Tube Implantation Research Articles

A Meta-Analysis of the Effect of Modified Gastric Tube Length on Enteral Nutrition in Stroke Patients

Objective: To systematically evaluate the effect of modified length of gastric tube implantation in stroke patients. Methods: Randomized controlled studies on the effect of narrative therapy on negative emotions of malignant tumor patients were published in PubMed, EMbase, Web of Science, Cochrane Library, CNKY. Wanfang Data, VIP Database and CBM disc from database establishment to May 2021. RewMan 5.2 software was used for the meta-analysis. Results: Ten articles were included, involving 1140 patients in total. Results of meta-analysis showed that improved length of gastric tube implantation could reduce the incidence of aspiration pneumonia in stroke patients with enteral nutrition [OR = 0.18, 95% CI (0.10, 0.31), P < 0.00001], reduce gastroesophageal reflux rate (OR = 0.13, 95% CI (0.04, 0.38), P < 0.0002], the incidence of aspiration (OR = 0.23, 95% CI (0.11, 0.38), P < 0.00001], the incidence of abdominal distension and diarrhea (OR = 0.13, 95% CI (0.06, 0.28), P < 0.00001], the incidence of choking cough (OR = 0.20, 95% CI (0.07, 0.61), P < 0.005], but no difference between the two groups in terms of reducing gastric residual (OR = 0.10, 95% CI (2.40, 2.60), P = 0.94]. Conclusions: The modified length of the gastric tube can replace the traditional length of the gastric tube in the application of stroke patients, can reduce the complications of enteral nutrition, is safe and feasible. However, due to the limitation of the quality and quantity of the included studies, we should be cautious about the results of this meta-analysis and expect to carry out more large-sample and high-quality randomized controlled trials for demonstration.

Surgical Implantation of Single-Staged Tissue-Engineered Urothelial Tubes in a Minipig Model.

Reconstructive surgeries are often challenged by a lack of grafting tissue. In the treatment of urogenital malformations, the conventional solution has been harvesting gastrointestinal tissue for non-orthotopic reconstruction due to its abundance to reestablish normal function in the patient. The clinical outcomes after rearranging native tissues within the body are often associated with significant morbidity; thus, tissue engineering holds specific potential within this field of surgery. Despite substantial advances, tissue-engineered scaffolds have not yet been established as a valid surgical treatment alternative, mainly due to the costly and complex requirements of materials, production, and implantation. In this protocol, we present a simple and accessible collagen-based tubular scaffold embedded with autologous organ-specific tissue particles, designed as a conduit for urinary diversion. The scaffold is constructed during the primary surgical procedure, comprises commonly available surgical materials, and requires conventional surgical skills. Secondly, the protocol describes an animal model designed to evaluate the short-term in vivo outcomes post-implantation, with the possibility of additional variations to the procedure. This publication aims to demonstrate the procedure step-by-step, with special attention to the use of autologous tissue and a tubular form.

Role of nutrition in cerebral palsy treatment – comprehensive literature review

Introduction and purpose: A collection of symptoms known as cerebral palsy first manifest in early childhood and result in profound physical impairment. Cerebral palsy is thought to affect 1 in 500 live births, or roughly 17 million people worldwide. The type of cerebral palsy determines the clinical symptoms. Movement coordination disorders, epilepsy, muscle weakness, and feeding difficulties are the most common symptoms. The purpose of this article is to familiarize readers with the options for nutritional therapy for cerebral palsy patients. Material and methods The following review was based on articles from the PubMed and Google Scholar databases. Key search terms included cerebral palsy; nutrition; treatment; gut microbiota.. State of knowledge Early identification of malnutrition symptoms and appropriate interventions, such as the implantation of a percutaneous endoscopic gastrostomy tube in patients who are unable to swallow food, are the cornerstones of nutritional therapy for cerebral palsy patients. Dysphagia is a major problem in the population of patients with cerebral palsy, and multidisciplinary therapy is necessary for them. Patients' serum vitamin D levels are also influenced by their diet; 50% of those with cerebral palsy have a deficiency in this nutrient. Conclusions For people with cerebral palsy, nutrition is very important. Premature death may arise from malnutrition brought on by the disease's advancement. As a result, individuals with cerebral palsy need to receive specialized care

Psychological experiences and needs of tumor patients with implanted intravenous infusion ports: a qualitative study.

