Manipulation Procedures Research Articles

Cellular therapy site-preparedness: Inpatient pharmacy implementation at a large academic medical center.

With the recent Food & Drug Administration (FDA) approval of cellular therapy that requires product manipulation prior to administration in combination with a short stability window, the need was identified for local dose preparation within the pharmacy rather than the off-site stem cell processing laboratory. This approval gave rise to assessment of regulatory standards surrounding cellular therapy, evaluation and revision of current standard operating procedures and policies with formal process validation, assessment of occupational exposure mitigation and safety considerations, and development of staff training and education. To describe and provide insight into the stepwise process of FACT validation and onboarding of commercially available cellular therapy products that require sterile compounding manipulation within a pharmacy prior to administration. A multidisciplinary effort is required to attain FACT certification and implement pharmacist compounding of cellular therapy products.1 Local preparation within a pharmacy facilitates a sound operational workflow and provides a pathway to perform aseptic manipulations of cellular therapy products safely and efficiently. Safe and successful administration of cellular therapies handled and compounded by pharmacy department staff along with program validation requires a preemptive review utilizing a multidisciplinary approach for process development. This manuscript will provide a foundation based on consistency and transparency in effective cellular therapy sterile compounding and aseptic manipulation, proper handling and disposal procedures, increased communication through creation and optimization of treatment plans and order-sets, standardized medical center staff education, and development of policies and standard operating procedures for the entire health care team.

Expanding the genetic toolbox for the obligate human pathogen Streptococcus pyogenes.

Genetic tools form the basis for the study of molecular mechanisms. Despite many recent advances in the field of genetic engineering in bacteria, genetic toolsets remain scarce for non-model organisms, such as the obligatory human pathogen Streptococcus pyogenes. To overcome this limitation and enable the straightforward investigation of gene functions in S. pyogenes, we have developed a comprehensive genetic toolset. By adapting and combining different tools previously applied in other Gram-positive bacteria, we have created new replicative and integrative plasmids for gene expression and genetic manipulation, constitutive and inducible promoters as well as fluorescence reporters for S. pyogenes. The new replicative plasmids feature low- and high-copy replicons combined with different resistance cassettes and a standardized multiple cloning site for rapid cloning procedures. We designed site-specific integrative plasmids and verified their integration by nanopore sequencing. To minimize the effect of plasmid integration on bacterial physiology, we screened publicly available RNA-sequencing datasets for transcriptionally silent sites. We validated this approach by designing the integrative plasmid pSpy0K6 targeting the transcriptionally silent gene SPy_1078. Analysis of the activity of different constitutive promoters indicated a wide variety of strengths, with the lactococcal promoter P 23 showing the strongest activity and the synthetic promoter P xylS2 showing the weakest activity. Further, we assessed the functionality of three inducible regulatory elements including a zinc- and an IPTG-inducible promoter as well as an erythromycin-inducible riboswitch that showed low-to-no background expression and high inducibility. Additionally, we demonstrated the applicability of two codon-optimized fluorescent proteins, mNeongreen and mKate2, as reporters in S. pyogenes. We therefore adapted the chemically defined medium called RPMI4Spy that showed reduced autofluorescence and enabled efficient signal detection in plate reader assays and fluorescence microscopy. Finally, we developed a plasmid-based system for genome engineering in S. pyogenes featuring the counterselection marker pheS*, which enabled the scarless deletion of the sagB gene. This new toolbox simplifies previously laborious genetic manipulation procedures and lays the foundation for new methodologies to study gene functions in S. pyogenes, leading to a better understanding of its virulence mechanisms and physiology.

Viable cesarean scar pregnancy from primary care perspective: A case report

Ectopic pregnancies within previous cesarean section scars are rare but potentially life-threatening complications. Diagnosis can be challenging, particularly in primary care settings, where the focus is often on routine primary care services. We present a case report of a patient who initially presented to a primary care clinic with non-specific symptoms of ectopic pregnancy and was referred to a tertiary center for incomplete miscarriage. It was found to be a viable ectopic pregnancy within a cesarean scar. This case highlights the importance of keeping an open mind in patients with a history of cesarean section and uterine manipulation procedures such as manually evacuating a retained placenta. It emphasizes prompt diagnosis and referral to a specialized healthcare facility.

