Direct Insertion Research Articles

OPEN VERSUS CLOSED METHOD OF ESTABLISHING PNEUMOPERITONEUM FOR LAPAROSCOPIC SURGERY- A PROSPECTIVE OBSERVATIONAL STUDY

Background: The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure and associated with many complications including life threading vascular and visceral injuries. Objectives:To compare the efcacy and safety of the open (direct trocar insertion/ DTI) and closed method (veress needle) to gain access in the abdominal cavity for laparoscopic surgery. Methods: This is Prospective Observational study conducted in the department of General surgery, from April 2020 to March 2022 comprising of 100 cases, 50 cases from each methods. The patients admitted in our department for Laparoscopic surgery was taken up for the study. 100 patients of either sex were selected who undergone operative procedure for laparoscopy surgery and written informed consent, appropriate workup is done. Purposive sampling technique was used. SPSS (Version 22.0) was used for analysis. Results: Duration for pneumoperitoneum creation in open method group is shorter as compared to closed method group for pneumoperitoneum creation in laparoscopic surgery and it was statistically signicant (p<0.05). Also difculties like multiple attempts, gas leak at port site and port site bleeding are more in open method than in closed method, which is attributed to larger size of incision in open method, Furthermore, a signicant higher incidence of such minor complications is found in case of BMI >25 (p<0.05). Wound infection (clear discharge) occurred in ve cases, one in open method and four in closed method group which was statistically signicant and were treated successfully by antibiotics and dressing. Port site hernia is reported in none 3 cases on the follow up period till date but longer period of follow up is needed. Previous surgery especially laparoscopic surgery and surgery around umbilicus and their scar may cause adhesions between viscera and scar and may increases likelihood of injury during pneumoperitoneum which was more in closed method and was signicant. Conclusions: Open technique is as good as closed technique, and is good alternative to closed technique.

Troubleshooting the migration of a double-pigtail plastic stent into a pelvic abscess (with videos).

The usefulness of EUS pelvic abscess drainage (EUS-PAD) for treating pelvic abscesses (PA) has recently been reported;[1] however, the procedure is often difficult to perform due to limited working space and field of view of that particular anatomical location. During EUS-related drainage, stent placement must be confirmed by both endoscopic and fluoroscopic images, to avoid risk of occurrence of misplacement.[2] A 70-year-old Japanese female with morbid obesity presented with PA secondary to a perforated appendicitis. Abdominal computed tomography revealed size of the PA to be125.3 mm that had originated from the appendix through the retroperitoneum [Figure 1a-c]. EUS-PAD was performed using a convex EUS scope. The abscess was punctured through the rectum using a 19-gauge needle [Figure 1d]. Two guidewires were inserted and coiled in the cavity, and the puncture tract was dilated using an 8-mm balloon dilator. Since the endoscope was inserted through a narrow and short space, it could easily shift position and slip out of the body. Due to the patient’s high obesity, the radiographic permeability was low, which made placing the double-pigtail plastic stent (DPPS) difficult. The DPPSs placement was finally performed, but under poor both endoscopic and fluoroscopy image. During placement of the second DPPS, it was observed that the first DPPS had strayed into the PA cavity [Figure 1e and Video 1]. After two DPPSs were placed incompletely, we proceeded to reposition the first DPPS that had migrated to the wrong position. After we dilated the puncture site using an 8-mm balloon dilator, a 5.8-mm endoscope was inserted into the cavity. The position of the migrated DPPS could be confirmed and its pigtail edge was re-inserted into the rectum using a 1.8-mm-diameter retrieval net [Figure 2]. No complications with the EUS-PAD procedures were encountered, and the patient’s symptoms improved gradually thereafter [Video 2]. Here, we present a procedure for dealing with an erroneously migrated DPPS during EUS-PAD. Additionally, the technique of direct insertion and drainage using a thin endoscope into the PA cavity, which was performed to retrieve the stray DPPS, may be useful in aggressive treatments of PA.Figure 1: Abdominal computed tomography revealed a pelvic abscess (a) with an air bubble of 125.3 mm that originated from an appendiceal perforation (b) and traversing the retroperitoneum (c; arrowhead). Endoscopic-ultrasound pelvic abscess drainage using a convex endoscopic-ultrasound scope. The abscess (outlined with asterisks) was punctured using a 19-gauge needle through the rectum (d). The first DPPS strayed into the pelvic cavity during the placement of the second DPPS (e; arrowhead). DPPS: Double-pigtail plastic stentFigure 2: Replacement of the migrated DPPSs following incomplete placement of two DPPSs. An esophagogastroduodenoscopy scope was inserted to place a guidewire into the PA cavity, and the puncture tract dilated using an 8-mm balloon dilator (a). Subsequent insertion of a 5.8-mm endoscope into the abscess cavity (b). A large amount of purulent fluid in the PA cavity, and the surface of the cavity with effusion, erythema, and purulent fluid (c). After aspiration of sufficient purulent fluid, the migrated DPPS was identified (d; arrow). DPPS: Double-pigtail plastic stent, PA: Pelvic abscesses {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 1","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_8datqvv1"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video Clip 2","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_hvyt4t8t"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Narrow Single Implants with a Reduced Platform (3.0) for the Resolution of Punctual Horizontal Atrophies in the Canine and Premolar Area: Case Series

