A case report of robotic-assisted resection of large fibrous benign tumor of second rib

BACKGROUND

Surgical resection is the most effective curative management of benign rib tumors and carries an excellent prognosis. Due to complex anatomy and narrow field, higher rib resection is technically demanding and requires extensive dissection.

CASE PRESENTATION

We report a case of second rib tumor resection performed transthoracic under Da Vinci robot assistance. A 32-year-old male complained about increasing pain in the left anterior chest wall. After 3D reconstruction of CT, it showed a well-circumscribed fusiform lesion with a multi-component structure. Measured 17 × 6 × 4 cm and extended into the chest cavity to the depth below the pectoralis minor muscle. The patient underwent robotic-assisted trans-thoracic second rib resection. At four weeks of outpatient follow-up, the patient reported no pain and uncomplicated wound healing.

CONCLUSION

This minimally invasive approach offers optimal visualization and tissue manipulation while dramatically decreasing the possibility of collateral damage, hence ensuring fast function recovery. To the best of our knowledge, these kinds of procedures are rarely reported in detail.

In vitro antioxidant and anti-diabetic analysis of Andrographis echioides and Andrographis paniculata ethanol extract

It is of interest to analyse and compare the antioxidant and anti-diabetic activity of ethanolic extracts of Andrographis echioides and Andrographis paniculata. Andrographis echioides and Andrographis paniculata were collected from a local farm. In vitro antioxidant activity was assessed by the potential of Piperine, Lupeol, beta sitosterol; DPPH free radical scavenging assay was performed by Liyana Pathirana and Shahidi method. In vitro anti-diabetic activity was assessed by alpha amylase inhibitory activity and alpha glucosidase inhibitory activity. The data were analysed by one-way-ANOVA to check the statistical significance among the groups and considered at the levels of p<0.05. Both the ethanolic extracts of Andrographis echioides and Andrographis paniculata showed significant antioxidant and anti-diabetic potential in a dose-dependent manner (100-500µg) and can be used as potential antidiabetic agents. Similar to antioxidant potential, Andrographis paniculata exhibited an increased anti-diabetic potential compared to Andrographis echioides. Data shows that the ethanolic extracts of Andrographis echioides and Andrographis paniculata possessed antioxidant and anti-diabetic activity and hence our present findings conclude that both plants can be considered for the development of natural drugs for the management of diabetes.

A systematic review of experimental and clinical studies reporting on in situ laser fenestration of aortic endografts

OBJECTIVE

To summarize available in-situ laser fenestration (ISLF) literature, including experimental studies with their subsequent recommendations regarding optimal fenestration technique and fabric; as well as the short and mid-term results of clinical studies.

METHODS

A systematic review of English articles was performed in MEDLINE, the Cochrane Database and EMBASE, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines by two researchers. The search period was without starting date until the 31^st August 2020, and search terms included were in situ, laser, fenestration, and endograft. Quality assessment of the studies was performed using the Newcastle-Ottawa scale by two other independent researchers.

RESULTS

A total of 19 clinical studies were included, with a total of 428 patients (390 supra-aortic trunk ISLF, 38 visceral vessel ISLF). The technical success was 96.9% and 95.6% supra-aortic and visceral vessel ISLF, respectively. Most studies have less than 12-month follow-up, and the longest available follow-up (in one study) was 5-years for left-subclavian fenestration and 17-months for visceral vessel ISLF. Overall, the quality of the evaluated clinical studies was low. Six experimental studies were included, with the highest level of evidence suggesting fenestration of multifilament polyethylene terephthalate grafts, followed by dilation with either a 6- or 8-mm non-compliant balloon.

CONCLUSION

Experimental studies favour the use of multifilament polyethylene terephthalate , followed by dilation with non-compliant balloons as the most durable "in-vitro" technique for ISLF. Short-term outcomes for arch and visceral vessel revascularization are promising, with low rates of in-hospital mortality, stroke, and end-organ ischemia. Nonetheless, the long-term durability of ISLF is yet to be determined and they should be limited to selected symptomatic or urgent cases.

