Application Of Sponge Research Articles

Conditional Knockdown of Endogenous MicroRNAs in CHO Cells Using TET-ON-SanDI Sponge Vectors.

MicroRNAs (miRNAs) are small, noncoding RNAs of about 22 nucleotides in length and have proven to be useful targets for genetic modifications for desirable phenotypes in the biotech industry. The use of constitutively expressed "miRNA sponge" vectors in which multiple, tandem miRNA-binding sites containing transcripts are transcriptionally regulated by a constitutive promoter for downregulating the levels of endogenous microRNAs in Chinese hamster ovary (CHO) cells has shown to be more advantageous than using synthetic antisense oligonucleotides. The application of miRNA sponges in biotechnological processes, however, could be more effective, if the expression of miRNA sponges could be tuned. In this chapter, we present a method for the generation of stable CHO cell lines expressing a TET-ON-SanDI-miRNA sponge which is in theory expressed only in the presence of an inducer.

A randomized comparison of an adhesive gelatin sponge and a plain collagen sponge for hemostatic control during canine liver surgery.

To compare the effectiveness of a modified surface gelatin sponge to a plain collagen sponge for hemostasis of parenchymal hepatic bleeding. Prospective, randomized trial of two hemostatic agents. A total of 45 dogs undergoing elective liver surgery were randomly allocated into two groups: 22 in the adhesive gelatin (AG) group and 23 in the plain collagen (PC) group. A total of 20 patients per group underwent liver biopsy to create a uniformly sized bleeding surface, with the remaining patients (AG = 2, PC = 3) undergoing liver lobectomy. Evaluation of hemostatic effectiveness and tissue adhesion of each sponge type was performed by the operating surgeon using structured scoring systems. Hemostatic parameters were primarily evaluated at the liver biopsy site to maintain homogeneity of bleeding surface size. For the liver biopsy group (n = 40), 5 min after hemostatic sponge application, 10/20 dogs were bleeding in the PC group, compared to 2/20 in AG group (p = .0138). The PC bleeding was significantly higher than AG across the 3 to 6 min evaluation period (p < .001). When surgeons tested the adhesion of the sponge across the whole cohort (n = 45), AG scored 2 (of 3) against 1 for PC (p < .001). In group PC, 5/23 sponges dislodged during abdominal lavage and preparations for closure and had to be replaced due to recurrence of bleeding, compared with no AG sponges dislodging (p = .042). There were no further complications related to the use of either sponge. In the dogs with hepatic parenchymal incision, use of an adhesive gelatin sponge improved intraoperative attachment and haemostatic effectiveness, compared to a collagen sponge. Based on our clinical experience in these cases, adhesive gelatin sponges could be considered an effective option when selecting a hemostatic agent for liver surgery in dogs.

Application of marine sponges for biomonitoring active pharmaceutical ingredients (APIs) in coral reefs. Optimization of an SPME and ESI-LC-MS/MS method

Chemical pollution is a threat to coral reefs. To preserve them, it is crucial to monitor novel contaminants and assess the related risks. The occurrence of active pharmaceutical ingredients (APIs) in coral reefs has been poorly investigated until now. Under this light, we tested the use of the marine sponge Cf. Hyrtios as bio-monitors and conducted a pilot study in the Faafu Atoll (Maldives). Analyses were carried out by in vivo solid-phase microextraction (SPME) and liquid chromatography (LC) electrospray ionization (ESI) tandem mass spectrometry (MS/MS). Twelve APIs were selected for method optimization. Limits of quantitation (LOQs) were in the 0.6 and 2.5 ng/g range, accuracy between 86.5 % and 104.7 %, and precision between 3.0 % and 14.9 %. All the sponges located in the inner reefs resulted contaminated with at least one API. Gabapentin and Carbamazepine displayed the highest detection rates, while Ketoprofen had the highest concentration (up to 15.7 ng/g).

"Long-term safety and efficacy of injection mitomycin C(MMC) versus sponge application in trabeculectomies".

