Conventional Needle Research Articles

Fabrication of a Polyglycolic Acid Porous Microneedle Array Patch Using the Nonsolvent Induced Phase Separation Method for Body Fluid Extraction

ABSTRACTTraditional blood sampling is essential for early diagnosis and subsequent analysis, but the methods using hypodermic needles are painful and burdensome. Recently, a minimally invasive approach utilizing porous microneedles has been developed and various porous microneedle array patches (MAPs) composed of biodegradable polymers have been investigated. To address issues about low mechanical strength and liquid absorption with porous MAPs, we used polyglycolic acid (PGA) as it is a biodegradable and hydrophilic polymer with high mechanical properties. In this study, we established a nonsolvent‐induced phase separation (NIPS) method for the fabrication of PGA porous MAPs, as the porous MAPs can be fabricated by simply immersing the molds injected with PGA‐hexafluoro‐2‐propanol (HFIP) solution in nonsolvents. We achieved the maximum liquid absorption rate of 16 ± 8.2 × 10−2 µL/min per one microneedle using the PGA porous MAPs fabricated by using ethanol as nonsolvent and PGA concentration of 10% (w/w). Our study provides a comprehensive understanding of porous MAPs fabricated using PGA material as well as its characteristics regarding the structural and mechanical properties of PGA MAPs, with potential as a diagnostic device to substitute conventional hypodermic needles for interstitial fluid (ISF) sampling and diagnosis.

Scalable electrospinning using a desktop, high throughput, self-contained system

Electrospinning is a specialized processing technique for the formation of submicron diameter fibers of polymeric and ceramic materials using an electrostatic field. The process has multiple advantages over other nano- and micro- fiber synthesis methods; however, generally suffers from very low fabrication speeds, making it undesirable for scalability. This work assesses the performance of a needle-less, self-contained, high throughput electrospinning system. It further compares the fiber fabrication rates obtained versus two single needle setups with different collectors: (i) a conventional single needle and flat plate geometry, and (ii) a single needle with a rotating collector geometry. Polyvinylpyrrolidone (PVP) in ethanol was used as the model material. The fabrication rate of the high throughput system “HTES” was measured at about 2.6 g/h and was about 15 times that collected of the flat plate. Comparing it to other systems reported in the literature also proved it to be a viable option for high throughput, lab scale electrospinning.

Comparison of diagnostic yields, operative times, and post-operative hemorrhage between twist drill versus burr hole craniotomy approaches for stereotactic needle brain biopsy.

Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0min (IQR 49-83) versus 35.5min (IQR 26-54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique.

Recent Innovations and Future Perspectives in Transferosomes for Transdermal Drug Delivery in Therapeutic and Pharmacological Applications.

There have been several non-invasive administrations that have emerged recently to replace conventional needle injections. With its minimal rejection rate, remarkable ease of administration, and remarkable patient comfort and perseverance, the transdermal drug delivery system (TDDS) is the most attractive of them all. The skincare industry, which includes cosmetics, may also find use for TDDS in addition to the pharmaceutical industry. As this strategy mainly entails local drug administration, it can prevent untargeted drug delivery to tissues not intended for the treatment and buildup of localized drug concentrations. Transdermal delivery is hampered by a number of physicochemical characteristics of the skin, which have led to a great deal of research into ways to get over these barriers. The majority of transdermal medicines that have proved effective do so by using smaller lipophilic compounds, which have a molecular weight of a few 100 Daltons. Transferosomes have proven to be an effective method for transdermal distribution of a range of therapies, including hydrophilic actives, bigger molecules, peptides, proteins, and nucleic acids, in order to get around the medications' size and lipophilicity limits. Because of their flexible form and increased surface hydrophilicity, transferosomes are essential for the delivery of medicines and other solutes through and into the skin by exploiting hydration gradients a source of energy. As a result, the medication is released into the skin layers under regulated conditions and has improved overall penetration. In this section we outline the development of transferosomes from liposomes and solid lipid nanoparticles, as well as their subsequent advancements as commercially available dosage forms, physical-chemical characteristics, and cutaneous kinetics.

Therapeutic Performance of Needle Injection Versus Needle-Free Jet Injector System for Polynucleotide Filler in Skin Rejuvenation.

