Modification Of Technique Research Articles

Percutaneous Mitral Balloon Valvuloplasty in a Patient with Situs Inversus with Dextrocardia: A Case Report

Situs inversus with dextrocardia is a rare congenital disorder. There is a rare coincidence of rheumatic severe mitral stenosis in a patient with situs inversus and dextrocardia. Most of these patients undergo surgery due to technical difficulty, here we report a case of a 41-year-old male managed successfully with percutaneous intervention. Percutaneous mitral balloon valvuloplasty (PMBV) is feasible in these rare group patient with some additional modifications of the standard Accura balloon technique. Procedure should be carried out under Transthoracic echocardiography (TEE) guidance with surgical team standby in case emergency need of surgery. Despite all the precautions, careful watch on these patients has to be kept during immediate post procedure phase for at least 12 hours for any untoward complication.

Intrahepatic bile duct anatomical variation in liver transplant donors and its implication in liver transplantation

BackgroundFor patients with end-stage liver disease, liver transplantation is considered the chief curative option. Radiological imaging has a pivotal role in evaluating both donors and recipients before and after transplantation. So the purpose of our study is to assess anatomical variant of intra-hepatic bile duct variation among liver transplant donors by MRCP and its implication in liver transplantation. Retrospective study was carried out in Mansoura University Hospitals over period from January 2019 till June 2022. Study included 64 liver transplant donors aged from 21 to 46 years old. All subjects underwent MRCP. Analysis of data obtained from images as well as reconstruction was performed to get images of bile ducts with a maximum intensity projection and volume rendering.ResultsOur study included 64 liver transplant donors. Donor mean age was 29.8 ± 2.57 years with range between 20 and 38 years. There were 40 males (62.5%) and 24 females (37.5%). Regarding right posterior hepatic duct drainage based on Huang classification, the type of bile duct variant was classified as follows: The most common variant was type A1 in 50% of the donors followed by type A4 in 20.3% then type A2 and type A3 in 14.1% each. The distance between RPHD insertion and junction between the right and left hepatic ducts (L) owns a surgical importance as it may need modification of surgical technique if L was more than 1 cm. So according to karakas classification, we had to subtype Huang A1 cases into K1 subtype (L > 1 cm) and K2a subtype (L ≤ 1 cm). Our subjects were 20 with K1 subtype (31.25%) and 12 with K2a subtype (18.75%).ConclusionsAssessment of anatomical variation of right hepatic duct in liver transplant donor by non-invasive method as MRCP had a fundamental role to obtain successful surgical outcome and also to reduce hepatobiliary surgical complications.

A Clinical Approach for the Removal of a Large Antral Pseudocyst with Simultaneous Maxillary Sinus Augmentation: A Case Series.

For a large benign lesion within the maxillary sinus, such as an antral pseudocyst, maxillary sinus floor augmentation is more commonly performed using a two-stage approach. This involves first removing the lesion, and then, re-entry following several months of healing. In this case series, we described the "one-bony-window" approach, which is a technical surgical modification of the previous one-stage approach, for simultaneous cyst removal and maxillary sinus floor augmentation. Four patients with large maxillary antral pseudocysts were included. The "one-bony-window" approach involves the preparation of a large window opening of approximately 15 mm × 20 mm at the lateral wall. A mesiodistally extended intentional perforation was made in the upper part of the exposed membrane to enhance the access for instrumentation. The antral pseudocyst was removed in its entirety without being deformed to prevent rupture or leakage of the cystic contents. Subsequent detachment and elevation of the Schneiderian membrane at the sinus floor significantly reduced the perforation site, and bone grafting with implant placement was performed simultaneously. This alleviated the need to surgically repair the perforation. The lateral opening was either uncovered or repositioned using bony window lids. Healing abutments were connected after six months, and the final prosthesis was placed after two months. At the 1-year follow-up, the antral pseudocysts had resolved with no specific recurrence, and the stability of the augmented sinus was maintained with excellent implant survival. Within the limitations of our findings, the "one-bony-window" technique can be suggested for the simultaneous removal of large antral pseudocysts and maxillary sinus floor augmentation with favorable clinical outcomes.

Intramedullary nailing as osteosynthesis technique for the fibula in total ankle arthroplasty via lateral approach

Objective: To describe a variation in the final osteosynthesis technique for total ankle replacement (TAR) implantation through lateralapproach. Methods: We retrospectively reviewed a series of cases dated between January 2022 and May 2023 in which intramedullary nailing was used as the osteosynthesis technique for the fibula during TAR implantation via lateral approach. Results: In all cases, skin scarring and soft tissue recovery to baseline were achieved in one and a half month to three months. Consolidation of the fibula occurred at an average of three months. No material was removed in any of the cases to date. Finally, patients were satisfied, resuming their previous activities. Conclusion: To our knowledge, this study is the first to investigate a modification of the osteosynthesis technique in the lateral approach to TAR. We believe the intramedullary nail for the fibula may be a useful tool to prevent soft tissue complications, requiring prospective and comparative studies to evaluate its efficacy. Level of Evidence IV; Therapeutic Studies; Case Series.

