Gauge Needle Research Articles

6/0 PROLENE DOUBLE-FLANGED INTRAOCULAR LENS SUTURELESS SCLERAL FIXATION WITH A 27-GAUGE NEEDLE FOR INTRAOCULAR LENS SURGERY.

To report the initial experience of a modified intraocular lens (IOL) scleral fixation technique using 6/0 prolene in a double-flanged sutureless technique with a 27-gauge needle. Twenty-nine consecutive patients with IOL surgery were retrospectively reviewed between December 2021 and October 2023. Early Treatment Diabetic Retinopathy Study letters, spherical equivalent (SE), astigmatism axial degree, and intraocular pressure were evaluated at baseline and 1, 2, 3, and 6 months postoperatively. Surgery-related complications were evaluated during follow-up. Early Treatment Diabetic Retinopathy Study letters or SE at 1, 2, 3, and 6 months postoperation was significantly improved compared with baseline levels. Patients with younger (estimate [SE] = 8.011 [2.485], P = 0.006), preoperative lens drop (estimate [SE] = 8.621 [2.906], P = 0.009), idiopathic cataract (estimate [SE] = 6.021 [2.099], P = 0.048), high baseline Early Treatment Diabetic Retinopathy Study letters (estimate [SE] = 15.449 [2.352], P < 0.001), or low baseline SE (estimate [SE] = 6.357 [2.406], P = 0.018) had the greatest improvement in Early Treatment Diabetic Retinopathy Study letters during follow-up. Patients with preoperative lens or IOL dislocation had a greater postoperative SE improvement than those with preoperative lens or IOL subluxation (dislocation vs. subluxation: estimate [SE] = -189.235 [70.692], P = 0.016). There were no cases of vitreous hemorrhage, cystoid macular edema, endophthalmitis, subluxation, or dislocation were observed during the 6-month follow-up. This modified IOL scleral fixation technique is a simple, safe, and efficient method that avoids haptic manipulation and slippage, reduces postoperative complications, achieves completely sutureless surgery, and results in an achievement of surgical refractive goals.

Graft-repositioning technique using infusion and small bubbles during Descemet’s membrane endothelial keratoplasty

BackgroundDescemet’s membrane endothelial keratoplasty (DMEK) is a highly effective procedure for corneal endothelial dysfunction; however, once a DMEK graft is deployed, repositioning can be challenging. Therefore, this study aimed to evaluate the efficacy of a technique that utilizes infusion and small air bubbles to reposition a misaligned deployed graft.MethodsThis retrospective interventional case series enrolled patients who underwent DMEK between January 2022 and July 2023, including cases where the DMEK graft was attached and unfolded in off-center positions”. Experienced surgeons performed DMEK by inserting an infusion cannula and positioning a small bubble in the anterior chamber after the graft unfolded off-center. The eye was tilted in a deviated direction, and the cornea was massaged from the corneal limbus to the center using a 27-gauge blunt needle. Before and after DMEK, we measured the best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), and endothelial cell density (ECD). Additionally, we monitored the incidence of postoperative complications.ResultsSix eyes of six patients were included in this study. Postoperatively, the overall BSCVA and CCT of the eyes improved (P < 0.001). However, one eye developed recurrent uveitis and required a sub-Tenon’s capsule triamcinolone acetonide injection. No eyes required re-bubbling, and no instances of primary graft failure were observed.ConclusionThe described technique enables the safe and feasible repositioning and unfolding of the DMEK graft.

Bright and Specific Targeting of Metastatic Lymph Nodes in Orthotopic Mouse Models of Gastric Cancer with a Fluorescent Anti-CEA Antibody.

