Needle Puncture Research Articles

ASPECTS OF LIVER ECHINOCOCCOSIS SURGERY

According to the WHO, «…at any given time, more than 1 million people worldwide are aff ected by echinococcosis…». Due to the lack of tendency to decrease the number of patients and the existence of endemic regions where the incidence rate varies from 1.2 to 9.0 per 100,000 population, this parasitic disease continues to be a serious medical and social problem. At the present stage, the diagnosis of echinococcosis does not present signifi cant diffi culties, mainly due to the emergence of non-invasive imaging methods, the informative value of the complex application of which reaches 95-100 %.Aim of the study. Improving the treatment results of patients with liver echinococcosis.Research materials. The study included 328 patients with liver echinococcosis admitted to the surgery department of the multidisciplinary clinic of the Samarkand State Medical University in the period from 2005 to 2023. Depending on the choice of treatment, the patients were divided into two groups: the comparison group consisted of 154 (46.9 %) patients treated from 2005 to 2012 and the main group included 174 (53.0 %) patients operated on from 2013 to 2023.Research results. Compared with the comparison group, in the main group of patients, intraoperative complications decreased from 6.5 to 2.3 %, and complications in the early postoperative period from 18.2 to 5.2 %. In the late postoperative period, the recurrence of the disease decreased from 16.2 % to 3.6 %.Conclusions. The introduction of improved surgical instruments into practice – a modifi ed puncture needle, a «basket clamp» allowed to level the risk of seeding of surrounding tissues with embryonic elements. The introduction of a device for the purpose of identifying hidden biliary fi stulas in the residual cavity after echinococcectomy from the liver reduced the number of bile leaks. With the introduction of a modifi ed method for eliminating the residual cavity after echinococcectomy from the liver, the number of complications during surgery and in the early postoperative period was minimized.

Margin of safety for needle puncture of a radial artery in children: Recommendation for ultrasound-guided cannulation.

The radial artery is commonly selected for arterial puncture and cannulation, but radial nerve palsy may occur. To minimize possible damage to the nerve, needle puncture should be made within the margin of safety (between the wrist to the distal end of the radial artery and the radial nerve running in parallel). In adults, the margin of safety for radial artery puncture is approximately 6.8cm from the wrist in men and approximately 5.4cm in women, but the margin of safety is not known in children of different age groups. Using an ultrasound device, we measured the margin of safety in 100 anesthetized patients aged 0months to 15yr. Polynomial quadratic regression models were made, and the lower limit of the prediction interval was regarded as the margin of safety. These results were then compared with the results obtained in adults. The margin of safety became wider as a child grows older, and the height, weight, and age were all suitable explanatory variables to predict the margin of safety, providing fairly a constant predicted margin of safety from a few millimeters in neonates to approximately 4cm in adolescents (much narrower than in adults). In children and adolescents, the margin of safety for radial artery puncture is much narrower than in adults, and these findings support the recommendation to use ultrasound guidance during radial artery puncture in children and adolescents, to minimize the risk of associated complications. jRCT1032230243.

The utilization of guidewires for adjusting the intraoperative catheter malposition during the venous access port implantation: A retrospective study.

This study presents an in-depth exploration of various adjustment methods for intraoperative catheter malposition by guidewires in the implantation of totally implantable venous access ports (TIVAP). It not only aims to summarize these methods but also endeavors to identify the most advantageous approach. The patient list was searched using the hospital information system from January 1, 2022, to October 31, 2023. All patients who had undergone chest port placement using the axillary vein (AxV) or subclavian vein (SCV) approach were reviewed, and further imaging was performed to confirm the guidewire applied to adjust the guidewire or catheter from the internal jugular vein into the superior vena cava (SVC) under fluoroscopy. Demographic data, diagnoses, technical outcomes, and perioperative complications were collected. About 32 patients with an average age of 62.8 years were included in the study. The operation time was 29.3 ± 13.3 minutes and SVC selecting time was 16.9 ± 11.5 seconds. The dose of X-ray exposure was only 7.2 ± 9.0 μGym2. Adjustments combined the guidewire with the puncture needle had the shortest SVC selection time and operation time with a minimal radiation dose. intraoperative catheter malposition can be timely and effectively adjusted using guidewires under fluoroscopy during any process of TIVAP implantation. Timely adjustment using a guidewire after inserting into the puncture needle is an optimal choice for a smooth and successful operation.

