Free Needle Research Articles

Revision Anterior Glenoid Reconstruction With Distal Tibia Allograft Combined With Open Capsular Shift

Background: Managing patients with recurrent anterior shoulder instability and glenoid bony deficiency remains a challenge. Multiple graft options, including iliac crest, distal clavicle, coracoid, and distal tibia allograft have been used. There is a growing body of evidence that supports distal tibia allograft for glenoid restoration in patients with shoulder instability due to its ability to restore the articular surface as well as the glenoid depth and curvature. Indications: Surgical indications for anterior glenoid reconstruction with distal tibia allograft combined with open capsular shift include patients with recurrent shoulder instability and glenoid bone loss. Technique Description: A deltopectoral interval is utilized and the subscapularis is split in lines with its fibers. The subscapularis and capsule are split together in a horizontal fashion and tagged together. Any prior hardware is then removed utilizing appropriate removal sets, a burr, and a broken screw set if necessary. The anterior glenoid is then prepared and the defect is measured. Bone marrow aspirate is then harvested from the proximal humerus using a vortex needle. The distal tibia allograft is then cut to size and prepared utilizing pulsed lavage, pressurized sterile carbon dioxide, and the bone marrow aspirate. The allograft is then fixed with solid stainless steel 3.5-mm cortical screws with washers. The medial, glenoid based capsular repair it completed by placing 1.8-mm knotless FiberTak anchor at the bottom of the distal tibia allograft. A free needle is utilized to place a horizontal mattress stitch from the anchor to the inferior capsule, which is then loaded onto a shuttling suture, to repair it to the anterior inferior glenoid. A knotless anchor is then placed right off the chondral margin of the humeral head, and this is used to repair both the capsule and subscapularis in the correct position by passing through both inferior and superior leaflets. This is then loaded onto the knotless anchor and reduced, which shifts the subscapularis and capsule laterally. The remainder of the subscapularis split is then closed. Patients are then placed in a sling with an abduction pillow with no shoulder range of motion for 6 weeks. They can then progress their therapy with a goal of returning to sport at 6 months. Results: Several large systemic reviews have shown that return to sport rates after anterior glenoid reconstruction range between 80% and 90%, with returning to the same level of play in the 70% range. Discussion: Anterior glenoid reconstruction utilizing distal tibia allograft combined with an open capsular shift is a durable surgical option for patients presenting with shoulder instability and glenoid bone loss. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Deep learning-based dose map prediction for high-dose-rate brachytherapy

Background. Creating a clinically acceptable plan in the time-sensitive clinic workflow of brachytherapy is challenging. Deep learning-based dose prediction techniques have been reported as promising solutions with high efficiency and accuracy. However, current dose prediction studies mainly target EBRT which are inappropriate for brachytherapy, the model designed specifically for brachytherapy has not yet well-established. Purpose. To predict dose distribution in brachytherapy using a novel Squeeze and Excitation Attention Net (SE_AN) model. Method. We hypothesized the tracks of 192Ir inside applicators are essential for brachytherapy dose prediction. To emphasize the applicator contribution, a novel SE module was integrated into a Cascaded UNet to recalibrate informative features and suppress less useful ones. The Cascaded UNet consists of two stacked UNets, with the first designed to predict coarse dose distribution and the second added for fine-tuning 250 cases including all typical clinical applicators were studied, including vaginal, tandem and ovoid, multi-channel, and free needle applicators. The developed SE_AN was subsequently compared to the classic UNet and classic Cascaded UNet (without SE module) models. The model performance was evaluated by comparing the predicted dose against the clinically approved plans using mean absolute error (MAE) of DVH metrics, including D 2cc and D 90%. Results. The MAEs of DVH metrics demonstrated that SE_AN accurately predicted the dose with 0.37 ± 0.25 difference for HRCTV D 90%, 0.23 ± 0.14 difference for bladder D 2cc, and 0.28 ± 0.20 difference for rectum D 2cc. In comparison studies, UNet achieved 0.34 ± 0.24 for HRCTV, 0.25 ± 0.20 for bladder, 0.25 ± 0.21 for rectum, and Cascaded UNet achieved 0.42 ± 0.31 for HRCTV, 0.24 ± 0.19 for bladder, 0.23 ± 0.19 for rectum. Conclusion. We successfully developed a method specifically for 3D brachytherapy dose prediction. Our model demonstrated comparable performance to clinical plans generated by experienced dosimetrists. The developed technique is expected to improve the standardization and quality control of brachytherapy treatment planning.

Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS).

Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS).

Super ring modern circumcision training with free needle injection anesthesia in improving the skills of health workers

The development of circumcision techniques in the world, including Indonesia, is very rapid. One of them is super ring modern circumcision with free needle injection anesthesia. Efforts to improve the skills of health workers such as doctors and nurses through training are carried out in collaboration with LKP Sunat Modern Indonesia. The methods used are question and answer lectures, demonstrations, FGDs, and the practice of performing circumcision on patients directly with the assistance and supervision of the instructor. The result of this activity is an increase in understanding and skills in performing super ring modern circumcision with free needle injection anesthesia, and producing entrepreneurs in this field.

Arthroscopic Hip Labral Reconstruction: Treatment of Irreparable Labral Tears With Segmental Allograft Reconstruction

Background: At the time of hip arthroscopy, some patients are found to have irreparable labral tears that are not amenable to primary repair. For these patients, treatment with segmental reconstruction is a surgical option to restore labral tissue and biomechanics. Indications: Patients with segmental irreparable hip labral tears that are technically not amenable for primary labral repair should be considered for labral reconstruction with allograft. Technique Description: Standard hip arthroscopic portals are established. An interportal capsulotomy is performed, and acetabular rim trimming is performed to remove the pincer deformity. Visualized segmental labral defects are measured using a piece of suture to allow for measurement of a curved surface and 1.4-mm polyether ether ketone (PEEK) anchors are placed in anticipation of labral fixation. On the back table, the tibialis anterior allograft is prepared for labral reconstruction. We mark a central portion of the graft tissue based on the measured defect size. A 3-0 vicryl suture is used to place a running stitch from one end to the other of the marked portion of the allograft and the marked, prepared graft is sharply divided from the rest of the tissue. Stitches from the anterior and posterior anchors are passed through the graft using a free needle. The graft is then placed through the distal accessory anterolateral portal and positioned into place. The posterolateral and then medial-most anchors are secured and tied using arthroscopic knots, followed by sequential tying of the middle anchors. Any additional arthroscopic procedures, such as cam resection, are performed, and capsular/skin closure is performed using standard methods. Results: Published outcomes support reconstruction of the labrum using allograft, with 2 series consisting of a total of 141 segmental/circumferential reconstructions demonstrating similar outcome scores at 2 years of follow-up as compared to matched cases of primary labral repairs. Discussion/Conclusion: Hip segmental labral reconstruction with tibialis anterior allograft provides a viable surgical option for patients with labral defects precluding primary labral repair. The presented material demonstrates a readily employable technique as well as clear, step-by-step postoperative rehabilitation protocols, and satisfactory published short- and mid-term outcomes literature.

Differences in the Effectiveness of Hypnocircumcision and Free Needle Anesthesia on Children's Pain Levels During the Circumcision Process

This study aimed to compare the level of pain in children during the circumcision process between the hypnosis method and free needle anesthesia (anesthesia without a needle). In the implementation of this study, the respondents (children) were divided into two groups, namely the group of children who were hypnotized and the group of children who used free needle anesthesia (anesthesia without a needle). researchers ranging from children aged 7-15 years), after which the data will be analyzed and concluded. The results of this study indicate that there are differences in pain levels with the hypnosis method and the neddle injection method with a sig value of 0.00 < 0.05 (Mann-Whitney U test). From the results of this study it was also found that hypnosis was more effective in overcoming pain in children during the circumcision process. It can be concluded that hypnosis is more effective than free needle injection.

