Aspiration Method Research Articles

Short-Term Efficacy of Using a Novel Low-Volume Bone Marrow Aspiration Technique to Treat Knee Osteoarthritis: A Retrospective Cohort Study.

Intra-articular bone marrow concentrate (BMC) and aspirate (BMA) injections have been used with mixed results to treat osteoarthritis (OA). Given the various aspiration and concentration methods available for preparing bone marrow, more data are needed to identify the optimal bone marrow harvesting techniques to treat OA. This retrospective cohort study examined the effect of using low-volume BMAs harvested using the Marrow Cellution™ (MC) device on 160 patients (262 knees) suffering from pain due to knee OA, KL grades 2-4, that did not respond to conservative treatment. Changes in visual analog scores (VAS) for overall daily activity were examined over a six-month time frame in these patients (63.5 ± 0.97 years of age; 48.1% male). In addition, changes in the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Patient Global Impression of Change (PGIC scores) were examined over the same time frame in a smaller subset of patients (95 patients including 172 knees). There was a statistically significant improvement in VAS scores for overall daily activity 6 months postprocedure in the study population, 7.29 ± 0.27 vs. 3.76 ± 0.34 (p < 0.0001), as well as statistically significant improvements in WOMAC scores, 49.3 ± 4.27 vs. 66.3 ± 4.08 (p < 0.0001). On the individual level, 71% of the cases displayed VAS improvements and 61% of the cases displayed WOMAC improvements that exceeded levels previous studies determined to be the minimal clinically important difference (MCID) for knee OA treatments. The improvements in WOMAC scores were also seen in both the WOMAC pain subscore, 52.2 ± 4.39 vs. 72.2 ± 4.36 (p < 0.0001) and the WOMAC function subscore, 51.6 ± 4.67 vs. 69.0 ± 4.36 (p < 0.0001). In addition, the PGIC scores measuring patient satisfaction improved from 4.03 ± 0.26 at 6 weeks postprocedure to 4.65 ± 0.28 at 6 months postprocedure (p < 0.0001). Knee OA patients treated with MC BMA intra-articular injections exhibited significant reductions in VAS pain scores and significant improvements in WOMAC scores that exceeded the minimal clinically important difference thresholds. In addition, reductions in VAS pain scores and improvements in WOMAC scores correlated with higher PGIC scores.

Hub aspiration strategies and flow loss analysis of a shock-in type supersonic compressor rotor with negative inlet pre-whirl

Large-scale corner separation is one of the key factors that limit the performance improvement of high-load compressors. In this paper, the hub aspiration method was applied to a supersonic shock-in type compressor rotor with negative inlet pre-whirl to suppress the hub corner separation. Six suction schemes composed of aspiration slots with different locations and orientations have been designed and numerically tested. The results revealed that the aspiration location is better to be placed starting from the post-shock point and extending to the deep separation zone. The streamwise slot satisfying such conditions could effectively suppress corner separation but narrows the rotor stable mass flow range by increasing the pitchwise secondary flow. The circumferential skew slot could exactly remedy such defects. The streamwise slot combined with a downstream skew slot is the optimal aspiration strategy that effectively improves the rotor performance without reducing mass flow range. At the design and near-stall operating point, the rotor efficiency (EF) and total pressure ratio (TPR) could be improved by 1.3% and 5.0%, 3.3% and 7.2%, respectively. Consequently, the stall margin was increased by 2.0%. According to the flow loss analysis, the combined aspiration scheme mainly alleviated losses from hub to middle span by reducing the shock strength and the magnitude of separation as well as its radial migration. But in the tip region, it strengthened the leakage flow and its interaction with shock waves, thus increasing the flow losses.

