Nylon Loop Research Articles

A Retrospective Study of 290 Patients with Resectable Benign and Malignant Gastric Neoplasms to Compare Postoperative Outcomes of Endoscopic Resection with and without the Internal Traction Method Using a Spring-and-Loop with Clip (S-O Clip).

BACKGROUND The spring-and-loop with clip (S-O clip) consists of a spring and a nylon loop located on one side of the claws of the clip, and is used in gastric endoscopic submucosal dissection (ESD) to allow countertraction. This retrospective study included 290 patients with early gastric neoplasms (eGNs) and aimed to compare postoperative outcomes of ESD with and without the use of the S-O clip. MATERIAL AND METHODS We retrospectively reviewed the data of 347 patients with eGN who underwent ESD, with or without an S-O clip, at our institution between April 1, 2017 and March 31, 2023. Overall, 290 patients were analyzed after excluding ineligible participants. The control group (n=149; adenoma: 1, carcinoma: 148) underwent ESD without an S-O clip between April 2017 and March 2020, while the S-O group (n=141; adenoma: 4, carcinoma: 137) used the clip between April 2020 and March 2023. Primary outcomes included procedure time, en bloc resection rate, and complete resection rate. Subgroup analysis for examined procedure time concerning endoscopist expertise, submucosal fibrosis, and neoplasm locations. RESULTS The S-O group had a shorter procedure time (44.4±23.9 vs 61.1±40.9 min, P<0.001) and a higher complete resection rate (97.9% vs 92.6%, P<0.05) than the control group. Subgroup analysis revealed that the S-O clip significantly reduced procedure time for trainees compared to the control group (40.8±18.3 vs 61.1±35.6 min, P<0.05). CONCLUSIONS The scheduled use of S-O clips in gastric ESD is effective in improving procedural time and complete resection rates, benefiting endoscopists across all experience levels.

A novel method for efficient closure of large mucosal defects using nylon loops combined with titanium clips after endoscopic submucosal dissection

A novel method for efficient closure of large mucosal defects using nylon loops combined with titanium clips after endoscopic submucosal dissection

Eradication of angiomas by nylon loop snare ligation under total enteroscopy, in disseminated intravascular coagulation associated with blue rubber bleb nevus syndrome.

Eradication of angiomas by nylon loop snare ligation under total enteroscopy, in disseminated intravascular coagulation associated with blue rubber bleb nevus syndrome.

Use of a nylon loop and transparent cap to assist in the endoscopic removal of a long and bent metal foreign body incarcerated in the duodenum.

Use of a nylon loop and transparent cap to assist in the endoscopic removal of a long and bent metal foreign body incarcerated in the duodenum.

P16 Endoloop ligatures in the retrieval of urethral foreign bodies: a narrative review

Abstract Introduction Self-insertion of foreign bodies into the urethra has been described previously in patients presenting to hospital emergency services. Treatment typically involves procedural retrieval under local anaesthesia using basket or forceps, cystoscopy, or open surgery. An Endoloop is a device designed to snare colonic polyps during endoscopy with nylon loops. It is not traditionally used for retrieval of urethral foreign bodies. Our objective was to determine the incidence, safety and efficacy of this approach. Methods A narrative review was performed. Primary outcomes were technical success, defined as uncomplicated retrieval of foreign body, and adverse events related to pain, bleeding, infection, and damage to structures. Electronic searches were performed using PubMed, Embase and Google Scholar. Reference lists of selected studies were searched manually. Results 2 case studies met inclusion criteria for analysis, both describing self-insertion of urethral foreign bodies for purposes of sexual arousal. These comprised a 30-year-old male (magnets) and a 29- year-old female (metal urethral sound). Both patients underwent successful retrieval of foreign body using an Endoloop ligature. There were no symptoms post-operatively and no procedural complications were reported. Conclusion An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval. Follow-up is mandatory to monitor for complications due to foreign body insertion such as urethritis, incontinence, fistula and diverticulum formation. Referral to psychological services is encouraged to reduce the risk of recurrence. Further studies are required to validate the efficacy and safety of this technique. Take-home message An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval of urethral foreign bodies.

Endoscopic removal of a migrated esophageal covered self-expandable metal stent: the nylon loop pusher-assisted method.