Vertical and lateral manipulation of single Cs atoms on the semiconductor InAs(111)A

The tip of the scanning tunneling microscope can be used to position atoms and molecules on surfaces with atomic scale precision. Here, we report the controlled vertical and lateral manipulation of single Cs atoms on the InAs(111)A surface. The Cs adatom adsorbs on the In-vacancy site of the InAs(111)A—(2x2) surface reconstruction. Lateral manipulation is possible in all directions over the surface, not just along high-symmetry directions. Both pushing and pulling modes were observed in the height profile of the tip. We assembled two artificial structures, demonstrating the reliability of the manipulation procedures. Structures remained intact to a temperature of at least 44 K.

Droplet manipulation in liquid flow using of magnetic micromotors for drug delivery and microfluidic systems

The task of droplet manipulation is of great practical importance in such areas as biochemistry, drug delivery and microfluidic systems. Here we demonstrate a method for controlling the movement of droplets in an oil-in-water emulsion flow using magnetic nanoparticles (MNPs). A distinctive feature of this method is that the MNPs are not dispersed within droplets but in the continuous phase of the emulsion. Due to this, after the droplet manipulation procedure is completed, the MNPs can be easily removed from the emulsion without destroying the droplets. This method represents an innovative alternative to the previously known methods. The MNPs can be used to change the speed and direction of droplet movement in a liquid flow. If the magnetic field gradient is directed against the liquid flow, and the flow velocity is less than a certain critical value, then with help of a magnetic field it is possible to move droplets against the liquid flow. The ability to control the movement of droplets in a flow largely depends on the surface wettability of the MNPs. Hydrophobic MNPs are adsorbed on the surface of droplets and move with them in a magnetic field. If the magnetic field gradient is directed along the liquid flow, this leads to an increase in the droplet speed. In the case of using hydrophilic MNPs, the influence of the magnetic field on the droplet speed in the flow turns out to be ambiguous. These results can provide a basis for the development of magnetic droplet-based drug delivery systems.

Cardiac tamponade due to coronary artery injury after left upper lobectomy

BackgroundCardiac tamponade caused by coronary artery injury is an extremely rare postlobectomy complication. Herein, we present a case of cardiac tamponade due to coronary artery injury after a left upper lobectomy for lung cancer and discuss the possible cause of coronary artery injury.Case presentationAn 82-year-old man with atrial fibrillation, emphysema, chronic heart failure-associated cardiomegaly, and a history of aortic stenting for an abdominal aortic aneurysm underwent a left upper lobectomy without mediastinal nodal dissection for lung cancer. Twenty-eight hours postoperatively, he lost consciousness and went into shock vitals; computed tomography revealed cardiac tamponade. Emergency surgery was performed, which revealed a left circumflex artery laceration. Although the laceration was successfully repaired, he had a gastrointestinal perforation and developed septic shock. He died 35 days after the lung surgery. Intraoperative injury to the heart cannot be ruled out, but the site of the coronary artery injury was located far from the hilum outside the surgical field during the lobectomy. Three-dimensional computed tomography showed that the site of injury was close to the multiple firing junction of the staples that divided the anterior interlobar fissure. Two staples at the multiple firing junction, which protruded perpendicularly to the cut surface, could injure the coronary artery.ConclusionAlthough we cannot rule out the possibility that the intraoperative manipulation procedures contributed to the coronary artery injury, we speculate that the protruding staples might penetrate the pericardium after lung expansion and eventually injured the coronary artery.