Introduction: Severe unitary atrophies in the horizontal direction make the direct insertion of dental implants difficult. Block grafting or guided bone regeneration in small sites is also complex, sometimes requiring a highly predictable option. The insertion of small-platform, low-diameter implants can be a safe and effective alternative for these sites, even on a single-unit basis. In the following article we present a series of cases rehabilitated with these implants. Material and Methods: Patients with horizontal atrophy of a tooth requiring the insertion of a single implant in the premolar and canine area were recruited, and 3 mm platform implants with a diameter of 3.3 mm were placed between May 2018 and December 2019 in a dental clinic in Vitoria, Spain. Marginal crestal bone loss was calculated by measuring from the implant shoulder to the first site where bone-to-implant contact was evident. The reference for comparing the radiographic records and thus estimating the bone loss produced in each of the patients was the radiograph taken at the time of prosthesis insertion. Qualitative variables were described by frequency analysis. Quantitative variables were described by means of mean and standard deviation. Implant survival was calculated using the Kaplan- Meier method. Result: Eight patients were recruited and eight 3.0 implants were placed in the canine and premolar region in a unitary form with a diameter of 3.3 mm. All implants were rehabilitated in a unitary form, in two phases, using a screw-retained prosthesis with unitary transepithelial. The mean follow-up time was 39.8 months (+/- 18). Survival of the implants studied was 100% and of the prostheses as well. The mean mesial crestal bone loss of the implants studied was 0.77 mm (+/- 0.01) and distal bone loss was 0.35 mm (+/- 0.7). Conclusions: Implants with a reduced diameter and platform can be used as a unit provided that a correct surgical and prosthetic treatment plan is followed, analysing the case as a whole and individualising the approach for each patient.

Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis

To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries. Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes. We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR=0.204; 95% Cl [0.136, 0.307], P=0.001), omental lesion (RR=0.444 95% Cl [0.239, 0.825], P=0.01), and failed entry (RR=0.169 95% Cl [0.101, 0.284], P=0.001). There is no significant difference between both cohort regarding the vascular lesion (RR=0.847 95% Cl [0.259, 2.777), P=0.7), infection of the trocar site (RR=0.583 95%Cl [0.106, 3.216], P=0.5, and visceral lesion (RR=1.308 95% Cl [0.314, 5.438], P=0.7. The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.

Correlation between morphological features of the anterior cruciate ligament: A quantitative study using a porcine model.