Polynucleotide (PN) filler often causes pain and can lead to delivery inaccuracies when applied via intradermal injection using a traditional needle. To evaluate the efficacy of treatment and the pain during the procedure using conventional needle injection versus a needle-free jet system for intradermal PN filler application. In this split-face clinical trial, 10 Korean subjects were enrolled. Each subject received an intradermal injection of PN filler on one side of the face and a needle-free jet injection using CureJet on the other side. Assessments included global and 3D skin imaging at each visit. Pain intensity was evaluated using visual analogue scale (VAS) scores during the injection. Additionally, patient satisfaction and adverse events were documented. Findings revealed that Global Aesthetic Improvement Scale scores and patient satisfaction were significantly higher with the CureJet compared to the needle injection method. VAS scores were notably lower on the CureJet side. Improvements in both pore and wrinkle indices were observed from baseline, with a more pronounced improvement rate on the CureJet side compared to the needle injection side. Needle-free injection of PN for aging skin was found to be effective in enhancing pore and wrinkle improvement, while reducing associated discomfort.

A Novel Sliding Knot Technique Without a Knot Pusher for Laparoscopic Pelvic Floor Surgery.

Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn. The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand. This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications. The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.

Thyroid fine needle aspiration specimen adequacy: a noninferiority study and cost-effectiveness comparison of puncture needles

Needle selection plays a pivotal role in determining the success of fine needle aspiration (FNA) procedures. Two commonly utilized puncture needles for thyroid FNA are the conventional syringe needle and the stylet needle. Syringe needles are known for their cost-effectiveness in comparison to stylet needles. This study aimed to determine if FNA with syringe needles is non-inferior to FNA with stylet needles in terms of specimen adequacy while also comparing the direct costs associated with both needle types. A total of 220 thyroid nodules from 185 patients were prospectively included in this study. The same operator performed a total of four punctures on the same nodule twice using a syringe and a stylet needle. The results of this study show that the utilization of syringe needles for thyroid FNA was non-inferior to the use of stylet needles in terms of specimen adequacy. Cost analysis revealed that syringe needle FNA was not only less expensive (CNY 500.9 versus CNY 780) but also more effective (adequacy 85.91% versus 84.55%). In summary, given the global prevalence of FNA procedures, the economic considerations are paramount, and our findings support the routine use of syringe needles in thyroid FNA.

Optimization of solvent system for chitosan/polylactic acid/nanocellulose nanofibers using needleless electrospinning

AbstractNeedless electrospinning (NES) is the most advanced and robust method to generate biopolymeric nanofibers. NES overcomes the needle clogging and low throughput issues of conventional needle based electrospinning (ES). However, the issue with all ES techniques is the absence of generalized methods in the literature, and most of the work is being done empirically. The solvent system dictates the feasibility of the ES process, and solvent system based studies can help create more generalized ES methods. The current work provides a systematic approach to fabricating tribiopolymeric nanofibers. NES was used to fabricate chitosan (CS)/polylactic acid (PLA)/nanocellulose (NCC) based nanofibers by optimizing the solvent system using dichloromethane (DCM) and trifluoroacetic acid (TFA). Biopolymeric blend PLA/CS/NCC (10:0.1:0.05 w/v %) in various formulated solvent systems were made and analyzed for their physical properties (sedimentation rate, particle size, viscosity, and surface tension) and subjected to NES. The binary solvent system SS91 (DCM (90):TFA (10) %) showed the lowest sedimentation rate and viscosity while the highest particle size and surface tension, resulting in the beads free nanofibers. The viscosity and surface tension comparison were used to determine a critical point for the feasibility of nanofiber fabrication. Overall, the study showed a systematic approach for fabricating complex tri‐biopolymeric nanofibers in future.

Impact of different activation procedures on sodium hypochlorite penetration into dentinal tubules after endodontic retreatment via confocal laser scanning microscopy

BackgroundInfected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment.MethodsA total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05).ResultsIn the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05).ConclusionsUI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment.

Effectiveness of XP-Endo Finisher, Endoactivator, and PUI agitation in the penetration of intracanal medicaments into dentinal tubules: A confocal laser scanning microscope analysis.

