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Background Several factors have been known to correlate with the early and long-term outcomes of patients undergoing CRS/HIPEC. However, the relation between surgical approach (open vs laparoscopic colectomy) at the index colectomy and oncological outcomes following CRS/HIPEC have not been studied. Methods Patients who underwent CRS/HIPEC after previous colectomy for colorectal cancer with peritoneal metastases from 2015 to 2022 were identified from a prospectively maintained database of peritoneal surface malignancies and were divided into two groups according to the primary colectomy approach open or laparoscopic colectomy. Operative and 30-day outcomes were compared between groups, as well as survival outcomes. Results A total of 159 patients met inclusion criteria, of those 101 patients were in the open group and 58 patients were in the laparoscopic group. Both groups had similar demographics and comorbidities. TNM staging at index colectomy was similar between the groups as well as peritoneal cancer index (PCI) score for CRS/HIPEC surgery; however, there was more upper jejunal disease involvement in the laparoscopic group compared with the open group (45.5% vs. 22%, p  = 0.004) and shorter mean duration of surgery (4.1 vs. 4.69 [hour], p  = 0.004). For the laparoscopic and open colectomy groups, respectively, estimated median disease-free survival (DFS) was 25.9 months (95%CI 0–68.1) vs. 9.9 months (95%CI 1.4–12.6) ( p  < 0.001). In a multivariable analysis the surgical approach of the index colectomy was independently associated with DFS. Conclusion Performing CRS HIPEC for metachronous peritoneal metastasis following laparoscopic colectomy may be associated with favorable perioperative and survival outcomes.

Background Since its introduction, robotic surgery has been utilized in different types of surgeries over various specialties. However, studies done thus far comparing robotic (Rob. IHR) and laparoscopic inguinal hernia repair (Lap. IHR) yielded contrasting results. Objectives This study evaluates the outcomes of adapting the robotic platform for IHR by a single experienced surgeon, comparing it to laparoscopic inguinal hernia repair (Lap. IHR) performed at same time period. Methods Retrospective analysis of a prospectively maintained database including all patients that underwent IHR between 2017 and 2019 ( n  = 188) was performed. Analyzed data included patient demographics, hernia characteristics, intraoperative data and postoperative outcomes. Results Patients (n = 188) underwent a total of 120 Rob. IHR and 157 Lap. IHR. Age, sex, BMI, ASA score and length of hospital stay were similar in both groups. Recurring hernias were repaired more often robotically ( p  = 0.001). Operative time was significantly longer using the robot. (78.8 ± 24 min vs 55.4 ± 17.4 min for unilateral) and (107.9 ± 30 min vs 62.6 ± 20.2 min for bilateral) Rob. IHR vs Lap. IHR respectively, p  < 0.001. Rob. IHR operative time decreased while building a learning curve. Rates of simple and severe postoperative complications were similar, p  = 0.414. Recurrence occurred once in Rob. IHR group (1.4%) and 3 times in the Lap. IHR (1.9%) ( p  = 0.642). Conclusion Our series shows that Rob. IHR is safe with comparable outcomes to Lap. IHR even in early learning curve. Robotic inguinal hernia repair allows the buildup of a short, safe and efficacious robotic learning experience for the minimally invasive surgeons for future more complex robotic surgeries.

Background and aims Extended left hemicolectomy might be necessary for several indications. Once the resection is completed, it would be difficult or impossible to anastomose the transverse colon to the rectum due to the difficulty in mobilizing the transverse colon to reach for a tension-free rectal anastomosis. The aim of this report is to present the “Flip-Flop” technique to overcome this challenging situation. The procedure is based on a surgical technique published in the early 1960s to avoid permanent stoma after proctectomy and consists of changing the location of the right colon to reach the rectum. Methods Clinical parameters, surgical aspects, and postoperative outcome of patients that underwent the flip-flop procedure following an extended left colectomy in our medical service was reviewed. Results Three patients underwent a flip-flop procedure after an extended left colectomy performed for various reasons. The surgical technique is detailed in a step by step manner. Patients had uneventful postoperative recovery with an adequate functional outcome. Conclusions We believe that this approach should be revived and be considered also in cases when the full length of the rectum is preserved to avoid ileo-rectal anastomosis or a high-tension colocolonic anastomosis. Popularization of this surgical solution among surgeons is highly important.