Mentalization-based approach for schizophrenia spectrum disorders: a psychotherapeutic proposal for evolved schizophrenic trajectories and serious mental disorders.

There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.

Characterization of sexual maturity-associated N6-methyladenosine in boar testes

BackgroundThe health and size of the testes are crucial for boar fertility. Testicular development is tightly regulated by epigenetics. N6-methyladenosine (m6A) modification is a prevalent internal modification on mRNA and plays an important role in development. The mRNA m6A methylation in boar testicular development still needs to be investigated.ResultsUsing the MeRIP-seq technique, we identify and profile m6A modification in boar testes between piglets and adults. The results showed 7783 distinct m6A peaks in piglets and 6590 distinct m6A peaks in adults, with 2,471 peaks shared between the two groups. Enrichment of GO and KEGG analysis reveal dynamic m6A methylation in various biological processes and signalling pathways. Meanwhile, we conjointly analyzed differentially methylated and expressed genes in boar testes before and after sexual maturity, and reproductive related genes (TLE4, TSSK3, TSSK6, C11ORF94, PATZ1, PHLPP1 and PAQR7) were identified. Functional enrichment analysis showed that differential genes are associated with important biological functions, including regulation of growth and development, regulation of metabolic processes and protein catabolic processes.ConclusionThe results demonstrate that m6A methylation, differential expression and the related signalling pathways are crucial for boar testicular development. These results suggest a role for m6A modification in boar testicular development and provided a resource for future studies on m6A function in boar testicular development.

Modified partial posthectomy surgery for chronic preputial prolapse in a Bos indicus bull

Modified partial posthectomy surgery for chronic preputial prolapse in a Bos indicus bull

Application and Advantages of the Trans-Unco-Discal (TUD) Approach for Cervical Spondylotic Myelopathy and Radiculopathy: Classification and Modification of Surgical Technique Based on the Location of Spinal Cord and/or Nerve Root Compression.

Purpose: We assess the application and advantages of modifying the trans-unco-discal (TUD) approach which we underwent for cervical myelo-radiculopathy. We present the surgical techniques of the modified TUD approach. Materials and Methods: The material was 180 cases where anterior cervical decompression (ACD) was performed by the modified TUD approach. We classified the material into four groups based on the location of the nerve root and/or spinal cord compression: I, compression of the root at intervertebral foramen (IVF); II, compression of the posterior margin of the vertebral body; III, compression of the IVF and posterior margin of the vertebral body; IV, compression of the bilateral IVF and posterior margin of the vertebral body. We applied the modified TUD approach to these four types. We present the surgical procedures and techniques for the modified TUD approach. The Japanese orthopedic association (JOA) score and neuroradiological alignment were examined. Results: The improvement rate of the JOA score was 78.4% at 6 months post-surgery and 77.5% in the most recent examinations. By the modified TUD approach, compressive lesions of the spinal cord and/or nerve roots were removed, and good alignment was acquired and sustained. Conclusions: ACD by the modified TUD approach safely achieved appropriate decompression for the spinal cord and/or nerve roots, and the patients had a high improvement rate and good alignment. Complications were less common than with other surgical procedures. If the TUD approach and endoscopic approaches can be combined, their application to new area is anticipated.

Individualized Technique Feedback for Instant Technique Improvements and Knee Abduction Moment Reductions - A New Approach for 'Sidestepping' ACL Injuries?

