Insertion Technique Research Articles

Are tinnitus burden and tinnitus exacerbation after cochlear implantation influenced by insertion technique, array dislocation, and intracochlear trauma?

IntroductionAlthough numerous studies suggest that cochlear implantation (CI) generally alleviates the overall burden of tinnitus, certain patients experience tinnitus exacerbation following CI. The exact cause of this exacerbation is still uncertain. This prospective study aimed to investigate whether cochlear trauma, resulting from scalar dislocation of the electrode array, affected postoperative tinnitus intensity, tinnitus burden, and speech perception. Additionally, the influence of CI insertion technique, insertion depth, insertion angle, and cochlear morphology on postoperative tinnitus was assessed.MethodsWe evaluated 66 CI recipients preoperatively at 2 days, 4 weeks, and 12- and 24-months following surgery. Digital volume tomography was employed to document scalar position, insertion depth, and cochlear morphology postoperatively. Speech perception was analyzed using Freiburg monosyllables. The tinnitus burden was evaluated using the tinnitus questionnaire, while the tinnitus intensity was quantified using a visual analog scale.ResultsStudy results pertaining to tinnitus intensity and burden did not reveal a significant difference in elevation regarding scalar position and dislocation after CI surgery compared to preoperative tinnitus levels. However, dislocation was only identified in four patients, and scala vestibuli insertions were observed in two patients. Comparing preoperative and 1-year postoperative outcomes, CI was noted to substantially reduce the tinnitus burden. When the speech processor was worn, the tinnitus intensity was significantly diminished. In comparison to round window (RW) insertion, the insertion technique cochleostomy (CS) did not exhibit a significant difference or a trend toward increased tinnitus intensity.ConclusionThis study demonstrates that CI significantly decreases the tinnitus burden. The observation implies that the electrical stimulation of the auditory pathway, facilitated by wearing the speech processor, significantly reduced the tinnitus intensity. The incidence of dislocations and scala vestibuli insertions has declined to the extent that it is no longer feasible to formulate statistically significant conclusions.

Comparing Right-sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial

INTRODUCTION: Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy. METHODS: We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR. RESULTS: WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94). CONCLUSIONS: The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393).

Safety in Perioperative Period in Laparoscopic Surgery

Laparoscopic surgery has revolutionized the field of surgery, offering significant improvements in patient outcomes such as reduced recovery times, pain, and hospital stays compared to traditional open surgery. However, safety concerns arose with its introduction, prompting the need for advancements in technique and equipment. This article explores critical safety improvements in laparoscopic surgery, simulating a patient’s perioperative journey. Key topics include the importance of team briefings, proper patient positioning, ergonomics, optimal laparoscopic setup, safe port insertion techniques, pneumoperitoneum management, instrument handling, and hemostasis. The review highlights the ongoing need for research and consensus in patient safety practices within laparoscopic surgery.

Outcomes in eyes with retained lens fragments undergoing pars plana lensectomy and scleral-fixated intraocular lens insertion.

To report the visual outcomes and complications in eyes with retained lens fragments (RLF) following cataract surgery undergoing pars plana lensectomy (PPL) and scleral-fixated intraocular lens insertion (SFIOL). Patients with RLF who underwent pars plana vitrectomy (PPV), PPL, and SFIOL insertion from January 2015 to December 2022 were included. The visual acuity (VA) outcomes and complication rates were compared between those receiving sutured versus sutureless SFIOL insertion as well as those undergoing SFIOL insertion at the time of PPV and PPL versus those undergoing SFIOL insertion during a subsequent surgery. 65 eyes of 65 patients were included. Median (interquartile range) pre-operative logarithm of the minimum angle of resolution (logMAR) VA was 2.3 (2-2.3; Snellen: HM). The median logMAR VA improved to 0.14 (Snellen: 20/100), at the most-recent follow-up (p<0.001, Hodges-Lehmann estimator:1.56, 95% confidence interval -1.30 to -1.71). There was no statistically significant difference in VA outcomes and the complication rates, including cystoid macular edema, corneal edema, and retinal detachment, regardless of technique or timing of SFIOL insertion. In this retrospective study with small sample size, similar visual acuity outcomes and complication rates were observed regardless of the timing or technique of SFIOL insertion.

