Removal Procedure Research Articles

Revisiting the Hβ Size–Luminosity Relation Using a Uniform Reverberation-mapping Analysis

We revisit the relation between active galactic nucleus (AGN) broad-line region (BLR) size and luminosity by conducting a uniform Hβ reverberation-mapping analysis for 212 AGNs with archival light curves. Our analysis incorporates three different lag measurement methods, including the interpolated cross-correlation function (ICCF), JAVELIN, and PyROA, alongside a consistently defined lag-searching window and an alias removal procedure. We find that ICCF, albeit with larger uncertainties compared to other methods, is the most reliable method based on our visual inspection of the matches between Hβ and the shifted continuum light curves. Combining this sample with the 32 AGNs from Seoul National University AGN Monitoring Project, we obtain the best-fit relation between the BLR size (R BLR) and the continuum luminosity at 5100 Å (L 5100) with a slope significantly flatter than 0.5. By selecting a subsample of 157 AGNs with the best-quality lag measurements using a set of quantitative criteria and visual inspection, we find a consistent slope and a slightly decreased intrinsic scatter. We further investigate the effect of luminosity tracers, including L 5100, Hβ luminosity (L Hβ ), [O iii] luminosity (L [O III]), and 2–10 keV hard X-ray luminosity L 2–10keV. We find that sub-Eddington and super-Eddington AGNs exhibit systematic offsets in both R BLR–L 5100 and R BLR–L Hβ relations, while they show comparable R BLR–L [O III] and R BLR–L 2–10keV relations. We discuss the potential causes for these different deviations when employing different luminosity tracers.

Ozonation procedure for removal of mycotoxins in maize: A promising screening approach for improvement of food safety.

Mycotoxins are well known secondary metabolites of various fungi. They pose a significant threat to human and animal when present in food or feed. They can be responsible for losses in grain production and in livestock or human intoxication. In this study, several mycotoxins were detected in Aspergillus fumigatus contaminated maize kernels. The contaminated kernels were treated with gaseous ozone at a concentration of 500 and 3000 ppm for 1 hour. Depending on the specific compound, the contamination level was reduced by up to 100%. This screening research showed that a concentration of ozone as high as 3000 ppm could be sufficient to completely remove several toxic compounds from the maize matrix.

Preoperative Immersive Virtual Reality (iVR) Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of complex or large renal stones. A major challenge for the surgeon, however, is the need to assimilate the nearly 2000 static images from a CT scan into a functional mental image to enable surgical planning. Accordingly, we investigated the potential of immersive virtual reality (iVR) to enhance surgical planning and its impact on the outcomes among patients undergoing PCNL. Between 2019-2023, 175 patients undergoing PCNL were pre-operatively randomized into a CT-only group (N=89) or a CT+iVR group (N=86). CT scans were rendered into iVR models that allowed the surgeon not only to visualize and manipulate each patient's relevant anatomy, but also simulate the percutaneous approach to the proposed calyx. Post-operative CT scans were defined as absolute stone-free, <2mm remnants or 2.1-4mm remnants. Pre-operative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs. 20.22%, p=0.043) and overall <4mm remnant rate (62.79% vs. 48.20%, p=0.044). Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs. 12.30%, p=0.03). The results were independent of the surgeon's years of PCNL experience. Pre-operative iVR model visualization benefited surgeons and patients alike. From a surgical standpoint, viewing the iVR model resulted in a safer, more effective percutaneous stone removal procedure.

