Minimally Invasive Research Articles

Endovascular treatment of postoperative gastrointestinal bleeding

Objective. To analyze the results of endovascular treatment of postoperative gastrointestinal bleeding. Materials and methods. During the period 2014–2024, 328 endovascular interventions were performed in 297 patients with postoperative gastrointestinal bleeding. The most common was vesicovaginal bleeding after pancreatic surgery. A total of 304 embolizations were performed and 24 stent grafts were installed. Results. In 253 (85.2%) patients, it was possible to diagnose the source of bleeding angiographically, and the bleeding was stopped with the help of embolization devices and stent grafts. In 44 (14.8%) patients, it was not possible to accurately diagnose the source of bleeding, and they underwent prophylactic embolization of the most likely source of bleeding. In 12 patients, embolization was repeated: in 6 patients it was performed twice, in 5 patients – three times, and in 1 patient – four times. In 16 (5.4%) patients, including 15 after prophylactic embolization, endovascular hemostasis was ineffective and they required surgical intervention. Conclusions. Endovascular treatment due to its minimal invasiveness, the possibility of repeated use, and the combination of diagnostic and therapeutic stages is the primary method in the treatment of postoperative gastrointestinal bleeding.

SURG-31. HYBRID THERAPY FOR NEWLY DIAGNOSED AND RECURRENT GLIOBLASTOMA: STAGED PROCEDURE INTEGRATING OPEN SURGICAL RESECTION WITH LASER INTERSTITIAL THERMAL THERAPY

Abstract BACKGROUND Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults with a median overall survival (OS) of 15.6 months. Despite advancements, 5-year survival rates have not significantly improved. Laser interstitial thermal therapy (LITT) has been employed to treat both newly diagnosed (nGBM) and recurrent GBM (rGBM) with demonstrable safety and efficacy. Traditionally, LITT has been limited to smaller lesions given physical and thermal constraints. OBJECTIVE We present two case examples of a novel, hybrid treatment approach to GBM, utilizing both surgery and laser ablation as part of a single-staged procedure. METHODS Two geriatric (>65 years) patients with nGBM or rGBM were treated with surgical resection followed by LITT the subsequent day. Both patients underwent preoperative magnetic resonance imaging (MRI) showing multifocal disease with a dominant component, causing mass effect in the second case, and an unresectable component. RESULTS The first case underwent surgical resection of a large, multicentric rGBM in the parieto-occipital region, followed by LITT of an unresectable lesion in the inferior temporal gyrus. The second patient underwent surgical resection of the dominant temporal lobe component, and LITT of the insular component. Neither patient had intraoperative or ablation complications. Both patients had stable postoperative neurological exams and were discharged on the day after ablation, with no new deficits at follow-up. CONCLUSION The prognosis for GBM remains dismal despite significant research and attempts at advancements in patient management. Surgical resection is a critical component of the GBM treatment paradigm. However, surgery alone is not sufficient in many patients. LITT has shown promise for improving GBM outcomes, mainly due to its minimal invasiveness, enhanced immune responses, BBB disruption, and cytoreductive potential. We demonstrate a novel, hybrid approach to GBM using hybrid surgical resection and LITT in a single-staged procedure to overcome traditional constraints of LITT.

Establishment of a Predictive Model for Seroma Formation After TAPP Repair for Unilateral Indirect Inguinal Hernia in Males.