Wire-in-needle versus conventional syringe-on-needle technique for ultrasound-guided central venous catheter insertion in the internal jugular vein: the WIN randomized trial.

There are different techniques for ultrasound-guided central venous catheter (CVC) insertion. When using the conventional syringe-on-needle technique, the syringe needs to be removed from the needle after venous puncture to pass the guidewire through the needle into the vein. When, alternatively, using the wire-in-needle technique, the needle is preloaded with the guidewire, and the guidewire-after venous puncture-is advanced into the vein under real-time ultrasound guidance. We tested the hypothesis that the wire-in-needle technique reduces the time to successful guidewire insertion in the internal jugular vein compared with the syringe-on-needle technique in adults. We randomized 250 patients to the wire-in-needle or syringe-on-needle technique. Our primary endpoint was the time to successful guidewire insertion in the internal jugular vein. Two hundred and thirty eight patients were analyzed. The median (25th percentile, 75th percentile) time to successful guidewire insertion was 22 (16, 38) s in patients assigned to the wire-in-needle technique and 25 (19, 34) s in patients assigned to the syringe-on-needle technique (estimated location shift: 2s; 95%-confidence-interval: - 1 to 5s, p = 0.165). CVC insertion was successful on the first attempt in 103/116 patients (89%) assigned to the wire-in-needle technique and in 113/122 patients (93%) assigned to the syringe-on-needle technique. CVC insertion-related complications occurred in 8/116 patients (7%) assigned to the wire-in-needle technique and 19/122 patients (16%) assigned to the syringe-on-needle technique. The wire-in-needle technique-compared with the syringe-on-needle technique-did not reduce the time to successful guidewire insertion in the internal jugular vein. Clinicians can consider either technique for ultrasound-guided CVC insertion in adults.

Percutaneous Insertion of Peritoneal Dialysis Catheters.

Patients with end-stage renal disease undergoing hemodialysis encounter significant challenges in care coordination and experience higher complication rates. Peritoneal dialysis (PD) is an evidence-based alternative that significantly improves patients' quality of life.Peritoneal dialysis catheter insertion methods include open surgical, laparoscopic, peritoneoscopic, and percutaneous image-guided approaches. Despite comparable success rates and cost-effectiveness, the US healthcare system underutilizes the percutaneous method.This article aims to provide an overview of the essential components of the technique of percutaneous peritoneal dialysis catheter insertion, as well as address patient selection nuances and considerations for urgent-start dialysis. Additionally, it reviews the outcomes and complications associated with image-guided percutaneous PD catheter placement, advocating for its wider adoption.

Comparative study between the halfway technique and the standard technique for exchange of tunneled hemodialysis catheter.

When indicated, tunneled hemodialysis catheters are usually inserted using the standard technique but, this technique has its complications. The halfway method is performed by exchange of an already-inserted dialysis catheter (tunneled or non-tunneled) to a tunneled one over a guidewire mounted via the old catheter. In this study, we aimed at evaluating the feasibility, safety, and durability of halfway method in comparison to the standard technique (de novo puncture). This prospective study was conducted during the period from May 2020 till May 2022 and included 87 patients with end-stage renal disease (ESRD) on regular hemodialysis (HD) in need for insertion new tunneled dialysis catheters instead of temporary or malfunctioning tunneled ones. According to the technique of catheter insertion, these patients were divided into two groups: group A (the halfway technique: catheters were exchanged over guidewires under fluoroscopic control; 48 patients) and group B (the standard technique: via de novo ultrasound-guided vein puncture; 39 patients). Instant, delayed complications and 12-months patency rates were reported and analyzed. The frequency of peri-operative bleeding complications was better in the halfway group with comparable infection rate and late catheter dysfunction results between the two groups. One year patency rates were 87.5% in halfway technique group compared to 79.5% in standard technique group, yet without statistical significance. However, there was a statistically significant shorter operative time in halfway group (15.54 ± 2.6 min vs 26.97 ± 5.6 min, p < 0.001). The halfway technique may be recommended over the standard technique of tunneled catheter insertion due to shorter operative time, lower rate of hematoma formation, with non-inferior 1-year patency rates and comparable technical success and infection rates. The advantage of access sites preservation for future demand makes this technique of great value to this group of ESRD patients.