Efficient Capture of Phosphate From Aqueous Media Using Bimetallic La‐Zr‐MOF

ABSTRACTDeposition of excessive phosphate in natural water column caused several issues, like the eutrophication and destruction of aquatic ecosystems. Adsorption has been an effective and convenient method for phosphate elimination. Herein, a novel bimetallic metal–organic framework adsorbent, namely, La‐Zr‐MOF, was prepared, and the morphology, crystallite, characteristic functional groups, specific surface area, and composite material surfaces were analyzed using XRD, FT‐IR, SEM‐EDS, and BET. The adsorption performance of the adsorbent was systematically evaluated by batch adsorption experiments, and the adsorption thermodynamic and kinetic properties were analyzed. The results reveal that La‐Zr‐MOF exhibits a high selectivity and sorption performance for phosphate, and the adsorption of La‐Zr‐MOF follows the Langmuir and pseudo–second‐order models; the phosphate removal procedure is a chemisorption accompanied by an endothermic reaction, and the maximum capacity was 127.7 mg g−1. Combined with batch adsorption experiments, kinetic and thermodynamic studies and various characterization analyses together revealed the phosphate removal mechanism, mainly ligand exchange and electrostatic interactions.

Optimisation of artefact detection in photoplethysmography heart rate data: influence of different classifiers in machine learning models

Abstract Background Heart rate (HR) tracking by wrist-worn devices using photoplethysmography (PPG) could assist in continuously following up physical activity. However, the accuracy can be impacted by (motion) artefacts. Machine learning models could help to recognise artefacts in PPG-based HR data. The choice of classifier in these machine learning models is a determing factor for task performance of the model. Purpose This study evaluates and determines the optimal classifier for a new machine learning-based approach to enhance the reliability of artefact detection in PPG-based HR data. Methods A total of 62 participants (27 cardiac rehabilitation patients, 35 healthy athletes) wore both a test device and a reference device measuring HR continuously for 24 hours. A training dataset was prepared, assigning two independent labels (i.e. anomaly and activity) to each HR episode based on the reference device data. Fitbit data were processed using our in-house designed artefact removal procedure, which involves the application of two classification models: one for anomaly detection and another for activity detection. Four distinct classifiers were employed for both models: Balanced Bagging, Balanced Bagging with Random Forest, Balanced Random Forest, and Logistic Regression. Each classifier was evaluated using area under the receiver operating characteristic curve (ROC-AUC), accuracy, sensitivity and specificity. Results Of the 1,647,328 HR data points collected, 103,095 (6.26%) were identified as artefacts. Figure 1 and Figure 2 summarise the performance of the distinct classifiers for the anomaly model and the activity model, respectively. Balanced Bagging and Balanced Bagging with Random Forest consistently demonstrate the highest AUC values and accuracies across both anomaly and activity detection models (anomaly detection: AUC = 0.95, accuracy = 89-85%; activity detection: AUC = 0.98, accuracy = 95%). Comparing these two, Balanced Bagging with Random Forest emerges as the preferred option, given the highest sensitivity in both anomaly detection (93%&amp;gt;86%) and activity detection models (99%&amp;gt;96%). In contrast, Balanced Random Forest and Logistic Regression exhibit inferior performance. In the anomaly detection model, Balanced Random Forest exhibits a lower sensitivity of 75%, while Logistic Regression performs even worse with a sensitivity of 25%. Similarly, in the activity detection model, both Balanced Random Forest and Logistic Regression demonstrate diminished performance. Conclusions Balanced Bagging with Random Forest emerges as the optimal classifier to detect anomalies and activities in continuous PPG-based HR data, thus contributing to the optimisation of our in-house designed procedure for removing artefacts. This processing aims to provide a reliable and automatic way for continuous HR monitoring, which can help monitor and guide physical activities.

The effect of the age at the time of targeting a lead implantation on the difficulty with the transvenous lead extraction technique