To compare the long-term safety and efficacy of subconjunctival injection mitomycin C(MMC) with conventional sponge applied MMC during trabeculectomy. Retrospective analysis of 98 eyes of 90 patients who underwent trabeculectomy with Mitomycin C were divided into two groups, group 1- sponge (n = 52) and group 2- Injection(n = 46). Follow-up data were collected on day one, day 15, one month, three months, six months, one year, two years and three years. Data from baseline and follow-up visits were analyzed and compared to study the significant difference in intraocular pressure (IOP), number of antiglaucoma medications (AGM) and best corrected visual acuity (BCVA) . P-value of <0.05 was considered statistically significant. Mean preop IOP was 34.61 ± 13.3 mmHg in group one and 33.07 ± 9.6 mmHg in group two, which reduced to 11.43 ± 3.2 and 11.59 ± 3.2 mmHg at three years (p < 0.001 in both groups) with no significant difference between the groups. Mean number of preoperative AGM was 2.28 ± 0.8 and 2.42 ± 0.7 in group one and two respectively which reduced to 1.19 ± 1.1(p = 0.405) and 0.88 ± 0.9(p = 0.001) at three years. Complete and overall success rates (complete + qualified) were 59.3% and 78.9% in group one and 60.9% and 80.4% in group two at three years. No statistically significant difference was found in complication rates, post-operative interventions, and final visual outcome in both groups. Subconjunctival Injection MMC was a safe and effective alternative to sponge application with comparable long term surgical outcomes.

Penerapan Terapi Water Tepid Sponge Pada Anak untuk Mengatasi Demam di Charitas Hospital Palembang

Fever is a symptom of all types of diseases, both infectious and noninfectious. Fever is also a symptom that often occurs in children. Children's body temperature defenses are still weak so they are very susceptible to infections, fungi and viruses. Fever can endanger a child's safety if treated quickly and appropriately and can cause seizures. Normal body temperature is 36.50C-37.50C. If the body temperature is more than 37.5 then a water tepid sponge compress can be applied. Able to apply a water tepid sponge compress to reduce fever in children. Able to determine body temperature before and after being given a water tepid sponge compress. In this study, a descriptive case study was used, three research subjects who received the fever-reducing drug paracetamol and were given water tepid sponge compress intervention to reduce fever in children. The data collection instrument uses an observation sheet. Based on the results of the study, it showed that children who were given fever-reducing medication and compressed water tepid sponge were used and for the three respondents for three days, the average result on the first day was 1.50C, on the second day the average was 1.50C. .3 0C and on the third day the average was 0.30C. Children who were given fever-reducing medication and given water tepid sponge compresses experienced a decrease in body temperature. Hospitals are expected to maximize the application of warm Tepid Water Sponge compresses to children to treat fever as a non-pharmacological therapy.

Safety and Efficacy of Mitomycin C: Augmented Trabeculectomy: Subtenon's Injection versus Sponge Application.

The objective of the study was to study the safety and efficacy of subtenon injection of mitomycin C (MMC) versus sponge application of MMC during trabeculectomy. Thirty-seven patients having primary glaucoma warranting trabeculectomy were enrolled in the study and their forty eyes were alternately allocated into either of the two groups: subtenon injection (ST) of 0.1 mL of 0.01% of MMC or sponge application (SP) of 0.02% of MMC and were operated by a single surgeon and followed for 3 months. The outcome was analyzed primarily based on reduction in intraocular pressure (IOP) and bleb morphology. Similar outcome in terms of complete success (ST - 90% and SP - 85%), qualified success (ST - 5% and SP - 5%), and failure rate (ST - 5% and SP - 10%) was seen at the end of 3 months. The absolute reduction in IOP from the baseline was -10.00 ± 3.67 mmHg (-41.2% ± 12.30) in ST versus -8.90 ± 5.56 mmHg (-35.9% ± 16.1) in the SP group at the end of 3 months. At the end of 3 months, blebs in the ST group had low-to-medium height and in the SP group had low height. Blebs in both the groups were diffuse with mild vascularity. Antiglaucoma medications required postoperatively were 0.20 ± 0.62 versus 0.40 ± 1.10 in the ST and SP group, respectively. The duration of surgery was 19.85 ± 0.75 min in the ST group versus 22.50 ± 0.51 min in the SP group. Subtenon injection of MMC is as efficacious and safe as the conventional sponge application technique.

