Conventional Needle Research Articles

A simple new technique for the induction of residual posterior vitreous cortex removal and membrane peeling.

To describe a quick, cost-effective alternative to using a scraper to remove the residual posterior vitreous cortex and create an inner limiting membrane (ILM) flap during vitrectomy. The surgical technique and a retrospective interventional single-center series of cases were described. A hook was made on the tip of a conventional syringe needle (outer diameter, 0.6 mm; 23 gauge) by bending the needle against a plate. We used this hook to remove the residual posterior vitreous cortex and create an ILM flap during vitrectomy. The efficacy and safety of using this instrument in ophthalmological procedures for a variety of vitreoretinal disorders were evaluated. The hook was effective for removing focal or diffuse residual posterior vitreous cortex in eyes with rhegmatogenous retinal detachment, proliferative diabetic retinopathy, and pathological myopia. It was also successfully used to make a free edge of the ILM and help strip the epiretinal membrane. There were no serious complications associated with using the hook in delicate ophthalmological procedures. The hook, made by bending a conventional needle, is a simple and cost-effective instrument for removing residual posterior vitreous vortex and to create epiretinal and ILM flaps during vitrectomy in eyes with various vitreoretinal diseases.

Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy Device for Lymphadenopathy.

Background Accurate diagnosis of benign and malignant lymphadenopathy is important for determining the appropriate treatment and prognosis. This study evaluated the diagnostic accuracy and usefulness of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a conventional needle compared to endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with a Franseen needle for diagnosing lymphadenopathy. Methods Patients who underwent EUS-FNA or EUS-FNB for mediastinal or abdominal lymphadenopathy between July 2013 and August 2020 were enrolled in the study. The outcomes between EUS-FNA patients (July 2013 to January 2017; 22-gauge conventional needle; Group A) and EUS-FNB patients (February 2017 to August 2020; 22-gauge Franseen needle; Group B) were compared. Results A total of 154 patients (Group A: 83; Group B: 71) were analyzed. The diagnostic accuracy (differentiating between malignant and benign lesions) was 88.0% (95% confidence interval [CI], 79.2–93.3%) in Group A and 95.8% (95% CI, 88.3–98.8%) in Group B. Group B had high diagnostic accuracy, but there was no difference between the groups (p = 0.14). Group B had significantly fewer passes (median 2, interquartile range (IQR): 2-4) than Group A (median 3, IQR: 3-4) (p < 0.001). No procedural adverse events occurred in either group. Conclusions Although the diagnostic accuracy between the groups was not statistically significant, EUS-FNB with a Franseen needle provided high diagnostic accuracy and required fewer passes to establish a diagnosis. Thus, EUS-FNB is useful for diagnosing lymphadenopathy.

Ultrasonic actuation of a fine-needle improves biopsy yield

Despite the ubiquitous use over the past 150 years, the functions of the current medical needle are facilitated only by mechanical shear and cutting by the needle tip, i.e. the lancet. In this study, we demonstrate how nonlinear ultrasonics (NLU) extends the functionality of the medical needle far beyond its present capability. The NLU actions were found to be localized to the proximity of the needle tip, the SonoLancet, but the effects extend to several millimeters from the physical needle boundary. The observed nonlinear phenomena, transient cavitation, fluid streams, translation of micro- and nanoparticles and atomization, were quantitatively characterized. In the fine-needle biopsy application, the SonoLancet contributed to obtaining tissue cores with an increase in tissue yield by 3–6× in different tissue types compared to conventional needle biopsy technique using the same 21G needle. In conclusion, the SonoLancet could be of interest to several other medical applications, including drug or gene delivery, cell modulation, and minimally invasive surgical procedures.

An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques

BackgroundWe established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal.MethodsTwenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05.ResultsThe pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05).ConclusionsAn experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.