Efficient random walks for generating random fuzzy measures in Möbius representation in large universe

Random generation of fuzzy measures plays a pivotal role in large-scale decision-making and optimization. Random walks ensure uniform generation and adequate coverage. The Möbius representation of set functions is a valuable tool for establishing the sparse structure of fuzzy measures, with its non-negativity closely linked to monotonicity and convexity/supermodularity checking. We propose three efficient methods for monotonicity verification and convexity/supermodularity verification applicable to random walks in Möbius representations, specifically tailored for universal sets larger than ten inputs and k-order fuzzy measures. We first present the baseline methods by directly inspecting monotonicity and convexity constraints. Building on the observation that the majority of initially generated values exhibit non-negativity, we intentionally track negative Möbius values to enhance the computational performance of these baseline approaches. Further, we introduce the more agile methods that employ insertion and merge sorting techniques for both monotonicity and convexity checks in random walks that involve small perturbations of fuzzy measures. To address sparsity in large-scale scenarios, we focus on two major types of measures: k-additive and k-interactive measures, demonstrating their effectiveness through theoretical analysis and experimental results.

An open comparative randomized prospective study: Direct trocar insertion vs Veress needle technique in laparoscopic surgeries.

Laparoscopy is a minimally invasive technique utilized for both diagnostic and surgical approaches. Minimally invasive procedures compared to laparotomy offer the advantages of reduced hospital stay, lower morbidity, decreased pain, and faster recovery. Common methods for laparoscopic entry include Veress needle insertion (VNI), direct optical trocar entry, direct trocar insertion (DTI), and the Hasson technique. This study aims to compare the efficacy and safety of VNI and DTI in laparoscopic gynecological surgeries. An open comparative randomized prospective study was conducted involving 200 women aged 18 to 70 years, scheduled for laparoscopic surgery at 2 tertiary centers. Participants were randomized into 2 groups: 1 using VNI and other using DTI. The groups were homogeneous regarding age, parity, and body mass index. The mean age of the VNI group is 45.22 ± 11.65 and the DTI group is 44.89 ± 10.5 (P = .833). There were no statistical significance in terms of the presence of chronic diseases and history of previous abdominal surgery between the groups (P = .802 and P = .510, respectively). Entry time to the abdomen, the decrease in hemoglobin values, and hospitalization length were found to be statistically significant between the entry methods (P < .001, P = .002, and P < .001, respectively). Entry time, the decrease in hemoglobin value, and hospitalization length were higher in the VNI group. In conclusion, although there is no definitive consensus on the optimal laparoscopic entry technique, direct trocar entry is an effective alternative to the Veress needle insertion technique. Direct trocar entry is associated with shorter entry times, fewer perioperative complications, less reduction in hemoglobin levels, and shorter hospitalization duration compared to VNI.