Three-dimensional-printed guide plate for direct percutaneous pedicle screw implantation in minimally invasive transforaminal lumbar interbody fusion surgery: a retrospective study of 162 patients

BackgroundThis study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.MethodsOverall, 162 patients who underwent MIS-TLIF at Tai’an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery.ResultsThe conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05).ConclusionThe novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery.

Improvement in pain by using lidocaine combined with esketamine in elderly patients receiving local anaesthesia for percutaneous kyphoplasty: a randomized controlled study

BackgroundElderly patients often experience severe pain during percutaneous kyphoplasty under local anaesthesia. The aim of this work was to evaluate the effect of lidocaine combined with esketamine on pain improvement in elderly patients receiving local anaesthesia via percutaneous kyphoplasty.MethodsThis prospective, randomized comparative trial was conducted on 66 elderly patients, aged 60–80 years, with an American Society of Anaesthesiologists (ASA) grade of I-III, I‒III and a BMI of 18.5–25 kg/m2, who underwent single-level lumbar percutaneous kyphoplasty under local anaesthesia. Patients were divided into two equal groups (33 per group). Group LE received 200 mg of 1% lidocaine and 25 mg of esketamine (total volume of 20 ml), and Group L received 200 mg of 1% lidocaine (total volume of 20 ml). Patient characteristics, surgery, VAS scores, MAP, HR, MOAA/S scores, patient satisfaction and related adverse reactions were compared for the groups. The VAS scores during and after surgery were considered the primary outcome.ResultsThere were statistically significant differences in the VAS score between the two groups at the following time points: channel establishment by the puncture needle, balloon dilation, bone cement injection and postoperative period (P < 0.05). The VAS score decreased in the LE group, but the MAP and HR were more stable, and the difference was statistically significant (P < 0.05). The difference in the MOAA/S score between the two groups was statistically significant (P < 0.05), and the MOAA/S score in the LE group decreased. The patient satisfaction level in the LE group was 100% and 48.48% in the L group (P < 0.05). There were no related complications or adverse reactions in either group.ConclusionThe application of lidocaine combined with esketamine in local episcopal percutaneous vertebral kyphoplasty in elderly patients not only provides an effective analgesic effect but also improves surgical safety and patient comfort, which has important clinical value in promoting the optimization of surgical anaesthesia management in elderly patients.Trial registrationThe study was registered at Chictr.org.cn with the number ChiCTR2400083466 on 06/12/2023.

An in vitro study of irrigation rate, operator duty cycle and intrarenal temperature in superpulse fiber thulium laser lithotripsy

ObjectiveThe present study aimed to examine the relationship between irrigation velocity, operator duty cycle (ODC), and intrarenal temperature during retrograde intrarenal surgery with a superpulse fiber thulium laser.MethodsPlace the stones into the fresh isolated porcine kidneys, use puncture needle to place the temperature probe 2 mm around the stones, and place the pressure probes in the upper calyx, lower calyx, and renal pelvis. Place the entire setup in a 37 °C constant temperature water bath to simulate the human body environment. The laser power varies between 10 and 30 W, and the irrigation speed is 10-30 ml/min. Additionally, at a laser power of 20 W and an irrigation speed of 10 ml/min, different On-Duty Cycles (ODC) are set. Monitor the changes in temperature and pressure.ResultsA direct proportionality of temperature in the kidney to the rate of irrigation has been reported between 10 W and 30 W laser powers. The percentage ratio of the rate of irrigation and power in the laser is 1:1, which can keep the temperature in the kidney at a safe level. At a laser power of 20 W and irrigation of 10 ml/min, the temperature inside the kidney increases sharply with the increase in ODC. By decreasing the ratio of ODC, the increase of temperature inside the kidney can be brought to a great reduction.ConclusionMaintaining a 1:1 ratio between laser power and irrigation speed can effectively prevent thermal damage or injury to kidney tissue.Additionally, by adjusting the On-Duty Cycle (ODC) ratio, the intrarenal temperature can also be reduced.