Inguinal hernia repair, particularly using TAPP, is common in males, and acclaimed for minimal invasiveness but often complicated by seromas, significantly affecting recovery and health care costs. This retrospective study analyzed data from 266 male patients with unilateral indirect inguinal hernia who underwent transabdominal preperitoneal (TAPP) repair. We divided the patients into a training set (n = 188) and a validation set (n = 78). We employed logistic regression to identify independent risk factors for post-TAPP seroma and developed a nomogram to predict the occurrence of seromas. The model's accuracy was evaluated using receiver operating characteristic (ROC) curves, Hosmer-Lemeshow goodness-of-fit test, calibration curves, and decision curve analysis (DCA). Postoperatively, 20.3% of patients developed a seroma. Multivariate logistic regression analysis highlighted several independent risk factors for seroma formation: the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac (P < 0.05). The ROC curves for the training and validation sets demonstrated areas under the curve of 0.893 (95% CI: 0.845-0.942) and 0.864 (95% CI: 0.765-0.963), respectively, indicating good model fits (P > 0.05). DCA confirmed significant clinical applicability of the model. The findings suggest that the use of anticoagulants, an internal ring defect ≥5cm, scrotal hernia, incarcerated hernia, and transected hernia sac are significant independent risk factors for seroma formation after TAPP repair. Clinical consideration of these factors and proactive preventive measures are essential. Although many of these factors are non-modifiable, understanding them is crucial for preoperative risk assessment and patient management.

Arthroscopic Management of Metacarpophalangeal Joint Synovial Chondromatosis

AbstractSynovial chondromatosis is a rare condition where cartilaginous nodules form within the synovium, which can detach and cause loose bodies within the joint. While it typically affects larger joints, involvement of the metacarpophalangeal (MCP) joints is rarely described. We report the case of a 42-year-old female patient who had a slow-growing mass in her right third MCP (MCP III) joint, associated with limited finger motion, swelling, and pain. The diagnosis was confirmed using imaging studies. The patient underwent arthroscopic excision of multiple tumors and synovectomy via dorsal radial and ulnar MCP III portals. Postoperatively, there was rapid improvement in hand function, including normal and pain-free range of motion. This case highlights the benefits of arthroscopic management for synovial chondromatosis in the MCP joint, as it offers advantages like minimal invasiveness, reduced tissue damage, faster recovery times, and lower infection risk compared with traditional open methods.

Advantages of adjuvant chemotherapy using S-1 following minimally invasive gastrectomy for gastric cancer versus open surgery: a propensity score-matched analysis.

It is essential to ensure optimal adherence to adjuvant chemotherapy regimens following gastric cancer surgery. However, treatment intensity for S-1 as adjuvant chemotherapy has not as yet been compared between minimally invasive (MI) and open (Open) surgery. We retrospectively compared dose modification of adjuvant S-1 between MI and Open surgery in patients undergoing R0 gastrectomy for gastric or esophago-gastric junction cancer at the Cancer Institute Hospital Tokyo, Japan, during the period from 2012 to 2022, and receiving S-1 for pStage II or S-1 plus docetaxel for pStage III as adjuvant chemotherapy. Propensity score matching (PSM) was conducted to adjust for possible confounders. In total, 323 patients were initially included. After PSM, 158 patients remained, 79 in each group. The adjuvant chemotherapy completion rates were similar in the two groups. However, the proportion of patients who required S-1 dose reduction was significantly lower in the MI than in the Open group (43.0% vs. 65.8%, p = 0.004). In addition, the MI group had significantly fewer patients requiring suspension of S-1 than the Open group (46.8% vs. 64.6%, p = 0.025). Moreover, the frequency of adverse events of grade ≥ 3 was significantly lower in the MI than in the Open group (17.7% vs. 31.7%, p = 0.042). In adjuvant chemotherapy for gastric cancer, minimally invasive surgery may offer better treatment intensity for oral S-1 administration than open surgery.

Navigating the Diagnostic Challenges in Lymph Node Cytology: The Case of Reactive Hyperplasia.

Fine needle cytology (FNC) is a pivotal diagnostic tool for distinguishing between benign and malignant lymphadenopathies mainly because of its minimal invasiveness, cost-effectiveness and accuracy. A major requirement for maximising diagnostic accuracy is proper sample management of aspirated cellular material. In this diagnostic process, the morphological evaluation of adequate smears is paramount, guiding cytopathologists in the selection of appropriate ancillary tests through the recognition of cell size and patterns of distribution. Here, we describe a peculiar 'concentric ovals distribution pattern', frequently observed in the FNC of benign reactive lymph nodes, which may represent an aid in the cytological diagnosis of reactive hyperplasia.