Gastric cancer poses a major diagnostic and therapeutic challenge. Improved visualization of tumor margins and lymph node metastaseswith tumor-specific fluorescent markers could improve outcomes. To establish orthotopic modelsof gastric cancer, one million cells of the humangastric cancer cell line, MKN45, were suspended in 50 μl of equal parts PBS and Matrigel and injected into the nude mouse stomach with a 29-gauge needle. Tumors were allowed to grow for 8-12 weeks before performing imaging studies. For tumor labeling, M5A (humanized anti-CEA mAb) and IgG as a control, were conjugated with the near-infrared dye IRDye800CW. Mice were randomized to receive 50 μg of M5A-IR800 (n = 14) or 50 μg of IgG-IR800 (n = 14) intravenously and were imaged 72 hours later. Fluorescence imaging was performed using the LI-COR Pearl Imaging System. Forty-two lymph nodes were collected from 28 mice, of which 59.5% were found to contain metastatic gastric cancer cells on pathologic examination. In mice that received M5A-IR800, there was a statistically significant difference in the mean fluorescence signal for cancer-positive lymphnodes at 0.431 (SE ± 0.224) compared with 0.105 (SE ± 0.009) for cancer-negative nodes (p: 0.002). For IgG-IR800, there was no significant difference in the mean fluorescence signal for cancer-positive nodes (0.057) compared with cancer-negative nodes (0.064), p-value 0.677. Humanized anti-CEA (M5A) antibodies conjugated to fluorescent dyes provide bright labeling of lymph nodes containing metastatic gastric cancer. This tumor-specific fluorescent antibody is a promising clinical tool for identifying lymph nodes containing metastatic gastric cancer.

Mandibular Prognathism Correction in a Juvenile Umbrella Cockatoo (Cacatua alba) With the Use of an Orthosis.

A 9-week-old male umbrella cockatoo (Cacatua alba) presented with mandibular prognathism. The rostral rhinothecal tomial length appeared subjectively shorter than the rostral gnathothecal length, which was subjectively rostrally elongated. After an initial orthosis failed, a second orthosis was designed that employed the use of an orthopedic wire anchor in the rostral end of the rhinotheca, leaving the premaxillary bone undisturbed. Prior to placement of the anchor, skull radiographs were taken to measure the distance from the rostral tip of the rhinotheca to the rostral end of the premaxillary bone. This was done to mitigate iatrogenic trauma and prevent disruption of bone and underlying tissues when the orthopedic wire was deployed to anchor the rhinothecal tip. A hole was created in the rostral rhinotheca with a 20-gauge hypodermic needle rostral to the premaxillary bone. Orthopedic wire was placed through the hole and wrapped over the dorsal rhinotheca as an anchor. A second piece of orthopedic wire was formed into an elongated oval shape as a frame for the rhinothecal extension. Flexible, moldable plastic mesh was wrapped over the rhinotheca and orthopedic wire extension. Waterproof epoxy putty was placed over the rhinotheca and orthotic wires. The epoxy putty was replaced as needed until the rhinotheca had regrown into correct alignment. Twenty-five days post-placement, correct alignment was achieved, and the orthosis removed. The beak remained in correct alignment, and the bird developed normal use of the beak to engage in activities such as feeding, preening, and podomandibulation. Whereas methods for correcting mandibular prognathism have been described utilizing a variety of techniques and materials, there is a paucity of peer-reviewed literature on this procedure. This report describes the management and correction of this condition in a young bird as well as the involved anatomy, kinesiology, and details of this corrective procedure.

An In Vivo Comparative Analysis of Pain Perception in Children Following Lidocaine Gel, Clove Oil, and Precooling for Intraoral Injections: A Pilot Study.

Dental anxiety about injections are common challenge in pediatric dentistry, often leading to delayed dental treatment. The aim of the study was to evaluate the anesthetic effectiveness of three different topical agents in pediatric dental procedures. The study was a cross-sectional in vivo study carried out in the department of pediatric and preventive dentistry. Ninety children were chosen using convenience sampling and divided into three groups based on the topical anesthetic agent administered. The procedure included anxiety assessment using the Modified Venham Picture Scale (MVPS) before and after the procedure, and pain perception was measured with the visual analog scale (VAS) and sound, eye, and motor scale (SEMS). Group A received 2% lidocaine gel, group B experienced precooling of the injection site with an ice cone, and group C was treated with clove oil, followed by a 0.9 mL infiltration injection of 2% lidocaine with 1:1,00,000 epinephrine using a 30-gauge needle for all groups. Variations in scores of the MVPS, VAS, and SEMS within and between the three groups were examined with the Kruskal-Wallis test. Spearman's correlation was employed to assess the relationships between the three scales with statistical significance set at p < 0.05. Clove oil demonstrated the best anesthetic properties and exhibited the least pain perception among all groups. Natural options like clove oil and precooling with ice cones may serve as cost-effective alternatives to lidocaine gel in reducing pain and anxiety during pediatric dental procedures. Sudha PM, Mathew BM, Rajasudhakar H, et al. An In Vivo Comparative Analysis of Pain Perception in Children Following Lidocaine Gel, Clove Oil, and Precooling for Intraoral Injections: A Pilot Study. Int J Clin Pediatr Dent 2024;17(12):1394-1398.