Integrating 3D technology with the Sampaio classification for enhanced percutaneous nephrolithotomy in complex renal calculi treatment.

To investigate the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the treatment of complicated renal calculi by integrating three-dimensional (3D) computed tomography (CT) reconstruction with the Sampaio classification of the renal collecting system. Sixty-four consecutive patients with complex kidney calculi who underwent PCNL between January 2019 and October 2023 were retrospectively analyzed and divided into experimental group (3D printing) and control group (CT imaging) according to their willingness to pay for 3D imaging. Both groups underwent preoperative CT urography. The Digital Imaging and Communications (DICOM) in Medicine data of the experimental group from CT imaging were used for 3D reconstruction and model printing. Then, the Sampaio classification system was used to design the puncture channel and develop a surgical strategy. The 3D-printed models of the experimental group successfully displayed the Sampaio classification system. There was no significant difference in the baseline parameters between the groups. Compared with the control group, the experimental group exhibited significant improvements in the puncture time, number of puncture needles, number of puncture channels, target calyx consistency, number of first puncture channels, and stone clearance. There were no significant differences in the total operative time, decrease in the hemoglobin level, length of hospital stay, and postoperative complications between the groups. Integration of 3D technology with the Sampaio classification of the renal collecting system can enhance the preoperative evaluation and planning of percutaneous renal access. This approach allows a more precise method of PCNL for treating complex renal calculi.

Analysis of risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer after surgery and establishment of a nomogram prediction model.

To analyze the risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer and to construct and validate a nomogram prediction model. A retrospective analysis was conducted on 148 patients who underwent 125I particle implantation for advanced lung cancer at the *** from December 2022 to December 2023. Potential risk factors were identified using univariate logistic regression analysis, followed by a multivariate logistic regression analysis to evaluate the predictive factors for pneumothorax. Interaction effects between variables were studied and incorporated into the model construction. ROC curves and nomograms were generated for visualization. Calibration analysis was performed, and the corresponding net benefit was calculated to adjust the predictive model. Among the 148 patients, 58 (39.19%) experienced pneumothorax, with a mean age of 62.5 (55.25, 70) years. Multivariate analysis showed that the angle between the puncture needle and the pleura < 50° (P = 0.002, OR: 3.908, CI: 1.621-9.422), preoperative CT suggesting emphysema (P = 0.002, OR: 3.798, CI: 1.600-9.016), atelectasis (P = 0.009, OR: 3.156, CI: 1.331-7.481), and lesion located in the left lung fissure (P = 0.008, OR: 4.675, CI: 14.683) were independent risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer. Preoperative CT suggesting lesions in the left lung fissure or suggesting emphysema had a significant impact in the nomogram, with probabilities of pneumothorax occurrence at 40% and 38%, respectively. The predictive AUC for the above four risk factors for pneumothorax after particle implantation in the treatment of lung adenocarcinoma was 0.837 (95% CI: 0.767-0.908). When the Youden index was 0.59, the sensitivity was 85.56%, specificity was 74.13%, accuracy was 81.01%, positive predictive value was 83.69%, and negative predictive value was 76.78%. The angle between the puncture needle and the pleura < 50°, preoperative CT suggesting emphysema, atelectasis, and lesion located in the left lung fissure are independent risk factors for pneumothorax after particle implantation in the treatment of advanced lung cancer. Preoperative planning of the puncture path should avoid lung bullae, interlobar fissures, areas of severe emphysema, and atelectasis.

Searching Method for Three-Dimensional Puncture Route to Support Computed Tomography-Guided Percutaneous Puncture.