Is there a difference in pelvic and femoral morphology in early periprosthetic femoral fracture in cementless short stem total hip arthroplasty via an anterolateral approach?

BackgroundThe pelvic and femoral morphology are associated with the occurrence of early periprosthetic femoral fractures (PFFs) in cementless total hip arthroplasty (THA). Differences exist depending on the performed approach and implanted stem design. Therefore, this study was conducted to analyze the pelvic and femoral morphology in cementless short stem THA via a minimally-invasive (MIS) anterolateral approach.MethodsA retrospective, single-center, multi-surgeon, comparative propensity-score matched study of a cohort of 1826 short stem THAs was conducted. A total of 39 PFFs within the first 90 days after surgery was matched on a 2:1 ratio to non-fracture patients. The morphology of the proximal femur was analyzed with canal flare index (CFI), canal-calcar ratio (CCR), canal-bone ratio (CBR), morphological cortical index (MCI), and femoral cortical index (CI). The pelvic morphology was analyzed with ilium–ischial ratio (IR), distance anterior superior iliac spine to the tip of the greater trochanter (AGT). Both groups were analyzed regarding several parameters for femoral and pelvic morphology in non-parametric testing and univariate regression analysis.ResultsA significantly higher AGT was detected in the fracture group (104.5 mm ± 18 versus 97.4 mm ± 9.8; p = 0.016). All other femoral and pelvic parameters did not differ between both groups, also when compared depending on the Vancouver type of the PFF.ConclusionsThe morphology of the proximal femur and the pelvis do not differ in several radiological parameters in patients sustaining a PFF in cementless short stem THA via an anterolateral approach compared with matched non-fracture group. The findings are controversial to other studies with different stem types and approaches. Future studies should focus on analyzing the influence of the pelvic geometry and the shape of the proximal femur in the occurrence of PFFs in different approaches with the same stem type and vice versa.Level of Evidence Level III case-controlled study

Magnetic assembly of microwires on a flexible substrate for minimally invasive electrophysiological recording

Understanding the neural system in the brain requires the detection of signals from the tissue. Microscale electrodes enable high spatiotemporal neural recording, whereas traditional microelectrodes cause material and geometry mismatches between the electrode and the tissue, leading to injury and signal loss during recording. In this study, we propose a fabrication technique that uses magnetic force to facilitate assembly of vertical microscale wire-electrodes on a flexible substrate. Two-channel 15-μm-diameter and 400-μm-length nickel-microwire electrodes on a 5-μm-thick flexible parylene film are designed and fabricated. Impedance characteristics of these electrodes are <500 kΩ at 1 kHz, with output/input signal amplitude ratios of over 90%. In vivo acute neural recording in mice demonstrates that both local field potentials and action potentials are detected through each wire electrode, confirming the minimal invasiveness during the electrode penetration and through immunohistochemical tissue analysis.

Facile synthesis of Fe3O4 photothermal nanoparticles coated with poly-3,4-dihydroxybenzaldehyde for improved photothermal therapy of cancer cells

Given the significant rise in the number of individuals diagnosed with cancer, the management of cancer therapy has become a prominent concern in society and a formidable task in human health care. Photothermal therapy has garnered significant interest in cancer treatment because of its exceptional efficacy and minimal invasiveness. Thus, current research mainly focuses on developing biocompatible materials with excellent photothermal properties. Therefore, we synthesized Fe3O4 nanoparticles coated with poly-3,4-dihydroxybenzaldehyde (Fe3O4@PDBA) where 3,4-dihydroxybenzaldehyde was covalently polymerized onto the surface of Fe3O4. The induction of PDBA leads to a dramatical improvement in the photothermal properties of Fe3O4. Besides, the thickness of the PDBA shell layer is also a key factor in the photothermal performance and various physicochemical properties of Fe3O4@PDBA and the photothermal performance of Fe3O4@PDBA increases with increasing thickness of the PDBA shell. Additional structural characterization of the products, DFT calculations of the UV-Vis absorption spectra and the HOMO-LUMO gap under the simple model of the polymer, and product identification by the use of H1NMR, MS, and other techniques were performed. Through multiple characterizations, the reaction solution color and UV-Vis absorption spectra were essentially consistent with the computed findings. The calculations confirm that the polymerization process of PDBA is progressively red-shifted and the absorption is gradually enhanced in the NIR region. Fe3O4@PDBA exhibited strong cytotoxicity against cancer cells (Hela, 98.0%) in vitro photothermal treatment. Hence, Fe3O4@PDBA exhibits superior photothermal characteristics, targeting, biocompatibility (99.0%), and degradability, which brings about significant potential for photothermal cancer therapy.

