Comparison of costs of staged versus simultaneous lower extremity arterial hybrid procedures

Background

Hybrid procedures combine endovascular and open surgical techniques. We examined utilization rates and ways of performing them more efficiently.

Methods

Hybrids were selected using codes for femoral endarterectomy, infrainguinal, or aorto-iliac-femoral bypass and angioplasty from Nationwide Inpatient Sample (NIS) data, then categorized as staged, or performed on the same day. Outcomes included utilization rates, total hospital charges, and length of stay (LOS). Confounders of charges and LOS were identified and excluded from final comparisons.

Results

Utilization increased 7% from 2000 to 2004. Univariate associations linked staging to variables included in linear regressions for hospital charges and LOS. Excluding identified confounders from the final subgroup analysis still showed large differences in charges (same-day = $34,206, staged = $60,087) and LOS (same-day = 3 days, staged = 7 days).

Conclusions

Utilization of hybrids is increasing. Performing hybrids on the same day, if possible, greatly reduces hospital charges and LOS, emphasizing preadmission planning and simultaneous coordination of both portions.     

Synthesis,characterization, and bioactivity evaluation of PES-Ni-SiO2 nanocomposite membranes cum stabilization of Ag NPs for nitrophenols hydrogenation and dyes discoloration studies

Polyethersulfone (PES) Ni–SiO₂ (NS) called PES-NS based composite membranes were prepared through the addition of different Ni–SiO₂ ratios in polyether sulfone. The hybrid membranes were examined to test the NS impact on the morphology, porosity, hydrophilicity, water permeability, mechanical properties, bovine serum albumin (BSA) separation, and antibacterial features of nanocomposite cum stabilization of Ag NPs for pollutants degradation. The porosity of PES hybrid membranes was enhanced through NS inclusion (79%–87.35%) thus, membranes possessed reduced mechanical properties as compared to pristine PES membranes. Meanwhile, the hydrophilic behavior of hybrid PES membranes was increased through the addition of NS nanoparticles which causes a gradual decline in contact angle from 73.4° to 54.86°, respectively. In contrast, hybrid membranes display higher water permeability than pure PES with further increased properties through enhanced content of NS inside the PES hybrid membrane. A hybrid membrane having higher NS contents displayed a water flux of about 642.7 L/hm² much higher than a pristine PES membrane which shows a flux of about 73.30 L/hm²). Additionally, the hybrid membrane showed stronger BSA rejection whereas the PES-NS4 membrane showed maximum rejection of BSA (92.2%). The NS nanoparticle incorporation improved the membrane’s antimicrobial activity which depends strongly on the nanoparticle’s content.     

Nanocomposites of iridium oxide and conducting polymers as electroactive phases in biological media

Much effort is currently devoted to implementing new materials in electrodes that will be used in the central nervous system, either for functional electrostimulation or for tests on nerve regeneration. Their main aim is to improve the charge capacity of the electrodes, while preventing damaging secondary reactions, such as peroxide formation, occurring while applying the electric field. Thus, hybrids may represent a new generation of materials. Two novel hybrid materials are synthesized using three known biocompatible materials tested in the neural system: polypyrrole (PPy), poly(3,4-ethylenedioxythiophene) (PEDOT) and iridium oxide (IrO₂). In particular, PPy–IrO₂ and PEDOT–IrO₂ hybrid nanocomposite materials are prepared by chemical polymerization in hydrothermal conditions, using IrO₂ as oxidizing agent. The reaction yields a significant ordered new hybrid where the conducting polymer is formed around the IrO₂ nanoparticles, encapsulating them. Scanning electron microscopy and backscattering techniques show the extent of the encapsulation. Both X-ray photoelectron and Fourier transform infrared spectroscopies identify the components of the phases, as well as the absence of impurities. Electrochemical properties of the final phases in powder and pellet form are evaluated by cyclic voltammetry. Biocompatibility is tested with MTT toxicity tests using primary cultures of cortical neurons grown in vitro for 6 and 9 days.     

Nefrectomía parcial laparoscópica off-clamp tras la embolización del tumor en sala híbrida frente a nefrectomía parcial convencional: un análisis de pares emparejados por puntuación de propensión