In CT-guided percutaneous punctures-an image-guided puncture method using CT images-physicians treat targets such as lung tumors, liver tumors, renal tumors, and intervertebral abscesses by inserting a puncture needle into the body from the exterior while viewing images. By recognizing two-dimensional CT images prior to a procedure, a physician determines the least invasive puncture route for the patient. Therefore, the candidate puncture route is limited to a two-dimensional region along the cross section of the human body. In this paper, we aim to construct a three-dimensional puncture space based on multiple two-dimensional CT images to search for a safer and shorter puncture route for a given patient. If all puncture routes starting from a target in the three-dimensional space were examined from all directions (the brute-force method), the processing time to derive the puncture route would be very long. We propose a more efficient method for three-dimensional puncture route selection in CT-guided percutaneous punctures. The proposed method extends the ray-tracing method, which quickly derives a line segment from a given start point to an end point on a two-dimensional plane, and applies it to three-dimensional space. During actual puncture route selection, a physician can use CT images to derive a three-dimensional puncture route that is safe for the patient and minimizes the puncture time. The main novelty is that we propose a method for deriving a three-dimensional puncture route within the allowed time in an actual puncture. The main goal is for physicians to select the puncture route they will use in the actual surgery from among the multiple three-dimensional puncture route candidates derived using the proposed method. The proposed method derives a three-dimensional puncture route within the allowed time in an actual puncture. Physicians can use the proposed method to derive a new puncture route, reducing the burden on patients and improving physician skills. In the evaluation results of a computer simulation, for a 3D CT image created by combining 170 two-dimensional CT images, the processing time for deriving the puncture route using the proposed method was approximately 59.4 s. The shortest length of the puncture route from the starting point to the target was between 20 mm and 22 mm. The search time for a three-dimensional human body consisting of 15 CT images was 4.77 s for the proposed method and 2599.0 s for a brute-force method. In a questionnaire, physicians who actually perform puncture treatments evaluated the candidate puncture routes derived by the proposed method. We confirmed that physicians could actually use these candidates as a puncture route.

Informative value of diagnostic imaging methods in the detection of subepithelial formations of the stomach: a clinical case

INTRODUCTION: Subepithelial formations (SubEO) of the upper gastrointestinal tract (GI tract) are asymptomatic in most cases, and are a diagnostic finding in routine studies. Given the risk of malignancy of some SubEO, the question of treatment tactics remains relevant today: observation or surgical intervention.PURPOSE: To demonstrate diagnostic capabilities at the outpatient stage when choosing observational tactics in a patient with SubEO.MATERIALS AND METHODS: A dynamic observation of a 68-year-old woman with a randomly identified SubEO was demonstrated. The patient has been observed by a gastroenterologist since 2005 with a diagnosis of functional disorder of the gallbladder and sphincter of Oddi. In August 2022, when contacting the clinic with complaints of epigastric pain and heartburn, the following studies were performed: gastroscopy (FGDS), endoscopic ultrasound (EUS) with fine needle puncture, transabdominal ultrasound (TAUZI), computed tomography (CT) of the abdominal cavity, during which a submucosal formation of the stomach was diagnosed. The picture is more consistent with a gastrointestinal stromal tumor (GISO). Given the small size of the formation, the surveillance tactic was chosen. At the time of 12.2023, according to the results of control studies of the SubEO without dynamics.RESULTS: The follow-up period was 17 months, the results of the control studies justified the wait-and-see tactics and allowed avoiding unjustified surgical interventions and intraoperative complications.CONCLUSION: The combined use of TAUZI with endoscopy contributes to a better differential diagnosis and the choice of adequate treatment tactics.

Computed tomography and structured light imaging guided orthopedic navigation puncture system: effective reduction of intraoperative image drift and mismatch.

