wastewater. The simultaneous decontamination of multi-target pollutants by 700 °C pyrolyzed peanut shell biochar (BC) with persulfate (PDS) was evaluated. The results showed that AO7, Cr(VI) and NH4+-N could finally reach 100%, 85% and 30% removal ratios separately in the BC/PDS/mixed pollutants system under certain basic conditions. Functional groups (hydroxyl groups (C-OH) and carboxylic ester/lactone groups (O-C=O)) were found by XPS as competing sites for adsorption and activation and were gradually consumed as the reaction proceeded. Combining a series of experiments results and EPR analysis, it was found that AO7 removal worked best and it relied on both the radical pathway (including SO4•-, •OH, O2-•, but not 1O2) and adsorption. Cr(VI) was mainly adsorbed and reduced by BC surface to form Cr(OH)3 and Cr2O3, and the remaining part could be reduced by O2-•, followed by •OH. NH4+-N was removed primarily by the radical same as AO7. Meanwhile, the three target pollutants have a co-competitive mechanism. Specifically, they competed for radicals and adsorption sites simultaneously, while the presence of AO7 and NH4+-N would consume the generated oxidizing radicals and further promote the removal of Cr(VI). The fixed-bed reactor simulated the continuous treatment of wastewater. Various anions (chloride (Cl-), nitrate (NO3-), carbonate (CO32-), and hydrogen phosphate (HPO42-)) interfered differently with the pollutant removal. These findings demonstrate a new dimension of BC potential for decontamination of azo pigment wastewater.

What is the likelihood of nonpulmonary metastasis occurring in the absence of lung metastasis in bone and soft tissue sarcoma? A nested case-control from a sarcoma referral centre.

BACKGROUND AND OBJECTIVES: Nonpulmonary metastases (NPM) are rare, associated with a poorer prognosis, and maybe missed on conventional chest imaging for sarcoma surveillance. We determined (1) the proportion of NPM occurring in isolation or with synchronous or prior pulmonary metastases (PM), and (2) if initial NPM would have been recognized with a standard surveillance protocol. METHODS: Investigators identified patients who developed initial NPM without prior evidence of or concurrent PM from an ongoing cohort of bone and soft tissue sarcoma (STS) patients. Logistic regression at univariate level was done. RESULTS: There were 138/630 (22%) patients with metastasis and 66 (10%) had NPM: 50 (8%) patients had PM presenting first, while 16 (3%) had initial NPM. Malignant peripheral nerve sheath tumor, angiosarcoma, rhabdomyosarcoma, synovial sarcoma, and myxoid liposarcoma were six times more likely to develop initial NPM than other subtypes of STS with odds ratio = 6 (95% confidence interval: 1.93-18.65, p value < 0.01). Chest imaging and physical examination were sufficient to identify NPM in all except three bone sarcoma patients. CONCLUSIONS: Patients who develop initial NPM are rare and demonstrate a predilection towards some subtypes of extremity sarcoma. They develop oligometastatic disease, which may be amenable for surgical excision. All isolated or initial NPM in STS patients were discovered by physical examination and standard chest imaging.

Is local recurrence in bone and soft tissue sarcomas just a local recurrence or does it impact the overall survival, retrospective cohort from a sarcoma referral center.

BACKGROUND AND OBJECTIVES: Sarcoma local recurrence (LR) is often associated with metastasis, but it is unclear if LR can be a causal event leading to metastasis. We question if LR is best viewed as an independent oncologic event or as a worrisome harbinger threatening a patient's overall survival. METHODS: We identified patients with LR and/or metastasis from an ongoing cohort of 629 patients with primary sarcoma and performed a detailed review to assess the timing of metastasis resulting in the following groups: (1) Isolated LR, (2) LR before metastasis, (3) LR within 6 months of metastasis, (4) LR 6-12 months after metastasis, (5) LR >12 months after metastasis, and (6) metastasis at diagnosis. RESULTS: Overall, 43 patients met the inclusion criteria with an LR rate of 7%. Ten patients (2% of the entire cohort, 23% of LR) developed an LR before or within 6 months of metastasis. For patients without systemic disease preceding LR, 3 of 23 soft tissue sarcoma STS (13%) and 7 of 10 bone sarcoma (70%) subsequently developed metastasis (p < 0.01). CONCLUSION: LR with subsequent metastasis is a rare event. LR appears to be best viewed as a marker of tumor aggressiveness rather than the cause of metastasis and poor survival. LR in bone sarcoma patients should warn providers of a high risk of imminent metastasis.

