22G Needle Research Articles

Development of Injectable Calcium Sulfate and Self-Setting Calcium Phosphate Composite Bone Graft Materials for Minimally Invasive Surgery.

The demand of bone grafting is increasing as the population ages worldwide. Although bone graft materials have been extensively developed over the decades, only a few injectable bone grafts are clinically available and none of them can be extruded from 18G needles. To overcome the existing treatment limitations, the aim of this study is to develop ideal injectable implants from biomaterials for minimally invasive surgery. An injectable composite bone graft containing calcium sulfate hemihydrate, tetracalcium phosphate, and anhydrous calcium hydrogen phosphate (CSH/CaP paste) was prepared with different CSH/CaP ratios and different concentrations of additives. The setting time, injectability, mechanical properties, and biocompatibility were evaluated. The developed injectable CSH/CaP paste (CSH/CaP 1:1 supplemented with 6% citric acid and 2% HPMC) presented good handling properties, great biocompatibility, and adequate mechanical strength. Furthermore, the paste was demonstrated to be extruded from a syringe equipped with 18G needles and exerted a great potential for minimally invasive surgery. The developed injectable implants with tissue repairing potentials will provide an ideal therapeutic strategy for minimally invasive surgery to apply in the treatment of maxillofacial defects, certain indications in the spine, inferior turbinate for empty nose syndrome (ENS), or reconstructive rhinoplasty.

Efficacy and safety of percutaneous renal biopsy performed using 18G needle versus 16G needle: a single-center retrospective study

BackgroundAt present, both 16G and 18G needles are used for percutaneous renal biopsy in China. This study aimed to compare the efficacy and safety of biopsy performed with the 18G needle vs. the 16G needle.MethodsThe data of patients who underwent percutaneous renal biopsy at our hospital between January 2015 and December 2019 were retrospectively analyzed. The number of glomeruli obtained by puncture and postoperative complications were compared between patients undergoing biopsy with the 16G and 18G needles. Continuous variables were compared by the t test or the Mann–Whitney U test, and categorical variables by the chi-square test. Correlation analysis was used to examine the relationship of different variables with hematoma size.ResultsOf the total 3138 kidney biopsies, 2526 were performed with the18G needle and 612 with the 16G needle. The number of glomeruli obtained was not significantly different between the two groups (P = 0.078). Large hematomas were significantly more common the 16G group than in the 18G group (9.31% vs. 5.98%, P = 0.003). Arteriovenous fistula was also more common in the 16G group (1.14% vs. 0.23%, P = 0.005). Other complications were rare, with similar incidence in the two groups.ConclusionThe 18G needle is as effective as the 16G needle for percutaneous renal biopsy. The risk of large hematoma and arteriovenous fistula appear to be lower with the 18G needle.

Passive mechanical properties of the left ventricular myocardium and extracellular matrix in hearts with chronic volume overload from mitral regurgitation.

Cardiac volume overload from mitral regurgitation (MR) is a trigger for left ventricular dilatation, remodeling, and ultimate failure. While the functional and structural adaptations to this overload are known, the adaptation of myocardial mechanical properties remains unknown. Using a rodent model of MR, in this study, we discern changes in the passive material properties of the intact and decellularized myocardium. Eighty Sprague‐Dawley rats (350–400 g) were assigned to two groups: (1) MR (n = 40) and (2) control (n = 40). MR was induced in the beating heart by perforating the mitral leaflet with a 23G needle, and rats were terminated at 2, 10, 20, or 40 weeks (n = 10/time‐point). Echocardiography was performed at baseline and termination, and explanted hearts were used for equibiaxial mechanical testing of the intact myocardium and after decellularization. Two weeks after inducing severe MR, the myocardium was more extensible compared to control, however, stiffness and extensibility of the extracellular matrix did not differ from control at this timepoint. By 20 weeks, the myocardium was stiffer with a higher elastic modulus of 1920 ± 246 kPa, and a parallel rise in extracellular matrix stiffness. Despite some matrix stiffening, it only contributed to 31% and 36% of the elastic modulus of the intact tissue in the circumferential and longitudinal directions. At 40 weeks, similar trends of increasing stiffness were observed, but the contribution of extracellular matrix remained relatively low. Chronic MR induces ventricular myocardial stiffening, which seems to be driven by the myocyte compartment of the muscle, and not the extracellular matrix.