A rare cause of abdominal pain managed unconventionally: acute renal infarction caused by atrial fibrillation: a case report

BackgroundAtrial fibrillation is one of the most common arrhythmias. The main thrombotic complication of arterial fibrillation is ischemic stroke, but it can also cause acute renal infarction from embolization. The low incidence and nonspecific clinical manifestations of acute renal infarction make it difficult to diagnose, often leading to either delayed diagnosis or misdiagnosis. Due to its rarity, more efficient treatment guidelines are helpful for the management of acute renal infarction related to the thromboembolic complication of arterial fibrillation.Case reportsWe report a case of acute renal infarction due to underlying arterial fibrillation, where a novel interventional therapeutic method was used. A 66-year-old Chinese man with arterial fibrillation, not on anticoagulation due to the patient’s preference, and coronary artery disease post-percutaneous coronary intervention to left anterior descending artery about 1 year ago, was currently on dual antiplatelet therapy. He suddenly developed intermittent and sharp left-sided abdominal pain and was found to have an acute left renal infarction on computed tomography scan. Angiogram showed acute occlusion of the left renal artery due to thromboembolism. For this patient, a combination method of local thrombus aspiration, angioplasty, and infusion of nitroglycerin and diltiazem were used, restoring blood flow to the left kidney. After recovery, the patient was discharged on aspirin, clopidogrel, and warfarin. At 6 months follow-up, there was no residual kidney dysfunction.ConclusionsAcute renal infarction from thromboembolism is a rare but serious complication of arterial fibrillation. More efficient and different options for intervention methods will benefit the treatment of this disease. Here, we report a combination therapeutic method that has not been used in acute renal infarction associated with arterial fibrillation, and which restored renal perfusion and prevented long-term kidney injury.

A Novel Stereotactic Aspiration Technique for Intracerebral Hemorrhage

Minimally invasive surgery is effective and recommended for treatment of intracerebral hemorrhage; however, neurosurgeons in grass-root hospitals in underdeveloped countries lack effective and precise minimally invasive surgery techniques. The aim of this study was to present a technique of computed tomography angiography-based three-dimensional-printed navigation mold-guided stereotactic aspiration and demonstrate its clinical application using a hard needle in a series of patients. The novel stereotactic aspiration technique was performed in 18 patients with spontaneous intracerebral hemorrhage at our center, and clinical outcomes were reported. We compared the volume of hematoma measured by 3 different methods: ABC/2 formula, manual segmentation with OsiriX, and manual segmentation with 3D Slicer. The surgery was completed safely within an average operative time of 15.11 minutes, achieving the goal of <15 mL residual clot volume or >70% clot removal in all patients. No intracranial rebleeding or infection was observed postoperatively. At the end of the 6-month follow-up, 61.11% (11/18) of patients achieved a modified Rankin Scale score <3. There was overall better agreement of hematoma measurement using segmentation with 3D Slicer rather than ABC/2 measurement or hematoma measurement using segmentation with OsiriX. Our novel method of stereotactic aspiration benefited patients in this study with good percent clot removal, few surgery-related complications, and a favorable prognosis. Manual segmentation with 3D Slicer could be used to provide the neurosurgeon with dependable information about hematoma volume. This cheap and convenient technique may be applied in grass-root hospitals in underdeveloped countries. Assessment in multicenter prospective clinical trials is needed.

NOTES ON THE SUBFAMILY PAEDERINAE OF EDİRNE PROVINCE IN TÜRKİYE. A NEW SPECIES OF THE GENUS Lathrobium GRAVENHORST, 1802 WITH NEW AND ADDITIONAL RECORDS (INSECTA: COLEOPTERA: STAPHYLINIDAE)

In this study, as a result of field studies conducted in Edirne province in the Marmara Region of Türkiye between March 2021 and June 2022, totally 18 species in 11 genera belonging to the subfamily Paederinae (Coleoptera: Staphylinidae) were recorded. Field studies were conducted from different localities in Edirne Province by using aspirator and sifter methods. A new species of the genus Lathrobiuum Gravenhorst, 1802 Lathrobium gocmeni sp. n. (Edirne, Enez) is described illusturated and distinguished from congeners. Astenus thoracicus (Baudi di Selve, 1857), A. procerus (Gravenhorst, 1806), Lobrathium rugipenne (Hochhuth, 1851), Medon fusculus (Mannerheim, 1830), Micrillus testaceus (Erichson, 1840), Paederus littoralis, Gravenhorst, 1802, and Scopaeus gracilis (Sperk, 1835) from Thrace, and Lathrobium fulvipenne Gravenhorst, 1806 are reported for the first time from the Marmara Region. In addition, all 18 species except for Achenium propontiacum Bordoni, 2009 and Scopaeus laevigatus (Gyllenhal, 1827) were recorded for the first time from Edirne province.

