Incidence and Risk Factors for Blood Transfusion in Simultaneous Bilateral Total Joint Arthroplasty: A Multicenter Retrospective Study

Background

The aim of this study was to identify the incidence and risk factors for blood transfusion in patients undergoing simultaneous bilateral total hip arthroplasty (SBTHA) and simultaneous bilateral total knee arthroplasty (SBTKA).

No Difference in Total Episode-of-Care Cost Between Staged and Simultaneous Bilateral Total Joint Arthroplasty

Background

Due to concerns about higher complication rates, surgeons debate whether to perform simultaneous bilateral total joint arthroplasty (BTJA), particularly in the higher-risk Medicare population. Advances in pain management and rehabilitation protocols have called into question older studies that found an overall cost benefit for simultaneous procedures. The purpose of this study was to compare 90-day episode-of-care costs between staged and simultaneous BTJA among Medicare beneficiaries.

Late pancreas retransplantation

Pancreas retransplantation, excluding immediate retransplantation for graft thrombosis, is a technically treacherous operation with the added challenges of adhesions from the prior transplant and difficulties identifying usable recipient vessels. The goal of this study was to review our single‐center experience with late pancreas retransplantation. Charts for all pancreas transplant recipients between 01/2003 and 04/2013 were reviewed for demographics, graft and patient survival, length of stay (LOS), readmissions, and technical complications. Of 473 pancreas transplants, there were 20 late pancreas retransplants compared to 441 first transplants. There were no significant differences in donor or recipient demographics. There was no significant difference in graft or patient survival. The mean and median lengths of stay were 22 and nine d, respectively (range 5–175 d), and 11 recipients required readmission within the first three months post‐transplant. Five patients were reexplored in the early postoperative period for an enteric leak at the site of the primary allograft (n = 1), complications of percutaneous gastrostomy tube placement (n = 1), hemorrhage (n = 1), and negative laparotomy for hyperglycemia (n = 2). Pancreas retransplantation is technically challenging but can be safely performed with graft and recipient survival comparable to primary transplants.     

Spatio–temporal patterns of cognitive control revealed with simultaneous electroencephalography and functional magnetic resonance imaging

Optimal performance depends in part on the ability to inhibit the automatic processing of irrelevant information and also on the adjusting the level of control from one trial to the next. In this study, we investigated the spatio–temporal neural correlates of cognitive control using simultaneous functional magnetic resonance imaging and electroencephalography, while 22 participants (10 women) performed a numerical Stroop task. We investigated the spatial and temporal dynamic of the conflict adaptation effects (i.e., reduced interference on items that follow an incongruent stimulus compared to after a congruent stimulus). Joint independent component analysis linked the N200 component to activation of anterior cingulate cortex (ACC) and the conflict slow potential to widespread activations within the fronto–parietal executive control network. Connectivity analyses with psychophysiological interactions and dynamic causal modeling demonstrated coordinated engagement of the cognitive control network after the processing of an incongruent item, and this was correlated with better behavioral performance. Our results combined high spatial and temporal resolution to propose the following network of conflict adaptation effect and specify the time course of activation within this model: first, the anterior insula and inferior frontal gyrus are activated when incongruence is detected. These regions then signal the need for higher control to the ACC, which in turn activates the fronto–parietal executive control network to improve the performance on the next trial.     

Proof‐of‐concept evidence for trimodal simultaneous investigation of human brain function

The link between spatial (where) and temporal (when) aspects of the neural correlates of most psychological phenomena is not clear. Elucidation of this relation, which is crucial to fully understand human brain function, requires integration across multiple brain imaging modalities and cognitive tasks that reliably modulate the engagement of the brain systems of interest. By overcoming the methodological challenges posed by simultaneous recordings, the present report provides proof‐of‐concept evidence for a novel approach using three complementary imaging modalities: functional magnetic resonance imaging (fMRI), event‐related potentials (ERPs), and event‐related optical signals (EROS). Using the emotional oddball task, a paradigm that taps into both cognitive and affective aspects of processing, we show the feasibility of capturing converging and complementary measures of brain function that are not currently attainable using traditional unimodal or other multimodal approaches. This opens up unprecedented possibilities to clarify spatiotemporal integration of brain function.     