Drug Product Characterization of High Concentration Non-Aqueous Protein Powder Suspensions

High concentration protein formulations for subcutaneous injection represent a substantial number of development projects in the pharmaceutical industry. Such concentrated aqueous protein solutions face some specific challenges such as increased viscosity and aggregation propensity. Protein powder suspensions in non-aqueous vehicles could be an alternative providing lower viscosity than the respective aqueous solution. The choice of potential suspension vehicles is limited as traditional non-aqueous liquids, such as oils, show an inherent high viscosity. We studied suspensions prepared by dispersing spray-dried protein powder in different vehicles including sesame oil and medium chain triglycerides, as well as fluorinated and semifluorinated alkanes. We found, that semifluorinated alkanes enable formulations with high concentrations up to 280 mg/ml monoclonal antibody with a low viscosity of less than 10 mPa·s and low injection forces. The glide force of suspensions containing 210 mg/ml protein was not affected by the particle size of the spray-dried powders with medians ranging from 1 to 14 µm. In contrast, suspensions prepared with cryo-milled powder showed markedly higher viscosities and were not injectable at the same concentration. Protein powder suspensions were syringeable using a 25G needle. Vial filling using a peristaltic pump was possible and lead to a uniform filling. Sedimentation of the suspension was slow and does not lead to challenges upon vial filling during manufacturing or transfer of the suspension into syringes. Thus, we could show that dispersions of spray-dried protein powders in non-aqueous vehicles, such as semifluorinated alkanes, are a promising alternative to aqueous protein solutions at high concentrations.

P-611 In vitro fertilization outcomes of the mature and immature oocyte in mild stimulation cycle

Abstract Study question Does in vitro maturation (IVM) of immature oocytes retrieved from small antral follicles during mild stimulation protocol have an impact on future IVF outcomes? Summary answer Although fertilization, cleavage, and blastocyst rates were lower in IVM oocytes, mature and immature groups are comparable for the implantation and cumulative clinical pregnancy rates What is known already Mild-stimulation protocols are patient-friendly, cost-effective, and have acceptable outcomes, especially among poor responders. IVM obtained attention among fertility specialists for riskless ovarian hyperstimulation syndrome along with acceptable clinical pregnancy and live birth. This study is aimed to investigate IVF outcomes of IVM during mild stimulation protocols. Study design, size, duration This prospective cohort study has enrolled 949 IVF/ICSI cycles carried out with clomiphene-based mild stimulation protocol during 2018-2020 at RMC national IVF center in Mongolia. A total of 2346 oocytes were selected and divided into mature (metaphase II-MII, n = 1272) and immature (metaphase I–MI, and prophase I-GV, n = 1074) groups. Participants/materials, setting, methods 50 mg of clomiphene citrate was provided from day 3 of menstruation. The oocyte retrieval was usually performed after 30-36 hours of triggering the GnRH agonist while using a 21-G needle (Kitazato Corporation). MII oocytes were either freshly fertilized conventional insemination or intracytoplasmic sperm injection approximately after 3 and 5 hours of oocyte retrieval. MI and GV oocytes had reached the metaphase II stage in vitro after 8 to 40h of culture. Main results and the role of chance Fertilization rate was 76.3% (n = 971/1272) in mature group and 62.4% (n = 312/500) in immature group (Chi square=34.8, p < 0.01). Cleavage rate was 98.4% (n = 955/971) vs 95.5%(n = 298/312) (Chi square=8.33, p < 0.01), and blast formation rate was 62.3% (n = 595/955) vs 38.7% (n = 115/298) (Chi square=51.3, p < 0.01) which is significantly lower compared to the mature group. A total of 296 fresh or frozen single embryo transfer procedures were performed at blastocysts. Implantation rate was 58.4% (n = 149/255) in mature group and 58.5% (n = 24/41) in immature group, cumulative clinical pregnancy rate was 33.3% (n = 85/255) vs 41.5% (n = 17/41), live birth rate was 28.2% (n = 72/255) vs 41.5% (n = 17/41), which has no statistical difference between the groups Limitations, reasons for caution The sample size of embryo transfer in the immature group was small in the study, and randomized clinical trials are further required to clarify the difference between outcomes of mature and immature oocytes in mild stimulation Wider implications of the findings Data from the study has confirmed favorable clinical outcomes of in vitro maturation of the immature oocytes during mild stimulation. IVM seems to remain as an alternative option and is recommended for all IVF laboratories rather than neglecting it. Trial registration number Not applicable