Knowledge of the morphological features of the anterior cruciate ligament (ACL) is critical for accurate reconstruction of it. This study aimed to explore the quantitative correlations among different morphological features of the ACL, thus to provide useful information for improving anatomical reconstruction techniques and designing artificial ligaments. 19 porcine knees were fixed at full extension using 10% formalin and were dissected to expose the ACL. ACL lengths were measured using a caliper. Mid-substances of the ACL were cut and scanned using X-ray microscopy, and the cross-sectional area (CSA) was measured at the isthmus. Margins of direct and indirect bone insertion sites were distinguished and marked. Measurements were performed on digital photographs to obtain the areas of bone insertions. Statistical analysis using nonlinear regression was used to identify potential correlations among the measurements. The results showed that the CSA at the isthmus was significantly correlated with the total area of the bone insertion sites and the area of tibial insertion. The area of the tibial insertion was significantly correlated with the area of its direct insertion site. In contrast, the area of the femoral insertion was significantly correlated with the area of its indirect insertion site. The area of the indirect tibial insertion showed a weak correlation with the length of ACL, whereas the length of the ACL was not able to predict or be predicted by any other parameters. The CSA at the ACL isthmus is more representative for assessing the size of the ACL. However, ACL length has little correlation with the CSA of the isthmus or bone insertion sites, and thus should be evaluated independently for ACL reconstruction.

Effectiveness of Direct Transcricothyroid Electromyographic Monitoring in Thyroidectomy Surgery.

Thyroid surgeries are associated with complications of vocal cord palsy and hypocalcemia which can be debilitating. The usage of intraoperative nerve monitoring is a useful adjunct to direct nerve visualization in thyroidectomies. We advocate the usage of direct transcricothyroid electromyographic monitoring in identifying recurrent laryngeal nerve. We retrospectively collected data of all patients who underwent thyroidectomies (total thyroidectomy, hemithyroidectomy, isthmusdectomy) using direct transcricothyroid electromyographic monitoring from April 2020 to August 2021. Data was analysed based on patient's demographics, comorbidities, complications post thyroidectomy such as vocal cord palsy, transient and permanent hypocalcemia. 50 thyroidectomies were performed, 10 developed unilateral vocal cord palsy. Out of 22 total thyroidectomies, 7 developed transient hypocalcemia and 4 permanently. 1 patient developed vocal cord hematoma secondary to direct insertion of intraoperative nerve monitor's electrode. Direct transcricothyroid electromyographic monitoring is a feasible and effective method in intraoperative monitoring of recurrent laryngeal nerve during thyroid surgeries.

Safety and efficacy of the expressman extension system for complex coronary lesions during percutaneous coronary intervention.

Safety and efficacy of the expressman extension system for complex coronary lesions during percutaneous coronary intervention.

Reduced Coating Diameter Fibers for High Density Optical Interconnects

Reduced coating diameter fibers (RCDF) are attractive for increasing fiber density in cables due to their compatibility with the standard 125 μm clad diameter. In this paper, we review recent progress on RCDF and present new modeling and experimental results. We developed microbending models to quantify both the intrinsic and extrinsic microbending sensitivities. Modeling results show that RCDF have lower intrinsic microbending sensitivity but higher extrinsic microbending sensitivity. We made RCDF with coating diameters from 125 to 175 μm. The fibers showed good attenuation on shipping reel, which confirms modeling results on intrinsic microbending. We performed microbending tests on RCDF to quantify their extrinsic microbending sensitivity. The extrinsic microbending results suggest that the microbending sensitivity of RCDF can be reduced by using softer primary coating materials and bend-insensitive fiber designs. We studied the mechanical properties of RCDF including fiber proof strength and puncture resistance. Fiber proof tests showed that fibers with coating diameter greater than 160 μm could pass the 100 kpsi proof test at similar break rates to 242 μm. Fiber puncture resistance could be improved by using better coating material designs. We also conducted a cable trial on a loose tube cable using RCDF with 160 and 170 μm coating diameters. It showed that the RCDF could increase the fiber density by more than 2 times without any microbending and fiber handling issues. Finally, we studied thin 125 μm coated fiber for making low-loss connectors with direct ferrule insertion without stripping the coating, which is promising to reduce fiber breaks and improve connector long term reliability.