Abstract Background In transvenous lead removal procedures, the number of years since the lead implantation is an indicator of procedural difficulty and complications. However, even with the same number of years since the lead implantation, we considered the possibility that a younger age at the time of the implantation (AoI) would increase the difficulty of the procedure. Objective To elucidate the procedural difficulty in the transvenous lead extraction procedure according to the age at the time of targeting the lead implantation. Method A total of 471 consecutive transvenous lead extraction cases were analyzed. The patient AoI of the oldest lead in extraction procedure cases was divided into two groups: those younger than 60 years (implant age &amp;lt;60 yrs old: AoI&amp;lt;60) and those older than 60 years (implant age ≧60 yrs old: AoI≧60). The analysis was conducted by the number of years since the lead implantation (&amp;lt;10 years: group A, 10 to 20 years: group B, and &amp;gt;20 years: group C). Results The number of AoI&amp;lt;60 and AoI≧60 patients were 60 and 254 (Group A), 51 and 56 (Group B), and 41 and 9 (Group C). The patient age significantly differed among the groups between an AoI&amp;lt;60 and AoI≧60 (group A: 51.7 vs. 77.1; P&amp;lt;0.001, group B: 61.6 vs. 83.1; P&amp;lt;0.001, group C: 71.2 vs. 88; P&amp;lt;0.001). But the oldest dwell time (years) was similar for all groups (group A: 4.6 vs. 4.2; P=0.324, group B: 14.2 vs. 13.5; P=0.148, and group C: 25.7 vs. 22.6; P=0.097). The complete removal rate (group A: 97.7% vs. 98.4%; P=0.722, group B: 90.4% vs. 93.3%; P=0.567, and group C: 78.05 vs. 90.95; P=0.337) and major complication-free rate (group A: 98.8% vs. 100%; P=0.391, group B: 96.2% vs. 100%; P=0.125, and group C: 90.2% vs. 100%; P=0.281) were not statistically significant in all groups but were higher for an AoI≧60. An AoI&amp;lt;60 resulted in a longer procedure time (group A: 78.4 min. vs. 65.3 min.; P=0.006, group B: 96.0 min. vs. 72.3 min.; P=0.002, and group C: 100.9 min. vs. 94.8 min.; P=0.709), longer fluoroscopy time (group A: 12.0 min. vs. 10.2 min.; P=0.247, group B: 19.2 min. vs. 11.6 min.; P=0.017, and group C: 22.2 min. vs. 16.0 min.; P=0.008), and higher number of laser pulses (group A: 779.6 vs. 433.7; P=0.002, group B: 2089.6 vs. 1032.9; P=0.017, and group C: 1509.3 vs. 831.5; P=0.201) in all groups. Conclusion This study suggested that the difficulty of transvenous lead extraction procedures may increase with a younger AoI, even if the lead dwelling time is the same.

Clinical Features and Complications of External Auditory Canal Foreign Bodies in the ENT Emergency Unit.

Objective: To determine the risk factor for developing complications in patients undergoing removal procedures for foreign bodies (FBs) in the external auditory canal (EAC) in the otolaryngology (ENT) emergency unit. Methods: Cases involving patients with EAC FBs treated at the ENT emergency unit of a tertiary medical center were retrospectively recruited. Patients were classified into the age < 10 years and ≥10 years groups. Univariate analyses of the complication rates were performed in all patients and the two age groups. Results: The mean age of the 457 patients was 29.9 ± 19.9 (range, 1.0-89.0) years; 42.7% (n = 195) were under 10 years of age, and 57.1% (n = 261) were male. Complications following FB removal occurred in 40 cases (8.8%), with EAC laceration being the most common (4.4%). Patients under 10 years of age had a higher risk of developing complications than those over 10 years (13.8% vs 5.0%, P = .001), with the younger group also showing an increased risk of EAC laceration (6.7% vs 2.7%, P = .039). Conclusion: Patients under 10 years of age had a significantly-higher rate of complications after EAC FB removal in the ENT emergency unit. Sedation or surgical removal under general anesthesia should be considered to minimize the risk of complications after a failed removal under direct vision in this patient group. Further studies are warranted to verify this implication for clinical practice.