There are many problems of psychological burden in patients with tumor implanted in port of intravenous infusion. However, more attention is paid to its complications in the literature, and psychological problems are seldom concerned. The purpose of this study was to explore the psychological state and needs of tumor patients after implantation of an intravenous infusion port and provide valuable references for psychological interventions. A semi-structured interview was conducted with 11 patients with intravenous infusion ports. Colaizzi's 7-step analysis was used to analyze the interview data. According to the primary information, four themes and nine sub-themes were extracted: (1) lack of self-worth, (2) multiple emotional experiences (guilt, doubt, worry, and gain). (3) Poor self-management and self-maintenance awareness (over-reliance on medical staff, unchanged family roles, lack of related knowledge). (4) Expectations and suggestions for the future (inner expectations, suggestions for infusion ports). The patient's psychological state should be carefully monitored during tube implantation, to relieve the patient's tension and anxiety and improve nursing satisfaction and patient outcomes.

Inferior long-term Results of a Prospective Randomized Controlled Trial initially demonstrating enhanced Sensory Nerve Recovery using a Chitosan Nerve Tube.

Traumatic peripheral nerve injuries can result in significant functional impairments and long-term sequelae. This study evaluated the long-term outcomes of a chitosan tube implantation protecting the epineural coaptation after peripheral nerve injuries using two different tube versions (V 1.0 and V 2.0 with different wall thickness and resorption characteristics) compared to a control group. The study focused on pain levels, sensory function, and overall functional outcomes. Patients who received tube implantation around direct coaptation sites of digital nerves were prospectively randomized and compared to control patients without additional tube protection. Pain levels, sensory function, grip force, and functional scores were assessed at different time points, ranging from three months to five years after the procedure. Furthermore, biodegradation of the tubes was measured via high-resolution MR-neurography (MRN) and categorized. Long-term evaluation revealed that patients with V 1.0 had higher pain levels compared to the control group after five years. They also reported more symptoms of numbness and hypersensitivity. V 2.0 patients exhibited higher pain levels at three months, which did not persist at six months. However, they showed compromised sensory function, with higher values of two-point discrimination compared to V 1.0 and the control group. No differences were found in grip force or functional scores between the groups. MRI displayed remnants of implants even in long-term follow-up. The findings suggest potential limitations due to pain increase and impaired sensory function associated with tube implantation in the long term. However, in the short term, the material seemed to have a protective effect (as published previously). The resorption process was not completed at the end of the observation period of five years. This might explain the prolonged scarring and inferior long-term results. Future research should focus on improving tube materials and design to minimize adverse effects and enhance functional outcomes in patients with peripheral nerve injuries.

Case Report: Temporary management of delayed postoperative hypotony with Baerveldt tube: Ab Interno stenting using 3-0 nylon suture

Background To describe the management of delayed postoperative hypotony and choroidal detachment in a 79-year-old female patient with advanced pseudoexfoliative open-angle glaucoma. Case The patient, refractory to maximal medical therapy, underwent Baerveldt tube implantation with a ripcord using a 4-0 nylon suture. Ripcord removal and the reintroduction of antiglaucoma medication were initiated in response to a hypertensive phase. Delayed postoperative hypotony and choroidal effusions were managed through ab interno stenting of the tube, employing a 3-0 nylon suture. Ab interno stenting of the tube, employing a short segment of 3-0 nylon suture, initially addressed delayed postoperative hypotony and choroidal effusions. However, recurrence of hypotony and choroidal detachment occurred as the short stent descended into the anterior chamber. To manage the recurrent hypotony, Baerveldt tube truncation was performed, along with re-stenting of the tube using a longer 3-0 Nylon ripcord. Conclusions While ab interno occlusion with a short segment of 3-0 nylon suture may offer temporary hypotony control, the risk of segment descent warranted the use of a longer ripcord to enhance efficacy and stability.

