Minimally Invasive Research Articles

Trends in Sacroiliac Joint Fusion Costs and Utilization in the Privately Insured Population.

Retrospective Cohort Study. Despite innovations in minimally invasive (MI) techniques for sacroiliac joint fusion (SIJF), trends in utilization and associated costs remain unclear. In this study, we assessed these trends and costs in a database of privately insured patients. Records of open and MI SIJFs were queried from the 2007-2021 MarketScan Databases with CPT codes. Net payments made by insurance carriers were identified, as were out-of-pocket payments made by patients for each encounter. Regression was used to model utilization, payments, and costs. 4124 SIJFs were identified, 1626 (39.4%) of which were MI SIJF. SIJF utilization increased by 1176.2% throughout the study period (P < .001). However, open SIJF utilization peaked in 2012. Open SIJF utilization was not significantly associated with time (P = .18). By contrast, the peak utilization for MI procedures occurred in 2021. Spine surgeons' volume of MI SIJF increased by 258% over the study period (P < .001), while nonsurgeon volume of MI SIJF increased by 990.9% (P < .001). Privately insured patients have increasingly utilized SIJF over the past several years. This is predominantly due to the adoption of MI techniques by spine surgeons and nonsurgeons.

Mucosa‐Interfacing Capsule for In Situ Sensing the Elasticity of Biological Tissues

AbstractMonitoring the elasticity of soft biological tissues in the gastrointestinal (GI) tract with minimal invasion holds promise for early diagnosis of intestinal fibrosis, colorectal cancer, and other diseases featuring abnormal elasticity. However, existing methods of sensing tissue elasticity have drawbacks such as insufficient resolution for elastography, and discomfort or the requirement of risky anesthesia for flexible endoscopes or implantable devices. Here a wirelessly actuated palpation mechanism is presented, integrated into a swallowable capsule device, offering in situ tissue elasticity measurement with minimal invasiveness. The approach employs a magnetic soft cantilever beam actuated by external magnetic fields to gently press against soft tissues. Mechanical stress and strain are monitored by an onboard magnetic sensor and a strain gauge, allowing for an accurate assessment of tissue elasticity. Additionally, wireless modules utilizing Bluetooth Low Energy (LE) and powered by a battery facilitate real‐time communication. The device operates under external magnetic field control, which can move freely over soft tissues during examinations and palpate suspicious areas. The elasticity sensing mechanism is validated and assessed on both phantom structures and ex vivo porcine colon tissues. The capsule device holds significant promise for assessing tissue physiological conditions and facilitating early disease diagnosis in hard‐to‐reach areas of the body.

Endoscopic Ultrasonography-Guided Drainage of the Pancreatic Duct (EUS-PD)—Indications and Results with a Literature Review

Background/Objectives: Drawing upon over twenty years of clinical experience in endoscopic and endosonographic procedures, along with comprehensive literature research, we present an overview on EUS-guided pancreatography and pancreatic duct drainage (EUS-PD) as an alternative approach, encompassing indications, procedural methods, and outcomes, including complications and the success rate. Methods: Narrative review. Results: (corner points): EUS-PD is indicated for cases, for which conventional methods are ineffective due to altered abdominal anatomy of the upper gastrointestinal (GI) tract, such as congenital or postoperative conditions that prevent access to the papilla or pancreatoenteric anastomosis. It is also considered if there is symptomatic retention of the pancreatic duct due to pathological changes in the papillary region or stenosis of the pancreatic duct or anastomosis, especially if surgery is not feasible or poses higher risks. EUS-PD has a technical success rate ranging from 25 to 92%, albeit with a complication rate spanning from 14 to 40%, primarily comprising bleeding, perforation, pancreatitis, and pain. Long-term clinical success, measured by pain and symptom relief, falls within a range of 65–85%. Conclusions: The method offers advantages such as minimal invasiveness, enhanced quality of life, the potential for endoscopic revision in the case of complications, and compatibility with most conventional endoscopic instruments requiring extensive expertise in interventional endoscopy and endosonography.