This investigation assessed the impact of irrigation activation systems on the depth of penetration of intracanal medicaments into dentinal tubules. Ninety-six mandibular premolar teeth were prepared using ProTaper Next up to size X3. The teeth were randomly divided into four groups based on the final irrigation activation systems (n=24): group 1: EndoActivator, group 2: XP-Endo Finisher, group 3: Passive ultrasonic irrigation (PUI), and group 4: control. After the final irrigation, all the samples were divided into two subgroups (n=12): subgroup A: calcium hydroxide (Ca(OH)2 ) and subgroup B: modified triple antibiotic paste (mTAP). Statistical analysis involved three-way analysis of variance (ANOVA). EndoActivator, XP-Endo Finisher, and PUI activation methods significantly increased the penetration of intracanal medicaments compared to conventional needle irrigation (P<0.05). The XP-Endo Finisher group exhibited the highest penetration percentage and maximum penetration depth, showing a statistically significant difference from the EndoActivator group (P<0.001). No significant difference was observed between XP-Endo Finisher and PUI, nor between PUI and EndoActivator (P>0.05). mTAP showed a higher percentage of dentinal tubule penetration than Ca(OH)2, although no significant difference was found in maximum penetration depth. The coronal region demonstrated the highest penetration percentage and depth, while the apical region showed the lowest. This study showed the effectiveness of XP-Endo Finisher in improving the penetration of intracanal medicaments into dentinal tubules. The findings emphasize the importance of selecting appropriate irrigation activation systems to improve treatment outcomes in endodontics. By demonstrating the effectiveness of advanced systems like XP-Endo Finisher, this research supports their integration into routine clinical practice for better endodontic success.

The value of rapid on-site evaluation during conventional and endobronchial ultrasound needle aspiration in the diagnosis of mediastinal lymphadenopathy and lung cancer

BackgroundThe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has revolutionized pulmonology by identifying cancer spread in lung cancer patients. It is now used for diagnosing sarcoidosis, tuberculosis, and lymphoma. Rapid onsite evaluation (ROSE) is a crucial tool for pathologists, assisting in sample adequacy, accuracy, and prompt decision-making. This study aimed to evaluate the efficacy of ROSE in identifying mediastinal lymphadenopathy and lung cancer during EBUS-TBNA and cTBNA.MethodsOur research was a prospective study in which we examined sixty cases that were separated into two groups of similar size. The rapid onsite evaluation group and the non-rapid onsite evaluation group were subjected to either Conventional TBNA or endobronchial ultrasound-guided transbronchial needle aspiration.ResultsThe total diagnostic yield of conventional and endobronchial ultrasound-guided transbronchial needle aspiration in both groups was 83.3% (50/60 cases). Twenty-eight cases (46.7%) were positive for malignancy, 22 cases (36.6%) were positive for benign lesions, and 10 cases (16.6%) were not conclusive. Regarding diagnostic accuracy, it was greater in the rapid onsite evaluation group than in the non-rapid onsite evaluation group (100% in the rapid onsite evaluation group vs. 66.7% in the non-ROSE group).ConclusionsRapid onsite evaluation during conventional or endobronchial ultrasound-guided transbronchial needle aspiration improves diagnostic accuracy of mediastinal lesions by excluding suspicious or nondiagnostic specimens and can reduce unnecessary punctures or eliminate the need for additional bronchoscopy procedures when reaching preliminary diagnosis.

Needle-Like Multifunctional Biphasic Microfiber for Minimally Invasive Implantable Bioelectronics.

Implantable bioelectronics has attracted significant attention in electroceuticals and clinical medicine for precise diagnosis and efficient treatment of target diseases. However, conventional rigid implantable devices face challenges such as poor tissue-device interface and unavoidable tissue damage during surgical implantation. Despite continuous efforts to utilize various soft materials to address such issues, their practical applications remain limited. Here, a needle-like stretchable microfiber composed of a phase-convertible liquid metal (LM) core and a multifunctional nanocomposite shell for minimally invasive soft bioelectronics is reported. The sharp tapered microfiber can be stiffened by freezing akin to a conventional needle to penetrate soft tissue with minimal incision. Once implanted in vivo where the LM melts, unlike conventional stiff needles, it regains soft mechanical properties, which facilitate a seamless tissue-device interface. The nanocomposite incorporating with functional nanomaterials exhibits both low impedance and the ability to detect physiological pH, providing biosensing and stimulation capabilities. The fluidic LM embedded in the nanocomposite shell enables high stretchability and strain-insensitive electrical properties. This multifunctional biphasic microfiber conforms to the surfaces of the stomach, muscle, and heart, offering a promising approach for electrophysiological recording, pH sensing, electrical stimulation, and radiofrequency ablation in vivo.