Solar-heated mono-domain-structured ferrimagnetic cellulosic sponge fabricated by using bidirectional freeze casting for energy-efficient liquid adsorption

Liquid adsorption has a wide range of industrial and environmental applications. In recent years, interest in liquid adsorption technology that leverages porous materials has surged, primarily driven by these materials’ substantial surface area and adjustable wettability. However, high tortuous structures of conventional porous materials impede the flow of liquids, limiting their applicability in situations requiring rapid liquid adsorption such as oil spill cleanups. This study proposed two strategies for rapid liquid adsorption. We introduced a polydimethylsiloxane (PDMS) wedge to control ice crystal growth by generating a dual temperature gradient. This led to a mono-domain lamellar structure composed of vertically aligned channels. Cubic iron oxide nanoparticles (CION) were also utilized to enhance solar heating, that enabled rapid adsorption, even of high-viscosity liquids, without an external power supply unit for heating sorbents. The application of a solar-heated ferrimagnetic cellulosic sponge with precisely controlled channels facilitates the rapid removal of high-viscosity oils, which have traditionally been challenging for large-scale oil spill cleanups in oceans.

(026) Application of Gelatin Sponge as a Hemostatic Agent in Penile Prosthesis Implantation

Abstract Introduction Gelfoam® Sterile Compressed Sponge is a hemostatic that is directly applied to bleeding surfaces. This cost-effective hemostatic agent is prepared from purified porcine skin, Gelatin granules and Water for Injection. It is water insoluble, however is completely absorbed within 4–6 weeks with minimal scar formation. Gelfoam is available sterile for intra-operative use, and is applied in a multitude of surgical specialties. Objective In this work, we demonstrate for the first time the of Gelfoam to minimize the risk of bleeding in penile prosthesis implantation. Methods Eight cases received a three-piece inflatable implant (Rigicon Infla10®) through a peno-scrotal incision. Following cylinder insertion, corporotomies were closed by tying the stay sutures rather than water-tight sewing. Gelfoam was soaked in antibiotic-supplemented saline. Air bubbles were squeezed out followed by soaking. Gelfoam was then applied to the corporotomies, pump space and entry rout to the reservoir space. It was secured over the corporotomies by closing a pre-fashioned layer of Buck’s fascia. A suction drain was inserted. Mummy wrap was not used. Drain output was monitored and complications recorded. Results In two cases, drain output was an average of 80 cc’s in the first 24 hours, then 20 cc’s in the following 24 hours. However, in 6 cases, drain output was an average of 18 cc’s in the first 24 hours, mostly sero-sanguinous, then none in the following 24 hours. No cases of hematoma formation, infection, foreign body reaction, mass formation or hypersensitivity reaction were encountered. Conclusions The initial results of the current small case series demonstrate that Gelfoam is well-tolerated in penile surgeries, with possible value at minimizing post-operative bleeding, encouraging a multi-center larger study. Disclosure No.

A systematic review comparing Mytomicyn-C subtenon injection to sponge during trabeculectomy in open angle glaucoma

Introduction &amp; ObjectivesMitomycin-C (MMC) is an effective agent to prevent scarring during the healing process followingtrabeculectomy procedure by inhibiting the multiplication of cells producing scar tissue. The aim ofthis study is to compare the efficacy of Mitomycin-C (MMC) delivered by either subtenon injection orsponge application during trabeculectomy surgery in open angle glaucoma patients.&#x0D; MethodsA systematic search was done using several databases including Pubmed, Medline, Embase, Scopus,and Jstor. Inclusion criteria were open angle glaucoma patients underwent trabeculectomy surgery,given either MMC via subtenon or sponge application, article in English, Randomized ControlledTrial (RCT) studies which published in the last 10 years. Intra-Ocular Pressure (IOP), EndothelialCell Counts (ECC) and Bleb Morphologic features with at least 1 month follow-up were evaluated.&#x0D; ResultsTwo RCT studies were included in this study. Both studies demonstrated that sub-tenon injectionand sponge application has no significant difference regarding IOP reduction from the baseline.Regarding morphologic features, both studies favor subtenon to conventional sponge application.Lastly, ECC in both studies conclude that there was no marked differences.&#x0D; ConclusionThe outcome of administration of MMC through subtenon injection and sponge application werecomparable to one another. However, less vascularization are shown in subtenon injection group.