Comparative assessment of the stability of buccal shelf mini-screws with and without pre-drilling- a split-mouth, randomized controlled trial

ObjectivesTo examine and compare the stability of buccal shelf mini-screws using self-drilling and pre-drilling implant placement techniques.MethodologyIt was a split-mouth, randomized controlled trial comprising of 7 patients, each receiving two buccal shelf bone screws. The screws were placed using a self-drilling protocol in one quadrant and a pre-drilling protocol in the opposing quadrant decided via coin toss randomization. Stability was examined at the time of placement and 1,2, 3 and 4 months thereafter, using the Resonance Frequency Analysis method with the Osstell Beacon TM device. The Implant Stability Quotient (ISQ) obtained was then compared and assessed between both quadrants. Friedman’s Two-Way Analysis of Variance and the Wilcoxon signed rank test were utilized for the intergroup comparison. A statistically significant result was defined as one with a p-value of less than 0.05.ResultsA statistically significant difference between the mean ISQ reading in the pre-drilling and self-drilling group was observed, indicating higher stability of bone screws placed with the pre-drilling protocol. The primary stability of the buccal shelf screws decreased after placement, but the secondary stability remained stable.ConclusionBuccal shelf bone screws placed with a pre-drilling protocol depicted greater primary and secondary stability as compared to the self-drilling protocol, as depicted by the ISQ readings obtained. Resonance Frequency Analysis can be used as a valuable tool to assess the stability of buccal shelf bone screws.Clinical relevanceThe use of buccal shelf screws has increased tremendously over the past few years due to their myriad applications and have now become an essential part of an orthodontist’s armamentarium. It is therefore essential for clinicians to be well-informed about all aspects of their use including insertion techniques. The results of this trial indicate that the pre-drilling protocol provides better stability and therefore treatment outcomes.

Comparison between the standard method and the 30° curved tongue depressor-aided technique for insertion of a laryngeal mask airway: a randomized controlled trial

BackgroundLaryngeal mask airway (LMA) has been increasingly used for airway management; however, LMA insertion can be difficult and cause adverse effects. Therefore, the rapid, safe, and effective insertion of LMA is necessary. This study aimed to compare the efficacy of the standard method with that of the 30° curved tongue depressor-aided technique for LMA insertion to determine the superior technique.MethodsThis study included 154 patients aged 18–70 years (American Society of Anesthesiologists class I or II) scheduled for general anesthesia. The patients were randomly assigned to the standard LMA insertion group (Group C, n = 77) or the 30° curved tongue depressor-aided LMA insertion group (Group T, n = 77). The primary outcome evaluated was the first-attempt success rate. The secondary outcomes were the second-attempt success rate, insertion time, fiberoptic position grade, oropharyngeal leak pressure (OPLP), and adverse events.ResultsThe first-attempt success rate was significantly higher in Group T than in Group C (97.40% vs. 88.31%, P = 0.029). The second-attempt success rate (P = 0.209), insertion time (P = 0.340), fiberoptic position grade (P = 0.872), and OPLP (P = 0.203) were slightly improved in Group T; however, there was no statistical significance. Bleeding events were reduced in Group T than in Group C (6.49% vs. 14.29%); however, there was no statistical significance. The incidence of sore throat symptoms was significantly reduced in Group T than in Group C (5.19% vs. 15.58%, P = 0.035).ConclusionsThe curved tongue depressor-aided technique significantly improved the first-attempt success rate of LMA insertion and reduced the incidence of sore throat symptoms.Trial registrationKCT0004964; Registered at https://cris.nih.go.kr on April 27, 2020.

Improving Successful Cannulation of External Ventricular Drain: 3D-Printed Surgical Guide for Inexperienced Neurosurgeons