Graduation Towers Impact on the Concentration and Chemical Composition of Ambient Aerosol: A Case Study from Wieliczka Salt Mine in Poland

The aim of the research was to determine the effect of graduation towers on the aerosol concentration and its composition not only in the vicinity of the graduation tower itself, but also at a distance from it, on the example of the brine graduation tower in the Wieliczka Salt Mine health resort. Two measurement sites were selected for the research, one located inside the graduation tower and the other at the guard booth—at a considerable distance from the graduation tower. Total suspended particulate (TSP) and PM10 (particulate matter with a diameter that does not exceed 10 µm) samples were taken simultaneously using the aspiration method. The collected samples were subjected to analyses of TSP and PM10 concentrations, the content of organic carbon (OC), elemental carbon (EC) and selected ions. It was confirmed that the composition of the aerosol in the Wieliczka Salt Mine significantly differs from the typical aerosol composition in inland locations and is similar to the aerosol composition in coastal zones. The comparison of the aerosol composition at both measuring sites clearly indicates a very favorable influence of the brine graduation tower on the composition of the atmospheric aerosol, even at a certain distance from it.

Hip aspiration: A comparison of ultrasound and fluoroscopic guidance

IntroductionHip aspirations are commonly performed for diagnostic purposes using either fluoroscopic or ultrasound guidance. The superiority of one type of image guidance over another for aspiration of a native or replaced hip remains a matter of debate. The questions to be evaluated in this study include 1) to determine if hip aspiration using fluoroscopy or ultrasound guidance more often obtains fluid from native and post-arthroplasty hip joints, and 2) to identify patient-related factors associated with the ability to obtain fluid. Material and methodsA retrospective analysis of all hip aspirations (433) performed at a single institution was undertaken, with the primary outcome variable being successful attainment of joint fluid. Age, body mass index (BMI), sex, presence of a trainee, presence of an arthroplasty at the time of aspiration on the affected side, amount of fluid collected, and type of image guidance were used as independent variables in regression models. Results1) The likelihood of obtaining fluid was approximately 2.1 times greater with ultrasound guidance than fluoroscopy guidance (95% CI = 1.382, 3.117; p < 0.001). 2) Ultrasound guidance and lower BMI were independently associated with a significantly higher likelihood of obtaining fluid. Additionally, one unit decrease in BMI was associated with about a 3% increase in the odds of obtaining fluid (95% CI = 0.950, 0.998; p = 0.033). ConclusionThis study demonstrates that the use of ultrasound guidance for hip joint aspiration, when compared to fluoroscopic guidance, is more likely to result in a successful aspiration and the acquisition of a greater volume of fluid. Therefore, ultrasound guidance is the preferred method for hip aspiration in both native and replaced hips.

In Vitro Analysis of the Efficacy of Endovascular Thrombectomy Techniques according to the Vascular Tortuosity Using 3D Printed Models.

Achieving complete recanalization with the front-line endovascular thrombectomy device improves the outcome of acute stroke. The aim of this study was to evaluate whether various thrombectomy techniques including contact aspiration, stent retriever thrombectomy, and combination therapy differ in first-pass effect and distal emboli in acute large-vessel occlusion simulated using 3D printed nontortuous and tortuous cerebrovascular anatomy models. 3D printed flow models were manufactured using angiographic data of nontortuous and acutely angulated tortuous vascular anatomy from real patients. Three thrombectomy techniques, contact aspiration, stent retriever, and combined methods, were tested under proximal protection with the balloon-guiding catheter. The first-pass effect and distal emboli rates were analyzed in addition to the thrombectomy-failure mechanisms of the respective techniques. A total of 30 thrombectomy experiments were performed. The overall incidence of first-pass effect in the nontortuous and tortuous anatomy was 80.0% versus 46.7%. The overall incidence of distal emboli in the nontortuous and tortuous anatomy was 26.7% versus 46.7%. The contact aspiration technique showed better first-pass effect (80.0%) and distal emboli rates (20%) in the tortuous model compared with other techniques. The combined technique did not show remarkable superiority of the first-pass effect and distal emboli in either the nontortuous or tortuous anatomy. Shearing off of the thrombus was the main mechanism of thrombectomy failure in the combined group. The tortuous vascular anatomy may worsen the first-pass effect and distal emboli rates. The combined techniques failed to show improvement in outcome due to the shearing-off phenomenon of the thrombus during retrieval.