IMPLANTATION OF CHONDROFILLER LIQUID® AS A SCAFFOLD MATERIAL FOR THE TREATMENT OF CHONDRAL LESIONS OF THE KNEE JOINT

Introduction: Trauma, sports, or the normal aging degenerative process may damage the articular cartilage. Surgical methods that are most often used to manage cartilage defects include autologous chondrocyte implantation, mosaicplasty, microfractures, perforations, and joint arthroplasty in cases of severe damage. Another approach is to use collagen gel for cartilage defect reconstruction. Its biocompatibility, high tensile strength, and minimal invasiveness make it an attractive solution. ChondroFiller gel is a two-component collagen implant that could be used in the treatment of traumatic or degenerative chondral lesions. After application, it forms a protective cover for the damaged chondral area and provides structural support for the stem cells that migrate to its collagen matrix. Thus, with ChondroFiller, we aim to restore articular cartilage, prevent further degenerative processes, and return to normal joint function. In this research, we have investigated the application of ChondroFiller during knee arthroscopy to treat knee articular cartilage lesions. Methods: The clinical study was conducted at the University Hospital - Pleven Clinic of Orthopedics and Traumatology between 2012 and 2023. Seventeen patients (ten males and seven females) with a mean age of 31 years underwent knee chondroplasty with ChondroFiller gel, and their data was analyzed. Knee function was assessed using the Lysholm scale and IKDC score. The follow-up period was twelve months. Results: Statistical analysis has shown a significant difference between pre-operative Lysholm and pre-operative IKDC score and 3rd month, 6th and 12 months. Significant difference is detected between the 3rd month and 6th and 12th months Lysholm and IKDC scores (p &lt; 0.05). No statistical difference was found between 6 and 12 month (p &gt; 0.05). Conclusion: Restoring joint congruity is challenging. Overall, we have found encouraging results by employing ChondroFiller to restore articular cartilage. We believe that Chondrofiller provides an excellent surgical solution to younger patients with chondral defects less than 2cm2. In our opinion, further research in the field of collagen implants is needed to discover long-term effect.

Great dangers of “small” anesthesia

Anesthetic management in various diagnostic and treatment procedures, such as gastroscopy, colonoscopy, hysteroscopy, and others, is aimed at protecting the patient from surgical stress, ensuring psychological comfort, and improving the quality of the procedure. Relative surgical safety, minimal invasiveness, short duration, rarity of anesthetic complications formed the perception of such procedures among patients and a large part of medical workers as absolutely safe. However, anesthetic care during short interventions carries all the dangers of general anesthesia, such as the risk of developing a difficult airway situation, aspiration, hypoventilation, and cardiovascular complications. In the article, the authors consider the current state of the problem of “small” anesthesia in Ukraine.

FBG‐driven simulation for virtual augmentation of fluoroscopic images during endovascular interventions

AbstractEndovascular interventions are procedures designed to diagnose and treat vascular diseases, using catheters to navigate inside arteries and veins. Thanks to their minimal invasiveness, they offer many benefits, such as reduced pain and hospital stays, but also present many challenges for clinicians, as they require specialized training and heavy use of X‐rays. This is particularly relevant when accessing (i.e. cannulating) small arteries with steep angles, such as most aortic branches. To address this difficulty, a novel solution that enhances fluoroscopic 2D images in real‐time by displaying virtual configurations of the catheter and guidewire is proposed. In contrast to existing works, proposing either simulators or simple augmented reality frameworks, this approach involves a predictive simulation showing the resulting shape of the catheter after guidewire withdrawal without requiring the clinician to perform this task. This system demonstrated accurate prediction with a mean 3D error of 2.4 1.3 mm and a mean error of 1.1 0.7 mm on the fluoroscopic image plane between the real catheter shape after guidewire withdrawal and the predicted shape. A user study reported an average intervention time reduction of 56 when adopting this system, resulting in a lower X‐ray exposure.

Oblique Lumbar Interbody Fusion Combined With Anterolateral Fixation and Cement Augmentation for the Treatment of Degenerative Lumbar Diseases in the Elderly Population: A Retrospective Study.