Objective: Abnormal glutamatergic neurotransmission is implicated in the pathophysiology of autism spectrum disorder (ASD). In this study, the safety, tolerability, and efficacy of the glutamatergic N-methyl-d-aspartate (NMDA) receptor antagonist memantine (once-daily extended-release [ER]) were investigated in children with autism in a randomized, placebo-controlled, 12 week trial and a 48 week open-label extension. Methods: A total of 121 children 6–12 years of age with Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision (DSM-IV-TR)-defined autistic disorder were randomized (1:1) to placebo or memantine ER for 12 weeks; 104 children entered the subsequent extension trial. Maximum memantine doses were determined by body weight and ranged from 3 to 15 mg/day. Results: There was one serious adverse event (SAE) (affective disorder, with memantine) in the 12 week study and one SAE (lobar pneumonia) in the 48 week extension; both were deemed unrelated to treatment. Other AEs were considered mild or moderate and most were deemed not related to treatment. No clinically significant changes occurred in clinical laboratory values, vital signs, or electrocardiogram (ECG). There was no significant between-group difference on the primary efficacy outcome of caregiver/parent ratings on the Social Responsiveness Scale (SRS), although an improvement over baseline at Week 12 was observed in both groups. A trend for improvement at the end of the 48 week extension was observed. No improvements in the active group were observed on any of the secondary end-points, with one communication measure showing significant worsening with memantine compared with placebo (p = 0.02) after 12 weeks. Conclusions: This trial did not demonstrate clinical efficacy of memantine ER in autism; however, the tolerability and safety data were reassuring. Our results could inform future trial design in this population and may facilitate the investigation of memantine ER for other clinical applications.

Background/Objectives: Postoperative paralytic ileus (POI) is a common complication after rectal resections. Although it is often argued that laparoscopic or robotic surgery reduces ileus compared to open surgery, research indicates that the incidence rates remain considerably high after minimally invasive surgery (MIS), and it is unclear whether laparoscopy or robotic surgery confers lower ileus rates. Furthermore, the literature lacks consistency in defining ileus and does not adequately address the severity levels of this complication. This study aims to compare the incidence and severity of ileus after open, laparoscopic, and robotic oncologic rectal resections, using definitions established in the current literature. Methods: This is a retrospective cohort study including patients who underwent rectal resection in a single tertiary academic-affiliated hospital between the years 2014 and 2019. The study compared patients who underwent laparoscopic and robotic surgeries to those who underwent open surgery. Results: The study involved 337 patients who underwent oncologic rectal resection. Among them, 188 underwent laparoscopic, 59 robotic and 90 underwent open surgery. The overall incidence of postoperative paralytic ileus (POI) was 19.6%, with a significant difference observed between surgical approaches: 15.4% in the MIS group compared to 31.1% in the open surgery group (p < 0.001). Additionally, a lower ileus incidence was noted between the robotic (8.5%) and laparoscopic (17.6%) subgroups, but it did not reach statistical significance (p = 0.092). The severity of ileus did not differ significantly between laparoscopic, robotic and open surgery. Ileus risk factors that were found included advanced age, male gender, high ASA score, preoperative anemia, intraoperative bowel injury, and postoperative opioid use. Conclusions: MIS for rectal cancer is linked to a significantly lower rate of POI compared to open surgery. However, when ileus does occur, its severity is comparable across all techniques.