Sidestep cutting technique is highly individual and has been shown to influence knee joint loading. However, studies assessing whether individualized technique feedback improves technique and ACL injury-relevant knee joint loads instantly in a sport-specific task are lacking. To determine the instant effects of individualized augmented technique feedback and instructions on technique and the peak external knee abduction moment (pKAM) in a handball-specific sidestep cut. Additionally, to determine the effects of technique modifications on the resultant ground reaction force and its frontal plane moment arm to the knee joint center. Controlled laboratory cohort study. Three-dimensional biomechanics of 48 adolescent female handball players were recorded during a handball-specific sidestep cut. Following baseline cuts to each side, leg-specific visual and verbal technique feedback on foot strike angle, knee valgus motion, or vertical impact velocity using a hierarchically organized structure accounting for the variables' association with performance was provided. Subsequently, sidestep cuts were performed again while verbal instructions were provided to guide technique modifications. Combined effects of feedback and instructions on technique and pKAM as well as on the resultant ground reaction force and its frontal plane moment arm to the knee joint center were assessed. On average, each targeted technique variable improved following feedback and instructions, leading to instant reductions in pKAM of 13.4% to 17.1%. High inter-individual differences in response to feedback-instruction combinations were observed. These differences were evident in both the adherence to instructions and the impact on pKAM and its components. Most players were able to instantly adapt their technique and decrease ACL injury-relevant knee joint loads through individualized augmented technique feedback, thereby potentially reducing the risk of injury. More research is needed to assess the retention of these adaptations and move towards on-field technique assessments using low-cost equipment. Level 3.

Interdisciplinary Management of Skull Base Tumors.

Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.

External dacryocystorhinostomy: A critical overview of the current evidence.

External dacryocystorhinostomy (ext-DCR) is still considered the gold standard in the treatment of distal lacrimal duct obstruction. Despite an overall high success rate, some patients do relapse after surgery and the ideal perioperative management has not been identified yet. The purpose of this study is to critically discuss the published evidence in the last five years on the medical and surgical management of external dacryocystorhinostomy. Furthermore, the drawbacks of the available literature and the perspectives in this field will be also highlighted. Systematic review of the literature in the last 5 years by using PubMed and Google Scholar. A total of 64 articles were included. Many technical modifications and surgical refinements have been proposed but a formal comparison among the various techniques is hampered by methodological heterogeneity. The use of local anesthesia, and the perioperative adjunctive techniques to reduce the risk of restenosis are also gaining popularity but the level of evidence remains weak. Ext-DCR offers satisfactory clinical outcomes even though there are many gray areas that need to be addressed in future high-quality studies.

Prussian Blue Analogues for Sodium-Ion Battery Cathodes: A Review of Mechanistic Insights, Current Challenges, and Future Pathways.

Prussian blue analogues (PBAs) have emerged as highly promising cathode materials for sodium-ion batteries (SIBs) due to their affordability, facile synthesis, porous framework, and high theoretical capacity. Despite their considerable potential, practical applications of PBAs face significant challenges that limit their performance. This review offers a comprehensive retrospective analysis of PBAs' development history as cathode materials, delving into their reaction mechanisms, including charge compensation and ion diffusion mechanisms. Furthermore, to overcome these challenges, a range of improvement strategies are proposed, encompassing modifications in synthesis techniques and enhancements in structural stability. Finally, the commercial viability of PBAs is examined, alongside discussions on advanced synthesis methods and existing concerns regarding cost and safety, aiming to foster ongoing advancements of PBAs for practical SIBs.

Present and Future Applications of Digital PCR in Infectious Diseases Diagnosis.

Infectious diseases account for about 3 million deaths per year. The advent of molecular techniques has led to an enormous improvement in their diagnosis, both in terms of sensitivity and specificity and in terms of the speed with which a clinically useful result can be obtained. Digital PCR, or 3rd generation PCR, is based on a series of technical modifications that result in more sensitive techniques, more resistant to the action of inhibitors and capable of direct quantification without the need for standard curves. This review presents the main applications that have been developed for the diagnosis of viral, bacterial, and parasitic infections and the potential prospects for the clinical use of this technology.

Costal margin reconstruction for slipping rib syndrome: Outcomes of more than 500 cases and advancements beyond earlier sutured repair technique

ObjectivesTo evaluate results of sutured repair for slipping rib syndrome (SRS), identify failure points, and discuss technique modifications to improve outcomes through costal margin reconstruction (CMR). MethodsPatients undergoing repair of SRS between February 2019 and February 2024 at an academic referral institution were retrospectively analyzed. Pain scores, quality of life, pain medication use, and reoperations were evaluated pre- and postoperatively at 1 and 6 months. In patients failing sutured repair we identified specific failure points and devised a new CMR technique to overcome them. Subsequent CMR patients were followed at 1, 6, 12, 18, and 24 months using the same outcome measures. ResultsFour hundred forty-nine patients underwent repair. Two hundred forty-one patients underwent sutured repair with revision required in 66. Median time to revision was 14 months. CMR was developed and performed in 247 patients. In CMR patients, preoperative mean pain score of 7.5 out of 10 dropped postoperatively to 4.0, 2.5, 1.9, 1.3, and 0.9 at 1, 6, 12, 18, and 24 months, respectively (P < .001). Mean quality of life of 38% improved to 73%, 83%, 88%, 93%, and 95% at the same intervals (P < .001). Preoperatively, 29% of patients chronically used opioid medications. Opioid use dropped postoperatively to 11%, 4%, 4%, 0%, and 0% at the same intervals. Use of nonopioid medications followed a similar pattern. One CMR patient required full revision. ConclusionsSRS is a debilitating, but correctable disorder. Improved pain and quality of life, reduction in chronic opioid use, and freedom from revision surgery suggest that CMR should be considered the standard operation for SRS.