307 Awareness and Reporting of Needle Stick Injury Amongst Junior Doctors in a General Surgery Department

Abstract Introduction This audit was performed to see if a new cohort of junior doctors in a general surgery department had received legally required sharps injury training, assess knowledge on what to do if a needle stick/splash injury were to occur; and to provide necessary training. Method Questionnaires about trust needle stick policy training including current job grade, awareness of general principles, reporting of previous needle stick injuries and barriers to reporting of needle stick injuries were filled in. Training was provided on needle free devices and trust needle stick/splash injury protocol. After training, a second questionnaire was filled in to see if there was better understanding of the trust protocol and the necessary steps after injury. The same group of junior doctors were re-audited at a later date to see if the knowledge gained from training had been retained. Results All junior doctors (total of 11) in general surgery reported receiving no formal needle stick/splash training since starting at the trust on the trust policy and no formal induction on needle-free devices and what to do in the event of a needle stick injury since starting at the trust. All doctors felt aware of what to do after training provided with time pressures being identified as a barrier for not reporting all needle stick injuries. Re-audit one month later demonstrated all doctors had awareness of the trusts needle stick/splash injury protocol. Conclusions The training provided was effective in providing legally required training and improving staff and patient safety.

Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey

BackgroundA Cross-sectional Rapid Situational Assessment of People Who Inject Drug (PWIDs) applying Respondent Driven sampling techniques (RDS) was used to recruit subjects/participants in a study aimed at assessing HIV prevalence and risk behaviors among injecting drug users in Nairobi and Coastal regions of Kenya. There is paucity of data and information on injecting drug use in sub-Saharan Africa and there is sufficient evidence of existence of the environment for development and growth of injecting drug use. Past studies on PWID and its association to HIV and AIDS that have been conducted in Kenya do not provide sufficient information to support effective planning and comprehensive national response to the HIV and AIDS epidemic.MethodsA cross-sectional study design was adopted in which a set of initial subjects referred to as ‘seeds’ were first identified from which an expanding chain of referrals were obtained, with subjects from each wave referring subjects of subsequent waves. The seeds were drawn randomly from the population and interviewed to pick the one with the largest network and other unique characteristics. A maximum of twelve seeds were recruited. The second stage involved conducting assessment visits to the sites to identify potential collaborators that included non-governmental organizations (NGOs), drug treatment centres, health facilities, community based organizations (CBO’s) among others. Three NGOs located in the coast region and one in Nairobi region were identified to assist in identifying drug injection locations and potential participants. Key informant interviews (KIIs) and Focus Group Discussions (FGDs) were also conducted using interview guides.ResultsA total of 646 individuals (344 in Nairobi and 302 at the coast) were recruited for the study between January and March 2010. Of these 590 (91%) were male and 56 (9%) were female. Findings showed that most PWIDs initiated injecting drug use between the ages of 20–29 years, with the youngest age of initiation being 11 years and oldest age being 53 years. Most commonly injected drug was heroin (98%), with a small (2%) percentage injecting cocaine. Other non-injecting methods such as smoking or combining these two drugs with other drugs such as cannabis or Rohypnol were also common. Most PWIDs used other substances (cigarettes, alcohol, and cannabis) before initiating injecting drug use. The adjusted national HIV prevalence of PWIDs was 18.3% (19.62% unadjusted) with PWIDs in Nairobi region registering 18.33% (20.58% unadjusted) compared PWIDs for Coastal region indicating 18.27% (18.59% - unadjusted). The gender based HIV prevalence showed that women were more at risk of acquiring HIV (44.51%-adjusted) compared to men (15.97%-adjusted). The age specific HIV prevalence showed that PWIDs who initiated injecting at 11–19 years (44.7% adjusted) were most at risk in Nairobi compared to those who initiated injecting at age 20–24 years (23.2% - adjusted) in the coastal region. While all PWIDs continue to be at risk in the two regions, those from the Western parts of Nairobi, Kenya were at a relatively higher risk given their increased propensity for sharing injecting equipment and solutions.ConclusionsCompared to the national HIV prevalence of (4.9%), the results show that People Who Inject Drugs (PWIDs) are at particularly high risk of infection in Kenya and there is urgent need for intervention (KenPHIA, 2018). This study also showed clear evidence that 70% of PWIDs are primary school educated, engage in high risk injecting and sexual behaviors comprising sharing of injecting equipment, unprotected heterosexual and homosexual sex. Given that initiation of injecting drug use begins early and peaks after formal school years (20–29 years), prevention programmes should be targeted at primary and secondary school students, college and out of school youth. Further, to protect People who inject drugs (PWIDs) from HIV infection, the country should introduce free Needle Syringe Programs (NSP) with provision of condoms and Methadone Assisted Therapy (MAT) as a substitute for drug use.