Comparative evaluation of effectiveness of different concentration of sodium hypochlorite with conventional irrigation method versus ultrasonic irrigation in the elimination of Enterococcus faecalis from root canals: an in-vitro study

Aim: The aim of this study is to compare the decrease in bacterial population in the root canals with 3 different concentrations of NaOCl and with two different irrigation systems Methods and Material: The study was conducted on 70 single rooted extracted teeth. Teeth were decoronated and the apices were sealed with auto polymerizing resin. The teeth were inoculated with a suspension comprising Enterococcus faecalis (E. faecalis). The canals were prepared were divided into three groups based on irrigation technique: Group 1; irrigation with 1% sodium hypochlorite, Group 2; irrigation with 3% sodium hypochlorite &amp; Group 3; irrigation with 5% sodium hypochlorite. All three groups were divided into 2 subgroups. In subgroup A irrigation was done by conventional side vented needle and in subgroup B with passive ultrasonic agitation. A fourth control group was also added in which conventional needle irrigation was done with normal saline. The samples were inoculated on the growth media and the mean colonies units were calculated. Statistical analysis used: The statistical analysis used was Student’s unpaired t-test for intergroup comparison and one-way ANOVA and Tukey’s post hoc test for intragroup comparison. Results: In our study, groups with passive ultrasonic irrigation showed better antimicrobial effect compared to groups which use conventional needle irrigation. Conclusions: Ultrasonic irrigation showed better antimicrobial activity compared to conventional needle irrigation

Investigating the optical, structural, and therapeutic properties of CuO nanoparticles coated with [BMIM][BF4] Ionic liquid

This work reports a chemical synthesis of 1-butyl-3-methyl imidazolium tetrafluoroborate ionic liquid ([BMIM][BF4] IL) coated copper oxide nanoparticles (CuO-[BMIM][BF4] NPs) by using co-precipitation method. Additionally, bare copper oxide nanoparticles (CuO NPs) are prepared without the addition of the ionic liquid for comparison. Structural morphology and optical properties were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM) with selected area electron diffraction (SAED), Fourier transform infrared spectroscopy (FT-IR), ultraviolet–visible spectroscopy (UV–Vis), and photoluminescence spectroscopy (PL). XRD analysis revealed the monoclinic phase of synthesised CuO NPs (with and without addition of IL) with an average crystallite size of 15.3 nm and 8.42 nm for CuO NPs and CuO-[BMIM][BF4] NPs respectively. An examination of the UV–Vis spectra revealed that the optical bandgap decreases with the addition of IL to CuO NPs. Scanning Electron Microscope (SEM) revealed the flake like morphologies in the range of nanoscale. TEM Microscope showed the conventional needle structure of CuO-[BMIM][BF4] NPs. Synthesised NPs showed antimicrobial effects against Streptococcus aureus and Pseudomonas aeruginosa as well as pathogenic fungi, including Aspergillus flavus and Candida albicans, as investigated using the disc diffusion technique. Pseudomonas aeruginosa (bacterial pathogen), Candida albicans (fungal pathogen) were significantly inhibited than the other two organisms. Additionally, the prepared CuO nanoparticles were evaluated for their anticancer properties on MCF7 human breast cancer cell lines using the MTT assay. The results indicated that the synthesised CuO nanoparticles exhibited effective cytotoxicity against MCF7 cells, with an IC50 value of 33.37 μg/mL. These findings are briefly discussed in this manuscript.

Study on needle stick injuries during surgery and blunt needle use for reducing occupational exposure and hygiene benefits.