Endoscopic removal of a migrated esophageal covered self-expandable metal stent: the nylon loop pusher-assisted method.

Transcutaneous medial fixation sutures for free flap inset after robot-assisted nipple-sparing mastectomy.

The application of minimal invasive mastectomy has allowed surgeons to perform nipplesparing mastectomy via a shorter, inconspicuous incision under clear vision and with more precise hemostasis. However, it poses new challenges in microsurgical breast reconstruction, such as vascular anastomosis and flap insetting, which are considerably more difficult to perform through the shorter incision on the lateral breast border. We propose an innovative technique of transcutaneous medial fixation sutures to help in flap insetting and creating and maintaining the medial breast border. The sutures are placed after mastectomy and before flap transfer. Three 4-0 nylon suture loops are placed transcutaneously and into the pocket at the markings of the preferred lower medial border of the reconstructed breast. After microvascular anastomosis and temporary shaping of the flap on top of the mastectomy skin, the three corresponding points for the sutures are identified. The three nylon loops are then sutured to the dermis of the corresponding medial point of the flap. The flap is placed into the pocket by a simultaneous gentle pull on the three sutures and a combined lateral push. The stitches are then tied and buried after completion of flap inset.

Arthroscopic Capsular Repair for Triangular Fibrocartilage Complex Tears.

Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique. Description of Technique We inserted a 21-gauge needle with 4-0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4-0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule. Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively. Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less. Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.

Microplates for Crystal Growth and in situ Data Collection at a Synchrotron Beamline

An efficient data collection method is important for microcrystals, because microcrystals are sensitive to radiation damage. Moreover, microcrystals are difficult to harvest and locate owing to refraction effects from the surface of the liquid drop or optically invisible, owing to their small size. Collecting X-ray diffraction data directly from the crystallization devices to completely eliminate the crystal harvesting step is of particular interest. To address these needs, novel microplates combining crystal growth and data collection have been designed for efficient in situ data collection and fully tested at Shanghai Synchrotron Radiation Facility (SSRF) crystallography beamlines. The design of the novel microplates fully adapts the advantage of in situ technology. Thin Kapton membranes were selected to seal the microplate for crystal growth, the crystallization plates can support hanging drop and setting drop vapor diffusion crystallization experiments. Then, the microplate was fixed on a magnetic base and mounted on the goniometer head for in situ data collection. Automatic grid scanning was applied for crystal location with a Blu-Ice data collection system and then in situ data collection was performed. The microcrystals of lysozyme were selected as the testing samples for diffraction data collection using the novel microplates. The results show that this method can achieve comparable data quality to that of the traditional method using the nylon loop. In addition, our method can efficiently and diversely perform data acquisition experiments, and be especially suitable for solving structures of multiple crystals at room temperature or cryogenic temperature.

Modified attachment method using an S-O clip for gastric endoscopic submucosal dissection.

Modified attachment method using an S-O clip for gastric endoscopic submucosal dissection.

Therapeutic application of purse-string sutures with nylon loops and metal clips under single-channel endoscopy for repair of gastrointestinal wall defects.

The present study was performed to evaluate the therapeutic safety and feasibility of purse-string sutures with nylon loops and metal clips under single-channel endoscopy to repair gastrointestinal wall defects that had previously developed during endoscopic full-thickness resection (EFR). A multicenter prospective cohort study of 42 patients who had developed defects of the gastrointestinal wall during EFR was conducted from April 2012 to October 2016. All lesions were endoscopically repaired with either a single-channel gastroscope (research group, n=18) or double-channel gastroscope (control group, n=24). The patients' clinical features, purse-string suturing times and complication rates were analyzed. There was no significant difference in the perforation rate between the research and control groups. There were also no significant differences in the purse-string suturing time (research vs. control group, 10.5 vs. 14.6 min, respectively; P=0.214), specimen size or complication rate (subcutaneous emphysema) between the two groups. No recurrences were observed during the follow-up period. The current data suggest that application of purse-string sutures with nylon loops and metal clips for repair of EFR-induced gastrointestinal wall defects may be safely and feasibly applied under single-channel gastroscopy as well as under double-channel gastroscopy.