ObjectiveOff-clamp laparoscopic partial nephrectomy in a hybrid operating room after superselective arterial embolization (hLPN) is a promising minimally invasive approach. In this study, we compared the perioperative surgical outcomes of this innovative technique with the conventional standard of care laparoscopic partial nephrectomy (cLPN) technique.Patients and methodsOverall, 86 and 127 patients treated with hLPN and cLPN, respectively, were included. These two techniques were compared in terms of surgical complications, estimated blood loss (EBL), operative time, length of stay (LOS), surgical margins, and Trifecta achievement rate (defined as warm ischemia duration < 25 min, negative surgical margins and absence of complications). A propensity score based on age, gender, BMI, preoperative eGFR and tumor size was used for a 1:1 matching of patients of each group. After matching, two groups of 67 patients with similar characteristics were obtained.ResultsConversion rate to open surgery, complications and EBL were similar in both groups. Conversely, operative time, LOS and Trifecta rates favored hLPN. The multivariate analysis showed that hLPN had a 70% higher chance of Trifecta achievement than cLPN in all age groups and for all tumor size across the study population.ConclusionCompared to a conventional approach, off-clamp laparoscopic partial nephrectomy in a hybrid room after superselective arterial embolization showed satisfying immediate surgical outcomes and reached a higher rate of Trifecta achievement. Mid and long-term functional and oncological results are needed to establish this minimally invasive surgical alternative.     

Hybrid procedure of bilateral pulmonary artery banding and bilateral ductal stenting in an infant with aortic atresia and interrupted aortic arch

We report an infant with aortic valve atresia, interrupted aortic arch, ventricular septal defect, confluent pulmonary arteries, bilateral arterial ducts, absent common carotid arteries, and anomalous coronary arteries arising from main pulmonary artery. Hybrid procedure consisting of bilateral pulmonary artery banding and bilateral arterial duct stenting was performed at 4 weeks of age. Hybrid procedure can be an alternative palliative approach in an infant with this complex cardiac anatomy. © 2014 Wiley Periodicals, Inc.     

Feature extraction and state identification in biomedical signals using hierarchical fuzzy clustering

Many problems in the field of biomedical signal processing can be reduced to a task of state recognition and event prediction. Examples can be found in tachycardia detection from ECG signals, epileptic seizure or psychotic attack prediction from an EEG signal, and prediction of vehicle drivers falling asleep from both signals. The problem generally treats a set of ordered measurements and asks for the recognition of some patterns of observed elements that will forecast an event or a transition between two different states of the biological system. It is proposed to apply clustering methods to grouping discontinuous related temporal patterns of a continuously sampled measurement. The vague switches from one stationary state to another are naturally treated by means of fuzzy clustering. In such cases, an adaptive selection of the number of clusters (the number of underlying semi-stationary processes) can overcome the general non-stationary nature of biomedical signals and enable the formation of a warning cluster. The algorithm suggested for the clustering is a new recursive algorithm for hierarchical fuzzy partioning. Each pattern can have a non-zero membership in more than one data subset in the hierarchy. A ‘natural’ and feasible solution to the cluster validity problem is suggested by combining hierarchical and fuzzy concepts. The algorithm is shown to be effective for a variety of data sets with a wide dynamic range of both covariance matrices and number of members in each class. The new method is applied to state recognition during recovery from exercise using the heart rate signal and to the forecasting of generalised epileptic seizures from the EEG signal.     

高危型HPV监测在宫颈上皮内瘤变Ⅰ随访中的意义

目的:探讨HR-HPV监测在宫颈上皮内瘤变I级(CINI)随访中的意义。方法:对158例CINI级患者每8个月随访1次,共2年。随访内容为采用HC-2检测技术检测HR-HPV感染、宫颈细胞学检查,异常者行阴道镜检查及活检,随访终点为病理诊断为CINII、CINIII及宫颈癌(此3项定义为CINII+)。结果:57例HR-HPV阴性者及63例一过性HR-HPV者中无一例病变进展;38例持续性HR-HPV感染者17例病变进展,3组间病变进展率之间有统计学差异(P<0.05),病毒负荷量与病变进展无相关性(P>0.05)。结论:持续性HR-HPV感染者CINI病变进展率高,应密切随访或采用手术治疗。     

Hybrid Assistive Limb® for sporadic inclusion body myositis: A case series

We evaluated the efficacy of rehabilitation therapy with Hybrid Assistive Limb® (HAL; hereafter HAL therapy) in three patients diagnosed with sporadic inclusion body myositis (sIBM) who were hospitalized to undergo HAL therapy. Among them, one patient participated in eight courses and the other two in two courses of HAL therapy between 2017 and 2020. We determined the mean rate of improvement in two-minute walking distance and 6 m walking speed at the time of hospital discharge. After HAL therapy, we confirmed the patients’ desire to continue the use of HAL. In one patient, we observed improvements of 146.0% and 120.0% in two-minute walk and 6 m walking speed, respectively, after the first course of HAL therapy; these values are 133.7% and 130% after the eighth course of HAL therapy. These values exceeded 90% in the other two patients after the second course of HAL therapy. HAL therapy maintained both quantity and quality of ambulation and showed positive psychological effects on patient conditions because it reduces exercise load and facilitates safety. While HAL therapy might be effective in maintaining and improving ambulation in patients with sIBM, we should consider to discontinue HAL therapy as it increased risk of falling.