Three-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma.

In our case series, the 3-year failure for Paul Glaucoma Implant (PGI) implantation was 14.6%. At 3 years postoperatively, there was a significant reduction in mean intraocular pressure (IOP) and the number of glaucoma medications used. To determine the 3-year efficacy and safety of the PGI, a novel glaucoma tube shunt in patients with glaucoma. Retrospective review of all patients who had undergone PGI implantation in a single tertiary institution in Singapore between May 1, 2017 and January 1, 2022. Data were extracted from electronic health records (Computerized Patient Support System 2 and Epic). The primary outcome measure was failure, defined as IOP >18 mm Hg or <6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant, or loss of light perception vision. Complete success was defined as the absence of failure without medications at 36 months, and qualified success similarly, but with medications. Postoperative mean IOP, mean number of IOP-lowering medications used, and visual acuity were also assessed. Forty-eight eyes in 48 patients were identified. Thirty-one patients (64.6%) had primary open angle and angle closure glaucoma, and 18 (37.5%) had previous existing tube implants or trabeculectomy. At 3 years postoperatively, 7 cases (14.6%) fulfilled the criteria for failure and 36 (75%) met the criteria for complete success. The mean IOP at 36 months was 14.9 ± 4.11 mm Hg, from the mean preoperative IOP of 20.6 ± 6.13 mm Hg ( P < 0.001). The mean number of IOP-lowering medications used was reduced from 3.13 ± 0.959 preoperatively to 0.167 ± 0.476 at 36 months ( P < 0.001). The most common postoperative complication was hypotony (n = 17, 35.4%), of which the majority were self-limiting, followed by hyphema (n = 5, 10.4%) and tube exposure (n = 4, 8.3%). The PGI demonstrated sustained IOP reduction and a reduction of medication burden at 3 years postoperatively.

Surgical plan selection and efficacy analysis in 32 cases of laryngotracheal stenosis

Objective: To explore the optimization of surgical procedures for laryngotracheal stenosis and its effect analysis. Methods: The data of 32 patients with acquired laryngotracheal stenosis who received surgical treatment from October 2015 to December 2021 were analyzed retrospectively. The age ranged from 19 to 72 years, with an average of (34.0±9.0) years. The medical history ranged from 1 to 32 months (median 3 months). As for etiology, there were 30 cases of iatrogenic laryngotracheal stenosis, including 20 cases of tracheal intubation and 10 cases of tracheotomy (7 cases of percutaneous tracheotomy and 3 cases of traditional tracheotomy). There were 1 case of laryngotracheal trauma and 1 case of airway Penicillium marneffei infection. According to Myer-Cotton grading system, grade Ⅳ stenosis was found in 14 cases, including 12 cases involving trachea and 2 cases involving trachea and subglottic area.There were 18 cases of grade Ⅲ, all of which involved the cervical trachea 5 cases failed in operation in other hospitals. According to stenosis grading, course of disease, primary disease control and the patient's general condition, the surgical plan was determined individually. The operations of end-to-end anastomosis, circumferential tracheal partial resection, T-tube placement and CO2 laser tracheal scar resection were performed respectively. The recovery of airway function and perioperative complications were observed one year after operation. Results: End-to-end anastomosis was performed in 16 cases, and partial circumferential tracheal resection in 2 cases, and tracheal granulation (scar) resection by CO2 laser in 2 cases and T-tube insertion in 12 cases. Eighteen cases which performed end-to-end anastomosis, partial resection of circumferential trachea in and 2 cases which performed laser tracheal scar resection were all recovered airway function at one stage. After 1 year, 19 cases were cured and 1 case was effective. Of 12 patients with T tube implantation, 11 cases were successfully extubated after 6-12 months, 7 cases were cured after 1 year, 2 cases were effective and 3 cases were ineffective. Among the 3 cases of failure, 2 cases were successfully extubated by sleeve resection and end-to-end anastomosis in the second stage, and the other case refused to accept other treatment methods and the T-tube was placed again, and the tube was blocked and the patient survived. During the follow-up period, the total cure rate was 87.5%, the effective rate was 9.4%, and the total extubation rate was 96.9%.The most common complication was subcutaneous emphysema, accounting for 78% (25/32), but no serious mediastinal emphysema or pneumothorax occurred. In the T-tube implantation group, granulation tissue grew in different degrees around the neck wound after operation, and improved or disappeared after 6-9 months. Anterior cervical tracheal fistula occurred in 4 cases of T-tube implantation group after extubation, which were cured by sealing the stoma. There were no complications such as severe bleeding or perioperative death. Conclusion: When there were various factors, the optimization of the surgical plan according to the degree of stenosis, the course of disease, the control of primary disease and the general condition was an important guarantee to improve the curative effect of laryngotracheal stenosis.

