Comparing The Rate of Radiological and Clinical Adjacent Segment Degeneration After Simple Anterior Cervical Discectomy Versus Discectomy Plus Fusion

Objective: To evaluate and compare the radiological changes on adjacent mobile segments and clinical findings in patients having undergone single-segment simple anterior cervical discectomy versus discectomy plus intervertebral fusion.Material and Methods: Twenty-five patients were treated with discectomy plus fusion and 20 patients with simple discectomy. Clinical pictures of the patients were evaluated with ODOM criteria before and 1 year after operation, and their improvement rates were calculated. The disc heights of superior and inferior adjacent segments, superior and inferior foramen heights, superior and inferior end plate heights of superior and inferior adjacent segments, new osteophyte development, segmental angulation and loss of cervical lordosis were evaluated on cervical radiographies before and 1 year after operation.Results: Although there were new degenerative findings in adjacent mobile segments in all patients when preoperative and postoperative measurements were compared, these radiological findings did not translate into clinical findings. In the fusion group, radiological degeneration findings were seen more frequently statistically; however, clinical results were not different between the two groups. On the other hand, loss of lordosis was significantly more frequent in the simple discectomy group.Conclusion: Although adding fusion to single-segment anterior cervical discectomy caused more frequent radiological degenerative changes in adjacent segments after 1 year compared to simple discectomy, clinical results were similar. It was thought that longer follow-up was necessary to observe clinical adjacent segment disease that was expected to become more frequent because of excessive mobility due to fusion

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

First Report and In Silico Analysis of Leishmania virus (LRV2) identified in an autochthonous Leishmania major isolate in Turkey

###EgeUn###Leishmania virus (LRV) has previously been identified in different Leishmania species. Host-LRV interaction is associated with exacerbated clinical manifestations of cutaneous leishmaniasis (CL) and may cause poor therapeutic response. CL cases due to L. major with large skin lesions resistant to routine therapy were recently identified in Turkey. Here, we report the first autochthonous case of cutaneous leislunaniasis caused by LRV-positive Leishmania major, using conventional PCR targeting the viral capsid protein of LRV The lesion of the case was 6 months old, relatively large (4 cm), and did not recover despite three consecutive intralesional applications of glucantime. Assessment of LRV's influence on prognosis and clinical outcomes of leishmaniasis, based on additional studies, is required

Supply network capacity planning for semiconductor manufacturing with uncertain demand and correlation in demand considerations

A semiconductor supply network involves many expensive steps, which have to be executed to serve global markets. The complexity of global capacity planning combined with the large capital expenditures to increase factory capacity makes it important to incorporate optimization methodologies for cost reduction and long-term planning. The typical view of a semiconductor supply network consists of layers for wafer fab, sort, assembly, test and demand centers. We present a two-stage stochastic integer-programming formulation to model a semiconductor supply network. The model makes strategic capacity decisions, (i.e., build factories or outsource) while accounting for the uncertainties in demand for multiple products. We use the model not only to analyze how variability in demand affects the make/buy decisions but also to investigate how the correlation between demands of different products affects these strategic decisions. Finally, we demonstrate the value of incorporating demand uncertainty into a decision-making scheme.Supply network capacity Stochastic programming Production planning Semiconductor manufacturing