Bubble plume effects on the flotation kinetics of nonmetallic inclusions based on experimental observations

AbstractSteelmaking has shown an increasing concern toward nonmetallic inclusions, leading to new technologies in the secondary metallurgy of steel. Although the typical inclusion removal procedure is by injecting inert gas into the ladle, this vessel does not fulfill all the requirements to accept a porous structure tailored to produce “clean steels.” Consequently, the spotlight has moved to the tundish, the last vessel before solidification, in which gas injection can continuously operate. Therefore, this work focuses on understanding the influence of typical gas flow rates (10–60 NL/min) on the kinetics of inclusion flotation, considering two bubble diameters (0.6 and 1.1 mm). For this purpose, experimental measurements were conducted in a water model, where glass hollow spheres played the role of inclusions, and their concentration was fitted by an exponential decay. In general, injecting bubbles into the system contributed positively to a faster and greater flotation of particles. The smaller bubbles led to a higher maximum efficiency, whereas the larger ones allowed a shorter time scale (i.e., a faster removal), defining a trade‐off to tune the bubble size. Regarding the gas flow rate, the results indicate an optimum range to decrease the time scale, and suggestions for bubble curtains in tundishes are drawn.

The Immediate Partial Removal of Cumulus-Oocyte Complexes: A Refined Approach for Rapid Observation of In Vitro Fertilization.

Despite the rapid advancements in clinical and laboratory technologies for in vitro fertilization (IVF), a significant proportion (10%-15%) of patients continue to experience fertilization disorders, leading to low fertilization rates and the production of nonviable embryos. Short-term fertilization involves the early removal of granulosa cells to observe the extrusion of the second polar body, enabling the assessment of fertilization and early remedial measures to address low fertilization rates and complete fertilization failure. However, the observation of short-term fertilization in IVF is impeded by challenges such as excessively large unprocessed clusters of cumulus-oocyte complexes and adhesion between eggs, necessitating complex external procedures for granulosa cell removal, and prolonged observation duration. To tackle this issue, this study proposes a method of immediate partial removal of granulosa cells post egg retrieval. This approach streamlines subsequent stages of short-term fertilization and traditional fertilization monitoring, reduces the time needed for oocyte extrusion, minimizes the likelihood of external environmental impacts on the oocytes, and decreases the risk of missing the critical fertilization observation window. Consequently, the study yields novel clinical evidence aimed at enhancing the operational efficiency of embryonic laboratories in IVF.

Optimizing Cylindrical Grinding Proficiency and Surface Finish for EN24 Steel Alloy with the Use of Taguchi Analysis and Artificial Neural Network

Grinding is a material removal procedure used at the end of manufacturing to obtain high dimensional precision and a desirable surface polish. External cylindrical grinding is a type of grinding procedure that used to grind cylindrical things such as engine shafts, connecting rods, spindles, and axles. This study examines how control settings affect response parameters using EN24 alloy steel on a cylindrical grinding machine. Response parameters are material removal rate (MRR) and surface roughness (Ra), whereas control parameters are workpiece speed (v), feed rate (f), and depth of cut (d). Taguchi DOE is employed with L16 orthogonal array to optimize control parameter levels, followed by cylindrical grinding tests.An artificial neural network (ANN) model was created to validate and predict cylindrical grinding reaction parameters. To train the network, experimental data was used, and ANN predictions were compared to real data. Data collection has also completed.In the purposed work minimum Ra is 0.52 µm and maximum MRR is 0.6588 g/sec found and results indicate that feed rate and workpiece speed are the most dominating parameters of cylindrical grinding. The experimental results can be employed by various manufacturing and industrial firms and they can select suitable combinations of input parameters for desired Ra and MRR

Warmer Temperatures Are More Predictive Than Solar Radiation for the Number of Skin Cancer Removal Procedures.