Biodegradable Starch Sachets Reinforced with Montmorillonite for Packing ZnO Nanoparticles: Solubility and Zn2+ Ions Release

Agriculture’s importance in human lives and the economy has directed studies to improve crop production. An essential challenge for improving fertilizer efficacy is reducing losses due to leaching and increasing nutrient supplies. In this context, biodegradable sachets stand out as internal packaging instead of direct insertion into the polymer matrix, facilitating the system processing and making it easier to adapt the soil’s nutritional quantity. Thus, the present work aimed to increase the zinc oxide (ZnO) solubility by obtaining nanoparticles using top-down and bottom-up approaches and packaging them in montmorillonite (MMT) reinforced starch sachets. The different diameters and forms of the ZnO nanoparticles were evaluated to understand the solubility dependence on these parameters. In this way, the top-down process for the attritor milling method allowed the nanoparticles with about 71 nm average diameter and greater homogeneity than the commercial one (approximately 174 nm). The milled ZnO nanoparticles presented better solubility than those synthesized bottom-up processes and the commercial ones, reaching a 90 to 100% solubility plateau in 48 h. Concerning starch sachets, the 1% MMT (w w− 1) insertion in the polymeric matrix promoted increased water vapor barrier and mechanical properties, improving tensile strength. In the solubility test for nanoparticulate ZnO packed in sachets, similar behaviors to free ZnO were observed due to the high affinity of the starch matrix with water. Therefore, starch sachet systems with improved properties from the MMT reinforcement insertion showed as an alternative source of Zn2+ ions to minimize losses during application.

Assessing the Potential of Combined SMAP and In-Situ Soil Moisture for Improving Streamflow Forecast

Soil moisture is an essential hydrological variable for a suite of hydrological applications. Its spatio-temporal variability can be estimated using satellite remote sensing (e.g., SMOS and SMAP) and in-situ measurements. However, both have their own strengths and limitations. For example, remote sensing has the strength of maintaining the spatial variability of near-surface soil moisture, while in-situ measurements are accurate and preserve the dynamics range of soil moisture at both surface and larger depths. Hence, this study is aimed at (1) merging the strength of SMAP with in-situ measurements and (2) exploring the effectiveness of merged SMAP/in-situ soil moisture in improving ensemble streamflow forecasts. The conditional merging technique was adopted to merge the SMAP-enhanced soil moisture (9 km) and its downscaled version (1 km) separately with the in-situ soil moisture collected over the au Saumon watershed, a 1025 km2 watershed located in Eastern Canada. The random forest machine learning technique was used for downscaling of the near-surface SMAP-enhanced soil moisture to 1 km resolution, whereas the exponential filter was used for vertical extrapolation of the SMAP near-surface soil moisture. A simple data assimilation technique known as direct insertion was used to update the topsoil layer of a physically-based distributed hydrological model with four soil moisture products: (1) the merged SMAP/in-situ soil moisture at 9 and 1 km resolutions; (2) the original SMAP-enhanced (9 km), (3) downscaled SMAP-enhanced (1 km), and (4) interpolated in-situ surface soil moisture. In addition, the vertically extrapolated merged SMAP/in-situ soil moisture and subsurface (rootzone) in-situ soil moisture were used to update the intermediate layer of the model. Results indicate that downscaling of the SMAP-enhanced soil moisture to 1 km resolution improved the spatial variability of soil moisture while maintaining the spatial pattern of its original counterpart. Similarly, merging of the SMAP with in- situ soil moisture preserved the dynamic range of in-situ soil moisture and maintained the spatial heterogeneity of SMAP soil moisture. Updating of the top layer of the model with the 1 km merged SMAP/in-situ soil moisture improved the ensemble streamflow forecast compared to the model updated with either the SMAP-enhanced or in-situ soil moisture alone. On the other hand, updating the top and intermediate layers of the model with surface and vertically extrapolated SMAP/in-situ soil moisture, respectively, did not further improve the accuracy of the ensemble streamflow forecast. Overall, this study demonstrated the potential of merging the SMAP and in-situ soil moisture for streamflow forecast.