Two-year outcomes of anterior versus posterior scleral application of mitomycin C-soaked sponge in trabeculectomy.

To compare the safety and efficacy of two different application methods of mitomycin C (MMC)-soaked sponge in trabeculectomy. Retrospective study. We included 71 eyes of 71 patients that had undergone trabeculectomy. In the anterior scleral application group, 36 eyes were treated using the long side of the MMC-soaked sponge placed parallel to the limbus. The efficacy and safety in these eyes were compared with eyes treated with the posterior scleral application group, consisting of 35 eyes treated with the long side of the MMC-soaked sponge placed perpendicular to the limbus. The follow-up period was 2 years. The safety of the procedure, including bleb morphology and complications, was the primary outcome, while the success rate was the secondary outcome. The cumulative success rate at 2 years postoperatively was 94.4% in the anterior and and 94.3% in the posterior scleral application group (P = 1.000). However, with the posterior scleral application of the MMC-soaked sponge, blebs were more low-lying (P = 0.048), less in extent (P < 0.001), more normally vascularized (P = 0.027) and more posteriorly directed (P < 0.001). Furthermore, the incidence of thin-walled cystic bleb (P = 0.028) and bleb leakage (P = 0.025) was significantly lower in the posterior scleral application group than in the anterior group. Although there were similar success rates, the posterior scleral application of MMC-soaked sponge with trabeculectomy was safer with a better bleb morphology than the anterior scleral application.

Induction of estrus as a strategy to improve the economic efficiency of the sheep flock

Productivity and profitability in sheep production systems are strongly influenced by the reproductive capacity of the flock.&#x0D; Objective: To evaluate the use of reproductive biotechnologies (e.g., the induction of estrus) and its impact on the economic efficiency and the productive and reproductive performance of technified sheep production systems, during the seasonal anestrus.&#x0D; Design/Methodology/Approach: Four-hundred recently weaned (60 days postpartum) ewes of the Katahdin breed were randomly divided into two treatments: T1 = natural mating (n= 200) and T2 = induction of estrus (n=200). Estrus was induced through the application of intravaginal sponges, impregnated with 20 mg of chronolone, plus the injection of 400 IU of Equine Chorionic Gonadotropin. The aim was to evaluate the reproductive and economic efficiency of the flock.&#x0D; Results: The induction of estrus during the seasonal anestrus recorded increases (p&lt;0.001) in prolificacy (32%), fertility (86%), and kilograms of lamb weaned per year per ewe (48%), while decreases (p &lt;0.05) were recorded in the number of open days (25%), calving interval (11%), cost per open days (23%), and the kilograms of lamb required per ewe per year (10%).&#x0D; Study Limitations/Implications: The constant variations in the price of supplies and services caused changes in the economic indicators.&#x0D; Findings/Conclusions: The use of reproductive biotechnologies (such as estrus induction) has a positive impact on production units, improving their profitability.

3D sponge loaded with cisplatin-CS-calcium alginate MPs utilized as a void-filling prosthesis for the efficient postoperative prevention of tumor recurrence and metastasis.

Intraoperative bleeding is a pivotal factor in the initiation of early recurrence and tumor metastasis following breast cancer excision. Distinct advantages are conferred upon postoperative breast cancer treatment through the utilization of locally administered implant therapies. This study devised a novel 3D sponge implant containing cisplatin-loaded chitosan-calcium alginate MPs capable of exerting combined chemotherapy and hemostasis effects. This innovative local drug-delivery implant absorbed blood and residual tumor cells post-tumor resection. Furthermore, the cisplatin-loaded chitosan-calcium alginate MPs sustainably targeted and eliminated cancer cells, thereby diminishing the risk of local recurrence and distant metastasis. This hydrogel material can also contribute to breast reconstruction, indicating the potential application of the 3D sponge in drug delivery for breast cancer treatment.