P-076 Standard IV cannula aspiration of testicular sperm: A novel, efficient and minimally invasive aspiration technique

Abstract Study question Can we aspirate enough testicular tissue for sperm retrieval in non-obstructive azoospermia (NOA), using a wide bore 14-G Standard IV cannula in comparison to micro-TESE? Summary answer Standard IV cannula Aspiration (SIVCA) can yield an ample amount of testicular tissue sufficient for sperm retrieval through a single puncture site on the scrotum. What is known already The current conventional method of testicular sperm aspiration is fine needle aspiration (FNA). FNA has the advantage of being a cost-effective and minimally invasive procedure compared to open testicular sperm extraction (TESE). But FNA with its conventional 23-G needle may not always yield enough testicular tissue for sperm retrieval. Furthermore, FNA may require multiple punctures on the scrotum to retrieve enough tissues from different areas of the testis. Study design, size, duration A 24 months prospective cohort study conducted at a specialized IVF center. A total of 130 men aged from 22 to 53 years old (35.03 +/- 9.04) with NOA and normal testicular volume (≥ 12ml) were enrolled in the study. The men had testicular biopsies taken at the day of their partners’ ovum pick-up. On each patient, the testes were randomized to undergo SIVCA on one testis followed by micro-TESE on the contralateral testis. Participants/materials, setting, methods After local anesthesia, a wide bore 14-G standard IV cannula was introduced near the lower pole of the testis. The needle was withdrawn and the catheter introduced into the testicular tissue. A 20-ml syringe was secured to the catheter and constant negative pressure applied and secured with a clamp. Back and forth motions were performed covering as many areas of the testis as possible. Micro-TESE was then performed on the contralateral testis. Main results and the role of chance Sperm retrieval rates (SRR) were compared between the two techniques using McNemar χ2 test. A P-value of less than 0.05 was considered to be statistically significant. Out of a total of 130 cases, an adequate tissue sample could successfully be aspirated using SIVCA in 122 cases, showing a 0.93 probability of success. In those 8 cases where SIVCA had not yielded sufficient tissue and were reverted to micro-TESE, 2 cases were positive for sperm retrieval. Whenever tissue aspiration was successful with both methods, both SIVCA and micro-TESE showed similar success rate with respect to SRR (56.2 vs 57.3%; McNemar P = 1.000). Limitations, reasons for caution Both FNA and SIVCA are not easy to perform on small sized testes. Moreover if testicular tissue is fibrotic or sclerotic, it may be difficult to aspirate and micro-TESE would be the ideal choice to yield enough testicular tissue. Further blinded randomized control studies with larger datasets are recommended. Wider implications of the findings The use of a peripheral IV wide bore cannula is suitable for the aspiration of adequate amounts of testicular tissue for sperm searching whilst requiring only a single puncture on the scrotum. We recommend routinely starting off with SIVCA to search for sperm before reverting to micro-TESE. Trial registration number Unique Protocol ID: SIVCA Protocol registration Records number will be made available to the public through the ClinicalTrials.gov web site within 2 to 5 days of today 31/1/2022

Unusual diagnosis of feline cardiac lymphoma using cardiac needle biopsy

BackgroundCardiac tumors in cats are relatively rare, with lymphoma accounting for more than half of all cases. However, feline cardiac lymphoma is often diagnosed post-mortem, and it is difficult to diagnose while the cat is still alive. It is the first report of a direct, rather than estimative, diagnosis with cardiac needle biopsy of a living cat with cardiac lymphoma.Case presentationA 3-year-old domestic short-haired male cat experienced loss of energy and loss of appetite. Thoracic radiography and transthoracic echocardiography showed cardiomegaly with slight pleural effusion and cardiac tamponade due to pericardial effusion, respectively. In addition, partial hyperechoic and hypertrophy of the papillary muscle and myocardium were observed. Blood test showed an increase in cardiac troponin I levels. Pericardial fluid, removed by pericardiocentesis, was analyzed; however, the cause could not be determined. With the owner’s consent, pericardiectomy performed under thoracotomy revealed a discolored myocardium. Cardiac needle biopsy was performed with a 25G needle, and a large number of large atypical lymphocytes were collected; therefore, a direct diagnosis of cardiac lymphoma was made. Pathological examination of the pericardium diagnosed at a later date revealed T-cell large cell lymphoma. The cat underwent chemotherapy followed by temporary remission but died 60 days after the diagnosis. Postmortem, two-dimensional speckle-tracking echocardiography (data when alive) revealed an abnormal left ventricular myocardial deformation, which corresponded to the site of cardiac needle biopsy.ConclusionsThis rare case demonstrates that cardiac lymphoma should be added to the differential diagnosis in cats with myocardial hypertrophy and that the diagnosis can be made directly by thoracotomy and cardiac needle biopsy. In addition, the measurement of cardiac troponin I levels and local deformation analysis of the myocardium by two-dimensional speckle-tracking echocardiography may be useful in the diagnosis of cardiac tumors.