Analgesia efficacy of lidocaine transfused by a novel disposable injectable cervical dilator during intrauterine device removal procedure: A randomized clinical trial

ObjectiveThe majority of intrauterine devices (IUDs) inserted in China are tailless, requiring intrauterine manipulations for removal and causing pain. This study aimed to investigate the analgesic efficacy of lidocaine injection into a novel disposable injectable cervical dilator for IUD removal procedures. Study designA double-blinded, placebo-controlled, randomized clinical trial was conducted with women aged 18–65 years old requesting outpatient IUD removal. The study randomly assigned participants to either lidocaine (injecting 5 ml of 2% lidocaine into the injectable cervical dilator) or placebo (injecting 5 ml of normal saline into the device) group. All participants received a standardized paracervical block. The primary outcome was pain reported during IUD removal on a 100 mm Visual Analog Scale (VAS). Intention-to-treat were conducted to evaluate the analgesic effectiveness of injecting lidocaine into the injectable cervical dilators. ResultsWe enrolled seventy-four eligible participants (37 in lidocaine group and 37 in placebo group). The results showed that the median intraoperative VAS score in the lidocaine group was lower than the placebo group (30.0 mm [IQR 20.0–46.0, n = 37] vs 46.0 mm [IQR 30.0–55.0, n = 37], p = 0.01. In subgroup analyses, among participants with IUD removal and without uterine manipulation and additional procedures, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (15.0 mm [IQR 10.0–27.5, n = 8] vs 20.0 mm [IQR 20.0–40.0, n = 6]), p = 0.28). Among participants with an IUD removal necessitating intrauterine manipulations and without additional procedures, showing lower intraoperative VAS scores in lidocaine group (25.0 mm [IQR 15.0–40.5, n = 17]) compared to placebo group (46.0 mm [IQR 38.5–50.0, n = 23]), p < 0.01. Among participants with additional procedures in addition to IUD removal, there was no statistically significant disparity observed in intraoperative VAS scores between the lidocaine and placebo group (41.0 mm [IQR 32.5–57.5, n = 12] vs 45.0 mm [IQR 22.5–69.0, n = 8]), p = 0.97). ConclusionsInjecting lidocaine into the novel disposable injectable cervical dilator for cervix dilation can significantly reduce pain during an IUD removal, particularly in patients necessitating intrauterine manipulations during IUD removal. ImplicationsWhen we have to perform intrauterine manipulations to remove an IUD, surgical pain and narrow cervical canal undoubtedly affect the implementation of the procedure. Injecting lidocaine into the injectable cervical dilator can achieve local anesthesia while dilating the cervix, and might reduce the choice of general anesthesia for IUD removal.

What do we manipulate when reminding people of (not) having control? In search of construct validity

The construct of personal control is crucial for understanding a variety of human behaviors. Perceived lack of control affects performance and psychological well-being in diverse contexts – educational, organizational, clinical, and social. Thus, it is important to know to what extent we can rely on the established experimental manipulations of (lack of) control. In this article, we examine the construct validity of recall-based manipulations of control (or lack thereof). Using existing datasets (Study 1a and 1b: N = 627 and N = 454, respectively) we performed content-based analyses of control experiences induced by two different procedures (free recall and positive events recall). The results indicate low comparability between high and low control conditions in terms of the emotionality of a recalled event, the domain and sphere of control, amongst other differences. In an experimental study that included three types of recall-based control manipulations (Study 2: N = 506), we found that the conditions differed not only in emotionality but also in a generalized sense of control. This suggests that different aspects of personal control can be activated, and other constructs evoked, depending on the experimental procedure. We discuss potential sources of variability between control manipulation procedures and propose improvements in practices when using experimental manipulations of sense of control and other psychological constructs.

Transient-based multiple branch detection in reservoir pipeline valve systems

Efficient management of pipeline assets is crucial for a reliable urban water supply. Unknown side branches in pipeline systems can hinder the prediction of hydraulic transients, owing to unexpected pressure responses. Herein, we developed a method for detecting multiple side branches in a simple reservoir pipeline valve system. A polynomial-based transient characterization scheme was proposed to address nonlinear valve manoeuvres, which substantially improved the transient simulations over conventional orifice-based approximations. A procedure for pressure signal manipulation via the superimposition of pressure signals with and without branches and isolation of the interference between various branched elements, which distorted the pressure response of multiple branches, was introduced. The model performance was evaluated by comparing the interference-isolated signals obtained from the conventional method, proposed scheme, and experimental datasets. Effective phase matching of the pressure responses obtained via the proposed scheme and experimental data indicated the potential of the former for detecting multiple branches.