Synthesis, crystal structure, and photophysical properties of mononuclear and dinuclear palladium BODIPY chromophores

AbstractMononuclear and dinuclear palladium‐centered boron dipyrromethene (BODIPY) complexes, HBDPPdI and BDPPd2I2, respectively, were synthesized by the direct insertion of a palladium source into iodine‐substituted BODIPY chromophores. The molecular structures of both metal complexes were characterized using several analytical techniques, including single crystal x‐ray diffraction, to find that Pd(0) is coordinated directly to the ligand through a PdC bond facilitated by the insertion reaction. The photophysical properties of these complexes were also detailed.

Оптимизация программы выведения полезной нагрузки на заданную траекторию

In this paper, the problem of choosing and optimizing a program for launching the payload (PL) into a specified circular orbit is considered. Both direct insertion into the circular orbit and the insertion using an intermediate elliptical orbit are examined. The mass range of the PL, which can be placed into the circular orbit with specified parameters, is calculated. The PL is launched using a medium-class launch vehicle (LV), which is proposed to be a hypothetical ballistic missile withdrawn from service. The LV movement program is divided into two sections: the escape from the atmosphere and the launch section. Both sections use a control program with the pitch angle as a parameter. The optimal parameters for the program are determined. Direct insertion into the circular orbit is revealed to be possible for a very limited range of PL masses. It is shown that the range can be significantly extended if an intermediate elliptical orbit is used. The study results prove that the use of the selected LV allows placing the PL in the specified circular and elliptical orbits. For the formation of the orbital trajectories of the PL launch, it is possible to use an almost invariable parametric class of LV flight control programs.

Photocatalyzed alkoxycarbonylmethylation of pyridines with α-diazoacetates

A photocatalyzed regioselective alkoxycarbonylmethylation of 2-aminopyridines with α-diazoacetates has been developed.

CuBr-mediated synthesis of 1,4-naphthoquinones via ring expansion of 2-aryl-1,3-indandiones.

A CuBr-mediated direct insertion of alkenes into unstrained ring 2-aryl-1,3-indandiones is reported, which provides a one-carbon ring expansion strategy for the synthesis of 1,4-naphthoquinones. Entirely differing from the existing reports, the alkenes herein behave as C1 units to participate in annulation reactions. This transformation provides a facile route to access a class of highly functionalized 1,4-naphthoquinones with good yields, good functional-group tolerance and high atom-economy. Further research on the application of this reaction is currently underway in our laboratory.

Increased ACL direct insertion coverage provided more positive biomechanical effects on graft and bone tunnel during knee flexion: a simulation study

PurposeFlattened femoral tunnels were recently applied in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Little is known about the biomechanical effect of such changes during knee flexion. The aim of the present simulation study was to assess the effect of altered ACL direct insertion coverage on the biomechanics of the graft and bone tunnel.MethodsFive finite element (FE) models, including a round femoral tunnel and four progressively flattened rounded rectangular femoral tunnels, were established to represent the ACL reconstructions. In vivo knee kinematics data obtained from the validated dual fluoroscopic imaging techniques controlled the FE models to simulate lunge motions. The maximal principal stress of the graft and the volume of equivalent strain within 1000–3000 microstrain (V1000-3000) of the cancellous bone were subsequently calculated at 0°, 30°, 60° and 90° of knee flexion.ResultsA lower stress state on the graft and a more beneficial strain state on the cancellous bone were observed when the femoral tunnel better covered the ACL direct insertion. The average maximal principal stress of each model were 3.93 ± 0.60 MPa, 3.82 ± 0.54 MPa, 3.43 ± 0.44 MPa, 3.45 ± 0.44 MPa and 3.05 ± 0.43 MPa, respectively. The average V1000-3000 of the cancellous bone of each model were 179.06 ± 89.62 mm3, 221.40 ± 129.83 mm3, 247.57 ± 157.78 mm3, 282.74 ± 178.51 mm3 and 295.71 ± 162.59 mm3, respectively. Both the stress and strain values exhibited two peaks during the flexion simulation. The highest value occurred at 30° of flexion, and the second highest value occurred at 90° of flexion.ConclusionsIncreased ACL direct insertion coverage provided more positive biomechanical effects after anatomical single-bundle ACL reconstruction during knee flexion.