ObjectiveExternal Ventricular Drain (EVD) is a fundamental neurosurgical procedure that is commonly performed by junior neurosurgeons. Expedient, successful cannulation of the ventricles can be lifesaving. Yet, the free-hand technique of EVD insertion is associated with significant mal-positioning rates. This study aims to improve EVD placement by junior neurosurgeons with the aid of a customized 3D printed surgical guide. MethodsA 3D printed surgical guide was developed and customized to our institution’s EVD insertion procedure. First year neurosurgical residents were taught how to perform pre-operative trajectory planning based on coronal brain images and how to use the surgical guide during standard EVD insertion procedure. Number of passes, accuracy of EVD placement, operative complications, need for revision, and surgeon’s experience with the guide were recorded. Results14 patients underwent guide-assisted EVD insertion by first year neurosurgical residents. Significantly, 6 (43%) patients had ventricular anatomy distorted by midline shift. All surgeons achieved successful ventricular cannulation using the EVD guide on first pass (100%). 13 out of 14 (93%) of the guide-assisted EVDs were optimally placed (Karkarla Grade 1). 1 (7%) guide-assisted EVD was suboptimally placed (Karkarla Grade 2). There was no intra or post-operative complication and there was no EVD revision. ConclusionsFor inexperienced surgeons, the 3D printed EVD guide can improve ventricular cannulation even in cases of altered ventricular anatomy. The benefit of 3D printing would also allow the guide to be widely adopted by other institutions worldwide.

A Novel Technique: Stapler-Assisted Total Laryngectomy with Concurrent Tracheoesophageal Prosthesis Insertion.

Stapling-assisted closure of pharyngeal mucosa during total laryngectomy was described in 1973.Few authors have demonstrated that this technique provides a faster and more reliable pharyngeal closure with ashorter operative period. However, the simultaneous placement of tracheoesophageal prostheses is quitechallenging and affects the patient's speech rehabilitation. We are reporting our novel concurrent tracheoesophageal prosthesis insertion technique in stapler-assistedtotal laryngectomy. A patient with locally advanced laryngeal cancer underwent total laryngectomy with stapler-assistedcloser and concurrent primary tracheoesophageal prosthesis. In a closed stapler-assisted reconstruction of theneopharynx, an inflate folye ballon was utilised to identify the ideal TEP puncture site. The immediate postop course was uneventful, and the patient acquired fluent alaryngeal speech after thespeech rehabilitation. Our novel technique of concurrent tracheoesophageal prosthesis insertion in stapler-assisted totallaryngectomy is practically simple and shortens the operative time.

Comparative analysis of LMA Blockbuster® clinical performance: Blind versus Miller laryngoscope-guided insertion in paediatric general anaesthesia - A double-blinded, randomised controlled trial.

The second-generation supraglottic airway device is conventionally inserted blindly, which might result in suboptimal placement. Limited literature exists on under-vision insertion techniques, particularly in paediatric patients. The primary objective of this study was to compare the oropharyngeal leak pressure (OPLP) between the blind insertion of the LMA Blockbuster® and the Miller laryngoscope-guided insertion in children. Secondary outcomes included the number of insertion attempts, haemodynamic disturbances, insertion time and airway complications. This randomised controlled trial study enroled 100 patients aged 1-4 years undergoing elective surgery. Patients were randomised into blind insertion (Group A) or Miller laryngoscope-guided insertion (Group B) of the LMA Blockbuster®. The primary outcome measure was OPLP. Insertion time, haemodynamic changes and postoperative complications were also assessed. The Chi-square, Fisher's exact and t-test were applied appropriately, with the significance level set at P < 0.05. Significantly higher mean OPLP was observed in Group B compared to Group A - 27.9 [standard deviation (SD): 1.58] cmH2O versus 25.94 (SD: 0.63) cmH2O [mean difference (MD): 1.96 (95% confidence interval {CI}: 1.48, 2.44; P < 0.001)]. Mean insertion time was longer in Group B, that is, 11.9 (SD: 1.91) s versus 8.7 (SD: 0.6) s [MD: 3.2 s; (95% CI: 2.63, 3.76; P < 0.001)]; however, the difference was not clinically relevant. First-attempt insertion, haemodynamic stability and postoperative complications were comparable (P > 0.05). Miller laryngoscope-guided under-vision insertion of LMA Blockbuster® improves alignment with epiglottic structures compared to blind insertion.

Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations

ObjectiveTo address the issue of traumatic foley catheterization we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs. MethodsA retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution. A nursing education program was implemented that included basic urological anatomy, coude urethral catheter insertion techniques, and catheter safety. We conducted our trial over a period of 2-months with all catheterizations tracked. Following the trial, the process and outcomes were reviewed and then implemented for all male patients >18 years old requiring indwelling catheter placement in the operating room. ResultsOn retrospective review there were 18 traumatic foley catheterizations of patients on the three surgical services out of a total 601 catheter placements (3% traumatic placement rate). The total cost of these traumatic catherizations was $27,793 when accounting for additional procedures, supplies, and additional OR time required for each traumatic catheterization. The average cost per patient was $1,544. After full implementation of the process across all operating room services in June 2021 there have been 2038 catheterizations performed using a coude catheter kit with 4 traumatic foley placements through May 2022 (0.2% traumatic catheterization rate). ConclusionImplementation of the nursing education program and utilization of the coude catheter for all male catheterizations reduces costs, decreases iatrogenic urethral injury, and improves patient safety.

Success rate and outcome of labor epidural among variable levels of residents and practicing anesthesiologists in an academic medical center in Saudi Arabia

Background and Aims: This study aimed to highlight differences in success rates and patient outcomes during epidural insertion among anesthesia staff, junior trainees, and staff anesthesiologists. Methods: We included all women who received a labor epidural between January 1, 2020 and April 30, 2022. The cases were divided into three groups: junior residents, senior residents, and staff anesthesiologists. Results: Among 822 cases included in analysis, 92, 240, and 490 catheters were placed by junior residents, senior residents, and staff anesthesiologists, respectively. Although the success rate among junior residents (90.7%) was lower than those of senior residents (97%) and staff anesthesiologists (95.1%), the difference was not significant (P = 0.067). The mean procedural time in minutes was significantly longer in the junior resident’s group (18.1 min) compared to the senior residents (14.18 min) and staff anesthesiologists (14.87 min) (P &lt; 0.001). A significant difference was observed in the number of needle pricks and catheter insertion attempts when comparing the junior residents, senior residents, and staff anesthesiologists’ groups (P &lt; 0.001). In the logistic regression analysis, procedural time remained the only predictor of epidural success. Conclusions: With the success rate above 90%, junior anesthesia trainees require more time and attempts to insert labor epidurals. It is essential that training programs provide opportunities for anesthesia trainees to become proficient in their epidural insertion techniques prior to clinical practice.

Skeletal Editing through Single-Atom Insertion and Transmutation: An Insight into a New Era of Synthetic Organic Chemistry

AbstractConsidering the importance of heterocycles, significantly represented in medicinal chemistry and drug development, the single-atom insertion technique and transmutation strategy provide productive approaches towards complicated molecular structures through heterocycle diversification. It shows a potentially powerful approach for modifying complex substrates concisely and chemospecifically. Although skeletal editing applies to cyclic and acyclic compounds, this review focuses on the diversification of carbo- and heterocyclic compounds for synthesizing various medicinally important molecules via the single-atom insertion technique. The classification system is based on recent and critical historical methods of single-atom insertion as applied to the transmutation of aromatic rings.1 Introduction2 Skeletal Editing through Carbon-Atom Insertion2.1 Skeletal Editing of Indoles and Pyrroles Derivatives: Carbon-Atom Insertion into a C=C Bond2.2 Skeletal Editing of Pyrazole and Indazole Derivatives: Carbon-Atom Insertion into an N–N Bond2.3 Skeletal Editing of Pyrazole and Indazole Derivatives: Insertion of CF3 Group into Heteroarenes2.4 Skeletal Editing of Imidazole Derivatives: Carbon-Atom Insertion into C–N Bond2.5 Skeletal Editing through Atom-to-Atom Transmutation3 Skeletal Editing through N-Atom Insertion3.1 Nitrogen-Atom Insertion into Carbocycles3.2 Nitrogen-Atom Insertion into Heterocycles3.3 Carbon to Nitrogen Transmutation3.3 Molecular Editing through Isotopic Transmutation4 Conclusion