Results of Early Manipulation Under General Anesthesia in Intra-Articular Distal Femur Fractures

Abstract Background: Postoperative knee stiffness after intra-articular distal femur fracture causes significant disability affecting daily activities of the patient and causing concern for the surgeon. Although the importance of early postoperative mobilization is emphasized to all patients, many patients, especially those from rural areas, have no access to specialized physiotherapy and do not understand the importance of the same. These patients also do not visit the hospital on scheduled days of follow-up due to various socio-economic reasons. Hence, such patients can have restrictions on knee movements (flexion as well as extension) very early during the postoperative period. We present our study protocol for early manipulation under general anesthesia (MUGA) and suture removal at 3 weeks after surgery for these fractures. At 3 weeks, the soft tissue healing of the trauma as well as the surgery have occurred to a great extent. The surgical site pain and inflammation have also reduced. All patients who are operated on will always come to hospital for suture removal. We planned to do a MUGA for the knee along with suture removal at 3 weeks for these patients. Materials and Methods: A prospective study was carried out at our institution for patients admitted and operated on for an intra-articular distal femur fracture. These patients were evaluated for knee range of motion at 3 weeks and posted for manipulation under anesthesia (MUA) and suture removal. Results: The 15 patients who were operated on for an intra-articular distal femur fracture underwent early MUA at 3 weeks. The mean pre-manipulation mean knee flexion was 60°. On manipulation, mean knee flexion of 110° was achieved. At the time of follow-up at 3 months, mean knee flexion was 123°. The average time for MUA was 15 min. No complications occurred during manipulation procedures. Conclusion: Early MUA is a suitable and effective noninvasive treatment modality for postoperative stiffness in cases of intra-articular distal femur fractures.

Atomic Force Microscopy Imaging and Analysis of Prokaryotic Genome Organization.

This protocol describes the application of atomic force microscopy for structural analysis of prokaryotic and organellar nucleoids. It is based on a simple cell manipulation procedure that enables stepwise dissection of the nucleoid. The procedure includes (i) on-substrate lysis of cells and (ii) enzyme treatment, followed by atomic force microscopy. This type of dissection analysis permits analysis of nucleoid structure ranging from the fundamental units assembled on DNA to higher-order levels of organization. The combination with molecular-genetic and biochemical techniques further permits analysis of the functions of key nucleoid factors relevant to signal-induced structural reorganization or building up of basic structures, as seen for Dps in Escherichia coli and TrmBL2 in Thermococcus kodakarensis. These systems are described here as examples of the successful application of AFM for this purpose. Moreover, we describe the procedures needed for quantitative analysis of the data.

Optofluidic-based cell multi-axis controllable rotation and 3D surface imaging

The controlled rotation of individual cells plays a crucial role in enabling three-dimensional multi-angle observation of cellular structure, function, and dynamic processes. Reported cell rotation techniques often struggle to strike a balance between high precision and simple control, and they exhibit limited control flexibility, typically achieving only uniaxial cell rotation. In this study, we propose a cell rotation technique in three dimensions based on optofluidics, which utilizes optical tweezers to immobilize the cell and exploits the asymmetry of the surrounding flow to drive cell rotation. By adjusting the focal position of the optical tweezers, cells can be positioned within various flow profiles, enabling control of the rotation speed, rotation direction, and rotation axis of cells. This approach simplifies the manipulation procedure, achieving desirable control precision and greater rotation flexibility. Using our approach, multi-angle surface imaging projections of target cells can be rapidly obtained, followed by capturing the cell contour data from the images. By combining the cell contour data with corresponding angular position information, we have reconstructed the 3D surface of the target cell. We have employed this technique in experiments for the analysis of red blood cell morphology. Based on the constructed 3D surface images of diverse-shaped red blood cells, we quantified structural parameters including cell surface area, volume, sphericity, and surface roughness, which demonstrates the potential application of this cell rotation technique for cellular morphological analysis.