Glaucoma surgical procedure choice in vulnerable corneal endothelium

This talk will focus on the decision making in patients with vulnerable corneal endothelium requiring glaucoma surgical intervention. The effect of glaucoma surgical procedures on corneal endothelium will be briefly analysed and conditions with vulnerable corneal endothelium and co‐existent intraocular pressure (IOP) elevation, such as Fuchs corneal endothelial dystrophy with primary open angle glaucoma or post‐keratoplasty steroid response, will be adequately described. The aim of the talk is to indicate the most appropriate glaucoma surgical interventions depending on the status of corneal endothelium and the desired IOP lowering effect, covering a wide spectrum of surgical procedures including minimally invasive interventions, such as Preserflow implantation, as well as ab interno/ab externo viscocanaloplasty or conventional procedures such as trabeculectomy or big tube implantation. Finally, the talk will highlight useful surgical tips for the abovementioned surgical procedures, and it will provide suggestions for patient selection in order to optimize clinical outcomes.

Management of refractory glaucoma in Cogan–Reese variant of ICE syndrome with secondary tube implantation

Glaucoma secondary to iridocorneal endothelial syndrome is refractory to medical treatment, and its management is always challenging. We report the clinical course and management of refractory glaucoma in a 47-year-old male diagnosed with Cogan–Reese syndrome with an 11-year follow-up result. He initially underwent trabeculectomy, which eventually failed after 7 years; hence, an Aurolab aqueous drainage implant (AADI) was placed superotemporally. On subsequent follow-up, as the AADI tube got retracted, secondary AADI implantation was placed in the superonasal quadrant. Later, his vision dropped due to cataract and underwent phacoemulsification with intraocular lens implantation along with tube trimming.

Application of B-ultrasound for localization and its impact on first-attempt success rates of nasogastric tube insertion in critically ill patients.

The objective of this study is to explore the application effect of B-ultrasound positioning in assisting nasointestinal tube implantation in critically ill patients. This study is a retrospective study. In this study, 90 cases of severe patients with nasointestinal tube implantation were included. According to the different ways of nasointestinal tube insertion received by patients, 61 patients with conventional blind insertion methods were included in the blind insertion group, and 29 patients with conventional methods and B-ultrasound assisted positioning were included in the B-ultrasound positioning group. The general clinical data, success rate of catheterization, catheterization time, pyloric passage rate, and target nutritional value time of the 2 groups were compared. The changes of the 2 groups after catheterization were compared by SOFA and APACHE II. The contents of albumin and lymphocyte count were compared between the 2 groups before and after catheterization. The time of target nutritional value of the patients of the B-ultrasound positioning group was markedly decreased comparing with the patients of the blind insertion group. The index of catheterization time of the patients between the blind insertion group and B-ultrasound positioning group had no obvious contrast. The APACHE II score and SOFA score of the patients of the B-ultrasound positioning group were obviously lower than the blind insertion group. The contents of lymphocyte count of the patients of the B-ultrasound positioning group were markedly increased comparing with the patients of the blind insertion group after catheterization, but the contents of albumin content had no obvious change. The scores of respiratory system, circulatory system, nervous system, and urinary system in the B-ultrasound positioning group were significantly higher than those in the blind insertion group, while the COPT scores were significantly lower than those in the blind insertion group. B-ultrasound assisted nasointestinal tube implantation is well tolerated in critically ill patients, and can effectively ameliorate the nutritional status and of the ill patients.