Solar radiation is the primary risk factor for skin cancer, with personal exposure influenced by environmental and behavioral factors. At higher temperatures, behavioral changes increase solar radiation exposure. Examine the relationships between solar radiation, ambient temperature, age, and skin cancer. For the contiguous United States, we obtained the state mean global horizontal irradiance (GHI), daily maximum temperature, and number of skin cancer removals in the Medicare population. For skin cancer removals, we defined more sun-exposed skin as the head, neck, hands, and feet, and less sun-exposed skin as the trunk, arms, and legs. By comparing the temperature thresholds 17°C, 20°C, 24°C, 27°C, 31°C, and 34°C, we found that the annual number of days above 24°C was the strongest temperature-related predictor of skin cancer removals. Multivariable linear regression showed that the number of days above 24°C predicted more skin cancer removals for all body locations and less sun-exposed skin (p = 0.008 and p = 0.003, respectively), while GHI did not (p = 0.1 and p = 0.8, respectively). GHI only predicted more skin cancer removals for more sun-exposed skin (p = 0.02). More days above 24°C was a better predictor of skin cancer removals than GHI for all skin locations and less sun-exposed skin, suggesting that the behavioral changes occurring at warmer temperatures are more predictive of skin cancer removals than solar irradiance. Due to rising global temperatures, skin cancer incidence may further increase. Temperature-related behavioral changes represent a potential target for skin cancer prevention efforts.

An associate of suspicious axillary node and sentinel node in breast cancer to minimizing axillary surgery, prospective cohort study

Background: Arm morbidity and postoperative complications following sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) are common problems in patients with breast cancer. The de-escalating axillary surgery is increasing; however, there is a lack of patients with suspicious nodes. This study aimed to reduce the need for SLNB in suspicious lymph node cases. Methods: A prospective cohort study of women with invasive breast cancer who underwent surgery between January 2021 and December 2022. The study included two cohorts: Cohort A comprised patients with stage cT1-2N0-1M0 cancer who planned upfront surgery, while Cohort B included patients with stages cT1-4N2M0, cT3-4N1M0, or cT1-2N0-1M0 who received neoadjuvant systemic treatment. During the study, a clip was inserted into the suspicious lymph node on imaging to determine whether it could serve as a sentinel node and potentially replace SLNB or reduce the need for axillary surgery. Result: In cohort A, twenty-two surgeries were performed, while in cohort B, seven surgeries were performed. The median follow-up time was 15 months. In cohort A, 71% of the patients had cN0 disease, while 28% had cN1 disease. A suspicious node correlated to a sentinel node was noted in 66.67% of cohort A. The false-negative rate (FNR) was 14.28%. However, when the clip node removal procedure was performed instead of the sentinel node procedure, the FNR was 10%. Conclusion: In early breast cancer, suspicious nodes in imaging studies could not currently represent sentinel lymph nodes, and the FNR was still high. Nevertheless, more studies with larger populations will provide a better understanding due to the limited number of patients.

Risk of Late Implant Loss and Peri-Implantitis Based on Dental Implant Surfaces and Abutment Types: A Nationwide Cohort Study in the Elderly.

This nationwide population-based cohort study aimed to assess the incidence of implant complication treatments, including implant removal procedures and peri-implantitis treatments, in relation to implant surfaces and abutment types. Data from the National Health Insurance Service, covering approximately 50 million individuals, were used. Implants and abutments were categorized by codes, including surfaces such as resorbable blasting media, sandblasted large grit and acid-etched (SA) and hydroxyapatite coating, along with abutment structures (one-piece straight, two-piece straight, angled). The incidence of implant complication treatments was analysed using Kaplan-Meier curves and Cox proportional hazards regression (α = 0.05). The study included 2,354,706 implants. The SA group had the lowest hazard ratio for implant removal procedures (p < 0.0001). No significant differences were found in the risk of peri-implantitis treatments between implant surfaces (p = 0.0587). The risk of implant complication treatments did not differ significantly by the abutment type (p = 0.9542). The incidence rate of implant complication treatments was < 3.9 per 1000 implant-years across all groups. The SA group showed a slightly lower risk of late implant loss, whereas no significant association was found for the abutment type groups. All implant and abutment type groups showed an incidence rate of < 3.9 per 1000 implant-years for complication treatments.

A novel puzzle ring replacement technique of a lumen-apposing metal stent with a double-pigtail plastic stent to prevent walled-off necrosis recurrence (with video).