Comparisons between needle puncture and chondroitinase ABC to induce intervertebral disc degeneration in rabbits.

This study aimed to compare the effect of needle puncture and chondroitinase ABC (ChABC) injection on inducing intervertebral disc (IVD) degeneration (IVDD) in rabbits. Sixteen New Zealand white rabbits were used in this study. Briefly, the rabbits were divided into four groups. In the annulus fibrosis (AF) needle puncture group, a 16-G needle was used to puncture the L5-6 and L6-7 IVDs, while in the sham group, these IVDs were not punctured. In the ChABC group, 30 μL 0.5 Unit/mL ChABC was injected into L5-6 and L6-7 IVDs using a 26-G needle, while in the vehicle group, these IVDs were injected with 30 μL phosphate-buffered saline (PBS). X-ray and MRI scans were performed at the 4th, 12th and 16th weeks postoperatively. Histological, immunohistochemical and biochemical analyses were performed at the 16th week postoperatively. Both needle puncture and ChABC successfully established IVDD in rabbits at 4th, 12th and 16th weeks, confirmed by X-ray and MRI scan. The progression of IVDD went in a time-dependent manner. The IVDD in the ChABC group was less severe than in the needle puncture group throughout the study. Aggrecan and type II collagen significantly decreased, while tumor necrosis factor-α and superoxide dismutase 2 increased in the needle puncture and ChABC groups, compared with the sham and PBS groups. Both AF needle puncture and ChABC injection can successfully induce IVDD in rabbits. Compared with ChABC injection, AF needle puncture can induce more severe IVDD.

Pregnancy and Antiphospholipid Antibody Syndrome

Introduction: ALPA is an autoimmune hypercoagulable state caused by antiphospholipid antibodies. It is characterized by thrombotic episodes in arteries, veins and pregnancy related complications like still birth, preterm delivery, miscarriage and severe preeclampsia. We report a case of APLA syndrome due to its rarity. Case Report: A 28 year old woman with a history of two previous abortions and positive serology for APLAs with 9 months gestation came to our hospital for safe confinement. She was diagnosed as primary APLA syndrome in view of bad obstetric history and positive lupus anticoagulant. She is a known hypothyroidism. She was on Injection Enoxaparin 0.6 ml OD for 1 year which was changed to unfractionated heparin 14000 units OD subcutaneously after admitting to our hospital. In view of bad obstetric history, an elective caesarean section was planned. Unfractionated heparin was stopped 24 hours before surgery. Preoperative investigations revealed a normal APTT, PT, INR. Spinal anesthesia given in L3–L4 inter-spinal space with 25G needle after preloading with 500 ml crystalloids and a sensory block up to T6 was attained. She delivered a single live male child with APGAR score 9. Injection Oxytocin 15 units was given intraoperatively. The further perioperative course was uneventful. She was restarted on Injection Enoxaparin 0.6ml OD for 6 weeks.

Hyaluronic Acid Filler Injection Technique in Multiple Layers of the Nasolabial Fold.