Comparison between direct trocar versus Veress needle for laparoscopic access: a randomized controlled study

Background: The existence of numerous techniques for creation of pneumoperitoneum at laparoscopy indicates that none has been proven totally efficacious or complication free. There is dearth of study in India comparing these techniques. The aim of present study was to compare the safety and duration for creating pneumoperitoneum between direct trocar (DT) and Veress needle (VN) technique.Methods: One hundred-fourteen patients aged between 18 and 70 years were included in this single-blind randomized controlled study. Group DT and group VN patients underwent laparoscopic surgery after trocar placement by direct trocar insertion technique and Veress needle technique respectively. The primary outcome measure was the incidence of complications whereas secondary outcome measures were number of items required and time needed to introduce the laparoscope. Intergroup comparison of categorical and continuous variables was done using the Chi-square test/Fisher’s exact test and unpaired t-test respectively.Results: The number of attempts for trocar placement, and complications were comparable between direct trocar and Veress needle group. The mean duration of trocar placement at the first attempt was 102.6 and 142.3 seconds in direct trocar and Veress needle group respectively (p value =0.001).Conclusions: Veress needle is a safe, efficient, and rapid alternative technique as compared to direct trocar.

Comparison of fiberoptic bronchoscopic intubation using silicone and polyvinyl chloride double-lumen tubes.

Direct insertion of a double-lumen tube (DLT) using a flexible fiberoptic bronchoscope (FOB) is an option for DLT intubation. The difficult process of fiberoptic intubation is that the different properties of polyvinyl chloride and silicone DLTs may affect railroading differently. Therefore, we aimed to compare intubation using polyvinyl chloride and silicone DLTs over an FOB. Patients aged 19-75 years who required one-lung ventilation under general anesthesia were enrolled in this study. After induction of anesthesia, the anesthesiologist intubated the DLT using FOB. The primary outcome was the difficulty of railroading over the flexible FOB scaled into five grades (I, II-1, II-2, III, and IV). Additionally, the intubation time and mucosal damage were recorded. A total of 46 patients participated in this study, 23 each in the silicone and polyvinyl groups. The difficulty of railroading over the FOB was significantly different between the two groups (P < 0.001). In the silicone group, the grades of difficulty in railroading were limited to I and II-1; 20 patients (87%) presented no difficulty in advancing the tube. In contrast, in the polyvinyl group, 13 patients (57%) had scores of II-2 and III. Both the intubation time and mucosal damage were significantly better in the silicone group than in the polyvinyl group. Intubation using a silicone DLT over an FOB was easier and faster than that with a polyvinyl chloride DLT with lesser trauma around the glottis.

Predicative and markedness bias in loan adjectives

Previous research on loan word accommodation has shown that English‑origin verbs in Present‑day Dutch and French‑origin verbs in Late Middle English are subject to usage biases. In both language‑contact settings, loan verbs are disproportionally frequent in non‑finite and morphologically unmarked forms as compared to native verbs. The present study demonstrates that accommodation biases are also found in loan adjectives. Concretely, loan adjectives are more prevalent in predicative than in attributive syntactic position as compared to native adjectives (predicative bias), and they are more prevalent in uninflected than in inflected forms (markedness bias). The predicative bias is found to rank stronger than the markedness bias, which is consistent with the findings for verbs. Additionally, biases are more pronounced in the French‑Middle English than in the English‑Dutch contact setting. The findings indicate that direct insertion of loan-words, despite being the cross-linguistically most frequent strategy for loan word integration, is not free of obstacles, possibly due to processing costs specifically associated with loan words.