Replacing a lumen-apposing metal stent (LAMS) with a double-pigtail plastic stent (DPS) after treatment for walled-off necrosis contributes to the prevention of recurrence. However, the success rate is not very high. To overcome this issue, we devised a novel stent-replacement technique. In the final treatment procedure, a 7-F DPS was placed in the lumen of the LAMS. Subsequently, the walled-off necrosisshrank, and granulation formed over the pigtail portion, which fixed the DPS. The LAMS alone was removed with grasping forceps, leaving the DPS in the lumen of the LAMS (i.e., a puzzle-ring technique; direct or rotary removal technique). Between August 2021 and August 2023, 18 patients were evaluated for recurrence prevention using this novel technique (median duration of LAMS placement, 37 days). In 17 patients (94.4%), the LAMS was successfully replaced with a 7-F DPS (direct technique 14, rotary technique 3; median removal procedure time, 3 min). No recurrence was observed during the median observation period of 385 days. Before using this technique (April 2012 to August 2022), the technical success rate of replacement of LAMS with 7-F DPS was significantly lower (61.8% [42/68, p = 0.02]). Recurrence of pancreatic fluid collection occurred in 15.3% (4/26) of the patients who could not undergo replacement with a 7-F DPS. The novel puzzle ring technique, which improves the success rate of LAMS for DPS replacement, may be useful in reducing recurrence after walled-off necrosistreatment.

Efficacy and safety of endoscopic subserosal dissection treatment for gastrointetinal submucosal tumors in the upper gastrointestinal tract

ObjectiveTo investigate the safety and efficacy of endoscopic subserosal dissection for patients with submucosal tumors in the upper gastrointestinal tract.MethodsThis retrospective single-center study included 16 patients who underwent ESSD. All patients were enrolled from July 2018 to Dec 2021. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time and follow-up were investigated and analyzed.ResultsOur study achieved 100% en bloc resection and 100% R0 resection. The most common location was the corpus with a mean tumor size of 2.78 ± 1.56 cm. The mean age, procedure time, were 53.4 ± 10.3 years, 85.31 ± 46.64 min respectively. Acocording to National Institutes of Health classification, 7 (13, 53.85%), 5 (13, 38.46%) ,and 1 (13, 7.69%) objects belonged to the very low, low, and intermediate classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 9.3 ± 2.5 months showed no recurrence or metastasis.ConclusionsESSD is effective and safe surgical procedure for curative removal of gastrointestinal submucosal tumors in the upper gastrointestinal tract, and it can be preferred for patients with no metastasis.

Angle-dependent ion-beam etching of RuAl thin films for structuring GHz-frequency electronics

The ruthenium aluminide (RuAl) alloy is a promising electrode material for wireless surface acoustic wave sensors working under harsh conditions at high temperatures. However, during the structuring of RuAl thin films using ion-beam etching, etched material can redeposit at the edges of the electrodes and form objects, so-called fences, on top of the structured features. These decrease the high-temperature stability and lead to an undesired alteration of the sensor performance. In this work, the angle-dependent ion-beam etching of RuAl thin films was investigated to inhibit the formation of such fence structures. The etch rate was determined as a function of the etching angle between ion-beam and sample surface in a range between 90° and 40°. Furthermore, finger structures with pitches below 500 nm, which are required for devices working in the intended GHz regime, were patterned to study the influence of the etching angle on the profile of the RuAl electrode fingers using transmission electron microscopy and energy-dispersive x-ray spectroscopy. The results show that an etching angle of 50° results in the highest etch rate. For etching angles of 50° and below, the width of the fences is reduced below 10 nm, so they break off during standard resist removal procedures. Such low etching angles lead to shadowed areas on the side of structured features in which unetched material remains. However, this material can be removed by using a two-step etching process combining a 50° step with a 90° step. This process is capable of structuring fence-free trapezoidal-shaped electrode finger profiles. Therefore, the developed process is well suited for the fabrication of high-temperature GHz-frequency RuAl electrodes.

Using Transparent Cap of Endoloop in Emergency Hemostasis as a Novel Rapid Clot Removal Procedure for Acute Upper Gastrointestinal Hemorrhage.