Background: Otitis externa (OE) is an infection of the external auditory canal that is typically treated with topically applied broad-spectrum antibiotics. Twice-daily topical treatment with ofloxacin otic 0.3% solution for 10 days has been reported to be as effective and well tolerated as the standard of care, neomycin sulfate/polymyxin B sulfate/hydrocortisone solution administered 4 times daily for 10 days. Objective: This study evaluated the efficacy and safety profile of 7 days of a once-daily regimen of ofloxacin otic 0.3% solution in the treatment of OE. Methods: This multicenter, open-label, Phase III study was conducted from June 12, 2002, to October 14, 2002. Eligible patients were aged ≥6 months and had OE of <2 weeks' duration with moderate to severe edema and tenderness involving 1 or both ears and sufficient exudate for microbiologic culture. Ofloxacin otic solution was instilled once daily for 7 days (5 drops for children aged 6 months to <13 years, 10 drops for adolescents/adults aged ≥13 years). Assessments were conducted at the end-of-treatment visit and 7 to 10 days later (the test-of-cure visit). Medication was supplied free of charge to study participants who incurred no costs for physician visits. Results: Of 489 patients enrolled at 58 sites in 3 countries, 439 were clinically evaluable (173 children, 266 adolescents/adults; 52 % males, 48% females; 47% Hispanic, 45% white; 5% black, and 3% other). The cure rate among clinically evaluable patients was 91% (95% of children, 88% of adolescents/adults); 68% of patients were cured within 7 days. Forty-three potentially pathogenic strains were isolated from 253 microbiologically evaluable patients. Pseudomonas aeruginosa was isolated from 158 (62%) microbiologically evaluable patients and Staphylococcus aureus from 32 (13%). Eradication rates were 96% overall. No serious adverse events were observed. Minor adverse events were experienced by 15 (3%) of 489 patients included in the safety population. The most common adverse events were pruritus (5 patients), increased earache (4 patients), and application-site reactions (3 patients). Overall mean (SD) adherence to therapy was 98% (11.9). Conclusions: Ofloxacin otic 0.3% solution administered once daily for 7 days was well tolerated and effective in achieving clinical and microbiologic cure of OE. The compliance rates in this study suggests that this regimen may be better accepted by patients than longer, more repetitive regimens.

Spatial correlations define the statistical structure of any visual image. Two-point correlations inform the visual system about the spatial frequency content of an image. Higher-order correlations can capture salient features such as object contours. We studied \"isodipole\" texture discrimination in V1 to determine if higher-order spatial correlations can be extracted by early stages of cortical processing. We made epicortical, local field potential, and single-cell recordings of responses elicited by isodipole texture interchange in anesthetized monkeys. Our studies demonstrate that single neurons in V1 can signal the presence of higher-order spatial correlations in visual textures. This places a computational mechanism, which may be essential for form vision at the earliest stage of cortical processing.

The importance of commissural connections in the medulla for maintenance of velocity storage, gaze holding, saccadic eye movements and gain adaptation of the vestibulo-ocular reflex (VOR) was assessed. Crossing fibers were cut by mid-sagital sections. Effective lesions extended from 1-2mm caudal to the abducens nucleus towards the obex and reached 1-4mm in depth. After lesions all functions related to velocity storage were lost. The time constant of per- and post-rotatory nystagmus shortened to 5-7 seconds without affecting the gain. The steady state velocity of OKN was unchanged, but opto kinetic after nystagmus (OKAN) was lost as well as the slow rise in slow phase velocity at the onset of optokinetic nystagmus (OKN). Horizontal-to-vertical cross-coupling during OKAN was lost, and steady-state velocity during off-vertical axis rotation (OVAR) was not maintained. Despite this, gaze holding and saccadic eye movements remained normal. One of the commissurectomized monkeys without velocity storage was able to adapt (raise and lower) its VOR gain. These findings suggest that a discrete and separate portion of the commissural fiber population that connects the vestibular and/or prepositus nuclei plays an important role in producing or maintaining velocity storage. These fibers are separate from the fibers that might contribute to gaze holding, saccade generation or VOR gain adaptation.