Simple Endoscopic Application of Laryngeal Keel Stent.

This study describes a simple extraendolaryngeal technique to apply laryngeal keel in dealing with anterior commissure web/fibrosis. Standard extraendolaryngeal punctures were applied via 20-gauge needles, 30° from the skin surface, in midline through the cricothyroid and thyrohyoid membranes. These needles were used as a conduit for the passage of 2/0 Prolene threads, which were retrieved through the laryngoscope by crocodile forceps. Both laryngoscopic ends of the Prolene threads were passed through a fabricated silastic sheet (keel stent) via a 22-gauge free needle, and these ends were tied to have a secure internal knot. Steady traction was applied on the other 2 external threads until there was appropriate application of this keel stent within the vicinity of anterior commissure. Finally, these external ends were tied to have a secure external knot. A keel stent could be applied without the need for special instrumentation and with reasonable outcomes (proper healing of anterior commissure, satisfied voice outcome, and patent airway).

Intracavitary/Interstitial Applicator Plus Distal Parametrial Free Needle Interstitial Brachytherapy in Locally Advanced Cervical Cancer: A Dosimetric Study.

PurposeTo explore the dosimetric advantage of combining intracavitary/interstitial applicator with distal parametrial free needle interstitial brachytherapy (IC/IS+ISBT DP) based on MRI for locally advanced cervical cancer.Methods and Materials77 IC/IS+ISBT DP treatment plans were developed for 34 patients with locally advanced cervical cancer from June 2016 to January 2020 in this study. We removed the free needles and devised a new IC/ISBT treatment plan based on the same principle. We then compared the dosimetric differences of D90, D98, V100, V150, V200 for HR-CTV (high-risk clinical target volume), D90 for IR-CTV (Intermediate risk-CTV) and D2cc for OARs (organs at risk) between the two groups of treatment plans for the same patient, and the paired T test was performed in parallel. Further, the dosage differences between the two group plans under different parametrial extension widths (the maximum distance of HR-CTV from the vertical direction of the uterine tandem at coronal position) were compared. The survival rate was calculated using the Kaplan-Meier method. Prognostic factors for overall survival (OS) and progression-free survival (PFS) were determined by Cox regression method. RTOG/EORTC criteria were used to grade toxicities.ResultsA total of 297 free needles were used, with a weight ratio of 15.8% ± 0.11, and a mean insertion depth of 6.52cm ± 2.8cm. D90, D98, V100 for HR-CTV, and D90 for IR-CTV for IC/IS+ISBT DP were significantly higher than IC/ISBT for which free needles were removed (p<0.05). And the V200 for HR-CTV and D2cc for bladder, rectum and sigmoid were decreased (p<0.05). When the parametrial extension widths were greater than 3cm, the HR-CTV D90 and the D2CC for rectum, bladder and sigmoid colon for IC/IS-ISBT DP were advantageous compared to IC/ISBT (p<0.05). The 2-yr OS, PFS and local control rate (LC) were 82.3, 66.8, and 93.1%, respectively. Parametrial extension widths was the only statistically prognostic factors for PFS (p = 0.002) on univariate analysis. No grade 3 or 4 Treatment-related toxicities were observed.ConclusionOur institutional experiences showed that IC/IS+ISBT DP is an effective treatment for cervical cancer patients with distal parametrial extension. IC/IS-ISBT DP had dosage advantage and clinical feasibility in locally advanced cervical cancer with distal parametrial extension when the parametrial extension widths were greater than 3cm.