Minimally invasive enucleation of pancreatic tumors: The main pancreatic duct is no longer a restricted area

BackgroundTumors involving the main pancreatic duct (MPD) used to be a contraindication for enucleation. MethodsClinical data of consecutive patients with pancreatic tumors who received laparoscopic or robotic enucleation (LEN or REN) between January 2019 and December 2021 at Fudan University Shanghai Cancer Center were analyzed. ResultsNinety-six patients were included in the analysis, with 55 in the LEN group and 41 in the REN group, and no conversion to laparotomy. Most tumors were located in the head of pancreas (71.9 %). The tumor diameter (3.1 vs. 1.9 cm) was larger, and more cystic tumors (92.7 % vs. 56.4 %) and more tumors involving the MPD (34.1 % vs. 3.6 %) were observed in the REN group. MPD support tube insertion was performed in 15 cases, with 11 in the REN group and 4 in the LEN group. The incidence of biochemical and grade B postoperative pancreatic fistula (POPF) was both 46.9 %, and no grade C POPF occurred. Among the 45 patients with grade B POPF, 28 cases (62.2 %) were due to carrying drainage tube >3 weeks without additional treatment, and only 4 cases required invasive treatment. For patients with MPD support tube implantation (n = 15), support tube fall-offs were observed in 12 cases, 2 patients had MPD dilatation, and no MPD stricture, stone formation or pancreatic atrophy was observed during follow-up. ConclusionsThe incidence of POPF was high but still controllable without serious complications after minimally invasive enucleation. The MPD is no longer a restricted area, and the robotic system has advantages in handling complex enucleations.

Building-Block Size Mediates Microporous Annealed Particle Hydrogel Tube Microenvironment Following Spinal Cord Injury.

Spinal cord injury (SCI) is a life-altering event, which often results in loss of sensory and motor function below the level of trauma. Biomaterial therapies have been widely investigated in SCI to promote directional regeneration but are often limited by their pre-constructed size and shape. Herein, the design parameters of microporous annealed particles (MAPs) are investigated with tubular geometries that conform to the injury and direct axons across the defect to support functional recovery. MAP tubes prepared from 20-, 40-, and 60-micron polyethylene glycol (PEG) beads are generated and implanted in a T9-10 murine hemisection model of SCI. Tubes attenuate glial and fibrotic scarring, increase innate immune cell density, and reduce inflammatory phenotypes in a bead size-dependent manner. Tubes composed of 60-micron beads increase the cell density of the chronic macrophage response, while neutrophil infiltration and phenotypes do not deviate from those seen in controls. At 8 weeks postinjury, implantation of tubes composed of 60-micron beads results in enhanced locomotor function, robust axonal ingrowth, and remyelination through both lumens and the inter-tube space. Collectively, these studies demonstrate the importance of bead size in MAP construction and highlight PEG tubes as a biomaterial therapy to promote regeneration and functional recovery in SCI.

Biocompatibility of three different root canal sealers, experimental study

ObjectivesThis study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis.MethodsFour groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA).ResultsHistopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage.ConclusionAll observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.

Endoscopic dacryocystorhinostomy with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent incarceration.