New design for multi-crystal data collection at SSRF

Data collection with microcrystals at synchrotron radiation facilities is challenging because it is difficult to harvest and locate microcrystals. Moreover, microcrystals are sensitive to radiation damage; thus, typically, a complete data set cannot be obtained with a single microcrystal. Herein, we report a new method for data collection with multiple microcrystals having a crystal size ranging from 1 to 30 µm. This method is suitable for not only low-temperature (100 K) data collection but also room-temperature data collection. Thin Kapton membranes were used to capture multiple crystals simultaneously. The microcrystals were visible under an optical microscope and easily located because the membrane was transparent and sufficiently thin. The film was fixed to a bracket that was prepared using a three-dimensional printer. The bracket was fixed on a magnetic base via screwing and employed by the goniometer system for data collection. Multiple data sets of fatty acid-binding protein 4 (FABP4) and lysozyme microcrystals were collected using this novel designed device. Finally, the structures of protein FABP4 and lysozyme were obtained from these data via the molecule replacement method. The data statistics reveal that this method provides a comparable result to traditional methods such as a nylon loop.

A Prospective Study of a Cost-Effective Method for Prevention of Incisional Hernia in Subcostal and Lumbar Incisions by Use of Nylon Loop, Intermittent Mass Closure

A Prospective Study of a Cost-Effective Method for Prevention of Incisional Hernia in Subcostal and Lumbar Incisions by Use of Nylon Loop, Intermittent Mass Closure

Fast two-dimensional grid and transmission X-ray microscopy scanning methods for visualizing and characterizing protein crystals.

A fast continuous grid scan protocol has been incorporated into the Swiss Light Source (SLS) data acquisition and analysis software suite on the macromolecular crystallography (MX) beamlines. Its combination with fast readout single-photon counting hybrid pixel array detectors (PILATUS and EIGER) allows for diffraction-based identification of crystal diffraction hotspots and the location and centering of membrane protein microcrystals in the lipid cubic phase (LCP) in in meso in situ serial crystallography plates and silicon nitride supports. Diffraction-based continuous grid scans with both still and oscillation images are supported. Examples that include a grid scan of a large (50 nl) LCP bolus and analysis of the resulting diffraction images are presented. Scanning transmission X-ray microscopy (STXM) complements and benefits from fast grid scanning. STXM has been demonstrated at the SLS beamline X06SA for near-zero-dose detection of protein crystals mounted on different types of sample supports at room and cryogenic temperatures. Flash-cooled crystals in nylon loops were successfully identified in differential and integrated phase images. Crystals of just 10 µm thickness were visible in integrated phase images using data collected with the EIGER detector. STXM offers a truly low-dose method for locating crystals on solid supports prior to diffraction data collection at both synchrotron microfocusing and free-electron laser X-ray facilities.

High survival of mouse oocytes using an optimized vitrification protocol.

The method of vitrification has been widely used for cryopreservation. However, the effectiveness of this method for mammalian oocytes could be improved by optimizing each step of the process. In the present study, we tested the effects of varying several key parameters to determine the most effective protocol for mouse oocyte vitrification. We found that cryoprotectant containing ethylene glycol and dimethylsulfoxide plus 20% fetal calf serum produced the highest rates of oocyte survival, fertilization, and blastocyst formation. The duration and temperature of oocyte exposure to vitrification and thawing solutions influenced survival rate. The presence of cumulus cells surrounding oocytes and the incubation of thawed oocytes in Toyoda-Yokoyama-Hosoki medium also increased oocyte survival. Open pulled straw and nylon loop methods were more effective than the mini-drop method. Finally, the combination of these improved methods resulted in better spindle morphology when compared to the unimproved methods. These results demonstrate that the outcomes of mouse oocyte vitrification can be improved by a suitable combination of cryopreservation methods, which could be applied to future clinical research with human oocytes.

Combined volume reduction with the loop-and-leave technique permits safe endoscopic management of high-risk giant gastric polyps

889 Combined Volume Reduction With the Loop and Leave Technique Permits Safe Endoscopic Management of High Risk Giant Gastric Polyps Suraj Gupta, Joshua Penfield, David Klibansky, Douglas A. Howell* Pancreaticobilary Center, Maine Medical Center, Portland, ME Endoscopic management may not require resection with a very low likelihood of malignancy and is challenged by size, thick stalks and inaccessible locations. We have experienced success in a series of huge hyperplastic polyps by reducing the size of the lesions with 1:10,000 epinephrine injection followed by placing 2 strangulated detachable nylon loops without resection. Three cases are presented with escalating difficulty and risk. All were successful without complication.