Ultrasound guided versus conventional single needle arthrocentesis

Ultrasound guided versus conventional single needle arthrocentesis

A technique to facilitate the cannulation of the foramen ovale for balloon compression

Background Percutaneous balloon compression is a safe and effective treatment for trigeminal neuralgia. Current technique consists of penetrating the foramen ovale using a sharp 14G needle with a stylet. Difficulty of cannulation of the foramen ovale, failures of cannulation and major neurovascular complications of the procedure, although rare, may be due to the relatively large caliber of this needle and its sharp tip. Objective To present a novel technique to facilitate and make the cannulation of the foramen ovale with a 14G cannula safer. Methods A rigid blunt-tip guide of 1.2 or 1.5 mm is used to penetrate the foramen ovale under lateral fluoroscopic control. Once the guide enters the foramen it is advanced further to the clival line, and a 14G cannula is then advanced over the guide to engage the foramen, at which point the guide is withdrawn and replaced with the balloon catheter. Results The technique was employed to deliver a 4F balloon catheter to Meckel's cave successfully in 500 consecutive procedures performed on 416 trigeminal neuralgia patients. None of the patients had neurovascular complications like facial hematoma, arterial injury, carotid-cavernous fistula or cranial nerve palsies. Conclusion A novel technique for cannulation of the foramen ovale is described. The use of blunt tip guides of smaller diameters instead of sharp 14 G needles considerably facilitated cannulation of the foramen ovale and enabled cannulation in all cases. Absence of complications of cannulation such as facial hematoma, carotid-cavernous fistula or intracranial hemorrhage in this series of patients suggests that the technique may be safer than the use of conventional sharp tipped 14G needles in terms of avoiding neurovascular complications.

Real‐time detection of cerebrospinal fluid with bioimpedance needle in paediatric lumbar puncture

BackgroundLumbar puncture is a common clinical procedure that can occasionally be difficult. Various needle guidance methods can facilitate performing this procedure, but at the expense of special expertise, equipment and facility. In the present study, we evaluated the clinical feasibility of a novel bioimpedance needle system regarding its ability to detect cerebrospinal fluid (CSF) in paediatric lumbar punctures.MethodsWe performed 40 lumbar puncture procedures using the bioimpedance needle system in 37 paediatric patients, aged from 0 days to 17 months, as a part of their prescribed examinations in two university hospitals. The bioimpedance needle is similar to a conventional 22G cutting‐edge spinal needle with a stylet, except the needle and stylet are configured as a bipolar electrode with high spatial resolution. The system measures in real‐time when the needle tip reaches the subarachnoid space containing CSF. The procedure was considered successful when the erythrocyte count was determined from the obtained CSF sample.ResultsSubarachnoid space was verifiably reached in 28 out of 40 procedures (70%). Bioimpedance needle system detected CSF in 23 out of these 28 successful procedures (82%) while failed in 3 out of 28 procedures (11%). No adverse events were reported.ConclusionBioimpedance spinal needle system was found clinically feasible in paediatric lumbar punctures, and it may offer an objective and simple means to detect the time point when the needle tip is in contact with the cerebrospinal fluid.

Endobronchial Ultrasound in Evaluating Mediastinal Lymphadenopathy

AbstractTuberculosis can involve most of the body parts, and tubercular lymphadenitis is common. But isolated involvement of mediastinal lymph nodes without lung parenchymal involvement is rare in adults. A 45-year-old lady presented with subcarinal lymph node enlargement. A conventional transbronchial needle aspiration done at a local hospital was inconclusive. Endobronchial ultrasound-guided transbronchial needle aspiration was done. Cytology showed epithelioid histiocytes and caseous necrosis. Stain for acid-fast bacilli and cartridge-based nucleic acid amplification test for tuberculosis were positive. Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive bronchoscopic technique to visualize and sample mediastinal lymph nodes. However, its availability is limited to specific centers and expertise is required to interpret images and take diagnostic samples.