Using Transparent Cap of Endoloop in Emergency Hemostasis as a Novel Rapid Clot Removal Procedure for Acute Upper Gastrointestinal Hemorrhage.

Athlete Perspectives on Concussion Recognition and Management in Gaelic Games: A Qualitative Analysis.

Background: The focus of this qualitative research was to interview current and retired Gaelic games athletes to ascertain how athletes viewed concussion recognition and management. Methods: A grounded theory methodology design was utilised to investigate concussion recognition and management experiences of a cohort of Gaelic games athletes (n = 22). Data for the study were collected using a semi-structured interview format. Results: Two major themes were identified: (1) an inconsistent identification of concussion as an injury and the absence of standardised procedures for removal from play, and (2) the impact of athlete-driven decision making on concussion management. Concussions were experienced by all the participants on multiple occasions while playing Gaelic games. However, concussion recognition and removal rarely occurred, as many athletes chose not to disclose their injuries or self-managed their concussions. Conclusions: The recognition and management of concussions in Gaelic games are currently inadequate, and they may be posing significant risks to athletes' long-term health. This research highlights the need for more stringent protocols for concussion recognition and removal at pitch side. In addition, Gaelic games require a more objective injury management plan during acute and chronic concussion recovery.

Technique for guttural pouch bead removal using a novel three-dimensional (3D)-printed instrument.

The aim of the present study was to determine if a three-dimensional (3D)-printed instrument technique would improve lavage removal of plastic beads (guttural pouch [GP] chondroid mimics) through a dorsal pharyngeal recess (DPR) fenestration. We hypothesized that using a 3D-printed instrument placed through the DPR fenestration would remove more beads, reduce lavage time and incur less soft tissue damage than using a lavage tube control or instrument placement through the salpingopharyngeal ostium (SPO). Experimental cadaveric study. A total of 30 cadaveric equine heads. DPR fenestration was performed using transendoscopic laser and 50 plastic 12 mm beads were placed into one GP of horse heads. Four removal procedures using a 3D-printed instrument or lavage tube control placed through the DPR fenestration or the SPO were compared. Number of beads removed and number of 2-min lavage cycles to recover ≥96% of beads or three consecutive no-yield cycles were recorded. Endoscopic soft tissue damage was graded. Data were compared by generalized estimating equations (GEE) model and Fisher's exact test (p < .05). More beads (median 48 beads; range 0-49) were removed faster (median 24 beads/cycle; range 12-50) using the 3D-printed instrument compared to control (median 6 beads; range 0-29, 0.66 beads/cycle, range 0-49). There was no difference between total beads removed or removal speed between placement sites. There was no difference in soft tissue damage between procedures. Our 3D-printed instrument enabled efficient plastic bead removal. DPR fenestration and use of our 3D-printed instrument represents an alternative to current chondroid removal techniques, warranting investigation in clinical cases.

Transoral approach for hilo-parenchymal submandibular stones: outcomes and predictors of success

ObjectiveTo evaluate the efficacy and safety of transoral surgical management for complex submandibular gland (SMG) stones. Study DesignA retrospective cohort study of 240 patients treated for sialolithiasis between 2015 and 2018, focusing on 57 cases of submandibular gland stones that underwent stone removal procedures. Treatment methods, success rates, and complications were analyzed using Kaplan-Meier analysis, Cox proportional hazards regression, and multiple logistic regression. ResultsTransoral surgical release was successful in 72.9% of cases. The overall complication rate was 10%. Stone size (HR = 0.85, p = 0.004) and hilar location (HR = 0.72, p = 0.036) were associated with longer symptom resolution time. Multivariate analysis revealed that stone size (OR = 0.78, p = 0.009) and hilar location (OR = 0.45, p = 0.029) decreased the odds of successful removal. ConclusionTransoral surgical management of hilo-parenchymal SMG stones appears to be a safe and effective approach, potentially reducing the need for sialoadenectomy.