Cage subsidence is a common complication of oblique lumbar interbody fusion (OLIF), particularly in elderly patients with osteoporosis or osteopenia. While bilateral pedicle screw fixation (BPS) is effective in reducing subsidence, it is associated with longer operative times, increased blood loss, and greater tissue trauma. In contrast, anterolateral fixation (AF) is less invasive but linked to higher subsidence rates. Ensuring both minimal invasiveness and adequate stability in OLIF-assisted fixation remains a significant challenge. This study aimed to evaluate the efficacy of combining AF with cement augmentation (AF + CA) in reducing cage subsidence and improving clinical outcomes compared with AF and BPS. A retrospective analysis was conducted on 138 elderly patients with degenerative lumbar diseases treated with OLIF. Patients were divided into three groups: AF + CA (32 patients), AF (32 patients), and BPS (74 patients). Clinical and radiographic outcomes were compared among the groups, and logistic regression analyses were performed to identify risk factors for cage subsidence after OLIF. At 1 year postoperatively, the disc height of the AF + CA group was significantly greater than that of the AF group. The cage subsidence rate in the AF + CA group was 24.3%, significantly lower than that in the AF group (48.8%, p < 0.05) and comparable to the BPS group (30.4%). Survivorship curve analysis showed better outcomes in reducing cage subsidence in theAF + CA group compared with the AF group, with no significant difference between the AF + CA and BPS groups. Compared with the AF + CA and BPS groups, the AF group had significantly higher grades and severity of cage subsidence. Fusion rates at 1 year were 91.9% in the AF + CA group, 90.2% in the AF group, and 95.1% in the BPS group, with no significant differences. The AF + CA group had significantly shorter operative times, less intraoperative blood loss, lower VAS scores at 3 days and 1 year postoperatively, and lower ODI scores at 3 days and 3 months compared with the BPS group. Multivariate regression analysis revealed that AF was a significant risk factor for cage subsidence, with an odds ratio of 3.399 compared with AF + CA. AF + CA effectively reduces cage subsidence in OLIF surgeries, offering results comparable to BPS while providing advantages such as shorter surgical time, reduced blood loss, and improved early postoperative outcomes. AF + CA is a viable alternative, especially for elderly patients with comorbidities who may not tolerate the longer operative durations or greater blood loss associated with BPS.

Cystic plate approach in laparoscopic cholecystectomy: a consecutive retrospective analysis.

This study aimed to investigate the safety, feasibility, and possible advantages of the cystic plate approach during laparoscopic cholecystectomy in a retrospective cohort of surgical patients. We summarized the key points of the technical approach, retrospectively analyzed the clinical outcomes of 156 patients in the cystic plate approach group from July 2018 to July 2023, and compared the findings with those of 173 cases in the routine approach group from the same period. We observed no differences in the average stone size, operation time, postoperative hospital stay, conversion rate, complications, or Visual Analog Scale pain scores on the second day of surgery between the two groups (p = 0.076, 0.067, 0.278, 1.000, 0.633, and 0.131, respectively). However, intraoperative blood loss, number of clips used, volume of postoperative drainage fluid, and Visual Analog Scale pain scores on the day of surgery in the cystic plate approach group were significantly lower than those in the routine approach group (p = 0.000, 0.031, 0.027, and 0.021, respectively). The cystic plate approach is a safe, feasible, and effective approach that has the advantages of minimal invasiveness with less bleeding and seepage, reduced use of biological clips, and less pain, potentially minimizing the risk of iatrogenic biliary injury. This study was registered at the International Clinical Trial Registry (ChiCTR2100052860). Registration date: November 6, 2021.

Teaching residents in emergency surgery for acute bowel obstruction-is supervised surgery safe and feasible? A retrospective single-center analysis from a MIS-specialized hospital.