Sir: As mentioned by the author in his publication,1 to resolve the nasolabial fold (NLF), filler injection is most commonly used. In the study, fillers were injected in multiple layers of the NLF. However, we would like to discuss some complications associated with this technique. First, the facial artery is one of the largest arteries in the face and it runs near the NLF. Lee et al2 described variations in the course and depth of the facial artery and reported that more than 70% of the facial arteries were found at the NLF. The author of this article described injecting the filler at the supraperiosteal, deep and superficial fatty layers, and subdermal layer,1 but as seen in another study,2 filler injection in the deep and superficial fatty layers can be dangerous. Ultrasound shows that the facial artery can be detected at the NLF.3 In addition, it was found that 29% of the facial arteries run in the subcutaneous layer.3 Ultrasonographic image of the facial artery at the NLF area is shown in Figure 1. This means that filler injection in multiple layers is a very dangerous procedure as vascular injuries can occur, resulting in tragic complications such as skin necrosis.Fig. 1.: Doppler ultrasound image of facial artery located in the subcutaneous layer at the NLF.Second, the author did not mention the diameter of the cannula and compared to the puncturing needle, the cannula seemed to be smaller than 25 G. The outer diameter of a 25 G cannula is 0.51 mm, and the facial artery diameter is described to be 1.7–3.6 mm.4 This shows that a cannula can perforate the facial artery anytime, resulting in vascular complications. Clinicians should not be overly confident when using a cannula for injecting the filler. A recent article shows that a 27-G cannula can be as dangerous as a 27-G needle.5 Third, to describe specific fillers as being highly elastic or cohesive, rheological data should be provided. The author described Yvoire Y solution 720° as having high particle elasticity and stated that this is characteristic of a biphasic filler. However, he described Yvoire Y solution 540° as having low particle elasticity. As far as we know, Yvoire Y solution 540° also has characteristics of a biphasic filler. Usually, hyaluronic acid filler has rheological properties like high elastic modulus (characteristic of a biphasic filler) or high cohesiveness (characteristic of a monophasic filler). “High particle elasticity” was unclear when the nature of the filler was described. Furthermore, the particle size and rheological data of the filler used in the research were not provided. We would prefer it if hyaluronic acid was described as being volumizing at deep to mid-levels rather than having a high or low particle elasticity. Filler injection is a relatively easy esthetic procedure; nevertheless, surgeons must be aware of the possible vascular complications associated with this procedure. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Shape memory injectable cryogel based on carboxymethyl chitosan/gelatin for minimally invasive tissue engineering: In vitro and in vivo assays.

Shape-memory cryogels have drawn attention as an injectable system to minimize the risks associated with surgical implantation in tissue engineering. To achieve shape memory behavior with hydration as an external stimulus, it is necessary to have a porous elastic network. To achieve this, it is crucial to control the crosslinking process at the time of pore formation, especially for natural-based polymers. In this study, a versatile method using a cryogelation method in the presence of chemical and physical crosslinkers is investigated to obtain an injectable super macroporous elastic structure based on a poly(ampholyte) (carboxymethyl chitosan) and a protein (gelatin). Mechanical, swelling, shape memorizing behavior, injectability, and in vitro and in vivo behavior of cryogels were studied. Cryogelation in a subzero temperature led to the formation of scaffolds with interconnected pores of the size of 350 μm which swelled completely after 3 min. Cryogels had crosslink density up to 22% and elastic modulus in the hydrated state up to 0.054 and 1.733 MPa at low and high strains, respectively, and low hysteresis (<30 kPa). Injectability studies confirmed the ability of the cryogels to be injected through a 16G needle. In vitro studies demonstrated good cellular penetration, cell adhesion, and high cell viability (>100%). In vivo studies using mice showed that the body's response was befitting without inflammation and any side effect for the liver and kidneys.

Investigation of the protective effect of gel incorporating Eugenia jambolana leaf extract on 5-fluorouracil-induced oral mucositis: an animal study.

The study aimed to evaluate the possible preventive effect of two concentrations (3 and 5% w/w) of Eugenia jambolana (EJ) extract against 5-FU-induced mucositis. Sixteen adult rats were separated into four groups: two control and two preventive groups. Animals in Groups 1, 2, and 3 were injected intraperitoneally with60mg/kg/day of 5-FU on Day 1 followed by 150mg/kg/day on Day 5. The rats in Group 4 (negative control) were given physiological saline at the same times and doses. Furthermore, on the fifth day of the study, the cheek and sublingual mucosa were irritated by external superficial scratches using the tip of an 18-G needle, followed by the application 15µL of 20% acetic acid, after which 3 and 5% EJ w/w gels were applied topically for animals in Groups 2 and 3, respectively. The weight and the mucositis scores were recorded. Antioxidant and anti-inflammatory markers and biochemical tests were analyzed. Significant differences were found between the study groups in weight loss, clinical mucositis scores, mortality rates, and antioxidant and anti-inflammatory parameters. The preventive effect of 3% gel was significant, with no mortality rate, making it an option for preventive strategies.