CT Texture Analysis in Breast Cancer Patients Undergoing CT-Guided Bone Biopsy: Correlations With Histopathology.

Texture analysis has the potential to deliver quantitative imaging markers. Patients receiving computed tomography (CT)-guided percutaneous bone biopsies could be characterized using texture analysis derived from CT. Especially for breast cancer (BC) patients, it could be crucial to better predict the outcome of the biopsy to better reflect the immunohistochemistry status of the tumor. The present study examined the relationship between texture features and outcomes in patients with BC receiving CT-guided bone biopsies. This study is based on a retrospective analysis. The present study included a total of 66 patients. All patients proceeded to undergo a CT-guided percutaneous bone biopsy, using an 11-gauge coaxial needle. Clinical and imaging characteristics as well as CT texture analysis were included in the analysis. Logistic regression analysis was performed to predict negative biopsy results. Overall, 33 patients had osteolytic metastases (50%) and 33 had osteoblastic metastases (50%). The overall positivity rate for the biopsy was 75%. The clinical model exhibited a predictive accuracy for a positive biopsy result, as indicated by an area under the curve (AUC) of 0.73 [95% confidence interval (CI) = 0.63-0.83]. Several CT texture features were different between Luminal A and Luminal B cancers; the best discrimination was reached for "WavEnHH_s-3" with a P-value of .002. When comparing triple-negative to non-triple-negative cancers, several CT texture features were different, the best discrimination achieved "S(5,5)SumVarnc" with a P-value of .01. For the Her 2 discrimination, only 3 parameters reached statistical significance, "S(4,-4)SumOfSqs" with a P-value of .01. The utilization of CT texture features may facilitate a more accurate characterization of bone metastases in patients with BC. There is the potential to predict the immunohistochemical subtype with a high degree of accuracy. The identified parameters may prove useful in clinical decision-making and could help to identify patients at risk of a negative biopsy result.

Transcameral straight-needle–assisted enclavation of retropupillary iris-claw intraocular lens through sclerocorneal tunnel

Intraoperatively, a 5.5-mm wide, partial-thickness sclerocorneal tunnel is constructed using a frown incision. 25-gauge pars plana vitrectomy is performed using ports at 3.5 mm from the limbus. A 16-mm STC-6 straight needle is inserted into the anterior chamber, 1 mm from the limbus, and is docked into the lumen of a 26-gauge needle inserted into the anterior chamber, through its diametrically opposite point along the horizontal axes marked preoperatively. The iris-claw lens is introduced into the anterior chamber, ensuring that it is posteriorly vaulted. Implantation forceps (Artisan IOL Implantation Forceps, TMF710 ) are used to grasp the lens just proximal to its optic center and to fixate the clips of the haptics on to the STC-6 needle. Ophthalmic viscosurgical device is aspirated from the anterior chamber, sclerotomy cannulae are removed, the wounds are checked for a leak, and if absent, the procedure is sutureless.

Diagnostic Accuracy of Fine Needle Aspiration Cytology In Palpable Breast Lump Taking Histopathology As Gold Standard

Background: Problems in the breast can present themselves in different ways like pain in the breast, discharge from nipples, cystic lesions and most commonly a lump. Breast lump is of great concern to the patients and is also challenge to the diagnostic acumen and judgment of the surgeon. This will be beneficial in early diagnosis and treatment, reducing its morbidity and mortality more over this study will provide us with local statistics of the magnitude of breast lump and this will open window for further research. Objective: To determine the diagnostic accuracy of FNAC of breast lump with the histopathology as a gold standard in diagnosis of breast cancer. Material and Methods: The current study was conducted at Department of General Surgery, Khyber Teaching Hospital, Peshawar for six month (from 2/7/2019 to 27/01/2020). A total of 179 women were observed in which women presenting with palpable breast lump, in age between 35 years to 60 years were included. Fine-needle aspiration cytology (FNAC) of the patients with breast lump was performed with 22-gauge needle, mounted on a 10-ml syringe. Excision biopsy was done for small tumors or lump found benign on fine needle aspiration cytology and histopathology of mastectomy. Histopathological slides of corresponding cytological cases were correlated. The collected data was entered and analyzed in SPSS version 22. Sensitivity, specificity, positive predictive value and negative predictive value of FNAC were calculated. Results: Our study shows that among 179 patients, mean age was 53 years ± 10.45. FNAC had sensitivity 90.22%, specificity 80%, PPV 99.36%, NPV 19.04% and diagnostic accuracy was 89.94% in the diagnosis of breast lump keeping histopathology as a gold standard. Conclusion: Our study concludes that Fine needle aspiration cytology (FNAC) is a simple, safe and minimally invasive diagnostic test that is accurate in detecting breast lumps, with a high correlation rate to histopathology. When used in conjunction with histopathology, FNAC can ensure an accurate diagnosis and appropriate management of breast lumps.