Dual solutions of nanomaterial flow comprising titanium alloy (Ti6Al4V) suspended in Williamson fluid through a thin moving needle with nonlinear thermal radiation: stability scrutinization

Titanium alloy nanoparticle has a variety of applications in the manufacturing of soap and plastic, microsensors, aerospace design material, nano-wires, optical filters, implantation of surgical, and many biological treatments. Therefore, this research article discussed the influence of nonlinear radiation on magneto Williamson fluid involving titanium alloy particles through a thin needle. The arising system of partial differential equations is exercised by the similarity transformations to get the dimensional form of ordinary differential equations. The dual nature of solutions is obtained by implementing bvp4c. The study of stability has been carried out to check which of the results are physically applicable and stable. Influences of pertinent constraints on the flow field are discussed with the help of graphical representations and the method validation is shown in Table 1. The results imply that more than one result is established when the moving needle and the free-stream travel in the reverse directions. Moreover, the magnetic parameter accelerates the severance of boundary-layer flow, while the separation delays in the absence of the nanoparticle. The velocity gradient of nanofluid decays owing to the Williamson parameter in both branches of the outcome, while the temperature shrinks in the first or upper branch solution (stable one) and uplifts in the second or lower branch solution (unstable one). The size of the needle decreases the velocity in the upper solution and accelerates in the lower solution. The patterns of streamlines are more complicated due to the reverse direction of the free stream and thin needle.

Development of a Device-to-Image Registration Free Needle Guide for Magnetic Resonance Imaging-Guided Targeted Prostate Biopsy

Abstract Significant research has been done in the past decade for the development of magnetic resonance imaging (MRI) guided needle guide (NG) systems for prostate intervention. Most of these systems have been restricted to application in the lab environment with lack of progress toward clinical application. Bulky and complex designs can be attributed to this practice. These systems also demand complex technical setup and usage procedures, which require extra technical personnel during the intervention in addition to specialized training for physicians. Moreover, “device-to-image” registration, essential for accurate and precise targeting, further complicates the overall process while increasing total time for intervention. In order to address these limitations, a simplified, MRI-guided, transperineal prostate biopsy NG system was designed and developed for rapid adoption into the clinical environment. The system consists of a NG device and a software toolkit. It does not require any special intraprocedural technical expertise or dedicated training. Also, to simplify and shorten total procedure time, the device uses the unique concept of “fixed coordinate device” eliminating the need for any device-to-image registration making it clinically friendly. To verify the NG design along with the registration free feature, image quality tests and agar phantom-based targeting experiments were performed under the guidance of 3T MRI scanner. The imaging tests resulted in a distortion of less than 1% in presence of the device and an average change of 1.3% in signal-to-noise ratio. For targeting experiments, maximum in-plane error distance of 3.8 mm with a mean of 2.2 mm and standard deviation of 0.8 mm was observed. The results show that an MRI-compatible simplified intervention device without the need of device-to-image registration is technically feasible.

Direction of the relationship between methamphetamine use and positive psychotic symptoms in regular methamphetamine users: evidence from a prospective cohort study.