Comparison of irrigant activation devices and conventional needle irrigation on smear layer and debris removal in curved canals. (Smear layer removal from irrigant activation using SEM).

To compare the effectiveness of smear layer and debris removal in the final rinse of curved canals of permanent molars using different commercially available irrigant activation devices. The mesial roots of 74 extracted maxillary and mandibular molars were instrumented using the Mtwo nickel-titanium rotary system (VDW GmbH, Munich, Germany). They were then randomly assigned to one of three groups, varying in their final rinse protocol. Group 1 (n=15) - conventional needle irrigation with 4% NaOCl; Group 2 (n=19) - EndoActivator® (Dentsply Tulsa Dental Specialties, Tulsa, OK, USA) with 4% NaOCl; Group 3 (n=17) - XP-endo® Finisher (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) with 4% NaOCl. After the final rinse, all canals were flushed with 1mL 15% EDTA for 60s and then flushed with saline. The roots were split longitudinally and prepared for scanning electron microscope imaging. ImageJ for Windows was utilised to assess the images for smear layer removal, while two blinded investigators assessed debris presence in the middle and apical thirds using a 5-point scale. There was no significant difference in smear layer and debris removal between treatment and control groups in the same canal zones. A significant difference was noted across different canal zones both within and across the groups. There is no statistically significant difference in effectiveness between activated irrigation techniques and manual activation. Further investigations are required to evaluate all methods available and determine the most efficient technique to irrigate successfully.

Continuous measurement of surface electrical potentials from transplanted cardiomyocyte tissue derived from human-induced pluripotent stem cells under physiological conditions in vivo.

Recording the electrical potentials of bioengineered cardiac tissue after transplantation would help to monitor the maturation of the tissue and detect adverse events such as arrhythmia. However, a few studies have reported the measurement of myocardial tissue potentials in vivo under physiological conditions. In this study, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSCM) sheets were stacked and ectopically transplanted into the subcutaneous tissue of rats for culture in vivo. Three months after transplantation, a flexible nanomesh sensor was implanted onto the hiPSCM tissue to record its surface electrical potentials under physiological conditions, i.e., without the need for anesthetic agents that might adversely affect cardiomyocyte function. The nanomesh sensor was able to record electrical potentials in non-sedated, ambulating animals for up to 48h. When compared with recordings made with conventional needle electrodes in anesthetized animals, the waveforms obtained with the nanomesh sensor showed less dispersion of waveform interval and waveform duration. However, waveform amplitude tended to show greater dispersion for the nanomesh sensor than for the needle electrodes, possibly due to motion artifacts produced by movements of the animal or local tissue changes in response to surgical implantation of the sensor. The implantable nanomesh sensor utilized in this study potentially could be used for long-term monitoring of bioengineered myocardial tissue in vivo under physiological conditions.

Use of an automatic needle-free injection device for foot-and-mouth disease vaccination in dairy heifers

The foot-and-mouth disease (FMD) vaccination of Thai dairy cows is routinely conducted to control and prevent the disease. In Thailand, FMD control strategies include a subcutaneous route (s.c.) vaccination with 2 ml of inactivated FMD vaccine 2–3 times a year produced by the Department of Livestock Development (DLD). A new way of vaccination was introduced in the form of an automatic needle-free injection device. This technology has several important advantages, such as requiring less animal restraint, reduced time and labour with high precision, and a consistent delivery system. Here, the effectiveness of an automatic needle-free injection (ANFI) device was evaluated in 30 dairy heifers (randomly divided into three groups, 10 in each group) in the FMD vaccine delivery. The first group was subcutaneously (s.c.) vaccinated using a conventional hypodermic needle with 2 ml of the vaccine, the second group received the same, but using a CO&lt;sub&gt;2&lt;/sub&gt;-powered ANFI device, and the third group received the vaccine using the same ANFI device, but administered intradermally (i.d.) with only 1 ml of the vaccine. The blood samples collected up to 120 days post-vaccination revealed that both injection methods resulted in a similar serological response. The results suggest that the i.d. and s.c. ANFI systems are effective and safe. Moreover, the i.d. use of the ANFI enabled the possibility to half the vaccination dose with the same efficacy. Therefore, the ANFI can be used as an alternative approach for FMD vaccination by s.c. or i.d. routes in dairy cows in Thailand. Ultimately, reducing the use of restraint devices and labour will improve the vaccination for the prevention and control of FMD and may improve the cows’ welfare.

COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world

COVID-19 pandemic and conventional transbronchial needle aspiration in the developing world

The simply modified intrascleral fixation using round flange (SMURF) technique for intrascleral intraocular lens fixation

We describe a simply modified intrascleral fixation using round flange (SMURF) technique and report the clinical outcomes of the surgery. Forty-one eyes of 41 consecutive patients, with intraocular lens (IOL) dislocation, crystalline lens subluxation, and zonular weakness, who underwent surgery using the SMURF technique were included. The modified technique included the use of a conventional 27-gauge needle, a non-bent needle, oblique sclerotomy, direct threading of the leading haptic, and simple placement of the following haptic. IOLs were successfully placed and showed good centring. There were no cases of wound leakage or hypotony during the early postoperative period. Postoperative complications included vitreous haemorrhage in one eye (2.4%), intraocular pressure elevation in one eye (2.4%), and iris capture in six eyes (14.6%). There were no cases of postoperative retinal detachment, cystoid macular oedema, endophthalmitis, or IOL dislocation during the follow-up period. We proposed a few modifications in the intrascleral flanged technique for IOL fixation. The modified technique is a simple, easy, and minimally invasive procedure for successful IOL intrascleral fixation.

String electrospinning based on the standing wave vibration

Preparation of high-quality nanofibers with low applied voltage remains a challenge for needleless electrospinning. In this work, we developed a novel electrospinning technique based on the standing wave vibration of a string. The effects of the process parameters and string parameters on nanofiber diameter and productivity were investigated. The results indicated that standing wave electrospinning is competitive in terms of fiber diameter and productivity when compared with single conventional needle electrospinning. Moreover, the threshold voltage of standing wave electrospinning (18 kV) was approximately 30% lower than most of the current needleless electrospinning techniques (30 kV). The finest nanofiber with a diameter of 173 ± 48 nm was prepared at an applied voltage of 28 kV, a spinning distance of 10 cm, and a standing wave number of 3. The fiber diameter and productivity were significantly influenced by the string diameter and shape instead of the electrical conductivity of the string. The results demonstrated the considerable potential of standing wave electrospinning for fine nanofiber preparation under a low applied voltage.

Live Vaccinia Virus-Coated Microneedle Array Patches for Smallpox Vaccination and Stockpiling.

Although smallpox has been eradicated globally, the potential use of the smallpox virus in bioterrorism indicates the importance of stockpiling smallpox vaccines. Considering the advantages of microneedle-based vaccination over conventional needle injections, in this study, we examined the feasibility of microneedle-based smallpox vaccination as an alternative approach for stockpiling smallpox vaccines. We prepared polylactic acid (PLA) microneedle array patches by micromolding and loaded a second-generation smallpox vaccine on the microneedle tips via dip coating. We evaluated the effect of excipients and drying conditions on vaccine stability in vitro and examined immune responses in female BALB/c mice by measuring neutralizing antibodies and interferon (IFN)-γ-secreting cells. Approximately 40% of the virus titer was reduced during the vaccine-coating process, with or without excipients. At −20 °C, the smallpox vaccine coated on the microneedles was stable up to 6 months. Compared to natural evaporation, vacuum drying was more efficient in improving the smallpox vaccine stability. Microneedle-based vaccination of the mice elicited neutralizing antibodies beginning 3 weeks after immunization; the levels were maintained for 12 weeks. It significantly increased IFN-γ-secreting cells 12 weeks after priming, indicating the induction of cellular immune responses. The smallpox-vaccine-coated microneedles could serve as an alternative delivery system for vaccination and stockpiling.