Sharp Recanalization of the Hepatic Vein Using a Chiba Needle in Budd–Chiari Syndrome

AbstractHepatic vein recanalization in Budd–Chiari syndrome may require procedural modification if the endovascular approach fails. Sharp recanalization using the stiff end of a guidewire or a thin Chiba needle remains an effective technique in difficult-to-cross hepatic vein stricture. Of note, this technique requires utmost precaution to avoid catastrophic hemorrhage. The present case describes the successful recanalization of the middle hepatic vein using a 21-gauge Chiba needle through the percutaneous transhepatic route.

In-Office Suprachoroidal Viscopexy for Acute Rhegmatogenous Retinal Detachment

In-office suprachoroidal viscopexy (SCVEXY) is a relatively new procedure for rhegmatogenous retinal detachment (RRD), but minimal information is available regarding outcomes and safety. To report outcomes with in-office SCVEXY for primary acute RRD. This retrospective case series was conducted at St Michael's Hospital in Toronto, Ontario, Canada from June 2023 to February 2024 among consecutive patients with primary acute RRDs who presented with retinal tears that were reachable with the current in-office SCVEXY technique in the temporal or nasal retina. Suprachoroidal injection of 0.6 mL of sodium hyaluronate, 2.3%, at the break location using a 30-gauge needle with a custom-made guard leaving 1 mm of the needle exposed. Laser retinopexy was applied around the break once reattachment was achieved. The primary outcome was primary anatomic reattachment rate with SCVEXY and recovery of function and anatomic integrity. Among 6 patients, 2 patients (33.3%) were female, and mean (SD) patient age was 52.5 (19.7) years. The final follow-up duration for each patient was 510, 420, 360, 360, 330, and 320 days, respectively. Baseline VAs were hand motions, counting fingers, 20/100, 20/100, 20/25, and hand motions for patients 1 through 6, respectively. A dome-shaped suprachoroidal buckle was present in all cases after the procedure. Five of 6 patients (83.3%) achieved anatomic reattachment with no retinal displacement or outer retinal folds, and these patients could resume normal activity immediately after the procedure with no restrictions. The mean (SD) logMAR VA at 3 months was +0.46 (0.34) (Snellen 20/57). The viscoelastic persisted in the suprachoroidal space as confirmed by multimodal imaging for 10, 14, 21, 13, 24, and 14 days, respectively, and the retina remained attached during the entire postoperative follow-up period. One patient's SCVEXY failed due to inadequate viscoelastic at the posterior edge of the retinal break, and this patient underwent a successful pneumatic retinopexy. One patient developed a localized choroidal effusion unrelated to the SCVEXY site following laser retinopexy that resolved in 1 week associated with topical prednisolone, 1%, 4 times daily and cyclopentolate, 1%, twice daily. In this case series, the outcomes of these 6 cases suggest that SCVEXY may offer durable retinal reattachment in RRD. However, randomized clinical trial data, larger sample sizes, and longer-term follow-up are necessary to assess the risk-benefit profile of SCVEXY compared with the standard of care.

First Report of Twig Dieback Caused by Neopestalotiopsis rosae on Highbush Blueberry in the Continental United States.