Methamphetamine has been consistently associated with positive psychotic symptoms, but little is known about whether the reverse also occurs. This study determined whether the relationship between methamphetamine use and positive psychotic symptoms is bidirectional over 12 months. The impact of lifetime psychotic disorders and methamphetamine dependence on these relationships was also examined. A total of 201 regular (at least monthly) primary methamphetamine users were recruited from free needle and syringe programmes in three Australian cities. Data on the frequency of methamphetamine and other drug use (from Timeline Followback inteviews) and the severity of positive psychotic symptoms (using the Brief Psychiatric Rating Scale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews (mean of 9.14/11 (s.d. = 3.16) follow-ups completed). Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders. The mean age of participants was 31.71 years (s.d. = 8.19) and 39% (n = 77) were women. At baseline 55% (n = 110) were dependent on methamphetamine and 51% (n = 102) had a lifetime psychotic disorder. Cross-lagged dynamic panel models found a significant bidirectional relationship between psychotic symptoms and methamphetamine use (Comparative Fit Index (CFI) = 0.94, standardised root mean square residual (SRMR) = 0.05, root mean square error of approximation (RMSEA) = 0.05, 95% CI 0.04-0.06). The magnitude of the relationship in each direction was similar, and the presence of methamphetamine dependence or a lifetime psychotic disorder did not have an impact on results. A dynamic, bidirectional relationship between methamphetamine and psychotic symptoms of similar magnitude in each direction was found over 1 year. This suggests integrated treatments that target methamphetamine, psychotic symptoms and their interrelationship may be of most benefit.

Bidirectional Relationship Between Methamphetamine Use and Positive Psychotic Symptoms in Regular Methamphetamine Users: Evidence From a Prospective Cohort Study

Background: Methamphetamine (MA) use is a major public health concern worldwide. MA has been causally associated with positive psychotic symptoms, but research is yet to determine if the reverse also occurs. This study prospectively determined whether the relationship between MA use and positive psychotic symptoms is bidirectional. impact of lifetime psychotic disorders and MA dependence on these relationships was also examined. Methods: This 12-month prospective study recruited a cohort of 201 regular (at least monthly use) primary MA users from free needle syringe programs in three Australian cities. Data on the frequency of MA use (Timeline Followback) and the severity of positive psychotic symptoms (Brief Psychiatric Rating Scale subscale) in the past 2 weeks were collected in 12 contiguous monthly face-to-face interviews. Diagnoses were derived using the Psychiatric Research Interview for DSM-IV Substance and Mental Disorders. Outcomes: Participants had a mean age of 31.71 years (SD=8.10) and 38% (n=77) were female. At baseline 55% (n=110) were dependent on MA and 51% (n=101) had a lifetime psychotic disorder, comprised of 23% (n=23) primary and 77% (n=79) substance-induced psychotic disorders. Participants completed a mean of 9.14 (SD=3.16) out of the 11 follow up interviews were completed, 52% (n=104) completed all 11 interviews. Cross-lagged dynamic panel models were used to simultaneously test whether psychotic symptoms predicted higher levels of MA use in the next wave; and higher MA use predicted psychotic symptoms in the same next wave. This indicated there was a significant bidirectional relationship between psychotic symptoms and MA use (CFI = 0.94, RMSEA = 0.05 (95% CI = 0.04, 0.06). magnitude of the relationship in each direction was similar, indicating neither direction predominated. This bidirectional relationship was found, regardless of whether participants had MA dependence or a lifetime psychotic disorder. Interpretation: A bidirectional relationship between MA use and psychotic symptoms, of similar magnitude in each direction was found over one year. This highlights the dynamic and reciprocal nature of the relationship between MA and psychotic symptoms among MA users, and suggests integrated treatments that simultaneously target both of these variables may be of most benefit. Funding Statement: This project was funded by an Australian National Health and Medical Research Council (NHMRC) Project Grant (APP326220). Leanne Hides and Maree Teesson are supported by NHMRC Senior Research and Principal Research Fellowships. Gary Chan and Rebecca McKetin are supported by University of Queensland and Curtin University Research Fellowships. Declaration of Interests: authors state: The authors have no conflicts of interest. Ethics Approval Statement: This project was approved by the relevant ethics review board and all participant provided written informed consent after receiving a description of the study.

Comparison of Clinical Failure Rates After 2 Techniques of Subpectoral Mini-Open Biceps Tenodesis: Sequence and Suture Passage Technique Matter.