Analysis of the influencing factors on fine-needle aspiration biopsy results of the thyroid.

ObjectiveThe objective of the study is to analyze the influencing factors on the results of thyroid fine-needle aspiration biopsy (FNAB).MethodA total of 339 patients who underwent FNAB in our hospital from December 2018 to July 2021 were retrospectively selected. The patients were chosen according to the gender ratio, age, and thyroid ultrasound characteristics and were divided into three groups: (1) a 22G needle vacuum aspiration group (Group 1, n = 85), (2) a 22G biopsy needle non-vacuum aspiration group (Group 2, n = 50), and (3) a 25G biopsy needle non-vacuum aspiration group (Group 3, n = 204). Patients in these groups were evaluated for determining the FNAB dissatisfaction rate of pathological samples. A bivariate regression analysis of independent risk factors related to the unsatisfactory pathological diagnosis of samples was performed.ResultsThe specimen dissatisfaction rates of the three groups were 22/85 (25.9%), 15/50 (30%), and 18/186 (9.7%), respectively. The overall sample dissatisfaction rate was 55/339 (16.2%), and the sample satisfaction rate of Group 3 was higher than that of Groups 1 and 2 (P < 0.05). Logistic bivariate regression analysis showed that the age of the patients and the capillary sampling needles and aspiration methods were two independent risk factors for determining the dissatisfaction rate of FNAB pathological samples.ConclusionA 25G capillary sampling aspiration biopsy needle was selected to perform FNAB in thyroid nodules without vacuum aspiration, which could effectively improve the accuracy of FNAB results with a high specimen satisfaction rate.

Direct hysteroscopic endometrial sampling and pipelle sampling in perimenopausal women.

Abnormal uterine bleeding is a common cause of hospital admission in perimenopausal women. It can be the first sign of many diseases such as endometrial cancer and endometrial hyperplasia. Endometrial sampling is valuable in early diagnosis and treatment. Although hysterectomy is the gold standard in the diagnosis of endometrial pathology, it is not considered an acceptable method for diagnosis. With the principle of "see and treat, hysteroscopy seems to be the most successful method. After obtaining the necessary ethics committee approval, we obtained liquid-based cytology samples of our perimenopausal patients who frequently applied to our outpatient clinic with abnormal uterine bleeding. To conduct endometrial sampling of our patients, we used pipelle aspiration method in our 75-disease group and direct hysteroscopic sampling method in our other 75 disease group. We then compared the pre- and postoperative pathology results. There was no statistically significant difference between preoperative and postoperative pathological results in both pipelle and hysteroscopic sampling groups. Evaluation of endometrial pathologies by hysteroscopic method and pipelle method has high sensitivity and specificity. Gynecologists may determine the method preference according to the status of the health system together with their patients.

Development of Immunological Assays Based on Leishmania donovani Antigen for Diagnosis of Canine Visceral Leishmaniasis and Their Multicenter Evaluation in Brazil and Italy.

Canine visceral leishmaniasis (CVL) due to Leishmania infantum infection is a zoonotic disease prevalent in the areas of South America and the Mediterranean. Infected dogs as reservoirs can contribute to disease transmission and can be a scourge to public health. Therefore, early diagnosis of infected dogs may play a pivotal role in circumscribing disease progression. Invasive tissue aspiration and insufficient serological methods impair a single assay for prompt CVL diagnosis. In the present study, we aimed to evaluate the potential of Leishmania donovani isolated membrane protein, LAg, for the diagnosis of CVL through immunological assays. Initially, enzyme-linked immunosorbent assay was done with Brazilian dog sera to evaluate the performance of LAg in diagnosing CVL and found sensitivity and specificity of 92.50% and 95%, respectively. The study further confirmed the diagnostic efficacy of LAg in a dipstick format. The dipstick test of canine sera from three centers in Brazil and one center in Italy collectively showed sensitivity values in the range of 53.33% to 100% in recognizing symptomatic dogs and specificity values between 75% and 100% to rule out healthy dogs. Moreover, a rapid immunochromatographic test was developed and optimized using LAg. This test was able to identify 94.73% of CVL of Brazilian origin with specificity of 97.29%. The current results highlight the reactive potential of the L. donovani antigen, LAg, for L. infantum CVL diagnosis and support our previous findings, which suggest the utility of LAg for the diagnosis of both L. donovani and L. infantum human VL in a variety of endemic regions. LAg as a diagnostic candidate may be employed to identify comprehensive CVL cases in epidemiological areas.