Highbush blueberry (Vaccinium corymbosum) is an important fruit crop for pick-your-own agritourism farms in the Midwest. Declining or diseased plants are a major concern for pick-your-own farms, as consumers prioritize healthy plants and organic practices (Norby and Retallick 2012). In August 2023, leaf spot and dieback symptoms were observed sporadically on the current year's growth throughout an organic berry agritourism farm in Eastern Iowa. Small red spots on the twigs and leaves progressed into larger lesions with gray centers, and brown borders with no observable acervuli or pycnidia. Symptomatic samples from 20 individual 'Duke' blueberry plants were collected for disease identification. Tissue was cut from lesion edges, surface sterilized with 10% bleach for 1 min, rinsed thrice in sterilized water, cultured on potato dextrose agar amended with 800 mg/L yeast extract (PDAY) and 100 µg/ml streptomycin, then kept at 20°C. Twenty isolates were identified morphologically, and three were submitted for molecular analysis. Isolated colonies had white aerial mycelia, irregular margins, and were light yellow underneath. Black, globular acervuli produced five-celled fusoid conidia that ranged from straight to slightly curved. The center three cells were light to dark brown. The basal cell was generally conical, with a small basal appendage. The apical cell ranged from conical to cylindrical, with 2-3 appendages. The spores averaged 23.7 µm long (range 19.7-30.1 µm) and 5.9 µm wide (range 5.0-6.5 µm), n=50. BLAST analysis demonstrated that sequences of ITS (ITS1-F/ITS4; PP764834, PQ344945-46), TUB2 (Bt2a/Bt2b; PP786462, PQ356370-71), and TEF1-α (EF1-526-F/; PP789161, PQ356368-69) were ~98 to 100% similar to KM199360, KM199430, and KM199524 published for Neopestalotiopsis rosae. Using MEGA 11 program (Kumar et al. 2018), maximum likelihood analysis based on the concatenated ITS, TUB2, and TEF1-α sequences placed all three isolates in a high-confidence cluster with N. rosae (Baggio et al. 2021; Jayawardena et al. 2016; Lee et al. 2019), confirming their identification. Pathogenicity of one isolate, NPB-1, was confirmed by inoculating three twigs on three 1-year-old V. corymbosum 'Blue Gold' plants (n=9). Twigs were pierced using a sterile 20-gauge needle with a mycelium plug to mimic pruning wounds, or a PDAY plug as a control (Borrero et al. 2018). Inoculated and control plants were kept at 28°C, 50% relative humidity, with an 18-hour photoperiod. Ten days post inoculation (dpi), inoculated plants showed symptoms of reddish-brown spots along wounded stems which were not present on control plants. At 35 dpi, inoculated plants displayed blight symptoms like the field-observed ones. Inoculated twigs had internal discoloration beyond the inoculation point, unlike the control twigs. N. rosae was successfully reisolated 2 cm away from the inoculation site and confirmed by sequencing in all inoculated twigs (n=9), but not in control plants (n=9). Neopestalotiopsis spp. have been previously reported to cause twig blight on blueberries in Korea, Chile, Uruguay, China, and Spain (Lee et al. 2019; Borrero et al. 2018; Chen et al. 2016; González et al. 2012; Espinoza et al. 2008). To our knowledge, this is the first report of N. rosae causing twig dieback on V. corymbosum in the US, and this knowledge will aid in proper diagnosis and treatment development.

Injectable Hierarchical Bioactive Hydrogels with Fibroblast Growth Factor 21/Edaravone/Caffeic Acid Asynchronous Delivery for Treating Parkinson's Disease.

Parkinson's disease (PD) is one of the most common long-term neurodegenerative disorders, with multiple comorbid psychiatric and behavioral abnormalities. The combination of clinical drugs targeting different symptoms with smart hydrogels to achieve asynchronous releases is highly translational and challenging. Here, a hierarchical bioactive hydrogel (OACDP) is designed with asynchronous release based on PD pathology. The hydrogel with caffeic acid-grafted polymer main chain is crosslinked using a micellar nanocrosslinker, with sufficient modulus (≈167Pa), antioxidant activity (>50%), injectability (30-gauge syringe needle), and shape-adaptability. Each of the three drugs (caffeic acid, fibroblast growth factor 21, and Edaravone) is separately engaged in different micro- or nanostructures of the hydrogel and released with asynchronous kinetics of first-order release, zero-order release, or matching Korsmeyer-Peppas model. The triple-loaded hydrogel is injected into the brains of PD rats, showing behavioral improvement. Histological analysis revealed that the triple-loaded OACDP hydrogels are effective in achieving immediate neuroprotection, i.e., reduction the loss of tyrosine hydroxylase in substantia nigra compacta and striatum (retained ≈10-fold versus control), decreasing oxidative stress, reducing astrocyte and microglia activation, and stimulating the AMPK/PGC-1α axis to regulate the mitochondrial function, providing a multi-dimensional PD therapy. The asynchronous release of OACDP hydrogel provides a new conception for PD treatment and other neurodegenerative diseases.