Background:A number of techniques are available for performing biceps tenodesis, the majority of which result in good or excellent outcomes. However, failure may result in pain and/or dissatisfying biceps deformity.Purpose:To compare the clinical failure rates of 2 methods of suture passage in subpectoral biceps tenodesis with suture anchors performed by the senior author.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was conducted of patients who underwent biceps tenodesis under the care of the senior author. Operative notes were used to determine whether the procedure was performed with a BirdBeak (BB) suture passer or a free needle (FN). Each subsequent clinical follow-up note was used to determine participation in physical therapy and duration, follow-up duration, and whether clinical tenodesis failure had occurred. Biceps tenodesis failure was defined as either cosmetic deformity (“Popeye” sign), pain at the tenodesis site, or need for revision.Results:Overall, 163 patients met the inclusion criteria (BB, n = 112; FN, n = 51). Mean follow-up was 5.3 months and 4.1 months in the BB and FN groups, respectively. Significantly more tenodesis failures occurred in the BB group (BB, 12%; FN, 2%, P = .042). Among all BB patients, 10% experienced failure due to cosmetic deformity, 2% required revision, and 4% had postoperative pain at the tenodesis site by latest follow-up. The 1 patient in the FN group who experienced failure presented with cosmetic deformity postoperatively.Conclusion:Biceps tenodesis with the use of an FN to pass the suture resulted in a significantly lower clinical failure rate compared with the use of a BB suture passer.

Clinical effects of needle free (INJEX30) versus traditional injection of botulinum toxin A for bromhidrosis

Objective To investigate the clinical efficacy of bromhidrosis with botulinum toxin A by needle free injection. Methods A total of 40 patients with bromhidrosis were collected and divided into needle free group and needle group. A comparative study was carried out in those subjects. Patients in needle free group received needle free injection of botulinum toxin A by INJEX30; Needle group received traditional injection by 26 G needles. Results In needle free group, 16 cases were cured, 3 cases were effective, 1 case was ineffective, no significant pain, hematomas or necrosis were found. In needle group, 15 cases were cured, 4 cases were effective, and 1 case was ineffective; localized hematoma occurred in 2 cases. And cases in group needle experienced pain more intensely than cases in needle free group. Conclusions The INJEX30 improves the security, comfort and therapy compliance of botulinum toxin A injection in the bromhidrosis patients, with similar efficacy with traditional injection. Key words: Bromhidrosis; Needle free injection; Botulinum toxin A

Highly Articulated Robotic Needle Achieves Distributed Ablation of Liver Tissue.

Robotic needle steering will improve percutaneous radio-frequency ablation (RFA) in the liver by performing distributed ablations without requiring multiple punctures of the liver capsule, thus enabling the treatment of large or multifocal tumors. However, state-of-the-art asymmetric-tip robotic needle steering systems do not yet achieve clinically relevant curvature. This work presents the design and development of a highly articulated needle that enables distributed RFA in liver tissue under ultrasound (US) image guidance. Our new needle design attains the target curvature required for liver procedures while meeting important clinical requirements, such as the use of fixed diameter needle introducers, presence of a free needle working channel, robustness for repeated insertions, and conductivity for the delivery of RF current for tissue ablation. The new needle tip includes two important design features: A tendon-actuated Nitinol asymmetric flexure joint, which allows for an active amplification of the needle steering force, and a steel back-bevel tip profile, which decreases the risk of needle jamming. The needle's resulting curvature was evaluated in both phantom and ex vivo liver tissues using segmented US images. The average radius of minimum curvature in ex vivo liver tissue was found to be 33.6 mm, the smallest reported to date. Furthermore, RFA in ex vivo porcine liver tissue tests were performed to demonstrate that distributedablation with a single puncture of the liver capsule is possible via robotic needle steering.

An intuitive method of duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: use of one-step circumferential interrupted sutures.

