Influence of previous abdominal surgery on clinical outcomes of patients undergoing total laparoscopic hysterectomy.

OBJECTIVE: To evaluate the potential effects of previous abdominal surgery on post-operative outcome and incidence of complications after total laparoscopic hysterectomy (TLH). METHODS: Between June 2008 and December 2016, 331 patients who underwent TLH were retrospectively reviewed. Participating patients were divided into 2 groups according to previous abdominal surgery. We compared the 2 groups based on estimated blood loss, operation time, hospital stay, surgery-related complications, and conversion to laparotomy rates. RESULTS: Group 1 included patients without a history of abdominal surgery (n=186), group 2 included patients with a history of abdominal surgery (n=145). The complication rate was 3.2% in group 1 and 2.8% in group 2. Other post-operative outcome and complications such as estimated blood loss, hospital stay and conversion to laparotomy rates did not differ significantly between groups. Adhesiolysis was significantly more common in group 2 (P<0.001) and operation time was significantly longer in the group 2 (P=0.004). The rate of conversion to laparotomy was higher in group 2, but this difference was not significant (P=0.115). Group 2 patients were divided into subgroups according to the number of surgery. In subgroups analysis of group 2, there were 70 patients who had one previous abdominal surgery and 75 patients who had 2 or more previous surgeries. Moreover, there were significant differences in adhesiolysis (P=0.004) and conversion to laparotomy (P=0.034). There were no significant differences in other complications observed upon subgroup analysis. CONCLUSION: TLH can be conducted successfully regardless of previous abdominal surgery. Patients with previous abdominal surgery are suitable and feasible candidates for TLH.

Nanomaterials and continuous wave laser-based efficient desorption for atmospheric pressure mass spectrometric imaging of live hippocampal tissue slices.

Micrometer-resolution mass spectrometric imaging of live hippocampal tissue is achieved with a highly efficient desorption of biomolecules using a 532 nm continuous wave laser and gold nanoparticles or graphene oxide as an energy transporter, which enables clear identification of the distributions of monoacylglycerol, adenine, cholesterol, sphingosine and ceramide.

Atmospheric pressure mass spectrometric imaging of live hippocampal tissue slices with subcellular spatial resolution.

We report a high spatial resolution mass spectrometry (MS) system that allows us to image live hippocampal tissue slices under open-air atmospheric pressure (AP) and ambient temperature conditions at the subcellular level. The method is based on an efficient desorption process by femtosecond (fs) laser assisted with nanoparticles and a subsequent ionization step by applying nonthermal plasma, termed AP nanoparticle and plasma assisted laser desorption ionization (AP-nanoPALDI) MS method. Combining the AP-nanoPALDI with microscopic sample scanning, MS imaging with spatial resolution of 2.9 µm was obtained. The observed AP-nanoPALDI MS imaging clearly revealed the differences of molecular composition between the apical and basal dendrite regions of a hippocampal tissue. In addition, the AP-nanoPALDI MS imaging showed the decrease of cholesterol in hippocampus by treating with methyl ß-cyclodextrin, which exemplifies the potential of AP-nanoPALDI for live tissue imaging for various biomedical applications without any chemical pretreatment and/or labeling process.

NO-dependent attenuation of TPA-induced immunoinflammatory skin changes in Balb/c mice by pindolol, heptaminol or ATRA, but not by verapamil.

Recently a mouse skin carcinogenesis study reported that a ß-blocker carvedilol displayed antitumor-properties via antihyperplastic effects. However, the antihyperplastic mechanism is unclear as the ß-blocker is characterized with multiple pleiotropic effects including stimulation of endothelial NO release and verapamil-like calcium channel blocking activity. To investigate the nature and the origin of the antihyperplastic effects, we tested topical pretreatment with pindolol, heptaminol, ATRA or verapamil against Balb/c mouse ear skin hyperplasia that was induced by TPA. We found that pindolol, heptaminol or ATRA, but not verapamil, inhibited the TPA-induced immunoinflammatory skin changes in an NO-dependent manner, which included epidermal hyperplasia, skin edema and fibrosis. Furthermore, we also observed NO-dependent alleviation of the TPA-induced NK cell depletion in the ear tissues by heptaminol pretreatment. Together our results suggest that stimulation of NO generation from constitutive synthases may be primarily responsible for the reported antihyperplastic and NK cell-preserving effects of the ß-blockers, and that similar effects may be observed in other immunity normalizing compounds that also promote endothelial NO synthesis.

The Effect of Umbilical Cord Blood Derived Mesenchymal Stem Cells in Monocrotaline-induced Pulmonary Artery Hypertension Rats.