Emergency surgery for acute bowel obstruction (ABO) is a common and occasionally technically demanding procedure, requiring both surgical skill and strategic planning. The risk entailed in teaching residents during ABO surgery has not been defined or investigated in detail to date. It is the aim of this study to reveal whether surgery for ABO, performed by resident surgeons under supervision, is safe and feasible. A retrospective analysis was conducted of all emergency surgeries for ABO performed between 2009 and 2023 at a community-based hospital. Patients' general characteristics, procedural data and outcome parameters were compared. Differences between teaching procedures and non-teaching procedures were analysed. The study was conducted at the Department of General and Visceral surgery at a community-based hospital (St. John of God Hospital Salzburg, Austria). All emergency surgeries for ABO (n = 300 patients) that were performed during the study period were included. Emergency surgery for ABO was performed in 300 patients during the study period, 15.3% of which operations were performed by residents under supervision and 84.7% by senior surgeons. No differences between these two groups were found in terms of patient characteristics, except for a past medical history of previous gynecologic or urologic surgery that was more frequent in the senior surgeon group (p = 0.02). Neither procedural data nor conversion rates from a minimally invasive (MIS) to an open (OS) approach, nor postoperative complication rates were found to be significantly different between these groups. Emergency surgery for ABO, performed by residents under supervision, is safe and feasible, showing no significant differences in terms of complication rates, morbidity or mortality as compared to procedures performed by senior surgeons.

Drug-device-field integration for mitochondria-targeting dysfunction and tumor therapy by home-tailored pyroelectric nanocomposites

In spite of the hypoxia tumor microenvironment, an efficacious treatment with minimal invasiveness is highly desirable. Among common cellular organelles, mitochondria is a common target for inductive cellular apoptosis and tumor proliferation inhibition. Nevertheless, tumor hypoxic circumstances always give rise to poor therapeutic efficiency and instead lead to lesion recurrence and unsatisfactory prognosis. Herein, a home-tailored pyroelectric nanocomposites of BTO@PDA-FA-DOX-EGCG have been developed via a layer-by-layer synthesis to serve a cutting-edge tumor treatment with specific mitochondria-targeting, hypoxia-relieving, chemo-photodynamic performance and high anti-tumor efficacy. In particular, this therapeutic modality is featured as drug-device-field integration (DDFI) by combining chemo-drugs of DOX and EGCG, a commercially available medical laser and physical pyroelectric fields, which synergistically contributed to continuing ROS production and consequently cell apoptosis and tumor growth inhibition. Meanwhile, an anti-tumor mechanism of immune actuation and mitochondria dysfunction was elucidated by analyzing specific biomarkers of mitochondria complexes and MMPs, and therefore this research opened up a potential pathway for advanced tumor treatment by incorporating nanocomposites, medical devices and physical fields in a DDFI manner.

Neonatal Liver Imaging: Techniques, Role of Imaging, and Indications.

The neonatal liver may be affected by a variety of congenital and acquired diseases. Imaging has an important role in the workup and management of many neonatal hepatic abnormalities. Some aspects of imaging the liver and imaging findings are specific to neonatal patients when compared with those in older children. Therefore, selecting and tailoring the imaging technique for each indication in the neonate is important for optimal care, with minimal invasiveness. Common indications for imaging include incidental focal lesions, neonatal liver failure, cholestasis, and sepsis. US is the primary imaging modality, and for most conditions it is the only imaging modality required. MRI is the next modality after US for neonatal liver assessment and is especially required for complete assessment and staging of neoplasms, vascular abnormalities, and diagnosis of neonatal hemochromatosis. CT can be used when MRI is not available and should be used sparingly and in patients with acute conditions such as intra-abdominal bleeding. The authors emphasize imaging modalities that can be used for assessment of neonatal liver abnormalities, the imaging appearances of normal and changing structures in the neonatal liver, and indications for imaging. Abnormalities that are described include neonatal liver failure, infections, hepatic calcifications, umbilical venous catheter-related complications, and vascular abnormalities. ©RSNA, 2024 Supplemental material is available for this article.