Minimally invasive denervation of the wrist: A cadaveric feasibility study for a single injection that targets both anterior and posterior interosseous nerves under ultrasound-guidance

BackgroundWrist osteoarthritis poses significant challenges in pain management and functional impairment. Current surgical interventions often sacrifice wrist motion and entail long recovery times. Minimally invasive denervation offers a promising alternative by targeting sensory nerves. This study investigates the efficacy of ultrasound-guided chemical ablation with phenol-glycerin for wrist denervation. MethodsUnder ultrasound guidance, 1–3 mL of 1 % methylene blue:8 % phenol:8 % glycerin solution was injected on both side of the interosseous membrane of six unembalmed cadaveric wrists. The entry point of the 22-gauge needle was along the lateral border of the ulna, just proximal to the most proximal aspect of the ulnar head. Dissections of the anterior and posterior compartment of the forearm were performed to visualize the length of both posterior interosseous (PIN) and anterior interosseous (AIN) nerves that were stained. ResultsResults showed a successful dispersion of methylene blue staining along the PIN (2.1 ± 0.82 cm), deep to the fourth extensor compartment of the wrist posteriorly, and along the AIN (2.5 ± 1.10 cm), between the interosseous membrane and pronator quadratus muscle anteriorly. Importantly, this diffusion spared the main motor branches of both nerves. CONCLUSIONS. Minimally invasive denervation of the wrist using ultrasound-guided chemical ablation with phenol-glycerin shows promise in targeting the sensory branches of both interosseous nerves.

Transesophageal endosonography in the diagnosis of sarcoidosis: a narrative review.

Transesophageal endosonography, including endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA), has been applied to the diagnosis of benign as well as malignant diseases. This narrative review summarizes the recent use of EUS-(B)-FNA in diagnosing sarcoidosis. A comprehensive and systematic online literature search of PubMed was conducted using the keywords ("sarcoidosis"), and ("EUS" OR "EUS-FNA" OR "EUS-B" OR "EUS-B-FNA" OR "endoscopic ultrasound guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS scope guided fine needle aspiration" OR "endoscopic ultrasound using the EBUS bronchoscope" OR "transesophageal" OR "transesophageal endoscopic ultrasound guided fine needle aspiration" OR "transesophageal bronchoscopic ultrasound guided fine needle aspiration"). Most EUS-FNA procedures were performed under moderate sedation, primarily using midazolam, with 22-gauge needles. The diagnostic sensitivity of sarcoidosis in mediastinal lymph node sampling is as high as 75-100% for EUS-FNA and 70-86% for EUS-B-FNA, much higher than that of traditional bronchoscopic procedures, such as transbronchial lung biopsy (TBLB) and conventional transbronchial needle aspiration (TBNA). The complications associated with EUS-(B)-FNA have thus far included only a few cases of mediastinitis, successfully treated with antibiotics, as well as lymph node hematoma, and sore throat. EUS-FNA and EUS-B-FNA provide high diagnostic yields in patients with sarcoidosis. The safety profile is acceptable, although there is a slight risk of infectious complications. EUS-B-FNA, a minimally invasive and well-tolerated procedure, offers a viable alternative to endobronchial ultrasound-guided TBNA (EBUS-TBNA) for the diagnosis of sarcoidosis, particularly in patients with cough and poor respiratory function; this procedure can easily be performed by pulmonologists.

Homologous recombination deficiency testing in patients with high grade ovarian cancer: factors influencing test success.

Testing for tumor BRCA mutations and homologous recombination deficiency (HRD) is recommended for all patients with advanced high-grade epithelial ovarian cancer. Delays in the HRD testing process can significantly affect the treatment offered to patients. HRD testing pathways and sampling processes were analyzed for tests sent from a tertiary gynae-oncology referral center between December 2020 and January 2023. A total of 148hRD tests were performed in 125 patients. The overall success rate of HRD testing was 69.6%. The success rates of obtaining results were: from diagnostic image-guided biopsy 66.7% (n = 40/60), at primary surgery 91.5% (n = 42/47), and at interval debulking surgery 51.2% (n = 21/41). The use of a larger 16-gauge needle used at image-guided biopsy produced a 100% success rate. Of 148 tests carried out, the median time for result was 28 days (range 14-158 days), with only 27% returned results in 21 or fewer days. In successful tests, 44.7% were classified as HRD-positive. 97% of patients with HRD-positive tumors treated at the center received a PARP inhibitor as part of their first-line maintenance treatment. By optimizing the factors affecting HRD test success, we can obtain faster results and offer patients appropriate treatment at earlier time points to improve patient outcomes.