Pancreaticoenteric anastomosis is the origin of postoperative pancreatic fistula (POPF). Although a variety of methods have been proposed to decrease the POPF rate, randomized controlled trials performed so far have failed to demonstrate superiority of any particular method to the others. Cattell-Warren duct-to-mucosa pancreaticojejunostomy (PJ) is a widely practiced procedure. Their method is challenging, especially when the pancreatic duct is small. We assumed that the difficulty resides in the pancreatic duct becoming difficult to access when the posterior row is tied before suturing the anterior row. We have modified the duct-to-mucosa PJ so that the entire circumference of the inner layer can be sutured and tied in one-step by anchoring and retracting the anterior row. The jejunal roux-limb and pancreatic stump are positioned spatially apart, allowing enough space for free needle work. During a 13-year period, 151 patients underwent pancreaticoduodenectomy with this method, and the cumulative POPF and mortality rates were 37.1% and 4.6%, respectively. These rates were stable throughout the study period, implicating a relative independence from surgeons' experience. We believe that our method is intuitive, easy to grasp, and can be readily adopted even by surgeons not accustomed to pancreaticoduodenectomy.

Predisposing, enabling, and need factors associated with utilization of HCV testing services among PWID in two settings in India.

BackgroundThe Hepatitis C virus (HCV) is very common among people who inject drugs (PWID), yet PWID in India have suboptimal access to HCV testing and treatment. This study sought to identify HCV risk factors among male PWID who utilized a free needle and syringe exchange program and to examine the predisposing, enabling, and need factors associated with utilization of HCV testing services by those PWID reporting that they had been tested.MethodsA cross-sectional study was conducted in Imphal, Manipur and Amritsar, Punjab. These two settings have high HCV prevalence and large numbers of PWID. A team of 18 field investigators obtained data through face-to-face interviews using a structured multiple-choice questionnaire. The questionnaire was administered to 1241 of 2644 male PWID aged 15 years and above enrolled in the needle and syringe program of India’s AIDS Control Program, with study participants selected through consecutive sampling. Statistical analyses included descriptive statistics and multivariate regression.ResultsTwenty-four percent of PWID in our study sample reported having been tested for HCV. Unlike PWID in Imphal, more than half of PWID in Amritsar reported unprotected sex and use of alcohol or non-injecting drugs as being among their HCV risk factors (67.1 and 77.8 %, respectively). However, opioid substitution therapy non-adherence was reported more often in Imphal than in Amritsar. Education, marital status, place of residence and duration of injecting drug use were found to significantly enable access to HCV testing while alcohol use, frequent mobility and unprotected sex were found to significantly inhibit access to HCV testing for PWID after controlling for other explanatory variables.ConclusionsPredisposing and enabling determinants provide an area for developing effective interventions to improve HCV testing practices among PWID. HCV prevention programs that address safe injecting and sexual practices, OST adherence and frequent mobility customized for PWID by age are strongly recommended.

The Application of Gorman’s Eigen Values to The Industrial Sewing Machine’s Needle Vibration

The free vibration of the sewing needle is divided into lateral free vibrations and an axial free vibration. In this work a theoretical study that concerns the free lateral vibrations will be applied to the sewing needle by the use of Gorman’s Eigen values (Daniel, 1975) technique. The study will be divided into the following: needles with constant cross-section (with classical and non classical boundary conditions) and needles with variable cross-section (conical and stepped). For all the different shapes of needles (Gorman’s classifications) the linear natural frequency in stitches per min (SPM) will be calculated by the use of Gorman’s Eigen values via special tables and graphs. It was found that the linear fundamental natural frequencies of the following: clamped free sewing needle (CF) is 21,548SMP, clamped simple sewing needle (CS) is 94,522SMP while for free–free needle (FF) for n=2 is 137,130SMP. For each type the Eigen value β was selected due to the sewing needle boundary conditions. The ratio between the lowest (CF) linear natural frequency and the highest (FF) one is 16%. In this work the selected sewing needle material was steel with E=206GPa and specific weight 785,000N/m3.