To investigate the feasibility of endoscopic dacryocystorhinostomy (En-DCR) with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent (NDS) incarceration. En-DCRs were performed on 44 chronic dacryocystitis patients (46 eyes) secondary to NDS incarceration from April 2016 to October 2022. The granuloma and scar tissues were separated, and the removal of NDS incarceration was achieved during the surgery; the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal, a bicanalicular silicone tube was implanted, and lacrimal size and condition were assessed. The tube was removed 3mo after surgery. During the final follow-up of 12mo when the surgery was completed, the complications and the rates of surgical success were assessed. This study covered 40 patients (42 eyes). Intraoperatively, it was found that the lacrimal sac became small, and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes. At 12mo after surgery completed, the rates of the functional and anatomical success reached 80.95% (34/42) and 83.33% (35/42), respectively. Under the effect of intranasal ostial closure, seven eyes failed to achieve anatomical success. No serious complications (e.g., visual impairment, sinusitis, and orbital fat prolapse) was observed. With the success rate over 80% and no serious complications, En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.

Host-Reaction Following Silicone Tube Implantation For Lower Limb Lymphoedema Mimicking Implant Infection.

Silicone tube implantation in lymphoedema reduces symptoms by improving fluid drainage. Although there are descriptions of implant host reaction that can be misdiagnosed as graft infections these are scarce. A 34 year old female with lymphoedema of the lower limb, underwent silicone tube implantation. Ten months after surgery, the patient presented with fever and dermatolymphangioadenitis of the limb. Ultrasound suggested an abscess surrounding the tubes. Clinical improvement was achieved after a 6-day cycle of meropenem. She was discharged under oral cefuroxime and clindamycin for one week. After 1 month, CT-angiography was performed showing only residual inflammation surrounding the tubes, the patient was asymptomatic and limb diameter was normal. Sudden onset and improvement of the patient's condition after a short cycle of antibiotics without the need of tube removal supports a host-like reaction rather than an actual infection. Doctors should be aware of such complications avoiding unnecessary procedures.

Factors affecting the need for silicon tube implantation in cases of congenital dacriostenosis: time of delivery, type of delivery and age of operation.

To evaluate the delivery time, type of delivery, age at the time of operation, and surgical methods applied in cases of congenital nasolacrimal duct obstruction (CNLDO). This study retrospectively included a total of 207 eyes of 160 cases who underwent surgery for CNLDO between February 2012 and April 2021. According to their age at the time of operation, the cases were divided into 0-12, 12-24, 24-36, 36-48 and > 48months groups. The cases were evaluated as term/preterm according to the delivery time and cesarean section/vaginal delivery according to the type of delivery. The surgical methods applied were examined as probing alone and probing plus silicone tube implantation. Of the cases, 146 (91.2%) were born at term and 14 (8.7%) were born preterm, and there was no statistically significant difference in the silicone tube implantation rates according to the time of delivery. The rate of silicone tube implantation was statistically significantly higher in the vaginal delivery group than in the cesarean section group (p = 0.001; p < 0.01). The rate of silicone tube implantation was higher in those who were older than the age of the operation. Although the rate of those who were born by cesarean section was higher in probing cases, those who required silicone intubation were more common in those who were born vaginally. This suggests that dacryostenosis in the vaginally born cases resulted from a persistent structural and anatomical obstruction despite the presence of a high intrauterine pressure increase and enzymatic lysis.

Five-Year Outcomes of Graft-Free Tube Shunts and Risk Factors for Tube Exposures in Glaucoma.