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

An efficient method of bronchial aspiration through a flexible fibre-optic bronchoscope.

An efficient method of bronchial aspiration through a flexible fibre-optic bronchoscope.

EBUS-TBNA: A 2-Year Experience from a Tertiary Pathology Centre with Cyto-Histological Correlation

Introduction: Endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) methods are expanding due to their minimally invasive nature using real-time image guidance, a low incidence of complications, and a diagnostic rate ranging from 89% to 93.6%. The application of EBUS-TBNA was able to downgrade 40% of patients with suspicion of stage III lung cancer on PET scan. Methods: In the present study, we analysed the diagnostic outcomes of EBUS cytology at the Laboratory of Pathology, Fimlab Laboratories, Tampere, Finland, during a 2-year period. In our analysis, 1176 EBUS samples from 486 patients that underwent EBUS-TBNA in Tampere University Hospital (TAYS) from January 2017 to December 2018 were reviewed. The mean age of the patients was 64 ± 14 (SD) years with the age range from 19 to 90 years. Cytospin cytology slides stained by Papanicolaou stain and cell blocks were performed in each sample. Further immunohistochemical stains were ordered by the pathologist on demand. Results: The diagnostic yield was 89.5% and the diagnostic accuracy was 77.9% in the present study. The sensitivity for malignancy in EBUS-TBNA diagnosis was 95.69% and the negative predictive value 96.75%. Cyto-histopathological diagnosis correlation was 54.7% (95% confidence interval [CI]: 40.6%–66.4%, p < 0.001), and the histological accuracy compared to the exact original diagnosis was 43.5%. When considering the histological diagnoses that support the original diagnosis, the correlation was 61.3% (95% CI: 48.4%–71.5%, p < 0.001) and the accuracy was 72.2%. The overall inadequate rate of EBUS-TBNA samples in this study was 10.5%. Conclusions: The EBUS-TBNA diagnostic yield, diagnostic accuracy, and inadequate rate in the present study are in line with previously published studies.

Hygienic assessment of the air environment of student classrooms

Introduction. The air quality in educational premises is an important factor determining the health of university students. Prolonged exposure to indoor environment leads to the accumulation of anthropotoxins and bacterial air pollution in university classrooms. Materials and methods. Monitoring of the CO2 content in the air environment of universities was carried out on the basis of four hundred eighty six measurements in the educational premises using the Testo 435-2 device. Bacterial air pollution in the classrooms of Ufa universities with the identification of microorganisms was studied in forty eight classrooms by the aspiration method using a PU-16 sampler; 182 sampling points were selected. Results. When assessing the air quality of university classrooms depending on the carbon dioxide content, it turned out that high air quality (400 ppm or less) was determined only in every tenth classroom (9.8%), while low quality (1000 ppm or more) was determined in every third classroom (32.1%). The assessment of bacterial air pollution in the classrooms of educational institutions with the identification of microorganisms revealed the presence of pathogenic microflora (Staphylococcus aureus) in 6.3% of the classrooms; mold fungi - in 16.8% of the classrooms; a high concentration and a wide variety of bacilli. The presence of a significant number of Pseudomonas stutzeri, Staphylococcus Epidermidis and Staphylococcus hominis in many rooms can be dangerous for students with a weakened immune system. Limitations. The study was conducted on the basis of four different universities in Ufa, Republic of Bashkortostan (12 universities and branches in total), which provided a representative sample of the volume. The subject of further research will be the study of the conditions of study in other universities in Ufa. Conclusion. The obtained data indicate the need for continuous monitoring of the air quality of educational institutions and the development of practical recommendations for each university, taking into account the risk factors obtained for each audience.

A Bibliometric Analysis of 8271 Publications on Thyroid Nodules From 2000 to 2021.