Flame retardant back-coated PET fabric with DOPO-based environmentally friendly formulations

There is a great demand for nontoxic flame retardants (FRs) in textile industry to replace harmful halogenated counterparts. On the other hand, the availability of eco-friendly phosphorus-based FRs for application on synthetic textiles are scarce for, especially for the back coating application. Thus, in this work, non-toxic phosphorus FRs such as EDA-DOPO (ED) and DOPO-PEPA (DP) were applied to PET fabric via a back coating process. For immobilizing these FRs on fabric, three different polymer resins, namely polyurethane, vinylacetate and acrylcopolymer, were utilized. The FR performance of fabrics was evaluated via a vertical burning test (FAR 25.853), a standard used commonly in aviation industry. For ED formulations (all resins), 5 % phosphorus (P) content on coating was sufficient for the textiles to pass the fire test. However, fabrics coated with DP formulations failed the fire test for the same P content. To further improve the FR performance of DP formulations, melamine was incorporated as a synergistic additive. In order to understand their FR behavior, thermogravimetric analysis (TGA) and direct insertion probe-mass spectrometry (DIP-MS) analysis was performed to elucidate the FR action of the additives. Herein, it was shown that DOPO-based FR compounds were first time successfully applied for the back coating application in textiles and their gas phase action was essential to pass the vertical burning test.

Reduction in Radiation Exposure in Minimally Invasive Pedicle Screw Placement Using a Tubular Retractor: A Pilot Study

Percutaneous pedicle screw (PPS) placement is a minimally invasive spinal procedure that has been rapidly adopted over the last decade. However, PPS placement has elicited fear of increased radiation exposure from some surgeons, medical staff, and patients. This is because PPS placement is performed using a K-wire, and the operator must perform K-wire insertion into the pedicle under fluoroscopy. In order to prevent erroneous insertion, there are many occasions when direct insertion is required during radiation exposure, and the amount of radiation exposure to hands and fingers in particular increases. Although these problems are being addressed by navigation systems, these systems are still expensive and not widely available. Attempts have been made to address this situation using instrumentation commonly used in spinal surgery. First, it was considered to visualize anatomical bone markers using a tubular retractor and a microscope. In addition, the use of a self-drilling pin was adopted to locate the pedicle in a narrower field of view. Based on these considerations, a minimally invasive and highly accurate pedicle screw placement technique was developed while avoiding direct radiation exposure. This study evaluated radiation exposure and accuracy of pedicle screw placement using this new procedure in one-level, minimally invasive, transforaminal lumbar interbody fusion (MIS-TLIF). Data were collected retrospectively to review pedicle screw placement in single-level MIS TLIFs using a tubular retractor under a microscope. The total fluoroscopy time, radiation dose, and screw placement accuracy were reviewed. Extension of operating time was also evaluated. Twenty-four patients underwent single-level MIS TLIFs, with placement of 96 pedicle screws. There were 15 females and 9 males, with an average age of 64.8 years and a mean body mass index of 25.5 kg/m2. The mean operating time was 201.8 min. The mean fluoroscopic time was 26.8 s. The mean radiation dose of the area dose product was 0.0706 mGy∗m2. The mean radiation dose of air kerma was 6.0 mGy. The mean radiation dose of the entrance skin dose was 11.31 mGy. Postoperative computed tomography scans demonstrated 93 pedicle screws confined to the pedicle (97%) and three pedicle screw breaches (3.2%; two lateral, one medial). A patient with screw deviation of the medial pedicle wall developed right-foot numbness necessitating reoperation. There were no complications after reoperation. The average added time with this combined procedure was 39 min (range 16-69 min) per patient. This novel pedicle screw insertion technique compares favorably with other reports in terms of radiation exposure reduction and accuracy and is also useful from the viewpoint of avoiding direct radiation exposure to hands and fingers. It is economical because it uses existing spinal surgical instrumentation.