Use of a scleral tunnel technique instead of a patch graft can be considered in most cases of tube shunt implantation. Grafts may still be considered in younger (<65y old) East Asians. (1) To assess the risk factors for tube exposure with a graft-free implantation technique and (2) to examine 5-year outcomes of graft-free tube shunt insertion. This was a retrospective case series of 204 consecutive eyes undergoing a glaucoma tube shunt implantation with a scleral tunnel technique in lieu of a graft. Preoperative and postoperative best-corrected visual acuity, intraocular pressure, and number of glaucoma medications were compared. Failure was defined as the following: (1) intraocular pressure >21mmHg or ≤5mmHg on 2 consecutive visits after 3mo; (2) required additional glaucoma surgery; (3) loss of light perception. Univariable and multivariable regression analyses were conducted to identify risk factors of tube exposures. Intraocular pressure and the number of glaucoma medications were significantly decreased at all postoperative time points ( P <0.001). Success rates were 91% at year 1, 75% at year 3, and 67% at year 5. The most common early (<3mo) complication was tube malpositioning. The most common late (>3mo to 5y) complications were corneal complications and uncontrolled intraocular pressure. By year 5, 6.9% of tubes were exposed. Multivariable regression showed that age less than 65 years old (odds ratio: 3.66, P =0.04) and East Asian ethnicity (odds ratio: 3.36, P =0.04) were associated with significantly increased risk of tube exposure. Graft-free glaucoma tube implantation has comparable long-term outcomes and complication rates to shunts with a graft. Younger (<65y old) East Asians are at greater risk of tube exposure without a graft.

Iodine-125 Seed Strand Implantation Combined with Biliary Stent for the Treatment of Malignant Obstructive Jaundice

Extrahepatic or intrahepatic bile duct stenosis and obstruction can lead to malignant obstructive jaundice (MOJ). Surgical treatment is an effective method, but for patients who cannot undergo surgery or miss the opportunity for surgery, biliary stent combined with 125I implantation can improve obstruction symptoms, relieve biliary obstruction, and improve liver function. This study was to investigate the efficacy of 125I implantation, single biliary stent and percutaneous transhepatic drainage (PTCD) in the treatment of MOJ. 107 patients with MOJ were included. Thirty-seven patients (study group) received biliary stent implantation of 125I particle radiotherapy drainage tube, and 35 patients (sem group) received biliary stent implantation of ordinary drainage tube. 35 patients (PTCD group) underwent PTCD interventional surgery. Biliary stenosis site, Child-Pugh grade and malignant tumor were recorded in the three groups. The changes of liver function before and after treatment were detected, and the survival time, stent patency time, and the occurrence of complications were recorded. All three groups achieved technical success. Liver function was improved in all patients (TBIL, DBIL and ALT were significantly decreased, and P values were all less than 0.05). This study demonstrates that 125I seed beam implantation combined with biliary stent implantation can be considered a safe treatment option for patients with MOJ. This treatment can improve median overall survival, improve liver function, prolong stent patency time.

Development and Validation of a Novel "Luminescent Guidewire“ for more Efficient and Safer Guidance During Endovascular Rescue Procedures

Introduction:Endovascular procedures in emergencies like the implantation of tubes for a life support system are increasing. Guidewires are the essential basis for the regularly used Seldinger Technique. We present a novel concept that may further optimize the safety and efficacy of guidewire handling and navigation during endovascular procedures.Method:Using specifically designed luminescent particles, a novel, clinical-grade coating protocol was created to develop a new luminescent guidewire. Different prototypes were designed and tested for their luminescent capacity following a short exposure to any light-source. Chemical-analysis, hemocompatibility, hemolysis and cytotoxicity testing of the new guidewire was performed. The usability of the new prototype was compared to regular guidewires by application into needles, catheters and tubes which are used during percutaneous procedures.Results:The engineered guidewires demonstrated a luminescent capacity of at least 20 minutes after less than ten seconds of exposure to a light source. Chemical analysis, cytotoxicity, hemolysis, and hemocompatibility indicated a biocompatibility profile of the guidewire. Good usability, safe and rapid handling was demonstrated when simulating endovascular procedures. Under dimmed-light conditions, the luminescent guidewire demonstrated substantially enhanced visibility when compared to the standard-of-care.Conclusion:We present a new, luminescent guidewire that may enhance the safety and efficacy of endovascular procedures, especially where light conditions are suboptimal or for emergency situations when procedures have to be as fast and efficient as possible.