The conventional round suture needle poses a significant risk of needle stick injuries among surgical physicians, identified as a global occupational hazard by the World Health Organization, increasing hospital costs and exposure to bloodborne pathogens. While novel blunt suture needles have shown promise in reducing these risks, their adoption is limited domestically, prompting a study to compare their efficacy against traditional sharp needles in reducing needle stick injuries among surgical physicians. To investigate suture needle stick injuries among surgical doctors during operations and assess the application effectiveness of a novel blunt suture needle. A total of 106 surgical department physicians from March 2021 to February 2023 participated in the study. After completing a questionnaire survey on suture needle injuries during surgery, the participants were divided into two groups. Over a 6-month intervention period, the control group used regular round needles while the study group utilized novel blunt suture needles. Subsequently, suture needle injury incidence rates and economic hygiene benefits were compared between the two groups. The suture needle injury questionnaire survey showed that over the past 6 months, among 106 surgical department physicians, 20 needle stick injuries occurred, yielding an incidence rate of 18.87%. The highest incidence (65.00%) was during suturing incisions longer than 10 cm, primarily when visibility was poor (70.00%). Surgeons linked most injuries (60.00%) to prolonged surgical duration causing fatigue. Although 85.00% detected injuries within 1 minute, only 40.00% were reported, often due to perceived reporting complexity. Following intervention, the study group had significantly fewer injuries per surgery and lower occupational exposure costs compared to the control group (p< 0.05). Surgical department physicians commonly sustain suture needle injuries while suturing incisions of 5-10 cm length under poor visibility, exacerbated by prolonged surgical duration. Despite detecting most injuries within 1 minute, only 40% are reported. The implementation of novel blunt suture needles significantly decreases injury rates, resulting in reduced occupational exposure costs and favorable safety and economic hygiene outcomes.

The Effectiveness of Three Different Irrigant Activation Methods in the Elimination of Enterococcus faecalis from Root Canals.

Background and Objective: Eliminating intracanal Enterococcus faecalis (E. faecalis) is challenging because of its ability to penetrate deep dentinal tubules and its high resistance to many chemicals. This study evaluated the effectiveness of conventional needle irrigation and three different irrigant activation methods in reducing E. faecalis. Methods: The root canals of extracted teeth were shaped, contaminated with E. faecalis, and incubated for three weeks. They were randomly allocated to four experimental groups of 15 teeth each according to the final irrigation method: group 1, conventional needle irrigation; group 2, passive ultrasonic (PU) irrigation; group 3, XP-endo Finisher (XPF); and group 4, laser-activated (LA) irrigation. Bacterial samples were taken and cultured before and after these final irrigation procedures. The colony-forming units were counted, and the bacterial reduction percentages of each group were calculated. The Kruskal-Wallis and Dunnet tests were used for statistical analysis. Results: All irrigant activation methods were significantly more effective than conventional needle irrigation. Although the LA group generated more negative samples than PU, there was no statistically significant difference between the LA and PU groups. LA was significantly more effective than the XPF, whereas PU and XPF were statistically similar. Conclusions: Within the limitations of this study, the final irrigation with LA and PU showed the best reductive effect on E. faecalis colonies. Considering that the LA group had more negative samples, it may be chosen as an alternative to enhance root canal disinfection, especially in difficult cases.

Needle tracking in low-resolution ultrasound volumes using deep learning

PurposeClinical needle insertion into tissue, commonly assisted by 2D ultrasound imaging for real-time navigation, faces the challenge of precise needle and probe alignment to reduce out-of-plane movement. Recent studies investigate 3D ultrasound imaging together with deep learning to overcome this problem, focusing on acquiring high-resolution images to create optimal conditions for needle tip detection. However, high-resolution also requires a lot of time for image acquisition and processing, which limits the real-time capability. Therefore, we aim to maximize the US volume rate with the trade-off of low image resolution. We propose a deep learning approach to directly extract the 3D needle tip position from sparsely sampled US volumes.MethodsWe design an experimental setup with a robot inserting a needle into water and chicken liver tissue. In contrast to manual annotation, we assess the needle tip position from the known robot pose. During insertion, we acquire a large data set of low-resolution volumes using a 16 ×\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ imes $$\\end{document} 16 element matrix transducer with a volume rate of 4 Hz. We compare the performance of our deep learning approach with conventional needle segmentation.ResultsOur experiments in water and liver show that deep learning outperforms the conventional approach while achieving sub-millimeter accuracy. We achieve mean position errors of 0.54 mm in water and 1.54 mm in liver for deep learning.ConclusionOur study underlines the strengths of deep learning to predict the 3D needle positions from low-resolution ultrasound volumes. This is an important milestone for real-time needle navigation, simplifying the alignment of needle and ultrasound probe and enabling a 3D motion analysis.