False positive PET-CT imaging after application of fibrin-based sponge at the site of previous hepatic resection for colo-rectal metastasis: A short series

Surgical resection is the treatment of choice with curative intent for colorectal liver metastasis. Preoperative accurate radiological staging is key for optimal treatment. Fluorine-18 fluorodeoxyglucose PET-CT (PETCT) is effective for this purpose. We present 4 cases of patients with history of hepatectomy for colorectal liver metastasis. In all patients, during the procedure, we used fibrin-based sponge to achieve optimal haemostasis of the parenchymal transection surface. During the oncologic follow-up, a suspicion of disease recurrence justified a staging PET-CT that revealed pathologic metabolic activity on sites of previous liver resection, highly suspicious of tumour recurrence. The delay between hepatectomy and PET-CT for recurrence ranged from 5 to 12 months. In all cases, a new surgical exploration was performed after neoadjuvant chemotherapy, and PET-CT positive sites of previous liver resection were removed. Definitive histological diagnosis showed inflammatory granuloma or fibrous tissue.

3D Sponge Electrodes for Soft Wearable Bioelectronics

AbstractBy definition, a sponge refers to a soft and porous material, which is typically made from cellulose or synthetic polymers. Structurally, it is 3D offering a high surface‐to‐volume ratio; mechanically, it is elastic and durable; economically, it is inexpensive and can be produced at industrial scales. These attributes promote a strong research interest in exploring 3D sponges for applications in absorption, separation, catalysis, and electronics. This work is dedicated to the discussion of the recent progress in design of mechanically deformable sponge electrodes for their application in soft electronics. First, the characteristics and advantages of sponge electrodes are described, which is followed by the discussion of various active materials for fabricating 3D sponge electrodes, including carbon, metal, conductive polymers, MXenes, and their hybrids. Then, the viable fabrication methodologies are reviewed by comparing their advantages and disadvantages. Furthermore, the applications of 3D conductive sponges in stretchable conductors, sensors, energy storage devices, and integrated systems are discussed. Finally, the challenges and opportunities in future sponge‐based soft electronics are covered.

Comparison of the Success Rate of External Dacryocystorhinostomy with Intramucosal Injection and Sponge Application of Mitomycin C to Circumosteal Mucosa

Objective: To compare the success rate of external dacryocystorhinostomy with intramucosal injection and sponge application of Mitomycin C to circumosteal mucosa. Study Design: Quasi-experimental study Place and Duration of Study: Eye Department, Combined Military Hospital, Jhelum Cantt Pakistan, from Feb 2019 to Dec 2021.Methodology: One hundred ten patients were selected and randomly allocated into two equal Groups labelled Group-A and Group-B. Group-A patients received 0.1ml of intramucosal injection of 0.02% Mitomycin C, and Group-B patients had 0.02% Mitomycin C applied with a sponge to the circumboreal mucosa. The result of DCR was evaluated at six months and declared successful if the patients were asymptomatic of epiphora and a patent lacrimal passage was found on probing and irrigation. Failure was defined as symptomatic epiphora along with regurgitation on probing and syringing. In failed cases, nasal endoscopy was performed along with probing. Results: Success rates of external dacryocystorhinostomy in the Intramucosal Injection Group was 96%, and in the Sponge Application Group, it was 92%. A comparison of both techniques depicted a statistically insignificant difference in success rate (p=0.60).Conclusion: Mitomycin C use as an adjunctive agent during external dacryocystorhinostomy is a safe and effective technique in achieving a high rate of success, and the route of application, whether applied topically or injected intramucosal does not significantly affect the outcome of this procedure.

Posterior scleral application of a mitomycin C-soaked sponge during trabeculectomy.