Controversies in Endoscopic Ultrasound-Guided Biliary Drainage.

In this 14th document in a series of papers entitled "Controversies in Endoscopic Ultrasound" we discuss various aspects of EUS-guided biliary drainage that are debated in the literature and in practice. Endoscopic retrograde cholangiography is still the reference technique for therapeutic biliary access, but EUS-guided techniques for biliary access and drainage have developed into safe and highly effective alternative options. However, EUS-guided biliary drainage techniques are technically demanding procedures for which few training models are currently available. Different access routes require modifications to the basic technique and specific instruments. In experienced hands, percutaneous transhepatic cholangiodrainage is also a good alternative. Therefore, in this paper, we compare arguments for different options of biliary drainage and different technical modifications.

THE FITBONE INTRAMEDULLARY LENGTHENING NAIL IN THE MANAGEMENT OF ADULT AND PAEDIATRIC LIMB DEFORMITY: A RETROSPECTIVE COHORT STUDY AT A TERTIARY REFERRAL LIMB RECONSTRUCTION SERVICE

IntroductionManagement of deformity involving limb length discrepancy (LLD) using intramedullary devices offers significant benefits to both patients and clinicians over traditional external fixation. Following the withdrawal of the PRECICE nail, the Fitbone became the primary implant available for intramedullary lengthening and deformity correction within our service. This consecutive series illustrates the advantages and complications associated with the use of this device, and describes a novel technique modification for antegrade intramedullary lengthening nails.Materials &amp; MethodsA retrospective cohort review was performed of patient outcomes after treatment with the Fitbone nail at two tertiary referral limb reconstruction services (one adult, one paediatric) between January 2021 to December 2023. Aetiology, indications, initial and final LLD, use of concomitant rail assisted deformity correction (ORDER), removal time and healing index were assessed. Complications of treatment were evaluated and described in detail, alongside technique modifications to reduce the rate of these complications.Results21 nails (18 femoral, 2 tibial, 1 humeral) were inserted in 6 adult and 13 paediatric patients. Post-traumatic and congenital/developmental LLD were the most common indications for surgery in the adult and paediatric cohorts respectively. ORDER was employed in 11 cases (9 femurs and 2 tibias). Treatment goals were achieved in all but one case. Complications included superficial infection, locking bolt migration, periprosthetic fracture and component failure. Seven patients required unplanned returns to theatre.ConclusionsThe Fitbone nail is an established option for intramedullary limb lengthening, however its use in the UK has been relatively limited compared to the PRECICE until 2021. Our data helps to define its place for limb lengthening and complex deformity correction in both adult and paediatric patients, including in humeral lengthening and retrograde femoral insertion across an open physis. We have identified important potential risks and novel techniques to simplify surgery and avoid complications.

The “Angel-Wing” Combined Labia Minoraplasty/Majoraplasty

Background: Reduction of prominent/hypertrophic/ptotic vulvar labia minora and/or labia majora is an increasingly common surgical procedure in the hands of plastic and cosmetic surgeons and female genital cosmetic and reconstructive surgeons. While several techniques for these reductions are described in the literature and are individually modified by experienced practitioners, 2 procedures for the minora (linear and wedge-type reductions), and the vertically-aligned reduction of redundant majora are the most utilized techniques. It is not unusual for a woman to present to her potential surgeon requesting “work” on both minora and majora. Historically, this has necessitated two separate incision lines (minora and majora) bilaterally, often resulting in a long case, difficult recovery, and a significant potential for visible incision lines and gaping of the vaginal introitus. Objective: To introduce a novel single-incision-line technique for combining labia minoraplasty and labia majoraplasty. Methods: A modification of a classic central V-Wedge technique is affected by “shifting” the wedge incision line across the interlabial fold to encompass a portion of the medial labum majorum, both reducing redundancy and “lifting” the lowermost portion of the majora to correct ptosis. This is accomplished in one incision line with “en-bloc” closure of both minora and majora, placing the incision line mostly within the interlabial fold. Results: The author has completed eight wedge-type combined labia minora-majoraplasties without complication and with 2.5-36 months of follow-up. Discussion: This modification in Wedge design converts two separate procedures into one, making the surgery both less time-consuming, easier to recover from, and more visually esthetic for those patients who are capable of the more rigorous recovery protocol that wedge procedures mandate. Conclusion: The “Angel-Wing combined labia minoraplasty + labia majoraplasty appears to be a relevant option for combined labia minor hypertrophy and labia majora deflation and redundancy.