Utilization and validation of dried blood spot-based metabolomics in plasma-derived diagnostic models

Metabolomics has rapidly advanced in life sciences, enhancing our understanding of physiological conditions. Plasma stands out as a predominant sample type in metabolomics studies. Dried blood spot (DBS) has been recognized as a valuable strategy due to its unique characteristics, such as minimal invasiveness, small sample volume, and easy transport. Most large cohort studies construct the diagnostic model using plasma-based metabolomics rather than DBS. However, the comparability of metabolite measurements between DBS and plasma samples, as well as the integration of DBS-based metabolomics into established plasma-derived diagnostic models, remains unclear. We collected plasma and DBS samples from the same 12 healthy controls under fasting and non-fasting conditions and performed ultra-high performance liquid chromatography-mass spectrometry (UPLC-MS)-based metabolomics. We identified 277 metabolites present in both plasma and DBS samples, with 229 (82.7 %) showing a strong correlation between the two sample types. Furthermore, pre-processing datasets from plasma and DBS samples before combining them effectively diminished inconsistencies between plasma- and DBS-based metabolomics without compromising the inherent classification within the data. For the clinical application, the plasma samples were obtained from the gastric cancer patients (n = 204) and the healthy controls (n = 128) to serve as the training cohorts. Additionally, DBS samples were collected from different participants of gastric cancer (n = 19) and healthy controls (n = 12) to validate the diagnostic model. Finally, DBS-based metabolomics were integrated into established plasma-derived gastric cancer diagnostic models, yielding an area under the ROC curve (AUC) of 0.934. Overall, incorporating DBS-based metabolomics into an established plasma-derived diagnostic model holds promise, offering valuable opportunities and insights for diagnostic research and clinical practice.

Reactive oxygen species augmented polydopamine-chlorin e6 nanosystem for enhanced chemo/photothermal/photodynamic therapy: A synergistic trimodal combination approach in vitro & in vivo

Amalgamation of near-infrared laser phototherapies with chemotherapy in multi-modal synergistic therapy holds great promise for future precision cancer nanomedicine due to its minimal invasiveness, reduced adverse reactions, and high anticancer efficacy. Herein, CuO nanoparticles were functionalized with photosensitizer molecule, chlorin e6 (Ce6) and coated with polydopamine (PDA) to achieve a drug delivery system (CuO@Ce6-PDA) with photothermal/photodynamic therapy (PTT/PDT). Subsequently, chemical drug PTX was loaded for chemotherapy, and folic acid (FA) serving as cancer-targeting exterior material. Prepared FA@CuO@Ce6-PDA/PTX nanoparticles were nano-sized with favorable biocompatibility, colloidal stability, optimal surface charge, effective PTX loading, and controllable PTX release. In vitro studies on 4 T1 cells showed that FA@CuO@Ce6-PDA/PTX had noteworthy synergistic therapeutic antitumour effects featuring chemo/PTT/PDT with IC50 of 50 μg/mL lower than that FA@CuO@Ce6-PDA/PTX without NIR laser irradiation (225 μg/mL). Additionally, FA@CuO@Ce6-PDA/PTX produced intracellular high reactive oxygen species (ROS) in presence of 660 nm laser, altering mitochondrial membrane potential and promoting tumour cell death. In vivo results indicate nanoplatform could accumulate in tumour spots enabling thermal imaging capabilities and exhibit synergistic therapeutic effect if irradiated with NIR laser (808 and 660 nm), evident from in vitro antitumour assay. Therefore, in vitro finding postulates FA@CuO@Ce6-PDA/PTX could be an intriguing nanoplatform for Chemo/PTT/PDT-based combination therapy.

Light affects the resistance of native plant communities to Solidago canadensis with low invasion degrees

Light is an important factor for plant growth, and native plant communities are frequently invaded by alien plants to varying degrees. However, little is known about the effect of lighting on the resistance of native plant communities to alien plants with different degrees of invasion. We assessed the interactive effects of light condition and invasion degree on the growth of the invasive plant Solidago canadensis, the characteristics of the native plant communities and the invasion success of S. canadensis through both a field survey and greenhouse experiment. The field survey data showed that shading decreased the biomass of both S. canadensis and the native plant communities. However, it improved the relative dominance and thus, the invasion success of S. canadensis under the low and moderate invasion degrees but not at the high invasion degree. The data of the greenhouse experiment also showed that the native plant communities under shade were more susceptible to invasion by S. canadensis than the unshaded communities, particularly under the low and moderate invasion degree. In summary, we found that shading can weaken the resistance of native plant communities to alien plant invasions when there is a minimal invasion degree. These results underscore that managers need to be more attentive to the invasion of S. canadensis in sheltered environments. These findings provide a scientific reference to manage and control invasion by S. canadensis.