A comparison of results following the treatment of placenta accreta and placenta increta using high-intensity focused ultrasound followed by hysteroscopic resection.

OBJECTIVE: To compare the safety and efficacy of high-intensity focused ultrasound (HIFU) followed by hysteroscopic resection for different placenta accreta spectrum disorders. MATERIALS AND METHODS: Thirty-four patients with placenta accreta, placenta increta, or placenta percreta were treated with USgHIFU from January 2016 to December 2019 and were retrospectively reviewed. The patients were classified into three categories according to the relationship between the trophoblastic villi and the myometrium, based on magnetic resonance imaging (MRI). Fifteen patients were classified as placenta accreta, 17 patients were classified as placenta increta, and 2 were classified as placenta percreta. All patients completed follow-up. Treatment efficacy and safety were evaluated. RESULTS: No significant differences in baseline characteristics and results of HIFU ablation were observed between the patients with placenta accreta and those with placenta increta. The return of HCG levels to normal was longer in patients with placenta accreta compared with patients with placenta increta, while no significant difference was observed in the amount of intraoperative blood loss, the return of normal menstruation and the length of hospital stay. CONCLUSIONS: HIFU treatment followed by hysteroscopic resection is safe and effective in the treatment of patients with placenta accreta and placenta increta.

Early Emergency Department Visits Following Primary Hip and Knee Arthroplasty.

BACKGROUND: Postoperative emergency department (ED) utilization remains an understudied aspect of total joint arthroplasty (TJA). The purpose of this study is to characterize 30-day ED visits following TJA. METHODS: We reviewed 4061 primary unilateral total hip and knee arthroplasty cases performed at our hospital from 2013 to 2017. The primary outcome was presentation to our institution's ED within 30 days of surgery. Chief complaints and their association to the TJA encounter, as well as readmissions and reoperations, were recorded. One-to-three propensity score matched analysis was used to identify index admission variables associated with early ED visits. RESULTS: There were 253 recorded ED visits within 30 days of TJA (218 cases, 5.4%). Nearly 60% of ED visits were directly related to the TJA encounter. The remainder were medically related, most commonly for gastrointestinal complaints. The most common TJA-related complaints were surgical limb pain (28%), wound concerns (20%), and swelling (20%). These complaints comprised two-thirds of TJA-related ED visits, though accounted for only 19.4% and 9.5% of readmissions and reoperations observed in this cohort, respectively. Perioperative transfusion, length of stay, primary insurer, and discharge disposition were not associated with an ED visit. CONCLUSION: ED visits within 30 days of TJA were common (5.4%). Most visits related to the index procedure were due to surgical limb pain, wound concerns, and swelling. These complaints accounted for a minority of readmissions and reoperations. This study suggests that perioperative strategies addressing common postoperative concerns are warranted to mitigate acute care use after TJA.

Resilience and Depression Influence Clinical Outcomes Following Primary Total Joint Arthroplasty.

BACKGROUND: Resilience and depression may impact clinical outcomes following primary total joint arthroplasty (TJA). This study aimed to quantify baseline resilience and depression prevalence in patients undergoing primary TJA and evaluate their influence on patient-reported clinical outcomes. METHODS: We prospectively enrolled 98 patients undergoing primary TJA. Exclusion criteria included patients under 18 years of age, undergoing surgery for fracture, or who underwent additional surgery during the study period. Patients completed the Brief Resilience Scale to measure resilience, Patient Health Questionnaire-9 to measure depression, and Patient-Reported Outcomes Measurement Information System-10 to measure global physical and mental health preoperatively and 1 year postoperatively. RESULTS: Preoperatively, 22% and 15% of patients demonstrated major and mild depression, respectively. High resilience was identified in 34% of patients, normal resilience in 55%, and low resilience in 11%. Preoperative depression correlated with lower resilience, global physical health, and global mental health scores preoperatively as well as at 1 year after surgery (P < .001). Higher levels of preoperative resilience correlated with higher global physical and mental health scores preoperatively and at 1 year postoperatively (P < .001). CONCLUSION: Depression symptoms are common among patients undergoing primary TJA and are associated with worse patient-reported outcomes. Patients with higher levels of resilience have higher global physical and mental health scores before and after TJA. Psychological traits and depression impact clinical outcomes following TJA.