Comprehensive evaluation of microneedle‐based intradermal adalimumab delivery vs. subcutaneous administration: results of a randomized controlled clinical trial

AimsTo evaluate feasibility of intradermal (i.d.) adalimumab administration using hollow microneedles, and to compare a single i.d. dose of adalimumab using a hollow microneedle with a single subcutaneous (s.c.) dose using a conventional needle.MethodsIn this single‐centre double‐blind, placebo‐controlled, double‐dummy clinical trial in 24 healthy adults we compared 40 mg adalimumab (0.4 mL) administered i.d. using a hollow microneedle with a s.c. dose using a conventional needle. Primary parameters were pain, acceptability and local tolerability; secondary parameters safety, pharmacokinetics and immunogenicity. We explored usability of optical coherence tomography, clinical photography, thermal imaging, and laser speckle contrast imaging to evaluate skin reaction after i.d. injections. In vitro protein analysis was performed to assess compatibility of adalimumab with the hollow microneedle device.ResultsWhile feasible and safe, injection pain of i.d. adalimumab was higher compared to s.c. adalimumab (35.4 vs. 7.9 on a 100‐point visual analogue scale). Initial absorption rate and relative bioavailability were higher after i.d. adalimumab (time to maximum plasma concentration = 95 h [47–120]; Frel = 129% [6.46%]) compared to s.c. adalimumab (time to maximum plasma concentration = 120 h [96–221]). Anti‐adalimumab antibodies were detected in 50% and 83% of the subjects after i.d. and s.c. adalimumab, respectively. We observed statistically significantly more erythema and skin perfusion after i.d. adalimumab, compared to s.c. adalimumab and placebo injections (P < .0001). Cytokine secretion after whole blood lipopolysaccharide challenge was comparable between administration routes.ConclusionsIntradermal injection of adalimumab using hollowing microneedles was perceived as more painful and less accepted than s.c. administration, but yields a higher relative bioavailability with similar safety and pharmacodynamic effects.

Endoultrasound versus Conventional Image Guided (CT/US) Fine Needle Aspiration in Diagnosis of Pancreatic Malignancy

Background:The emergence of endoultrasound (EUS) has shown this modality to be an excellent method of detecting and staging lesions in the pancreas with a low rate of complications. Controversy has arisen about whether the approach with the conventional image (CT/US) guided FNA or endoultrasound (EUS) guided FNA is the preferred method to obtain cells from suspicious mass.&#x0D; Objectives:To assess the diagnostic efficacy of endoultrasound guided fine needle aspiration (EUS FNA) versus conventional imageguided fine needle aspiration (CT/US FNA) in pancreatic malignancy.&#x0D; Methodology:Twentyeight cases of clinically suspected patients of pancreatic malignancy were included in the study. Each enrolled patient underwent to either a conventional image guided fine needle aspiration or endoultrasound guided fine needle aspiration of the pancreatic mass for diagnosis of pancreatic malignancy. Data were analyzed with the help of SPSS version 23. Statistical analysis was done by student t-test and Chi square (÷2) test. Statistical significance was set at p&lt;0.05.&#x0D; Result: Diagnostic accuracy in terms of distinguishing the cytopathology was 57.1% in conventional image(CT/US) guided FNA group and 85.7% in EUS guided FNA group. These values were numerically convincing for preferring EUS guided FNA method but was statistically insignificant. Again, if we consider the diagnosis of malignancy alone the values were 35.7% and 64.3% for CT/US guided FNA and EUS guided FNA respectively. This was also not significant statistically.&#x0D; Conclusion:Numerically EUS guided FNA showed better precision in detecting pancreatic malignancy and thereby its accuracy in yielding adequate tissue sample for cytological evaluation and inference.&#x0D; Journal of Surgical Sciences (2020) Vol. 24 (2) : 57-60

Influence of injection technique, drug formulation and tumor microenvironment on intratumoral immunotherapy delivery and efficacy

BackgroundIntratumoral delivery of immunotherapeutics represents a compelling solution to directly address local barriers to tumor immunity. However, we have previously shown that off-target delivery is a substantial problem during intratumoral...