Characterization and modelling of carbon black nanocomposite strain sensor on pneumatic driven flexible catheter for pulmonary surgery robots

The pulmonary surgery robot is equipped with a flexible catheter designed to navigate narrow bronchi and perform precise surgical operations on lesions, offering benefits such as minimal invasiveness and high flexibility. This study focuses on the shape control and strain sensing of the catheter’s tip. A gas-driven control platform was developed for a three-channel catheter, incorporating miniaturized precision valves to enhance the accuracy of pneumatic pressure control. Concurrently, ultra-thin flexible strain sensors were fabricated using PDMS and carbon black to detect bending strain, and their sensing performance was assessed to identify optimal fabrication parameters. Finally, the control platform and strain sensors were integrated to validate the system’s capability to manage the catheter’s bending shape while simultaneously sensing its deformation. This integration provides a theoretical foundation for enhancing the precision and safety of catheters in practical applications of surgical robots.

Transvaginal natural orifice endoscopic surgery for hysterectomy: a prospective cohort study

ObjectiveVaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its advantages, including reduced postoperative pain and the absence of visible scarring. However, the anatomical specificity required for vNOTES may increase the risk of injury to nearby organs, such as the rectum and bladder. This study aims to evaluate the safety and potential benefits of vNOTES compared to transumbilical laparoendoscopic single-site surgery (LESS) for Hysterectomy.MethodsThe Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), conducted in Chengdu, China, included 192 patients who underwent hysterectomy between May and October 2023. This study prospectively collected and compared perioperative and follow-up data between the two groups.ResultsThe vNOTES group demonstrated shorter surgery times, postoperative flatus time, and hospital stays, but it also had a higher conversion rate. Specifically, the vNOTES approach reduced surgery duration by approximately 29.8 min (95% CI: -41.31, -18.34, P < 0.001) but increased intraoperative blood loss by about 41.82 mL (95% CI: 25.81, 57.82, P < 0.001).ConclusionBy combining laparoscopy with traditional vaginal surgery, vNOTES offers advantages such as shorter surgery times, faster postoperative recovery, reduced hospital stays, greater minimal invasiveness, and improved cosmetic outcomes. However, it is essential for surgeons to continually enhance and standardize preoperative assessments and surgical techniques to minimize conversion rates and reduce intraoperative blood loss.Trial registry numberChiCTR2200059282, China Clinical Trials Registry, April 28, 2022.

Role of stretch-activated channels in light-generated action potentials mediated by an intramembrane molecular photoswitch

BackgroundThe use of light to control the activity of living cells is a promising approach in cardiac research due to its unparalleled spatio-temporal selectivity and minimal invasiveness. Ziapin2, a newly synthesized azobenzene compound, has recently been reported as an efficient tool for light-driven modulation of excitation-contraction coupling (ECC) in human-induced pluripotent stem cells–derived cardiomyocytes. However, the exact biophysical mechanism of this process remains incompletely understood.MethodsTo address this, we performed a detailed electrophysiological characterization in a more mature cardiac model, specifically adult mouse ventricular myocytes (AMVMs).ResultsOur in vitro results demonstrate that Ziapin2 can photomodulate cardiac ECC in mature AMVMs without affecting the main transporters and receptors located within the sarcolemma. We established a connection between Ziapin2-induced membrane thickness modulation and light-generated action potentials by showcasing the pivotal role of stretch-activated channels (SACs). Notably, our experimental findings, through pharmacological blockade, suggest that non-selective SACs might serve as the biological culprit responsible for the effect.ConclusionsTaken together, these findings elucidate the intricacies of Ziapin2-mediated photostimulation mechanism and open new perspectives for its application in cardiac research.

Outcomes of One Versus Two Level MIS Decompression With Adjacent Level Stenosis.