Image-guided surgical navigation systems are widely regarded as the benchmark for computer-assisted surgical robotic platforms, yet a persistent challenge remains in addressing intraoperative image drift and mismatch. It can significantly impact the accuracy and precision of surgical procedures. Therefore, further research and development are necessary to mitigate this issue and enhance the overall performance of these advanced surgical platforms. The primary objective is to improve the precision of image guided puncture navigation systems by developing a computed tomography (CT) and structured light imaging (SLI) based navigation system. Furthermore, we also aim to quantifying and visualize intraoperative image drift and mismatch in real time and provide feedback to surgeons, ensuring that surgical procedures are executed with accuracy and reliability. A CT-SLI guided orthopedic navigation puncture system was developed. Polymer bandages are employed to pressurize, plasticize, immobilize and toughen the surface of a specimen for surgical operations. Preoperative CT images of the specimen are acquired, a 3D navigation map is reconstructed and a puncture path planned accordingly. During surgery, an SLI module captures and reconstructs the 3D surfaces of both the specimen and a guiding tube for the puncture needle. The SLI reconstructed 3D surface of the specimen is matched to the CT navigation map via two-step point cloud registrations, while the SLI reconstructed 3D surface of the guiding tube is fitted by a cylindrical model, which is in turn aligned with the planned puncture path. The proposed system has been tested and evaluated using 20 formalin-soaked lower limb cadaver specimens preserved at a local hospital. The proposed method achieved image registration RMS errors of 0.576 ± 0.146 mm and 0.407 ± 0.234 mm between preoperative CT and intraoperative SLI surface models and between preoperative and postoperative CT surface models. In addition, preoperative and postoperative specimen surface and skeletal drifts were 0.033 ± 0.272 mm and 0.235 ± 0.197 mm respectively. The results indicate that the proposed method is effective in reducing intraoperative image drift and mismatch. The system also visualizes intraoperative image drift and mismatch, and provides real time visual feedback to surgeons.

Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature.

Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

Prevention of Argentinian flag sign in intumescent cataracts using anterior chamber air bubble and cortical fluid release techniques

BackgroundTo investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29.MethodsPreoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed.ResultsFifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted.ConclusionsThe anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.

EP.07A.26 A Novel Four-Hook Puncture Needle for Accurate Localization of Small Pulmonary Nodules in VATS: A Single-Center Retrospective Study

EP.07A.26 A Novel Four-Hook Puncture Needle for Accurate Localization of Small Pulmonary Nodules in VATS: A Single-Center Retrospective Study

A Novel Transverse Ultrasound-Guided Approach for Puncturing the Cervical Dorsal Root Ganglion at the Level of Articular Pillar for Radiofrequency Treatment.

Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly involves the use of cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. Here, we proposed a novel transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment. A retrospective analysis of the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated with Hubei Medical University from January 2021 to March 2024 was performed. During surgery, motor electrical stimulation was used to induce movement in the nerve-innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. The numerical rating scale (NRS) was used for preoperative and postoperative pain assessment, clinical treatment effectiveness was evaluated, surgical duration and the associated complications were also recorded. Thirty patients exhibited clear cervical DRG images under ultrasound guidance, and the punctures were successful in all patients. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3-0.8 mv in all patients. No serious complications occurred during the procedure. The transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment is effective, convenient, and safe.

Selection of the Preferred Puncture Site on Manual Intraosseous Infusion: Proximal Humerus or Proximal Tibia?

Aims/Background Establishing an intraosseous infusion (IO) pathway can rapidly open an urgent route of drug administration for critically ill patients. This study aims to assess different puncture sites on the efficacy of manual intraosseous infusion. Methods Upon applying computed tomography (CT), we compared compact bone thickness and CT values at the same individual's proximal humerus and proximal tibia puncture sites (n = 40). Additionally, cadaveric experiments were used to compare the efficiency of manual puncture at two different insertion sites of the proximal humerus and proximal tibia in the same individual (n = 5). Results The compact bone thickness and CT values at the proximal humerus were significantly lower than those at the proximal tibia. The cadaveric experiments further confirmed that the proximal humerus was superior to the proximal tibia as an insertion site, indicating the proximal humerus is a more suitable insertion site for manual bone marrow puncture needles. Conclusion Selection of the puncture site markedly influences the effectiveness of manual intraosseous infusion, with the proximal humerus potentially offering better puncture efficacy than the proximal tibia.