Role of Ultrasound in the Diagnosis of Hepatocellular Carcinoma in Patients with Chronic Liver Disease

Background: Hepatocellular carcinoma (HCC) is a common cancer in humans. Its mortality ranks third among human malignancies. Cirrhosis of liver is a major contributor to hepatocellular carcinoma, about in 80% of the affected individuals. Fine needle aspiration cytology (FNAC) of the liver which is a minimal invasive procedure is essential to sort out primary and secondary neoplasm of the liver. Objective: The aim of this cross-sectional study was to determine the accuracy of ultrasound for diagnosis of HCC in comparison with FNAC findings. Materials and Methods: This study was done in the Radiology & Imaging Department in Enam Medical College & Hospital, Savar, Dhaka in collaboration with the Department of Pathology of the same institution for FNAC correlation during October 2017 to November 2019. A total number of 50 patients with CLD with known hepatic mass, referred to the department were included in the study. Ultrasound was done with TOSHIBA using low frequency curvilinear probe of 3.5 MHz. USGguided aspirations was performed using 18G needle under full aseptic measure. USG findings were validated by histopathology reports. Analysis was done by SPSS 19.0. Results: Mean age of the study population was 58.6 ± 10.9 years, of whom 37(74%) were male and 13 (26%) were female. Mean size of the hepatic lesions was 4.7 ± 1.08 cm. The lesions were characterized as iso-, hypo- and hyperechoic as compared with hepatic parenchyma. Doppler study shows both central and peripheral vascularity. Compared with FNAC findings, accuracy of USG findings was determined. Sensitivity of USG in detection of HCC was 97.7%, specificity was 66.7%, and positive prediction value 95.6% and negative prediction value 80%. Conclusion: Conventional USG can be used as a screening method in patients with CLD having hepatic masses. However, further workup is required for definite diagnosis. J Enam Med Col 2020; 10(3): 153-158

Percutaneous transosseous embolization of a diploic vein arteriovenous fistula with intracranial and extracranial shunting.

Transosseous embolization of diploic vein arteriovenous fistula is feasible when necessary in select cases.

MO122: Bleeding Complications after Allograft Kidney Biopsy and Role of Antiplatelet Therapy

Abstract BACKGROUND AND AIMS Percutaneous biopsy is an important tool for monitoring renal allograft and early diagnosis when dysfunction occurs. Bleeding is the most dangerous adverse event, even if it is rare (risk of 0.5%). Cardiovascular (CV) disease affects 2/3 of elderly with CKD and antiplatelet therapy is taken for primary and secondary prevention of CV events. A systematic review on aspirin discontinuation among 50 279 patients at risk for coronary disease shows a 3-fold risk of adverse CV event. The aim of this study is to compare bleeding complications of antiplatelet administration within 5 days from renal biopsy versus absence of therapy. METHOD We conducted a 10-year (2010–2020) single-centre retrospective study on 285 consecutive ultrasound assisted percutaneous allograft kidney biopsy. We collected information about demographic, laboratory (eGFR, platelets, haemoglobin pre/post biopsy, proteinuria) data, biopsy indication (elective/urgent), clinical presentation [acute kidney injury (AKI)/nephrotic syndrome], needle gauge, use of antiplatelet or anticoagulant, diagnosis and complications (categorized as minor and major, according to the need for intervention). We divided patients in two groups: antiplatelet therapy within 5 days versus therapy discontinuation or absence. Bivariate logistic regression was used to analyse possible risk factors associated with complications. RESULTS Among the 285 patients: 173 patients received antiplatelet agents (low-dose aspirin in >90% of cases) within 5 days from biopsy and 112 patients were not on antiplatelet therapy. Diastolic hypertension, AKI and proteinuria were statistically greater in the group without antiplatelet therapy. Histologic diagnoses were evenly present in the two groups, and no differences were observed in the rate of complications. Major complications were diagnosed in 0/112 patients without antiplatelet therapy and 1/173 patients with therapy within 5 days. Minor complications were documented in 14/112 and in 15/173 patients, respectively. There were no statistically significant differences in terms of complications between antiplatelet therapy within 5 days and absence of therapy (Table 1). Furthermore, there were no differences between taking antiplatelet within 48 h or stopping it within 48 h of the procedure (Table 2). No deaths were attributed to procedure and all events occurred within 24 h from biopsy, irrespective of their severity. The univariate logistic regression model (dependent variable: major complication) documented a lower BMI as a significant risk factor; indeed, this was not confirmed at multivariate regression. The analysis did not find a significant difference between 16-G and 18-G biopsy needle in terms of major/minor complications; however, the use of the latter was associated with a significant lower number of glomeruli in the sample. CONCLUSION Our study suggests that the use of antiplatelet agents within 5 days from procedure does not increase the bleeding risk, so it should be safe to continue the therapy in patients at risk for CV events. However, this is a weak evidence that needs prospective studies to be validated. Our data also suggest that 16-G biopsy needle may be safely used to obtain enough tissue for histologic diagnosis.