Pulmonary arterial hypertension (PAH) causes right ventricular failure due to a gradual increase in pulmonary vascular resistance. The purposes of this study were to confirm the engraftment of human umbilical cord blood-mesenchymal stem cells (hUCB-MSCs) placed in the correct place in the lung and research on changes of hemodynamics, pulmonary pathology, immunomodulation and several gene expressions in monocrotaline (MCT)-induced PAH rat models after hUCB-MSCs transfusion. The rats were grouped as follows: the control (C) group; the M group (MCT 60 mg/kg); the U group (hUCB-MSCs transfusion). They received transfusions via the external jugular vein a week after MCT injection. The mean right ventricular pressure (RVP) was significantly reduced in the U group after the 2 week. The indicators of RV hypertrophy were significantly reduced in the U group at week 4. Reduced medial wall thickness in the pulmonary arteriole was noted in the U group at week 4. Reduced number of intra-acinar muscular pulmonary arteries was observed in the U group after 2 week. Protein expressions such as endothelin (ET)-1, endothelin receptor A (ERA), endothelial nitric oxide synthase (eNOS) and matrix metalloproteinase (MMP)-2 significantly decreased at week 4. The decreased levels of ERA, eNOS and MMP-2 immunoreactivity were noted by immnohistochemical staining. After hUCB-MSCs were administered, there were the improvement of RVH and mean RVP. Reductions in several protein expressions and immunomodulation were also detected. It is suggested that hUCB-MSCs may be a promising therapeutic option for PAH.

Detection of heparin in the salivary gland and midgut of Aedes togoi.

Mosquitoes secrete saliva that contains biological substances, including anticoagulants that counteract a host's hemostatic response and prevent blood clotting during blood feeding. This study aimed to detect heparin, an anticoagulant in Aedes togoi using an immunohistochemical detection method, in the salivary canal, salivary gland, and midgut of male and female mosquitoes. Comparisons showed that female mosquitoes contained higher concentrations of heparin than male mosquitoes. On average, the level of heparin was higher in blood-fed female mosquitoes than in non-blood-fed female mosquitoes. Heparin concentrations were higher in the midgut than in the salivary gland. This indicates presence of heparin in tissues of A. togoi.

Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial.

PURPOSE: Despite the documented blood-saving effects of tranexamic acid (TNA) in total knee arthroplasty (TKA), the question whether clinical values of TNA are identical in unilateral and bilateral TKAs remains unclear. This study was undertaken to determine the clinical values of TNA in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol in terms of efficacy (total blood loss and transfusion rate) and safety (the incidences of symptomatic deep vein thrombosis and pulmonary embolism). METHODS: One hundred and eighty unilateral and 146 bilateral TKA patients were randomized into TNA group or control group. In unilateral TKA patients, TNA (10 mg/kg) was administered intravenously 20 min before tourniquet deflation and repeated 3 h after surgery. In bilateral TKA patients, one more dose (10 mg/kg) was given before tourniquet deflation in the second TKA. A contemporary blood-saving protocol was applied to all patients. The TNA and control groups were compared separately in unilateral and bilateral TKA patients for the efficacy and safety variables. RESULTS: In unilateral TKA patients, the TNA group had less total blood loss (905 vs. 1,018 mL, p = 0.018) than the control group, but there was no difference in the allogenic transfusion rate (1 vs. 7 %, n.s.). In bilateral TKA patients, the TNA group showed no differences in total blood loss (1,282 vs. 1,379 mL, n.s.), but a significant reduction in the allogenic transfusion rate (7 vs. 27 %, p = 0.002). No symptomatic deep vein thrombosis or pulmonary embolism was found in all patients. CONCLUSION: This study demonstrates that the use of TNA reduces total blood loss, but the effects on the transfusion rate can differ depending on the type of TKAs (unilateral vs. bilateral) and the blood-saving protocols.

Effect of fluid viscosity on the liquid-feeding flow phenomena of a female mosquito.

Liquid-sucking phenomena by the two-pump system of female mosquitoes were investigated to understand the feeding mechanism. In most previous experimental studies on liquid-feeding insects, the net increase of mass was divided by the feeding time and fluid density to evaluate the intake rate. However, this weighting method is not so precise for mosquitoes, because they are too lightweight to measure the gain of mass accurately. In this study, the intake rate of female mosquitoes feeding on various sucrose solutions was estimated using a micro-particle image velocimetry technique. As the sucrose concentration increased from 1% to 50%, the intake rate decreased from 17.3 to 5.8 nl s(-1). In addition, the temporal volume variations of the two pump chambers were estimated based on the velocity and acceleration information of the flow at the center of the food canal of the proboscis. One pumping period was divided into four elementary phases, which are related to the different operational modes of the two pumps. According to the hypothetical model established in this study, the phase shift () between the two pump chambers increases from 14 to 28 ms and the percentage of reverse flow to forward flow in a pumping period decreases from 7.6% to 1.7% with increasing viscosity. The developed analytical methodology thus aids in the study of an insect's feeding mechanism.