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.

“Balloon-like” biomimetic erythrocyte vesicles potentiate photodynamic therapy for inducing immunogenic cell death

Photodynamic therapy (PDT) for cancer is known for its minimal invasiveness and safe characteristics, but the hypoxic tumor microenvironment still limits efficacy. Herein, we have developed a novel “balloon-like” biomimetic erythrocyte vesicle, which is constructed by loading chlorin e6 (Ce6) and oxygenated hemoglobin (Hb) in a folate (FA)-modified, PEGylated liposome, denoted as Ce6-Hb-FA@lip (CHFL). The CHFL exhibits high biocompatibility and good stability in PBS solution. Moreover, CHFL possesses the “balloon-like” elastic structure for oxygen binding with the change of volume. Both in vitro and in vivo studies demonstrate an effective PDT of CHFL, which significantly reverses the hypoxic microenvironment of tumor cells through the targeted cotransmission of Ce6 and Hb. Additionally, this biomimetic erythrocyte vesicle can induce oxidative stress to enhance tumor immunogenicity and trigger immunogenic cell death (ICD). Thus, the dying tumor cells can activate both dendritic cells (DCs) and T lymphocytes, which, in turn, initiates the antitumor immune response by releasing the damage-associated molecular patterns (DAMPs). This effective and safe platform holds great promise in the development of nanomedicines for innovative oxygen-enhanced PDT in the treatment of cancer.

Intravascular delivery of an ultraflexible neural electrode array for recordings of cortical spiking activity

Although intracranial neural electrodes have significantly contributed to both fundamental research and clinical treatment of neurological diseases, their implantation requires invasive surgery to open craniotomies, which can introduce brain damage and disrupt normal brain functions. Recent emergence of endovascular neural devices offers minimally invasive approaches for neural recording and stimulation. However, existing endovascular neural devices are unable to resolve single-unit activity in large animal models or human patients, impeding a broader application as neural interfaces in clinical practice. Here, we present the ultraflexible implantable neural electrode as an intravascular device (uFINE-I) for recording brain activity at single-unit resolution. We successfully implanted uFINE-Is into the sheep occipital lobe by penetrating through the confluence of sinuses and recorded both local field potentials (LFPs) and multi-channel single-unit spiking activity under spontaneous and visually evoked conditions. Imaging and histological analysis revealed minimal tissue damage and immune response. The uFINE-I provides a practical solution for achieving high-resolution neural recording with minimal invasiveness and can be readily transferred to clinical settings for future neural interface applications such as brain-machine interfaces (BMIs) and the treatment of neurological diseases.

Early NRS Leg and Back Thresholds Predict Clinical Recovery after MIS Transforaminal Lumbar Interbody Fusion for Degenerative Spine Disease.