The impact of needle size and angle on rubber coring after multiple puncturing of multi-dose propofol vial rubber stoppers

BackgroundMultiple puncturing of the rubber stoppers of multi-doses vials can produce a rubber core. Propofol is one of the multi-dose anesthesia frequently used for sedation and induction of general anesthesia, and a previous study reported a high incidence of rubber coring in propofol vials but no study has yet reported the factors that affect rubber coring. ObjectiveTo investigate the variables which have an impact on rubber core contamination after the puncturing of rubber stoppers of multi-dose propofol vials using various sizes of needles and different angles of piercing. Materials and methodsAn experimental study which involved puncturing the rubber stoppers of 50 ml propofol vials with needles of various sizes (18G, 20G, 21G) and at different angles of puncture (45 and 90°). The particles occurred in the vials in each situation were evaluated under the microscope, including the number, width and length. Sizes of the needle and degrees of puncture were evaluated to determine the cause of coring. ResultsRubber coring occurred in 26 out of a total of 150 samples (17.33%). Comparing the incidence of coring by needle size, the 18G needle produced the highest number (38%, P-value < 0.01). Especially, puncturing with 18 gauge needle at 45° (56%, P-value 0.01). ConclusionLarge-bore needle was the factor that impacted rubber coring after puncturing through the rubber stopper of the multi-dose vial, regardless of the angle of puncture.

Mediastinal "deep freeze"-transcarinal lymph node cryobiopsy.

BackgroundThe diagnostic yield of endobronchial ultrasound‐transbronchial needle aspiration (EBUS‐TBNA) from mediastinal lymph nodes ranges from 66%–89%. However, in many cases cytologic material is not sufficient for full molecular evaluation. A novel method of transcarinal cryobiopsy aims to provide bronchoscopically obtained, larger specimen samples from mediastinal lymph nodes. We aimed to assess the efficacy and safety of transcarinal EBUS‐guided lymph node cryobiopsy.MethodsPatients referred for EBUS‐TBNA, based on abnormal mediastinal clinical and radiographic findings, were enrolled into this prospective interventional study between July 2020 and August 2021. All EBUS‐TBNA procedures were performed using ProCore 22G needle (Cook Medical) to create, both a transcarinal tract for the cryoprobe and to obtain TBNA samples. For EBUS guided transcarinal cryobiopsy, we used flexible 1.1 mm or 1.7 mm cryoprobe inserted into the working channel of the EBUS scope and into the target subcarinal lymph node.ResultsTwenty‐four patients with male predominance 2:1 and mean age of 60.12 ± 10.16 years were enrolled. All target lymph nodes had hypoechoic, homogenic consistency with demarcated borders, without central structures. Cryobiopsy provided pathological diagnosis in 20 cases (83.33%), with 1.1 mm cryoprobe in 14 and with 1.7 mm cryoprobe in 6 cases. In one case each, pathology was provided by TBNA or by cryoprobe alone. No immediate or late complications were encountered during the procedures.ConclusionTranscarinal EBUS guided lymph node cryobiopsy following EBUS‐TBNA proved to be efficient with a high diagnostic yield and can be considered safe, because no immediate or late complications occurred.

Overcoming the Force Limitations of Magnetic Robotic Surgery: Magnetic Pulse Actuated Collisions for Tissue-Penetrating-Needle for Tetherless Interventions.

The field of magnetic robotics aims to obviate physical connections between the actuators and end-effectors. Such tetherless control may enable new ultra-minimally invasive surgical manipulations in clinical settings. While wireless actuation offers advantages in medical applications, the challenge of providing sufficient force to magnetic needles for tissue penetration remains a barrier to practical application. Applying sufficient force for tissue penetration is required for tasks such as biopsy, suturing, cutting, drug delivery, and accessing deep seated regions of complex structures in organs such as the eye. To expand the force landscape for such magnetic surgical tools, an impact-force based suture needle capable of penetrating in vitro and ex vivo samples with 3-DOF planar motion is proposed. Using custom-built 14G and 25G needles, we demonstrate generation of 410 mN penetration force, a 22.7-fold force increase with more than 20 times smaller volume compared to similar magnetically guided needles. With the MPACT-Needle, in vitro suturing of a gauze mesh onto an agar gel is demonstrated. In addition, we have reduced the tip size to 25G, which is a typical needle size for interventions in the eye, to demonstrate ex vivo penetration in a rabbit eye, mimicking procedures such as corneal injections and transscleral drug delivery.