Choice of suture technique may mitigate figure-of-8 deformity in slide tracheoplasty

ObjectivesTo demonstrate varying degrees of immediate postoperative figure of 8 deformity following three different methods of tracheal suturing. Study designComparative ex-vivo study. MethodsA fresh, unfixed rabbit trachea was harvested and bisected at its midpoint. The posterior membranous trachea was excised from both segments to mimic the anatomy of complete tracheal rings following longitudinal release. A slide tracheoplasty was performed on the same tracheal segments as an internal control, using three different methods of closure: simple running, running horizontal mattress, and a modified baseball stitch. Endoscopic and external photographs were taken immediately following repair to document the effect of closure technique on external and endoluminal anatomy. ResultsA simple running closure, in which traveling occurs between needle passes, showed the greatest degree of postoperative figure of 8 deformity. A running horizontal mattress suture closure showed less deformity and a modified running closure, in which traveling occurs within needle passes, showed the least deformity. ConclusionsOur study suggests that a minor modification of standard running closure techniques may help limit the common figure-of-8 deformity often noted following slide tracheoplasty. Lay SummaryFigure of-8 deformity is a problem that can occur when repairing a narrow trachea referred to as tracheal stenosis. This deformity may be prevented using particular suture techniques which may decrease the likelihood that the trachea becomes blocked again following repair.

Adding Short to Left Gastric Artery Embolization for the Treatment of Obesity: Safety and Effectiveness.

This study assessed the safety and effectiveness of a technical modification that involves adding short gastric artery (SGA) embolization to left gastric artery (LGA) embolization. This retrospective single-center study analyzed twenty obese patients (median age of 53.5 (30-73)) who were not eligible for bariatric surgery and underwent bariatric embolization with 300-500-µm microspheres in addition to a lifestyle counseling program between March 2021 and July 2022. Eight patients had LGA + SGA embolization, and twelve had LGA embolization alone. The primary outcome measure was total body weight loss (TBWL) at 6months in the SGA + LGA and the LGA-only cohorts. Safety was assessed, defined as the 30-day adverse events rate according to the SIR classification. The mean 6-month post-embolization TBWL in the SGA + LGA cohort was 7.3kg (95%CI 2.1-12.4; p = .01) and 4.1kg (95%CI 0.4-8.6; p = 0.034) in the LGA-only cohort (mean difference - 3.1kg ± 2.8; 95%CI (- 9.1-2.8); p = .28). The mean 6-month post-embolization TBWL in the entire cohort was 5.3kg (p < .01). The rate of complications was similar between the two groups. Combined SGA and LGA embolization is safe and effective to treat obesity. Larger studies are needed to determine whether SGA + LGA embolization results in more significant weight loss than LGA embolization alone.

A proposed tacho-less order tracking technique suitable for railway vehicle condition monitoring applications

To perform a condition monitoring for rotating machines with variable running speed, order tracking is considered as an effective technique suitable for their non-stationary vibration signals. A tachometer signal is necessary to perform a computed order tracking (COT) technique; however, in some applications it's not possible to add tachometer hardware due to its complexity or shortage of power. To improve the applicability of order tracking techniques, some tacho-less order tracking techniques have been introduced in the last few years. These techniques are working off-line by inspecting the vibration signals in time-frequency domain to extract the machine rotating speed. In this paper, a new tacho-less technique suitable for continuous structural health monitoring applications of railway vehicles, is proposed. In the presented approach, a coarse angular speed of the railway axle is estimated firstly using estimation train speed. Then this coarse angular speed is used to improve the applicability of the traditional tacho-less techniques to be able to work online. The train speed is estimated from two acceleration signals obtained from vertical vibration of axle-boxes from same side of train. The sequential properties of the two signals are used to estimate the delay time of one signal with respect to the other one by means of cross-correlation function. By knowing the horizontal distance between the two sensors collected the vibration signals, the train speed can be estimated. This modification of tacho-less technique improves the effectiveness and robustness of the traditional maxima tracking strategy to be performed automatically. Thereafter, signal processing technique based on the computed order tracking as well as averaging technique can be applied to extract the useful information from noisy and non-stationary signals. This technique has been proposed in a framework of a project investigating crack detection using vibration measurements, therefore, vibration signals of cracked axle have been processed using tacho-based method and using the proposed tacho-less technique and a good agreement has been found between the two techniques.