Single-channel endoscopic closure of large endoscopy-related perforations.

Gastrointestinal endoscopy procedures, such as endoscopic retrograde cholangiopancreatography (ERCP), endoscopic submucosal dissection (ESD), and colonoscopy are widely used for the diagnosis or treatment of digestive diseases. Perforation is a rare but potentially lethal complication. Large perforations usually require immediate endoscopic or surgical repair. Endoscopic closure using a nylon loop pouch suture is usually performed with a double-channel endoscope. This paper describes the endoscopic closure of large procedure-related perforations using a single-channel endoscope. A total of 10 patients with large perforations (2.5 - 4.0 cm), which occurred during ERCP, ESD, or colonoscopy, were treated using the single-channel endoscope technique. All perforations were successfully closed using a nylon loop pouch suture through the single-channel endoscope. No surgery or further endoscopic intervention was required. Nylon loop pouch suture through a single-channel endoscope was easy to perform and was feasible for the closure of large gastrointestinal perforations.

57 THE EFFECT OF VITRIFICATION FOR SHEEP EMBRYO VIABILITY

This work evaluated different methods for sheep embryo cryopreservation by vitrification (V) and super-cooling ultra-rapid vitrification (SCURV). The vitrification method was applied according to the method described by Vajta et al. Both treatments used a vitrification solution (VS) containing 20% ethylene glycol, 20% dimethylsulfoxide (Me2SO), 0.5 mol L–1 sucrose in Dulbecco's phosphate buffered saline (DPBS) with 10% BSA. The super-cooled LN facilitates heat transmission between LN and the cryosolution interface, and this is efficient for bovine semen and blastocyst cryoconservation (Arav et al. 2002). By surgical flushing 25 super-stimulated ewes, 109 transferable morulae were harvested; 35 morulae were transferred fresh to synchronized recipients (control) and the others were cryopreserved by V (n = 36) or SCURV (n = 38), respectively, thawed or warmed, and transferred to recipients. Embryos were vitrified using the HSV Kit. They were first incubated in 50% VS for 2 min and then transferred for 30 s into 100% VS. Each embryo was loaded by HSV Kit, which was immediately submerged into and stored in LN. Warming was done by placing the narrow end of the straw into DPBS + 0.25 M sucrose for 5 min. Embryos were then transferred into DPBS + 0.125 M sucrose for 3 min and finally to DPBS until transfer. The SCURV morulae were then exposed to 50 and 100% VS at 37°C for 2 min and 30 s, respectively. Embryos after saturation in VS were transferred on a surface of a nylon loop (volume 20 μL, diameter 0.5 mm) and using negative pressure of LN in the chamber for freezing with the VIT-Master. Thawing vitrified embryos was accomplished by placing the vitrified embryos in solutions of sucrose 0.25 M and 0.125 M with expositions 2 and 3 min accordingly. After thawing embryos, only good-quality embryos were transferred. Statistical analyses were performed with Student's t-test. The lambing rate following transfer of fresh, frozen-thawed vitrification and SCURV methods were 18, 12, 14 lambs accordingly. No statistical difference was found for the percentage of does lambing following transfer thawed after vitrification (33.4 ± 5.2a%) and SCURV methods (36.8 ± 6.3b%). The survival rate following transfer of fresh embryos (51.4 ± 4.8c) was higher and in line with previous findings using VS. Differences were statistically significant (ac,bc P &lt; 0.05). Importantly, our data suggest that the HSV Kit can be used to produce viable morulae for implantation as the SCURV, and to as vitrification method. Although further work on the developmental competence of embryos cryopreserved with the SCURV method are needed, these data suggest that with SCURV a faster freeze rate and lower level of cryoprotectants is able to minimize ice crystal formation and should be further evaluated as a routine mechanism for cryopreserving sheep embryos.