IntroductionThyroid nodules (TNs) are a common clinical condition. The probability of thyroid nodules being malignant is 7-15%. However, in recent decades, a number of publications on TNs have not been well summarized and discussed. The aim of this study was to summarize and sort out medical publications on TNs over the past 2 decades using a bibliometric method.Materials and MethodsMedical publications from January 1st, 2000, to November 1st, 2021, were searched in the Web of Science Core Collection database using the Medical Subject Heading (MeSH) term “thyroid nodule”. Full associated data were downloaded, and detailed information was extracted using the bibliometric analysis platform VOSviewer.ResultsA total of 8271 publications related to TNs from the last 2 decades were found and included in this study. An increasing trend was presented in the annual number of publications. The United States, China and Italy contributed the most publications. Carcinoma, management, ultrasound, and fine-needle aspiration were the most popular subjects in the field of TNs. The topics of the studies could be stratified into four clusters. The first cluster was using ultrasound to evaluate the nodules, including the thyroid imaging reporting and data system (TI-RADS), elastography and benign features. The second cluster was the fine-needle aspiration method, including the Bethesda system, cytology and BRAF mutations. The third cluster was the management of nodules, including radiofrequency and thermal ablation, surgery, and consensus statements. The last cluster was carcinoma, which is correlated with all three clusters described above. The preoperative diagnosis of cytologically indeterminate nodules was particularly highlighted in the top 10 most cited publications in recent years.ConclusionHow to diagnose thyroid nodules as malignant or benign, especially in cytologically indeterminate nodules, is still the most concerning topic in TN research. Although the fine-needle aspiration method and gene-expression classifiers show promising results, there is still a crucial need for translations from fundamental studies to clinical applications.

Carotid Artery Stenting in Patients With Contralateral Carotid Occlusion Using a Combined Protection Method.

Carotid artery stenting has become widespread as a revascularization method and has increasingly replaced carotid endarterectomy for treating internal carotid artery stenosis with contralateral carotid occlusion. Hence, this study aimed to establish the clinical characteristics and perioperative outcomes of carotid artery stenting for internal carotid artery stenosis in patients with contralateral carotid occlusion using a combined protection method. This retrospective single-center study assessed 218 patients with internal carotid artery stenosis who underwent carotid artery stenting using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method. We distinguished 2 patient groups: contralateral carotid occlusion (n = 11) and no contralateral carotid occlusion (n = 207). We evaluated the patients' characteristics, intraoperative transient neurological symptoms, hypotension, bradycardia, major adverse events (major stroke, myocardial infarction, and death within 90days), minor stroke, hyperintensities on diffusion-weighted images after carotid artery stenting, captured visible debris, and restenosis. In this cohort, 5% of patients with internal carotid artery stenosis had contralateral carotid occlusion. No statistically significant differences in patient characteristics existed between the groups. The success rate of carotid artery stenting was 100%. There were no statistically significant differences in intraoperative complications, postoperative major adverse events, or other outcomes between both groups. In this cohort, carotid artery stenting using dual protection combined with blood aspiration was safe and effective in preventing distal embolism in patients with internal carotid artery stenosis and contralateral carotid occlusion.

Treatment of Septic Arthritis of the Hip Joint Using Repeated Aspirations: When Should We Operate?

The well-accepted treatment of septic arthritis of the hip joint (SAHJ) is surgical drainage of the joint, but repeated aspirations of the hip joint under sonography, have been used for over twenty years with significant success in some centers, including ours. In recent years, we identified some children who did not respond to aspirations and had to undergo arthrotomies. We were concerned that some children may have reached the operating room after a longer than ideal time. Identification of the characteristics of patients who did not respond to repeated aspirations and development of a treatment algorithm that expedites decision-making regarding the necessity of surgery. This is a single-center retrospective cohort analysis. All the patients diagnosed with SAHJ between 2007 and 2019 were identified. Patients who responded to repeated aspirations were compared to those who did not improve and required surgery. Demographic and clinical data and laboratory results were obtained from the patients' electronic medical records. Forty-eight children (88.9%) were treated successfully with repeated aspirations and six children (11.1%) did not improve after aspirations and underwent hip arthrotomies. Five out of 48 children from the aspiration group (10.4%) and 4 out of 6 from the arthrotomy group (66.7%) had chronic comorbidities (p = 0.0051). The mean duration of fever over 38.5 degrees centigrade and the length of stay were higher in the arthrotomy group (p = 0.0040, p = 0.0301, respectively). When we examined the change in C-reactive protein (CRP) levels before and after the first aspiration (Delta CRP), we found a decrease in the aspiration group and an increase in the arthrotomy group (p = 0.0044). The new algorithm which we present allows an expeditious assessment of the patient's response to the repeated aspiration method and thus prevents unnecessary surgeries for the treatment of SAHJ. Patients with chronic comorbidities, prolonged fever, and an increase in CRP level following the first aspiration, are at risk of treatment failure and should be treated with an arthrotomy. Level 4-cohort study.