Review of ultrasound combinations with hybrid and innovative techniques for extraction and processing of food and natural products

Ultrasound has a significant effect on the rate of various processes in food, perfume, cosmetic, pharmaceutical, bio-fuel, materials, or fine chemical industries, despite some shortcomings. Combination with other conventional or innovative techniques can overcome these limitations, enhance energy, momentum and mass transfer, and has been successfully demonstrated in many recent studies. Various ultrasound combined hybrid and innovative techniques are systematically summarized in this review for the first time. Ultrasound can be combined with diverse conventional techniques including Soxhlet, Clevenger, enzyme, hydrotropes, ionic liquids, Deep Eutectic Solvents (DES) or Natural Deep Eutectic Solvents (NADES), to enhance mixing and micro-mixing, reduced thermal and concentration gradients, and selective extraction. Moreover, combinations of ultrasound with other innovative techniques such as microwave, extrusion, supercritical fluid, subcritical and pressure liquids, Instant controlled pressure drop (DIC), Pulsed Electric Field (PEF), Ultra-Violet (UV) or Infra-Red (IR) radiations, Counter-current chromatography (CCC), or centrifugal partition chromatographs (CPC) can enable reduced equipment size, faster response to process control, faster start-up, increased production, and elimination of process steps. The theories and applications of these ultrasound combined hybrid and innovative techniques as well as their advantages and limitations are compared, and further perspectives are proposed. This review provides new insights into advances in ultrasound combined techniques and their application at research, educational, and industrial level in modern food and plant-based chemistry.

Large-sample neutron activation analysis in mass balance and nutritional studies

Low concentrations of elements in food can be measured with various techniques, mostly in small samples (mg). These techniques provide only reliable data when the element is distributed homogeneously in the material to be analysed either naturally or after a homogenisation procedure. When this is not the case or homogenisation fails, a technique should be applied that is able to measure in samples up to grams and even kilograms and regardless of the distribution of the element. An adaptation of neutron activation analysis (NAA), called large-sample NAA, has been developed and proven accurate and may be an attractive alternative in food research and mass balance studies. Like standard NAA, large-sample NAA can be used to measure both toxic and trace elements relevant for nutrition.

In-hospital cost comparison between percutaneous pulmonary valve implantation and surgery

OBJECTIVES: Today, both surgical and percutaneous techniques are available for pulmonary valve implantation in patients with right ventricle outflow tract obstruction or insufficiency. In this controlled, non-randomized study the hospital costs per patient of the two treatment options were identified and compared.

METHODS: During the period of June 2011 until October 2014 cost data in 20 patients treated with the percutaneous technique and 14 patients treated with open surgery were consecutively included. Two methods for cost analysis were used, a retrospective average cost estimate (overhead costs) and a direct prospective detailed cost acquisition related to each individual patient (patient-specific costs).

RESULTS: The equipment cost, particularly the stents and valve itself was by far the main cost-driving factor in the percutaneous pulmonary valve group, representing 96% of the direct costs, whereas in the open surgery group the main costs derived from the postoperative care and particularly the stay in the intensive care department. The device-related cost in this group represented 13.5% of the direct costs. Length-of-stay-related costs in the percutaneous group were mean $3885 (1618) and mean $17 848 (5060) in the open surgery group. The difference in postoperative stay between the groups was statistically significant (P≤ 0.001).

CONCLUSIONS: Given the high postoperative cost in open surgery, the percutaneous procedure could be cost saving even with a device cost of more than five times the cost of the surgical device.

Nanotools and molecular techniques to rapidly identify and fight bacterial infections

Reducing the emergence and spread of antibiotic-resistant bacteria is one of the major healthcare issues of our century. In addition to the increased mortality, infections caused by multi-resistant bacteria drastically enhance the healthcare costs, mainly because of the longer duration of illness and treatment. While in the last 20years, bacterial identification has been revolutionized by the introduction of new molecular techniques, the current phenotypic techniques to determine the susceptibilities of common Gram-positive and Gram-negative bacteria require at least two days from collection of clinical samples. Therefore, there is an urgent need for the development of new technologies to determine rapidly drug susceptibility in bacteria and to achieve faster diagnoses. These techniques would also lead to a better understanding of the mechanisms that lead to the insurgence of the resistance, greatly helping the quest for new antibacterial systems and drugs. In this review, we describe some of the tools most currently used in clinical and microbiological research to study bacteria and to address the challenge of infections. We discuss the most interesting advancements in the molecular susceptibility testing systems, with a particular focus on the many applications of the MALDI-TOF MS system. In the field of the phenotypic characterization protocols, we detail some of the most promising semi-automated commercial systems and we focus on some emerging developments in the field of nanomechanical sensors, which constitute a step towards the development of rapid and affordable point-of-care testing devices and techniques. While there is still no innovative technique that is capable of completely substituting for the conventional protocols and clinical practices, many exciting new experimental setups and tools could constitute the basis of the standard testing package of future microbiological tests.