World Federation of Acupuncture-Moxibustion Societies (WFAS) Clinical Practice Guidelines on Acupuncture and Moxibustion: Female Urinary Incontinence recommendation summaries: 世界针灸学会联合会《针灸临床实践指南:女性尿失禁》推荐意见概述

Urinary incontinence (UI) is common in women and affects the quality of life in female patients severely. But the clinical consideration and treatment are insufficient. Acupuncture and-moxibustion has been proposed as a potentially effective intervention for female UI. Hence, the World Federation of Acupuncture-moxibustion Societies (WFAS) have initiated a project to develop the clinical practice guideline (CPG) on acupuncture and moxibustion for female UI towards global acupuncture practitioners. The CPG was developed according to the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology, referring to the principles of the World Health Organization Handbook for Guideline Development. During the development of the CPG, the guideline development group (GDG) played an important role, which is composed of multi-national and multi-disciplinary experts. The clinical questions, recommendations and therapeutic protocols were all formulated by GDG using the modified Delphi method and basing on the results of the latest systematic review. This article focuses on the recommendations in the CPG. The CPG contains ten recommendations for ten clinical questions, including nine conditional recommendations for the intervention, one conditional recommendations for either the intervention or the comparison. The CPG also provides one conventional filiform needle therapy protocol, two deep puncturing stimulation on lumbosacral acupoints therapy protocols, and four moxibustion therapy protocols, extracted from the included clinical evidence of this CPG.

Comparative Evaluation of Pain Perception with Conventional and Septoject XL Needle in 6-8-year-old Children: A Randomized Controlled Trial.

To evaluate and compare pain perception with Septoject XL and conventional needles in 6-8 years old children. In this split-mouth randomized controlled trial, a single-blinded study, 24 children (6-8 years) were assigned at random to receive the local anesthetic (LA) injection for treatment needs either with Septoject XL or conventional needle for the first visit in one of the quadrants, while during the second visit in a different quadrant with the other one. Children's pain levels were assessed during each visit using an objective sound eye motor (SEM) scale and subjective Wong-Baker faces rating scale (FRS). The mean objective score rating using SEM for the conventional needle (3.8 ± 2.35) and Septoject XL needle (3.3 ± 2.01) was not found to be statistically significant among the two study groups Septoject XL or conventional needle (Z score-0.996, p = 0.3). Using the Wilcoxon test, the mean subjective rating score was not found to be statistically significant among the two study groups [Z score = 0.636 and p-value = 0.524, nonsignificant (NS)]. In the gender-wise comparison of male (n =15), (6.8667 ± 91548) and female (n = 9), (6.8889 ± 1.05409), NS mean ages of male and female study participants was observed (p = 0.873). Statistically, NS difference was observed in the pain perception while administration of LA using Septoject XL or conventional needle in 6-8-year-old children. This research can be useful in the selection of the gauge of the needle to be used while planning the treatment for different behavior groups.

Effectiveness of EndoActivator, PATS Vario system, and XP-endo Finisher files on smear layer removal under scanning electron microscope: A comparative study.

The smear layer may harbor many bacteria; hence, alternative methods are used to disrupt and remove biofilm. The aim of the study was to compare the effectiveness of EndoActivator, PATS Vario System, and XP-endo Finisher files on smear layer removal using a scanning electron microscope. Sixty single-rooted extracted premolars with Vertucci Type 1 configuration were decoronated and divided into four groups. The groups were instrumented with the rotary ProTaper file system. All specimens were flushed with 1 ml of 3% sodium hypochlorite. Group 1 was irrigated with a conventional needle and syringe. In Group 2, the irrigant was activated with an EndoActivator. In Group 3, the irrigant was activated with PATS Vario system, and in Group 4, XP-endo Finisher files were used after biomechanical preparation to remove debris and smear layer. All specimens were finally rinsed with 3 ml of 3% sodium hypochlorite. The teeth underwent longitudinal splitting and grooving in the coronal, middle, and apical thirds, and then, the samples were taken for scanning electron microscopy to evaluate the amount of smear layer removal in each third. The middle and coronal thirds Showed that almost similar efficacy to remove smear layer in both Group II and Group III. At the apical third, Group III showed comparatively better results than Group I, II, and IV, respectively. Equal amount of smear layer was seen with EndoActivator and PATS Vario system when used as sonic irrigation devices.