The Study on Lymphatic Cysts Caused by Lymphadenectomy

&amp;lt;i&amp;gt;Background&amp;lt;/i&amp;gt;: Traumatic lymphatic cyst, also known as cystic lymphangioma, is a multidisciplinary disease, with congenital lymphatic cysts being more common. Lymphatic cysts lack specific clinical manifestations, and the vast majority of cases are incidentally discovered during auxiliary examinations or surgeries, making diagnosis challenging. Surgery is the most effective treatment for this condition, with a favorable prognosis. Lymphatic cysts caused by lymphatic injury are clinically rare. This study theoretically analyzes the clinical characteristics of lymphatic cysts resulting from lymphatic injury. &amp;lt;i&amp;gt;Objective&amp;lt;/i&amp;gt;: To explore the mechanisms by which lymphatic injury leads to lymphatic cyst formation and provide guidance for clinical treatment measures. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: The study involves analyzing the principles of lymphatic injury and examining the process of lymphatic cystic transformation and cyst formation. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: The causes of lymphatic injury include mechanical cutting, thermal energy conduction from electrocautery, needle puncture, and trauma. &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: There are various mechanisms and causes of lymphatic injury, and lymphatic injury is common during surgery. When lymphatic vessels are identified during surgery, they should be managed similarly to blood vessel ligation and disconnection. Lymphatic cysts are prone to recurrence, and complete resection is an effective treatment for this condition. Puncture and subtotal resection have a high recurrence rate.

Thyroid fine needle aspiration specimen adequacy: a noninferiority study and cost-effectiveness comparison of puncture needles

Needle selection plays a pivotal role in determining the success of fine needle aspiration (FNA) procedures. Two commonly utilized puncture needles for thyroid FNA are the conventional syringe needle and the stylet needle. Syringe needles are known for their cost-effectiveness in comparison to stylet needles. This study aimed to determine if FNA with syringe needles is non-inferior to FNA with stylet needles in terms of specimen adequacy while also comparing the direct costs associated with both needle types. A total of 220 thyroid nodules from 185 patients were prospectively included in this study. The same operator performed a total of four punctures on the same nodule twice using a syringe and a stylet needle. The results of this study show that the utilization of syringe needles for thyroid FNA was non-inferior to the use of stylet needles in terms of specimen adequacy. Cost analysis revealed that syringe needle FNA was not only less expensive (CNY 500.9 versus CNY 780) but also more effective (adequacy 85.91% versus 84.55%). In summary, given the global prevalence of FNA procedures, the economic considerations are paramount, and our findings support the routine use of syringe needles in thyroid FNA.

Efficacy of brachytherapy versus radical prostatectomy for localized prostate cancer–propensity score-matched comparison

ObjectiveThe brachytherapy (BT) and radical prostatectomy (RP) are two methods recommended in current guidelines for the treatment of localized prostate cancer (PCa). It is difficult to compare the oncological results of these two treatments because of differences in baseline characteristics and treatment selection.we sought to compare the efficacy of BT and RP after propensity score matching(PSM)analysis.MethodsBetween January 2009 and December 2021, our institution treated 657 patients with localized PCa (BT: n = 198; RP: n = 459)and followed up for > 2 years. Biochemical recurrence was defined as prostate-specific antigen (PSA) levels of nadir plus 2 ng/ml or higher (Phoenix definition) for BT, and as PSA0.2 ng/ml or greater for RP. PSM was applied based on the age, body mass index, PSA, prostate volume, clinical T-stage, Gleason grade, percentage of positive puncture needles ≥ 1/2, maximum tumor diameter ≥ 5 mm, and follow-up period.ResultsMedian follow-up was 63 months for BT and 52 months for RP. After propensity score adjustment, a total of 294 (147 each) patients remained for further analysis.Kaplan–Meier curves showed no statistically significant difference in clinical relapse-free survivals (cRFS) (p = 0.637),overall survival (OS) (p = 0.726),and cancer-specific survival (CSS) (p = 0.505).BT was associated with improved biochemical relapse-free survivals (bRFS) compared to RP (p = 0.022), Logistic multivariate analysis based on the whole cohort revealed that clinical T stage ≥ T2b (p = 0.043) and tumor maximum diameter ≥ 5 mm (p = 0.044) were associated with significantly bRFS.ConclusionThe BT and RP group patients exhibited similar cRFS, OS, and CSS. However, patients in the BT groups exhibited better bRFS than those in the RP group.Clinical T stage ≥ T2b and a maximum tumor diameter ≥ 5 mm were independent prognostic factors.