Retrospective cohort study. Decompression for the treatment of lumbar spinal stenosis (LSS) has shown excellent clinical outcomes. In patients with symptomatic single level stenosis and asymptomatic adjacent level disease, it is unknown whether decompressing only the symptomatic level is sufficient. The objective of this study is to compare outcomes between single level and dual level minimally invasive (MIS) decompression in patients with adjacent level stenosis. The current study is a retrospective review of patients undergoing primary single or dual level MIS decompression for LSS. Radiographic stenosis severity was graded using the Schizas grading. Patients undergoing single level decompression (SLD) with moderate stenosis at the adjacent level were compared with patients undergoing dual level decompression (DLD) for multi-level LSS. Clinical outcomes, complications, and reoperations were compared. Subgroup analysis was performed on patients with the same Schizas grade at the adjacent level in the SLD group and the second surgical level in the DLD group. 148 patients were included (126 SLD, 76 DLD). There were no significant differences in patient reported outcomes between the two groups at any timepoint up to 2years postoperatively, including in the matched stenosis severity subgroups. Operative time was longer in the DLD cohort (P < 0.001). There were no significant differences in complications or reoperation rates. In patients with single level symptomatic LSS and adjacent level stenosis, decompression of only the symptomatic level provided equivalent clinical outcomes compared to dual level decompression. The additional operative time and potential incremental risk of dual level surgery may not be justified.

Mechanical Behavior of Thin Ceramic Laminates on Central Incisors.

Restorative dentistry often uses ceramic laminate veneers for aesthetic anterior teeth restorations due to their natural appearance and minimal invasiveness. However, the understanding of their clinical performance and how ceramic microstructure and processing affect longevity is limited. Objective: This study aimed to address this gap by determining the mechanical behavior, fracture load, and failure modes of CAD-CAM processed laminate veneers made of either lithium-disilicate-based glass ceramic (IPS e.max CAD) or feldspathic porcelain (Vita Mark II). It also aimed to develop a mechanical cycling methodology capable of determining the lifetime and failure modes of thin ceramic laminate veneers. Materials and Methods: Eighteen human maxillary central incisors were used to create the specimens. Minimal enamel preparation was required to ensure the proper adaptation of the thin ceramic laminates. Ceramic laminates made from lithium disilicate and feldspathic porcelain (Vita Mark II) were produced via CAD-CAM, with the final thicknesses less than 0.5 mm, then cemented with resin cement. Results: The mean fracture load for the glass ceramic was 431.8 ± 217.9 N, while for the porcelain, it was 454.4 ± 72.1 N. Failure modes differed considerably: porcelain showed more chipping, while lithium disilicate was associated with tooth structure failure. Conclusion: The material used did not significantly affect the fracture load of thin ceramic laminates in static tests. However, failure modes differed considerably. It was not possible to determine a set of mechanical cycling parameters that could establish the fatigue properties of thin ceramic laminates, as the maximum number of cycles reached was 536,818.

Modular Synthetic Platform to Tailor Therapeutic-Specific Delivery in Injectable Hydrogels.

Injectable thermoresponsive hydrogels (thermogels), valued for their conformability and minimal invasiveness, are increasingly used as in situ forming implants for drug delivery and as regenerative scaffolds. These gels exhibit sol-to-gel phase transitions at body temperature. As localized depots and scaffolds, these gels determine the chemical and mechanical environments and could dramatically influence the release kinetics of drugs or the fate of cells. Current synthetic approaches for thermogels, however, often limit the ability to fully exploit interactions between the thermogel matrix and the encapsulated agent. In this study, we introduce a modular synthetic platform for creating a library of functionalized polyurethane thermogels that enables customization of gelation properties and intermolecular interactions. These thermogels can exhibit a wide range of stiffness, offer complementary ionic interactions, and enhance hydrophobic interactions and hydrogen bonding. By leveraging these tunable interactions between the thermogelling scaffold, functional groups, and encapsulated agents, we achieved sustained and controlled release, from days to over 6 months, for both low and high molecular weight drug analogs. Release profiles varied from monophasic to biphasic and triphasic depending on the compatibility between the thermogel properties and the encapsulated agents. The design rules identified here support the development of drug-specific formulations, facilitating precise, sustained, and modulated release tailored to therapeutic needs. Beyond providing an adaptable strategy for customizable injectable drug depots, this synthetic strategy lays the groundwork for future iterations of multi stimuli-responsive thermogels with enhanced bioactivity, advancing the potential for customizable, biointeractive therapeutic systems.