This retrospective study included patients who underwent primary one-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine conditions. To identify early predictors of failing to achieve the Oswestry Disability Index (ODI) minimum clinically important difference (MCID) one-year post-surgery. Early identification of patients at risk of failing to achieve ODI-MCID is crucial for early intervention and improved postoperative counseling. Currently, no specific thresholds guide patient follow-up for optimal recovery. The assessment included demographic information, surgical details, and patient-reported outcome measures (PROMs). PROMs were collected postoperatively at 2-, 6-, and 12-week time points, as well as at 6- and 12-months. The study included 166 patients, with 34% failing to achieve ODI-MCID at one year. Early VAS back and leg scores were found to be significant predictors of ODI-MCID achievement. The optimal thresholds identified were 2.25 for early VAS back and 4.25 for early VAS leg. A rerun regression identified the thresholds as independent predictors of ODI-MCID, with odds ratios of 0.31 for both measures. VAS back and leg score thresholds at 6-12 weeks can predict ODI-MCID achievement one year after MIS TLIF. Patients exceeding the identified thresholds may be at risk of failing ODI-MCID and should be monitored closely. Level 3.

Machine learning prediction for prognosis and long-term effectiveness for transcatheter ventricular septal defect closure: a 5-year single center experience

Abstract Background Transcatheter therapy, with minimal invasiveness and rapid recovery advantages, has emerged as the primary choice for treating perimembranous ventricular septal defect. However, patients receiving transcatheter occlusion may confront conduction abnormalities due to the occluder's proximity to the cardiac conduction bundle during implantation. Few have assessed the risks of postoperative conduction block (CB) via robust machine learning models. Purpose The purpose of this study was to evaluate our long-term follow up results of pmVSD occlusion and establish a prediction model to identify risk predictors of conduction abnormalities via robust machine learning methods. Methods Five methods including logistic regression with a stepwise selection of variables, lasso regularization; random forest; gradient descent boosting (GBM); and support vector machine, were used to train models for predicting risks of late-onset and persistent conduction block through 5 years of follow-up and were validated using 5-fold cross-validation. Receiver-operating characteristic curves and Brier scores were utilized to evaluate model discrimination and calibration, respectively. The top prediction variables were identified by using the best performing models, using the relative influence score of each variable in 5-fold cross-validation. Results The GBM model performed the best with an AUC of 0.82 (95% confidence interval [CI]: 0.75 to 0.89) for predicting late-onset CB (Brier score: 0.0204), and 0.70 (95% CI: 0.62 to 0.78) for persistent CB (Brier score: 0.0003) over entire study period. Conduction block on admission, advanced age and aortic regurgitation before discharge were strongly associated with late-onset CB, whereas decreased left ventricular ejection fraction, enlarged left ventricle end diastolic diameter at 1-month follow-up were the most significant predictors of persistent CB. Conclusions These models predict the risks of temporary and persistent postoperative conduction block in patients with pmVSD occlusion and shed light on preventing long-term complications.Study FlowchartCentral Illustration

Super-Resolution Microscopy as a Versatile Tool in Probing Molecular Assembly.

Molecular assembly is promising in the construction of advanced materials, obtaining structures with specific functions. In-depth investigation of the relationships between the formation, dynamics, structure, and functionality of the specific molecular assemblies is one of the greatest challenges in nanotechnology and chemistry, which is essential in the rational design and development of functional materials for a variety of applications. Super-resolution microscopy (SRM) has been used as a versatile tool for investigating and elucidating the structures of individual molecular assemblies with its nanometric resolution, multicolor ability, and minimal invasiveness, which are also complementary to conventional optical or electronic techniques that provide the direct observation. In this review, we will provide an overview of the representative studies that utilize SRM to probe molecular assemblies, mainly focusing on the imaging of biomolecular assemblies (lipid-based, peptide-based, protein-based, and DNA-based), organic-inorganic hybrid assemblies, and polymer assemblies. This review will provide guidelines for the evaluation of the dynamics of molecular assemblies, assembly and disassembly processes with distinct dynamic behaviors, and multicomponent assembly through the application of these advanced imaging techniques. We believe that this review will inspire new ideas and propel the development of structural analyses of molecular assemblies to promote the exploitation of new-generation functional materials.