47 COMPARISON BETWEEN CRYOLOOP AND OPEN PULLED STRAW VITRIFICATION METHODS FOR BOS INDICUS BLASTOCYSTS

A major obstacle of large-scale commercial application of bovine in vitro fertilization is the lack of a suitable cryopreservation method for supernumerary embryos produced. The traditional slow-freezing method has proven to be effective for embryos of a wide range of mammalian species; however, the formation of intracellular ice is still a challenge and the efficiency needs to be improved. Over the past decade, several advances have taken place in vitrification technologies, such that it can provide high efficiency with better pregnancy outcome due to its high cooling rates and the lack of crystals formed inside the cells. Most vitrification methods have been evaluated in Bos taurus cattle but more still remains to be investigated in Bos indicus races predominant in the tropics. There are several vitrification protocols and holders, including CryoLoop, open pulled straw (OPS), MS Grids, and Cryotop, among others. The CryoLoop method uses a nylon loop attached to a metal Cryovial lid were blastocysts are placed on an equilibration solution film. CryoLoop cooling rates are approximately 20.000°C min–1 and have shown very good results in humans. The OPS is a well-known support for bovine blastocysts; the embryos are taken by capillarity into the OPS and use a 1- to 2-μL drop of final equilibration solution. Cooling rates using this method are approximately 2.000°C min–1. The aim of this work was to prove CryoLoop and OPS vitrification methods in Bos indicus blastocyst and compare re-expansion and hatching rates 24 h after warming. Ovaries were collected from a local slaughterhouse and cumulus-oocyte complexes (COC) were treated for the standard IVF method. A total of 60 blastocysts were vitrified in CryoLoops and 68 blastocysts in OPS (within 4 repeats). For CryoLoops, groups of 2 blastocysts were placed in a solution of 7.5% ethylene glycol (EG) and 7.5% dimethyl sulfoxide (DMSO) for 3 min, and then were placed in a solution of 15% EG, 15% DMSO, 10 mg mL–1 of Ficoll 70, and 0.65 M sucrose for 20 s, and rapidly were put into the nylon loop and taken to the LN. For OPS, groups of 2 to 3 blastocysts were placed in a solution of 10% EG and 10% DMSO for 1 min, and then were placed in a solution of 20% EG and 20% DMSO for 20 s, and rapidly were taken by capillarity into the OPS and taken to the LN. Thawing was the same for both treatments; vitrified blastocysts were taken out from the LN and rapidly put into a solution of 0.3 M sucrose for 2 min and then put into a solution of 0.2 M sucrose for 3 min, were washed twice in TCM199 supplemented with 10% FCS, and cultured for 24 h in CR1aa media. Data were analysed using the R language. Media comparison for proportions was done using a chi-squared test. No significant difference was observed in re-expansion or hatching rates between CryoLoop and OPS supports (P = 0.01 for both); however, the CryoLoop method showed more efficiency than OPS in re-expansion rate (65 v. 44.4%, respectively) and hatching rate (30.8 v. 20%, respectively). In all cases, the CryoLoop method showed much better outcomes. The results indicate that vitrification in CryoLoops is a suitable method for cryopreservation of Bos indicus blastocysts.

Identification of Biochemically Distinct Properties of the Small Ubiquitin-related Modifier (SUMO) Conjugation Pathway in Plasmodium falciparum

Small ubiquitin-related modifiers (SUMOs) are post-translationally conjugated to other proteins and are thereby essential regulators of a wide range of cellular processes. Sumoylation, and enzymes of the sumoylation pathway, are conserved in the malaria causing parasite, Plasmodium falciparum. However, the specific functions of sumoylation in P. falciparum, and the degree of functional conservation between enzymes of the human and P. falciparum sumoylation pathways, have not been characterized. Here, we demonstrate that sumoylation levels peak during midstages of the intra-erythrocyte developmental cycle, concomitant with hemoglobin consumption and elevated oxidative stress. In vitro studies revealed that P. falciparum E1- and E2-conjugating enzymes interact effectively to recognize and modify RanGAP1, a model mammalian SUMO substrate. However, in heterologous reactions, P. falciparum E1 and E2 enzymes failed to interact with cognate human E2 and E1 partners, respectively, to modify RanGAP1. Structural analysis, binding studies, and functional assays revealed divergent amino acid residues within the E1-E2 binding interface that define organism-specific enzyme interactions. Our studies identify sumoylation as a potentially important regulator of oxidative stress response during the P. falciparum intra-erythrocyte developmental cycle, and define E1 and E2 interactions as a promising target for development of parasite-specific inhibitors of sumoylation and parasite replication.