Aberration compensation for objective phase curvature in phase holographic microscopy.

In this study, we proposed a simple and fast numerical approach to compensate for aberrations induced by objective phase curvature. This method is based on the extraction of virtual background phase from reconstructed phase values using a line profile, followed by subtraction of the virtual background phase from the reconstructed phase image. The performance and feasibility of the method were demonstrated by applying it to the phase imaging of polystyrene microspheres and red blood cells.

Efficacy of extramedullary femoral component alignment guide system for blood saving after total knee arthroplasty.

PURPOSE: To compare the extramedullary femoral alignment guide system with the conventional intramedullary alignment guide system for bleeding and transfusion rate after total knee arthroplasty (TKA). MATERIALS AND METHODS: Forty-nine female TKA patients were randomized into two groups: intramedullary (IM) group vs. extramedullary (EM) group. Drained volume of blood, hemoglobin concentration, hemoglobin drop, and transfusion rate were compared between the two groups. Wound problems, bleeding-related problems and thromboembolic complications were collected. RESULTS: The mean drained volume via vacuum drainage was less in the EM group than that in the IM group (482.9 mL vs. 266.8 mL, p=0.001). Hemoglobin at 5 days after surgery was higher in the EM group (9.3 g/dL vs. 9.9 g/dL, p=0.002) than that in the IM group. The drop in hemoglobin after 5 days was smaller in the EM group (3.5 g/dL vs. 2.9 g/dL, p=0.003) than that in the IM group. The EM group had a lower prevalence of allogeneic transfusion (45.0% vs. 20.5%, p=0.026) than that in the IM group. No significant complications developed in either group. CONCLUSIONS: The results suggest that the extramedullary femoral alignment guide technique is an advantageous method that can reduce the drained volume of blood and the allogeneic transfusion rate.

Synchrotron X-ray microscopic computed tomography of the pump system of a female mosquito.

The pumping organ of blood-sucking female mosquitoes has a three-dimensional (3D) structure. However, conventional two-dimensional imaging methods are insufficient for visualizing the 3D structure in detail. Furthermore, their 3D imaging tasks are highly time consuming and sample preparation process requires elaborate skill. Among 3D imaging techniques, synchrotron X-ray microscopic computed tomography (SR-µCT) is especially suitable for small insects with opaque cuticles, such as mosquitoes. In this study, the 3D morphological structure of the pump system of a female mosquito was visualized using SR-µCT. Expandable volume capacities of two pump chambers were measured for several mosquito samples of similar size. To verify the cross-sectional images acquired by SR-µCT, complementary paraffin-sectioning data were compared.

Pain management by periarticular multimodal drug injection after anterior cruciate ligament reconstruction: a randomized, controlled study.

PURPOSE: We aimed to determine the efficacy of periarticular (PA) multimodal drug cocktail (MDC) infiltration for pain control after anterior cruciate ligament reconstruction with an autogenous bone-patellar tendon-bone graft. METHODS: We randomly assigned 100 patients to five study groups (20 per group): control group, no injection; intra-articular (IA) ropivacaine group, IA injection of ropivacaine alone; IA MDC group, IA injection of MDC; PA MDC group, PA injection of MDC; and IA + PA MDC group, IA and PA injections of MDC. The MDC consisted of ropivacaine, morphine, ketorolac, epinephrine, and cefuroxime. The five groups were compared in terms of pain levels during the first night after surgery and on postoperative days 1, 2, and 14; patient satisfaction was assessed on postoperative day 14. RESULTS: The PA MDC and IA + PA MDC groups had less pain during the first night than patients in the other three groups (P < .001) and were more likely to have the same amount of pain or less pain on postoperative day 1 than their preoperative expectation (P = .05). However, there were no group differences in patient satisfaction on postoperative day 14. No MDC-related side effect was reported. CONCLUSIONS: The MDC injection, particularly when delivered periarticularly, provides an effective, safe means of reducing early postoperative pain after anterior cruciate ligament reconstruction at minimal cost. In addition, a single IA injection would have no value in pain relief, regardless of types of drugs. LEVEL OF EVIDENCE: Level I, randomized controlled trial.

The radiographic predictors of symptom severity in advanced knee osteoarthritis with varus deformity.