Bone Marrow Stem Cell Population in Single- and Multiple-Level Aspiration.

Bone marrow aspiration concentrate (BMAC) has garnered increasing interest due to its potential for healing musculoskeletal injuries. While the iliac crest remains a common harvest site, the aspiration technique's efficacy in offering the highest yield and prevalence of mesenchymal stem cells (MSCs) is controversial. This study aimed to compare two different techniques of bone marrow aspiration over the anterior iliac crest from a single level versus multiple levels. Anterior iliac crests were selected in seven adult patients (aged between 31 and 59 years old). Aspiration was achieved using an 11-gauge needle (length: 100 mm; diameter: 2.3 mm) specifically manufactured for bone marrow collection (BD, Becton, Franklin Lakes, NJ, USA) connected to a 10 mL syringe. On one side, 4cc of bone marrow was aspirated at a single level to a depth of 7 cm without changing the needle direction. On the other side, over the same portion of the iliac crest, 1 cc of bone marrow was obtained from multiple levels of different depths during needle retrieval, maintaining a distance of 1 cm and changing the tip direction. The samples were blindly sent to the laboratory without indicating whether they came from an single level or multiple levels. Fluorescence-activated cell sorting (FACS) and osteoblast differentiation were analyzed and compared. In the FACS analysis, the single level resulted in a higher population of MSCs that were positive for CD105, CD73, and CD90 and negative for CD34, compared to the multiple-level method. In the process of osteoblast differentiation, it was observed that MSCs exhibited more advanced features of enhanced osteoblastic abilities in the single-level method rather than the multiple-level method. A single-level aspiration technique at the anterior iliac crest may produce a high-quality bone marrow aspirate. This technique may help obtain specific populations of MSCs with the desired characteristics for use in regenerative therapies for musculoskeletal injuries.

Amorphous Calcium Carbonate Enhances Fracture Healing in a Rat Fracture Model.

Background: Delayed and failed fracture repair and bone healing remain significant public health issues. Dietary supplements serve as a safe, inexpensive, and non-surgical means to aid in different stages of fracture repair. Studies have shown that amorphous calcium carbonate (ACC) is absorbed 2 to 4.6 times more than crystalline calcium carbonate in humans. Objectives: In the present study, we assessed the efficacy of ACC on femoral fracture healing in a male Wistar rat model. Methods: Eighty male Wistar rats were randomly divided into five groups (n = six per group): sham, fracture + water, fracture + 0.5× (206 mg/kg) ACC, fracture + 1× ACC (412 mg/kg), and fracture + 1.5× (618 mg/kg) ACC, where ACC refers to the equivalent supplemental dose of ACC for humans. A 21-gauge needle was placed in the left femoral shaft, and we then waited for three weeks. After three weeks, the sham group of rats was left without fractures, while the remaining animals had their left mid-femur fractured with an impactor, followed by treatment with different doses of oral ACC for three weeks. Weight-bearing capacity, microcomputed tomography, and serum biomarkers were evaluated weekly. After three weeks, the rats were sacrificed, and their femur bones were isolated to conduct an evaluation of biomechanical strength and histological analysis. Results: Weight-bearing tests showed that treatment with ACC at all the tested doses led to a significant increase in weight-bearing capacity compared to the controls. In addition, microcomputed tomography and histological studies revealed that ACC treatment improved callus formation dose-dependently. Moreover, biomechanical strength was improved in a dose-dependent fashion in ACC-treated rats compared to the controls. In addition, supplementation with ACC significantly lowered bone formation and resorption marker levels two-three weeks post-fracture induction, indicating accelerated fracture recovery. Conclusions: Our preliminary data demonstrate that ACC supplementation improves fracture healing, with ACC-supplemented rats healing in a shorter time than control rats.

Periradicular repair after single-visit root canal treatment using sonic irrigant activation of teeth with apical periodontitis.