A study on the effect of platelet-rich plasma (PRP) to promote bone fusion in lateral interbody fusion of the lumbar spine using artificial bone

BackgroundLateral lumbar interbody fusion (LLIF) via a retroperitoneum approach has gained popularity due to minimal invasiveness, which avoids resection of the spinous process and laminae. However, as challenges in grafting autogenous bone persist, artificial bone has been tested in Japan to fill the spinal cage. Platelet-rich plasma (PRP) contains growth factors and anti-inflammatory cytokines to promote cellular proliferation and repair damaged tissues. While the effects of PRP on tendon and ligament repair are widely known, any effects on bone healing are scarcely reported. However, PRP-loaded artificial bone carries potential to improve intervertebral bone fusion.ObjectiveThis study assessed whether PRP enhances intervertebral bone fusion in LLIF surgery using β-tricalcium phosphate artificial bone.MethodsThe current study was a prospective, randomized, controlled trial. We evaluated 13 consecutive patients undergoing LLIF surgery in our hospital. Patients received artificial bone impregnated with PRP or without PRP within the same fusion cage. The primary outcome was the intervertebral bone fusion rate at 6 and 12 months postoperatively, evaluated using CT imaging. The intervertebral bone fusion rates with and without PRP loading and with and without contact part between the endplate and the artificial bone were compared. Secondary outcomes included clinical evaluations using visual analog scale scores for low back pain, buttock-leg pain, and leg numbness from the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOA-BPEQ) and the Oswestry Disability Index (ODI), plus adverse events information.ResultsOf the 13 patients (29 vertebral segments) included, bone fusion was observed in 43.4% of the PRP group and 26.1% of the non-PRP group at 6 months (p = 0.216). At 12 months, fusion rates were 60.9% with PRP and 34.8% without PRP (p = 0.074). The fusion rate was significantly higher in cases with good contact between the vertebral endplate and the artificial bone (p = 0.0004). Clinical scores improved postoperatively. Adverse events were in accordance with expectations from LLIF surgery and no PRP-specific events occurred.ConclusionPRP did not significantly improve intervertebral bone fusion rates in LLIF surgeries, particularly in cases with poor contact between the vertebral endplate and artificial bone. While PRP may have a limited role in enhancing bone fusion, maintaining good contact between the vertebral endplate and artificial bone is crucial for successful outcomes. Further research is needed to explore optimal uses of PRP in spinal fusion surgeries.

Analysis of 15 children with type Ⅳ branchial cleft cyst treated with endoscopic transoral approach

Objective: To analyze the clinical characteristics and endoscopic surgical procedures of the second branchial cleft cyst type Ⅳ in children. Methods: A retrospective review was conducted on 15 pediatric cases with type Ⅳ second branchial cleft cysts treated at the Beijing Children's Hospital affiliated with Capital Medical University and Henan Children's Hospital from September 2019 to November 2023. All patients underwent excision via a two-person, three-hand endoscopic transoral approach. The cohort included 12 males and 3 females, with an age range of 10 months to 10 years and 5 months, and a median age of (59.20±32.05) months. The clinical data of initial symptoms, sides, imaging features, treatment methods, complications, length of hospital stay, prognosis and outcome were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: Of the 15 children, 13 cases presented with snoring as the primary symptom, 1 case with dysphagia, and 1 case was asymptomatic and was found unintentionally. The mean disease duration was (6.74±9.05) months (range, from 3 days-2 years). MRI revealed cystic lesions on the right side in 12 cases and on the left side in 3 cases, characterized by uniform long T2 signal, equal T1 or short T1 signal. The cysts appeared dumbbell-shaped in 10 cases with the pharyngeal constrictor muscle as the waist, the posterior outside of the mass was adjacent to the internal carotid artery. The remaining 5 cases showed an isolated cyst located inside the pharyngeal constrictor muscle. The intraoperative MRI findings were consistent. Partial cystectomy was performed in 10 cases near the internal carotid artery, leaving only the portion with a clear arterial pulse intact. Five cases with isolated cysts on the medial side of the pharyngeal constrictor muscle were totally removed. The average length of hospital stay was (4.53±0.52) days (4-5 days). All patients were followed up for 7-56 months [median (30±15.12) months] with no recurrence of symptoms observed. Conclusions: The second branchial cleft cyst type Ⅳ in children is characterized by prominent pharyngeal cystic mass, with snoring as a predominant initial symptom, MRI provides excellent diagnostic value. The two-person, third-hand endoscopic transoral approach for cyst excision is feasible, safe, and offers the benefits of minimal invasiveness and reduced hospitalization time.