To evaluate the safety and efficacy of posterior scleral application (a modified technique) of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma. This retrospective study included 101 patients (115 eyes) with glaucoma (aged 12-83y) who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method. A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus. The mitomycin C concentration and exposure time were 0.2-0.5 mg/mL and 1-5min, respectively. Intraocular pressure, best-corrected visual acuity, and hypotensive medications were recorded at baseline and at the final visit. Complications, interventions required, and bleb morphology were recorded postoperatively. The primary outcome was trabeculectomy safety, including complications and bleb morphology; the secondary outcome was the trabeculectomy success rate. At the final follow-up [median 28mo, range 7-67mo and interquartile range (IQR) 13mo], the qualified (cumulative) success rate was 93.0% and the complete success rate was 60.0%. No bleb-related complications were observed. The mean height, extent, and vascularity grades were 0.6±0.9, 1.1±0.4, and 2.4±0.9, respectively. All Seidel tests were negative. The mean posteriority grade was 0.8±0.4. Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.

Augmented trabeculectomy - The surgical journey and road trip forward.

Augmented trabeculectomy - The surgical journey and road trip forward.

The prokaryotic community of Chondrosia reniformis Nardo, 1847: from diversity to mercury detection

Microbial communities inhabiting sponges are known to take part in many metabolic pathways, including nutrient cycles, and possibly also in the bioaccumulation of trace elements (TEs). Here, we used high-throughput, Illumina sequencing of 16S rRNA genes to characterize the prokaryotic communities present in the cortex and choanosome, respectively the external and internal body region of Chondrosia reniformis, and in the surrounding seawater. Furthermore, we estimated the total mercury content (THg) in these body regions of the sponge and in the corresponding microbial cell pellets. Fifteen prokaryotic phyla were detected in association with C. reniformis, 13 belonging to the domain Bacteria and two to the Archaea. No significant differences between the prokaryotic community composition of the two regions were found. Three lineages of ammonium-oxidizing organisms (Cenarchaeum symbiosum, Nitrosopumilus maritimus, and Nitrosococcus sp.) co-dominated the prokaryotic community, suggesting ammonium oxidation/nitrification as a key metabolic pathway within the microbiome of C. reniformis. In the sponge fractions, higher THg levels were found in the choanosome compared to the cortex. In contrast, comparable THg levels found in the microbial pellets obtained from both regions were significantly lower than those observed in the corresponding sponge fractions. Our work provides new insights into the prokaryotic communities and TEs distribution in different body parts of a model organism relevant for marine conservation and biotechnology. In this sense, this study paves the way for scientists to deepen the possible application of sponges not only as bioindicators, but also as bioremediation tools of metal polluted environments.

Application of Nanocube-Functionalized Nitrogen-Doped Melamine Sponge for Dispersive Micro-Solid Phase Extraction (SPE) of Phenolic Compounds From Aquatic Media

A procedure is reported for the efficient extraction and determination of phenolics from aqueous media. The approach is based on the dispersive micro-solid phase extraction using synthesized Co3O4 nanocube-functionalized nitrogen-doped melamine foam. The adsorption and desorption conditions were optimized by response surface methodology and one-variable-at-a-time approaches. The proposed method was fully validated. Under the optimized conditions, the limits of detection were lower than 0.5 ng mL−1. Calibration curves were linear in the range from 1.0 to 250.0 ng mL−1, 0.7 to 200.0 ng mL−1, 0.2 to 250.0 ng mL−1, and 1.0 to 250.0 ng mL−1 for phenol, 2,4-dichlorophenol, 2,4,6-trichlorophenol, and pentachlorophenol, respectively. Enrichment factors and absolute recoveries from 17.5 to 20.7 and 70% to 83% were achieved. The method was successfully applied for trace monitoring of the analytes in environmental and industrial water samples with gas chromatography—flame ionization detection analysis. Satisfactory relative recoveries between 89.0% and 105.8% were obtained along with acceptable precision below 8.1%. This method is a simple, rapid, sensitive, and reliable protocol for efficient screening of the phenolics.

Two routes of administration of mitomycin C in a trabeculectomy.

The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates. https://youtu.be/RLEbK4IeRtU.