非对称PCR-FP技术同步检测HSV-1/-2、CMV和EBV

目的应用非对称PCR-荧光偏振(FP)技术建立一种同步检测全血中4种主要疱疹病毒(单纯疱疹病毒1/2型,巨细胞病毒、EB病毒)的新方法。方法以人疱疹病毒属通用引物行非对称PCR,扩增从179例样本中抽提的DNA。PCR扩增产物与特异性单纯疱疹病毒1/2型(HSV-1/-2)、巨细胞病毒(CMV)和EB病毒(EBV)寡核苷酸探针混合物温育杂交,荧光偏振检测技术检测杂交液荧光偏振值,据荧光偏振值判断病毒感染类型,并以DNA序列测定结果为参照。结果与DNA序列测定的阳性检测符合率为100%,但DNA序列测定检测均未检出多重混合感染。非对称PCR-FP方法对HSV-1/-2检测的灵敏度达到1.0×10~3拷贝/ml,对EBV和CMV检测的灵敏度达到2.0×10~3拷贝/ml。结论本法对于4种主要疱疹病毒感染的筛查及预防、预后判断具重要价值。     

Brain dynamics of post‐task resting state are influenced by expertise: Insights from baseball players

Post‐task resting state dynamics can be viewed as a task‐driven state where behavioral performance is improved through endogenous, non‐explicit learning. Tasks that have intrinsic value for individuals are hypothesized to produce post‐task resting state dynamics that promote learning. We measured simultaneous fMRI/EEG and DTI in Division‐1 collegiate baseball players and compared to a group of controls, examining differences in both functional and structural connectivity. Participants performed a surrogate baseball pitch Go/No‐Go task before a resting state scan, and we compared post‐task resting state connectivity using a seed‐based analysis from the supplementary motor area (SMA), an area whose activity discriminated players and controls in our previous results using this task. Although both groups were equally trained on the task, the experts showed differential activity in their post‐task resting state consistent with motor learning. Specifically, we found (1) differences in bilateral SMA–L Insula functional connectivity between experts and controls that may reflect group differences in motor learning, (2) differences in BOLD‐alpha oscillation correlations between groups suggests variability in modulatory attention in the post‐task state, and (3) group differences between BOLD‐beta oscillations that may indicate cognitive processing of motor inhibition. Structural connectivity analysis identified group differences in portions of the functionally derived network, suggesting that functional differences may also partially arise from variability in the underlying white matter pathways. Generally, we find that brain dynamics in the post‐task resting state differ as a function of subject expertise and potentially result from differences in both functional and structural connectivity. Hum Brain Mapp 37:4454–4471, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.     

Right inferior frontal gyrus: An integrative hub in tonal bilinguals

Right hemispheric dominance in tonal bilingualism is still controversial. In this study, we investigated hemispheric dominance in 30 simultaneous Bai‐Mandarin tonal bilinguals and 28 Mandarin monolinguals using multimodal neuroimaging. Resting‐state functional connectivity (RSFC) analysis was first performed to reveal the changes of functional connections within the language‐related network. Voxel‐based morphology (VBM) and tract‐based spatial statistics (TBSS) analyses were then used to identify bilinguals' alterations in gray matter volume (GMV) and fractional anisotropy (FA) of white matter, respectively. RSFC analyses revealed significantly increased functional connections of the right pars‐orbital part of the inferior frontal gyrus (IFG) with right caudate, right pars‐opercular part of IFG, and left inferior temporal gyrus in Bai‐Mandarin bilinguals compared to monolinguals. VBM and TBSS analyses further identified significantly greater GMV in right pars‐triangular IFG and increased FA in right superior longitudinal fasciculus (SLF) in bilinguals than in monolinguals. Taken together, these results demonstrate the integrative role of the right IFG in tonal language processing of bilinguals. Our findings suggest that the intrinsic language network in simultaneous tonal bilinguals differs from that of monolinguals in terms of both function and structure.