The accuracy of fine needle aspiration cytology and ultrasonography in assessing thyroid nodules in correlation with histopathology: a retrospective study

Background: Accurately diagnosing thyroid nodules is vital for preventing unnecessary surgeries and providing prompt therapy. Although fine needle aspiration cytology (FNAC) and ultrasonography (US) are widely used diagnostic methods, their reliability is questioned. This study investigates the effectiveness of US and FNAC in thyroid nodule diagnosis and differentiates benign from malignant nodules in relation to final histopathological diagnosis. Method: A retrospective study including 307 adult patients with thyroid diseases who underwent neck US and FNAC before surgery was conducted between April 2019 and May 2023. The diagnostic efficacy of US, FNAC, and their combination usage was compared to histopathological results. Result: Histopathological findings revealed that 187(61%) cases were benign, while 120 (39%) were malignant. The US features of “taller-than-wider” forms and hypoechoic appearance had the highest diagnostic accuracy in characterizing malignant thyroid nodules, with 83% and 73% accuracy, respectively. The combination of US parameters demonstrated high sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 88.33%, 63.10%, 60.6%, and 89.4%, with a statistically significant area under the ROC curve (AUC: 0.828, P&lt;0.001) than individual parameters. FNAC’s sensitivity, specificity, PPV NPV, and accuracy in detecting malignant lesions were 50%, 95%, 86%, 75%, and 77%, respectively, with acceptable discrimination and statistical significance (AUC: 0.723, P&lt;0.0001). The combination of US parameters and FNAC significantly improved the AUC value (AUC: 0.878, P&lt;0.0001), sensitivity (83.33%), and specificity (79.14%). Univariate analysis showed that hypoechoic appearance, heterogenicity, large mass size (&gt;4 cm), “taller-than-wider,” infiltrative margins, and microcalcifications were risk factors for malignancy in thyroid nodules and were statistically significant (all P values &lt;0.05). Conclusion: Combining US characteristics with FNAC results can afford the maximum analytical accuracy in distinguishing benign from malignant thyroid nodules. This strategy is practical due to its simplicity, minimal invasiveness, and cost-effectiveness, enabling robust management regimens and avoiding additional surgical procedures.

Green synthesis of highly fluorescent carbon quantum dots from almond resin for advanced theranostics in biomedical applications

Fluorescent Carbon Quantum Dots (CQDs) are being used in medical applications, particularly in theranostics. These Carbon Quantum Dots have been gaining more attention lately due to their potential as an effective replacement for hazardous synthetic organic dyes in a variety of biomedical applications, including live cell imaging and diagnostics. In this study, highly fluorescent Carbon Quantum Dots by one pot microwave based green route with a size of less than 10 nm, was prepared from commercially available almond resin, Prunus dulcis and conjugated with honey as additional reagent for surface functionalization. They exhibit a deep blue emission on excitation at 350 nm with an elevated quantum yield at 61%. They possess atomic nature and basic features such as high photo-stability, varying fluorescence, greater biocompatibility, and better water solubility. These fluorescent labels exhibit faster cellular invagination without disturbing the cell stability. The CQDs present cell imaging capacity with multi-coloration for visualizing the fine architecture of the nucleus naming, the nuclear membrane and nucleolus, which is linked with their varied, surface structures such as amphiphilic property and higher positive charges. These characteristics with minimal invasion have made carbon quantum dots to become the spotlight in theranostics. They can be used as alternatives to synthetic dyes for fluorescence- related cell-imaging. The intriguing fact about this approach is that it opens the possibility of combining therapy and diagnostics into one unit, which can alter how some diseases are handled and, in turn, transform the field of healthcare.