"Air-Assisted" Donor Lenticule Insertion in Descemet Stripping Endothelial Keratoplasty in Aphakia With Large Iris Defect and Without Posterior Capsular Support.

The purpose of this study was to report a novel technique of donor lenticule insertion in Descemet stripping endothelial keratoplasty (DSEK) in aphakic corneal edema with large iris defect and without any posterior capsular support. This was a retrospective consecutive interventional case series. Clinical records of ten 1-eyed aphakic patients with corneal edema with large iris defect and no capsular support who underwent air-assisted donor lenticule insertion in DSEK were evaluated. After making 6.0- to 6.5-mm sclerocorneal tunnel and 2 side ports, limited anterior vitrectomy was performed if required. Then, Descemetorhexis was performed under air through side ports. Manually dissected donor lenticule was inserted into the anterior chamber under full-chamber air by a 30-G needle push-in technique. Further air tamponade was given if necessary. No fluid-air exchange was performed. The patient was kept on the same operating table for at least 1 hour and then shifted. Graft attachments in early postoperative period, corrected distant visual acuity, and endothelial cell density after 3, 6, and 12 months were analyzed. The mean postoperative follow-up period was 19.2 ± 6.7 months. There was no donor dislocation in this small group. All patients achieved a corrected distant visual acuity of 0.70 (20/100) after 3 months and maintained until 12 months. The endothelial cell density at 3 months (n = 8) was 2028 ± 151/mm 2 , at 6 months (n = 7) 1776 ± 198/mm 2 , and at 12 months (n = 7) 1721 ± 172/mm 2 . The corresponding endothelial cell loss was 25.8% ± 5.6%, 34.4% ± 5.1%, and 37.8% ± 7.1%, respectively. One graft failed after 15 months. "Air-assisted" donor lenticule insertion in DSEK is a safe surgical technique in aphakic patients with corneal edema with large iris defect and no capsular support.

Endobronchial Ultrasound Transbronchial Needle Aspiration With a 19-Gauge Needle vs 21- and 22-Gauge Needles for Mediastinal Lymphadenopathy

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used to evaluate mediastinal lymphadenopathy. Studies focusing on malignant lymphadenopathy have compared 21- and 22-gauge (21G and 22G, respectively) needles and have not identified an advantage of one needle size over the other in terms of diagnostic yield. Does the 19-gauge (19G) EBUS needle offer greater diagnostic yield and sensitivity vsthe 21G and 22G EBUS needles for a diagnosis of sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed? This study retrospectively examined records of 730 patients from the Stather Canadian Outcomes Registry for Chest Procedures (SCOPE) database who underwent EBUS-TBNA for a diagnosis of suspected sarcoidosis, lymphoma, or mediastinal lymphadenopathy not yet diagnosed. A propensity score analysis of two groups was performed. One group comprised patients undergoing EBUS-TBNA with a 19G needle, the other with a 21G or 22G needle. Cases for analysis were selected with a 1:2 ratio of 19G vs21/22G using logistic regression and random matching with all eligible 19G cases included. There were 137 patients (312 targets) in the 19G group and 274 patients (631 targets) in the 21/22G group in the propensity score analysis. The diagnostic yield was 107 of 137 (78.1%) in the 19G group vs194 of 274 (70.8%) in the 21/22G group (difference, 7.3%; 95%CI, -1.9 to 15.6; P= .116). The sensitivity of EBUS-TBNA for sarcoidosis was 80 of 83 (96.4%) in the 19G group vs150 of 156 (96.2%) in the 21/22G group (difference, 0.24%; 95%CI, -6.6 to 85.1; P= .93). In patients with a final diagnosis of lymphoma, EBUS was diagnostic in 10 of 13 (76.9%) in the 19G group vs12 of 12 (100%) in the 21/22G group (difference, 23.1%; 95%CI, -5.4 to 50.3; P= .08). The study did not identify an advantage of the 19G EBUS needle over the 21/22G EBUS needles for diagnostic yield nor sensitivity for sarcoidosis or lymphoma.