This study aimed to explore whether using sonic irrigant activation during endodontic treatment favors periradicular repair in teeth with apical periodontitis. One clinician treated 140 posterior (either premolar or molar) asymptomatic teeth with periapical lesions: 70 were randomly assigned to the sonic activation with EndoActivator (EA) group, and 70 were treated by conventional needle irrigation (CNI). Both groups underwent chemomechanical root canal preparation using 35/04 diameter rotary files and 2.5% NaOCl as the irrigant. NaOCl was sonically activated in the EA group, and the final irrigation with NaOCl was performed using a 30-gauge side-perforated needle in the CNI group. All root canal obturations were performed with lateral compaction. All patients were followed up for 12 months. Success was determined based on both healed and healing cases. The chi-square or Fisher's exact test was used to compare success rates and outcome-influencing factors between groups. The recall rate was 131 (94%). At 12 months, 50 teeth (77%) were considered healed, 12 teeth (18%) as healing, and three (5%) as failed in the EA group, while 43 teeth (65%) were considered healed, 17 (26%) as healing, and six (9%) as failed in the CNI group. Verbal Rating Scale scores were significantly lower in the EA group than in the CNI group on postoperative days 1 (p < 0.0001) and 2 (p = 0.0002). Postoperative Periapical Index scores were significantly lower in the EA group than in the CNI group (p = 0.0023). Postoperative lesion sizes were also significantly smaller in the EA group (0.7 [0.2-11.7] mm) than in the CNI group (1.7 [0.5-11.5] mm; p = 0.0118). While the success rate was higher in the EA group (62 [95%]) than in the CNI group (60 [91%]), the difference was not significant (p = 0.492). The periradicular repair of posterior teeth with apical periodontitis demonstrated the efficacy of EndoActivator on treatment outcomes and reduced postoperative pain. These results suggest the adjunctive use of sonic activation to enhance the decontamination of the root canal system during the chemomechanical stage. This clinical trial is the first to evaluate the effects of sonic activation on postoperative healing. Sonic activation with the EndoActivator can reduce postoperative pain and accelerate the healing of the periapical tissues.

Management of late postoperative capsular bag distension syndrome - two year case series.

Late capsular bag distension syndrome (CBS) is a rare complication of the ^lcataract surgery. The aim is to present 9 cases with delayed presentation and describe their successful management with surgical approach. A two-year retrospective review of 9 cases was undertaken. Anterior segment optical coherence tomography (AS-OCT) was used to confirm this diagnosis. Aspiration of the milky fluid with 26 gauge needle followed by capsular bag lavage was performed and aspirated fluid was examined. Patients showed signs of late CBS 6,56 ± 1,94 years after uncomplicated phacoemulsification with intraocular lens (IOL) implantation into the capsular bag. All 9 patients presented with a turbid fluid collection within the distended capsular bag. AS-OCT showed a hyper-reflective material in the space between the IOL and distended posterior capsule. Awareness of the manifestations of CBS and choice of the correct imaging modality may lead to regular diagnosis and successful treatment. Management with aspiration of the milky fluid and lavage of the capsular bag is technically safe and effective procedure. It has the advantage of microbial testing of the fluid. AS-OCT is useful tool to differentiate this condition clearly from IOL opacification and posterior capsule opacification.

A Mouse Model for Vascular Cognitive Impairment and Dementia Based on Needle-guided Asymmetric Bilateral Common Carotid Artery Stenosis.

Vascular cognitive impairment and dementia (VCID) results from vascular brain injury. Given VCID's high incidence, which is expected to continue rising as the population ages, it is critical to establish a robust animal model for the disease. This paper presents a novel method of creating a mouse model of VCID that is based on asymmetric bilateral common carotid artery stenosis, which mimics human chronic cerebral hypoperfusion caused by carotid atherosclerosis. Briefly, common carotid arteries (CCAs) are ligated to different gauge needles (32 G for the right CCA and 34 G for the left CCA) using 7-0 silk sutures followed by immediate needle removal. The remaining suture rings cause persistent blood flow reduction and long-term cognitive impairment associated with white matter injury, microinfarcts, and reactive gliosis, thus closely mimicking the pathogenesis of VCID. Importantly, in this needle model, the clinical representations do not revert with time, providing reliable long-term cognitive impairment. Moreover, the survival rate 24 weeks post surgery was 81.6%, which is higher compared to the other established models of VCID with a similar level of blood flow reduction. Additional advantages include low material cost and compatibility with MRI to monitor brain injury in live animals since no metal is implanted. The main challenge in employing the needle model of VCID is the requirement for developing advanced surgical skills since mouse CCAs are less than 0.6 mm in diameter and are very fragile. High-quality visual representation of the surgery will thus help researchers to master this technique and advance our understanding of VCID, potentially leading to the development of novel therapeutic modalities to decrease the devastating cognitive decline associated with VCID.