Information concerning the abilities of radiographic parameters to predict the symptoms of advanced osteoarthritis (OA) of the knee would be valuable, because plain knee radiographs are used as one of the primary tools for the selection of treatment modalities. We aimed to identify the radiographic predictors of symptom severity in patients with varus knee OA advanced enough to warrant total knee arthroplasty (TKA). In 341 knees with primary varus OA warranting TKA, pertinent radiographic features of the medial and lateral tibiofemoral joint (TFJ), and the patellofemoral joint (PFJ) were assessed separately and scored. In addition, TF alignment was assessed on standing full-limb radiographs. Symptoms and functions were evaluated using WOMAC pain and function scores. In the univariate analyses with generalized estimating equations (GEE), multiple radiographic features (subluxation of the TFJ, overall severity of the medial TFJ, and degree of TF varus alignment) were associated with poorer WOMAC function scores, whereas only the degree of TF varus alignment was associated with poorer WOMAC pain scores. None of radiographic parameters in the PFJ or lateral TFJ (except TFJ subluxation) was associated with WOMAC scores. Multivariate analyses revealed that the degree of TF varus alignment was the strongest predictor of poorer WOMAC pain and function scores. We propose that extent of TF varus malalignment should be considered as the primary indicator of objective disease severity when selecting treatment options for patients with advanced knee OA.

Additional pain relieving effect of intraoperative periarticular injections after simultaneous bilateral TKA: a randomized, controlled study.

The authors investigated the clinical value of intraoperative periarticular multimodal drug injections (PMDI) in patients on continuous epidural analgesia after simultaneous bilateral TKAs. In 55 patients scheduled to undergo simultaneous bilateral TKAs, one knee was randomly assigned to the PMDI group for which intraoperative periarticular injections were administered and the other knee was assigned to the No-PMDI group for which the injections were not done. These two groups were compared for pain level (during the operation night and on postoperative days (POD) 1, 4, and 7), functional recovery (ability to perform straight leg raising on POD 1 and maximum flexion on POD 7), patient satisfaction (POD 7), and the incidence of wound complications. The PMDI group showed a lower pain level during the operation night and on POD 1 than the No-PMDI group, but no differences in pain levels were observed between the groups on POD 4 or 7. Furthermore, no significant group differences were found in terms of functional recovery, patient satisfaction. No wound complication has been occurred in the PMDI group. This study demonstrates that PMDI provides additional pain relief limited to the immediate postoperative period but does not improve pain relief after POD 1, patient satisfaction and functional recovery.

Subcutaneous versus intraarticular indwelling closed suction drainage after TKA: a randomized controlled trial.

BACKGROUND: TKA can involve substantial bleeding, and the issue regarding whether vacuum drainage should be used during TKA continues to be debated as both methods have disadvantages. QUESTIONS/PURPOSES: We therefore asked whether subcutaneous indwelling vacuum drainage is advantageous over intraarticular indwelling vacuum drainage in terms of blood drainage, bleeding-related complications, and functional outcomes in primary TKA. PATIENTS AND METHODS: We randomized 111 patients undergoing TKAs to have either a subcutaneous indwelling or an intraarticular indwelling catheter and compared the two groups for blood loss (hemoglobin decrease, transfusion requirements, hypotension episode), incidence of wound problems (requirements for dressing reinforcement, oozing, hematoma, hemarthrosis, ecchymosis, infection), and functional outcomes (recovery of motion arc, American Knee Society, WOMAC, and SF-36 scores) at 12 months after surgery. RESULTS: The mean vacuum drainage volume was less in the subcutaneous indwelling group than in the intraarticular indwelling group (140 mL versus 352 mL). The groups were similar in terms of decreases in hemoglobin after 2 and 5 days (3.0 versus 3.3 g/dL and 3.3 versus 3.7 g/dL, respectively), allogenic transfusion requirements (4% versus 11%), incidence of wound problems, and functional scores. CONCLUSIONS: The data suggest subcutaneous indwelling closed-suction drainage is a reasonable alternative to intraarticular indwelling closed-suction drainage and to no suction drainage. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Inter- and intra-observer reliability of MRI for lumbar lateral disc herniation.

BACKGROUND: The authors analyzed inter- and intra-observer agreement with respect to interpretation of simple magnetic resonance T1- and T2-weighted axial and sagittal images for the diagnosis of lumbar lateral disc herniation, including foraminal and extraforaminal disc herniations. METHODS: Forty-two patients in whom lumbar lateral disc herniation was suspected or confirmed by simple magnetic resonance imaging at one institute between May 2003 and December 2004 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. RESULTS: The kappa values for inter-observer agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-observer agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. CONCLUSIONS: The present study indicates that simple magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. Another imaging study with improved diagnostic values should be developed to diagnose this pathologic finding.