Peduncle Rot of Banana Caused by Fusarium petroliphilum and F. pernambucanum in Guangxi, China.

Banana is one of the main fruit crops worldwide. In October 2020, peduncles with rot were observed on bananas (Musa sp. ABB, Pisang Awak subgroup) at a about 1600 square meter commercial banana plantation in Dayu Town (23.17° N, 109.80° E), Guigang, Guangxi, China. The incidence of the disease was about 40%. The interior of the peduncle initially appeared reddish-brown and gradually turned black, and the peduncle eventually rotted. Two whole diseased bunches diseased samples were collected from banana plantations. Small pieces of tissues from the peduncle at the junction of disease and health were surface-disinfected in 75% ethanol for 10 s, 2% NaClO for 1 min, and rinsed three times in sterile water, then placed on potato dextrose agar (PDA) for incubation at 25°C. Forty-nine fungal isolates with similar morphology were recovered from diseased tissues, with 82% isolation frequency. Six isolates (GG3-1, GG3-2, GG3-3, GG4-1, GG4-2 and GG4-3) were selected for further study. Genomic DNAs of these isolates were extracted from 7-day-old mycelia. The internal transcribed spacer (ITS), translation elongation factor (TEF1), calmodulin (CAM), and partial RNA polymerase second largest subunit (RPB2) of six representative isolates were amplified and sequenced (O'Donnell et al. 2000, 2010; White et al. 1990). Sequences were deposited in GenBank. (accessions PP087392-PP087397 for ITS; PP102792-PP102797 for TEF1; PP102798-PP102803 for CAM; PP102804-P102809 for RPB2). A phylogenetic tree based on concatenated sequences of all markers using the Maximum Likelihood algorithm (Xia et al. 2019; Schroers et al. 2016). Based on phylogenetic analyses, GG3-1, -2 and -3 were identified as F. petroliphilum with 100% bootstrap support, and GG4-1, -2 and -3 were tightly clustered with F. pernambucanum with 95% bootstrap support. The two representative isolates GG3-2 and GG4-2 were selected for morphology and pathogenicity observation. Colonies of GG3-2 were light yellow and flat mycelium. They produced falciform macroconidia of 46.1 ± 5.3 × 2.6 ± 0.4 μm with 3 to 5 septates, and hyaline, ovoid microconidia of 7.6 ± 0.9 × 4.0 ± 0.6 μm with 0 septate (Brown et al. 2022). Mycelia were whitish to yellowish aerial mycelium for GG4-2. Their macroconidia were falcate of 31.6 ± 3.0 × 4.3 ± 0.3 μm with curved apical cells, foot-shaped basal cells, and 3 to 5 septates. The microconidia were fusoid of 8.9 ± 1.0 × 2.7 ± 0.3 μm with 0 to 1 septate (Santos et al. 2019). For pathogenicity tests, the ends of the banana peduncles were cut off. Needle punctures were made on the ethanol-treated peduncle pieces, followed by inoculation with 20 μL of conidial suspension (106 spores/ml) of each of the two isolates with three replications each. Sterilized water was used as a control. Peduncle pieces were placed in a humid box and incubated at 28ºC. After 7 days, reddish-brown to black lesions were observed on all inoculated peduncle pieces, while no symptoms were observed on the control pieces. The fungus was isolated from the inoculated peduncle pieces and found to match the morphological characteristics and marker sequences of the original isolates, confirming Koch's postulates. To our knowledge, this is the first report of peduncle rot on banana caused by F. petroliphilum and F. pernambucanum in China. This study will provide valuable information on causal pathogens of this disease which can contribute to improving prevention and disease management strategies for growers.