Novel Needle for Intravitreal Drug Delivery: Comparative Study of Needle Tip Aspirates, Injection Stream and Penetration Forces.

PurposeTo study the efficacy of a novel needle for intravitreal injection (IVI) in comparison to the conventional needle under experimental conditions.MethodsThe newly designed 30-gauge (G) needle (NDN) (EP 18158 542.3, patent pending) with occluded outer orifice and a side port for drug delivery was compared to the conventional standard hypodermic 30 G needle for IVI (SHN). An animal study to obtain needle tip aspirates was performed on 10 albino rat eyes. During IVIs, cellular content, which was cut by the needle tip, was aspirated. Cellular material was studied in regard to cell types and their quantity. The injection stream was studied using trypan blue dye in vitro and pig cadaver eyes. The penetration force was tested on polyurethane Testing Foil Strips PU 04 (Melab, Leonberg, Germany) by applying a velocity of 100 mm/min. The results were analyzed using descriptive statistics, correlation matrices and t-test methods with p<0.05 as statistically significant.ResultsCytological analysis of the needle aspirates showed the presence of cellular content in each case. The amount of conjunctival, ciliary body epithelial cells and granulated basophilic protein sediments (sign of cellular damage) in the case of the NDN tips was significantly lower compared to the SHN. The average penetration force of the NDN was 0.791 N, and in the case of the SHN was 0.566 N. The injection stream study revealed a difference in the initial injection phase between the two needle types, although the diffuse filling of the vitreous area which surrounded the needle tip appeared to be similar.DiscussionThe NDN demonstrated superior performance with regard to a significantly reduced number of cells being captured by the needle tip. Delivery of the injected fluid into the vitreous cavity was comparable. In order to investigate superior properties of the NDN needle design, further studies with improved prototypes would be necessary.

VersaCross radiofrequency system reduces time to left atrial access versus conventional mechanical needle

Despite maturing experience, transseptal puncture (TSP) remains a challenging part of percutaneous left atrial appendage closure (LAAC) and has inherent risks and safety concerns in accessing the left atrium (LA). The VersaCross radiofrequency (RF) system (Baylis Medical), a new RF-tipped pigtail wire-based TSP system, may facilitate LA access by serving as an exchange support wire once access is achieved. We retrospectively compared TSP safety and procedural efficiency in 10 consecutive LAAC cases using the VersaCross RF system to 10 cases using the conventional BRK1-XS mechanical needle (Abbott Vascular). The safety and time from femoral access to delivery of the device sheath were compared to the conventional workflow using BRK1-XS/SL1. We included consecutive 20 cases between July 2019 and November 2019 (12 with WATCHMAN (Boston Scientific, Natick, MA) and 8 with Amulet (St. Jude Medical, St Paul, MN)). Baseline patient characteristics and procedural details were similar in both groups (VersaCross RF system vs. conventional BRK1-XS mechanical needle). All cases were completed successfully with no procedural or in-hospital complications. VersaCross reduced time from femoral access to TSP [4.1 ± 2.5 min vs. 8.4 ± 4.0 min (p = 0.009)] and time from femoral access to delivery sheath access into LA [6.7 ± 2.4 min vs. 13.4 ± 5.4 min (p = 0.002)] compared to BRK1-XS. Combining a starter wire, transseptal needle and exchange guidewire in the VersaCross RF system enabled faster LA access, which potentially leads to efficient workflow. Further investigation with larger sample size is warranted to corroborate our findings.