Effect of Epididymal Spermatozoa of Local Iraqi Goat on in vitro Fertilization and Evolution of Embryos.

In vitro fertilization (IVF) has been considered one of the greatest improvements in livestock science and production. Epididymal spermatozoon is a valuable gamete source obtained from slaughtered animals, and it has great importance in livestock IVF. This study aimed to create caprine embryos in Baghdad using local Iraqi goats. Ovaries were obtained from 50 female local goats at the Al-shu'alah abattoir. The ovaries were transported to the laboratory in physiological saline solution at 38°C. After oocyte recovery from the mature antral follicle, the oocytes with grades A or B were used for in vitro maturation (IVM). Moreover, 10 testicles were obtained from slaughtered adult goats, and the sperm was recovered from the caudal epididymis. All the stage-specific culture mediums were incubated at 39°C with 5% CO2 and 90% relative humidity. In this study, embryonic development on a 24-h basis was evaluated and in vitro culture media was replaced 50% of the volume every day for nine days with fresh media until an enlarged or hatched blastocyst appeared. The recorded data showed that the mean size of the large follicles was 6.23±1.34 mm, while the small follicles were in the mean size of 3.10±0.62. On the other hand, the results showed a significant increase in the oocyte recovery rate from the large size follicle (81.22%), compared to the small size follicle (62.67%). The recorded data showed that the total number of retrieved oocytes with grades A and B was 290 (79.5%) . The recorded data showed that 50.1% of these oocyte cohorts had reached metaphase II (145/290). Furthermore, 45.45% of the recovered oocytes by aspiration from large follicles were developed to the blastocyst stage, compared to 25% of recovered oocytes from the small follicles reaching the same developmental stage (blastocyst). On the other hand, the recorded data showed that the oocyte recovery method had a great influence on the oocyte competence regardless of the follicle size. The results revealed that the number of recovered oocytes by aspiration was greater than slicing. In conclusion, the results approved that the slicing method could be considered a safe and more efficient method in oocyte recovery from the slaughtered animals, compared to the aspiration method. On the other hand, according to the findings, the epididymal spermatozoa from local Iraqi goats are a reliable source of oocytes for IVF and in vitro conversion.

Прогнозируемая интраоперационная индукция задней отслойки стекловидного тела

Purpose. To develop a technique for predictive intraoperative induction of posterior vitreous detachment as the first stage of surgical treatment of various vitreoretinal pathologies based on data of preoperative spectral optical coherence tomography (SOCT) and to evaluate its clinical effectiveness. Material and methods. 30 patients were performed surgery, 15 of them (15 eyes) with epiretinal fibrosis and 15 (15 eyes) with macular hole. Preoperatively, SOCT was used to determine the place of the retina in the parapapillary area, which is the most optimal for induction of posterior vitreous detachment during the operation. For this, a vitreoretinal interface was used on a Solix device (Optovue, USA) with a Full Range Retina protocol with a scan length of 16 mm, according to which the degree of vitreomacular and vitreopapillary adhesion was assessed. In the optimal zone of the posterior hyaloid membrane, microperforations were applied with a parapapillary vitreotom. At maximum vacuum (650 mm Hg), the vitreous body fibers were aspirated into the hole of the vitreotom until a characteristic “wave” or “meniscus” (“crescentic fold”) appeared along the edge of the optic disc. At the final stage, in the “vacuum mode”, movements from the optic nerve head to the periphery by the aspiration method raised the cortical layers of the vitreous body and torn off the posterior hyaloid membrane from the edge of the optic nerve head, separating the vitreous body from the center to the periphery of the retina. Results. In all 30 cases, it was possible to initiate intraoperatively posterior vitreous detachment without the use of dyes. There were no intraoperative complications. Conclusion. The proposed technique makes it possible to perform a predictable intraoperative induction of detachment of the posterior cortical layers of the vitreous from the retina, which is a necessary step for subsequent vitreoretinal surgery. Keywords: intraoperative induction of posterior vitreous detachment, posterior hyaloid membrane, posterior cortical layers.