Glaucoma drainage devices in patients following injector-assisted implantation of an artificial iris into the ciliary sulcus : Video article

The aim of this surgical technique is the implantation of aglaucoma drainage device (GDD) in eyes with aphakic glaucoma following injector-assisted implantation of an artificial iris into the ciliary sulcus. This atraumatic tube insertion technique can be performed during GDD implantation after implantation of an artificial iris into the ciliary sulcus. Following injector-assisted implantation of an artificial iris into the ciliary sulcus of eyes, the iris can shift into the chamber angle. The GDD should be positioned in the quadrant in which the iridectomy is located. Otherwise, GDD implantation is not possible due to the resistance of the artificial iris. Alternatively, the artificial iris can be easily and non-traumatically rotated in the ciliary sulcus by flushing the anterior chamber with balanced salt solution (BSS) to move the iridectomy into the desired area and position the GDD tube in the anterior chamber. Asurgical video, which is available online, shows the surgical technique in detail. After GDD, dexamethasone eye drops should be applied 8 times daily for 1 week tapering down by 1 drop per week thereafter. Antibiotic eye drops, e.g., ofloxacin eye drops, are prescribed 4times daily for 1 week and might be discontinued thereafter. To date, this is the first description of arotation of an artificial iris located in the ciliary sulcus by irrigation of the anterior chamber during GDD implantation.

A Robust Newton Iteration Method for Mixed-Cell-Height Circuit Legalization Under Technology and Region Constraints

The evolution of advanced technology nodes has prompted a shift toward mixed-cell-height circuit design, while the introduction of technology and fence region constraints further increases the complexity of placement. In this article, we innovatively transform the mixed-cell-height circuit legalization problem into a generalized absolute value equation (GAVE) and propose a novel and effective robust Newton (RN) iteration method to address the challenge of the legalization problem. 1 First, the window-based cell insertion technique is applied to obtain the initial cell row allocation and cell order, and the cells are allocated to the matching region based on the R-tree structure. Then, the legalization problem of cells within the region is transformed into a GAVE, and an RN iteration method is proposed to solve the GAVE. Finally, the maximum displacement cells and technology violation cells are optimized based on a greedy method. Experimental results confirm the efficiency and robustness of the proposed method compared with the state-of-the-art methods.

Optimizing sacral screw fixation in patients with caudal regression syndrome.

The aim of this study is to evaluate and compare techniques and outcomes associated with two different technique of pelvic screw insertion in patients with caudal spine absence. A cohort of patients with varying degrees of caudal structural regression, serves as the focal point of this investigation. Pelvic configurations were classified based on established criteria to facilitate comparative analysis. Each patient underwent spinal surgical interventions, with a follow-up period extending beyond 2years. The primary surgical interventions predominantly involved spinal stabilization coupled with correction of scoliosis and kyphosis through one or two pairs of pelvic screws. In this study, we investigated a cohort of 22 patients with caudal spine absence, encompassing diverse conditions, such as lumbo-sacral aplasia, hemisacrum, and lumbar absence, with preserved sacrum. Following spinal surgery, notable improvements were observed in scoliosis and pathological lumbar kyphosis, with several patients achieving significant functional milestones such as independent ambulation. There were no significant differences in short-term complications between patients undergoing single versus double pair pelvic screw implantation. Long-term complications, primarily non-fusion, were notably more prevalent in patients undergoing fixation with a single pair of pelvic screws. Surgical intervention, particularly spinopelvic fixation, demonstrated promising outcomes in terms of improving spinal deformities. The implantation of two pairs of pelvic screws demonstrates greater reliability compared to the insertion of a single pair, diminishing the risk of non-fusion.