Employing Cloning-Independent Mutagenesis of Parvimonas micra for the Study of Cell Wall Biogenesis.

The cell wall plays an important structural role for bacteria and is intimately tied to a variety of critical processes ranging from growth and differentiation to pathogenesis. Our understanding of cell wall biogenesis is primarily derived from a relatively small number of heavily studied model organisms. Consequently, these processes can only be inferred for the vast majority of prokaryotes, especially among groups of uncharacterized and/or genetically intractable organisms. Recently, we developed the first tractable genetic system for Parvimonas micra, which is a ubiquitous Gram-positive pathobiont of the human microbiome involved in numerous types of inflammatory infections as well as a variety of malignant tumors. P. micra is also the first, and currently only, member of the entire Tissierellia class of the Bacillota phylum in which targeted genetic manipulation has been demonstrated. Thus, it is now possible to study cell wall biogenesis mechanisms within a member of the Tissierellia, which may also reveal novel aspects of P. micra pathobiology. Herein, we describe a procedure for cloning-independent genetic manipulation of P. micra, including allelic replacement mutagenesis and genetic complementation. The described techniques are also similarly applicable for the study of other aspects of P. micra pathobiology and physiology.

Clinical Implementation of Combined Quasi-Static Ultrasound Elastographic and Regional Blood Flow Assessment Techniques, in Areas of Forearm Myofascial Dysfunction, Before and After Osteopathic Physical Manipulation

A fast-growing area of high-resolution ultrasound imaging is localizing painful regions termed myofascial tender points (MTP). To mitigate pain and reduce musculoskeletal nodularity and stiffness, osteopathic physicians perform loco-regional osteopathic manipulative procedures (OMT). Current MTP-diagnostic and clinical efficacy criteria using sono-elastographic, or regional flow biomarkers are poorly characterized. This research aims to develop a well-grounded approach to identify forearm MTPs and track changes post-physical interventions, using elastography combined with regional power Doppler. A 44-subject clinical study cohort, was randomly divided in OMT, mild exercise and “rest” groups: imaging was performed using an open-platform SonixTouch Q + . During controlled tissue deformation (4.5-5 Hz), ultrasound elastography was performed by computing root-main-square (RMS) strain of beamformed ultrasound echoes (13 MHz, 15fps) for 3 s. Similarly, power Doppler maps were averaged over 5 seconds (5–12 fps), to evaluate regional blood flow. Data acquisition and processing sequence was repeated post-intervention. Changes in tissue stiffness as well as regional blood flow were compared pre- and post-intervention for all three human subject groups. With the experimental technique used in this study, a significant reduction in tissue stiffness, and increase in regional blood flow is demonstrated in the OMT group compared to the exercise and rest group.

Short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures

Objective To explore the short-term efficacy of digitally-assisted traditional Chinese medicine manual reduction combined with 3D printed splint in the treatment of AO type-A distal radius fractures, and explore the quantification of traditional Chinese medicine manual reduction and personalized improvement of splinting. Methods The clinical data of 50 patients with AO type-A distal radius fractures, who received treatment at the outpatient department of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital in Hebei Province, were retrospective analyzed. The patient cohort included 22 females and 28 males, with ages ranging from 25 to 75 years old. Among them, 27 cases presented with distal radius fractures on the left side, and 24 cases on the right side. The patients were categorized into two groups: treatment group (n=25) and control group(n=25). There were 13 males and 12 females in the treatment group, with an average age of (56.2±5.5) years old. Treatment approach for this group involved several steps. Initially, Mimics Research software was used to conduct comprehensive analysis of complete CT data from the affected limb, resulting in the creation of a three-dimensional model. Subsequently, 3D models of the bones and skin contours, stored as STL format files, were imported into the Materialise Magics 23.0 software for model processing and repair. This facilitated the simulation of reduction and recording of displacement data, effectively generating a "digital prescription" to guide and quantify traditional Chinese medicine manipulation procedures. Finally, a personalized 3D printed splint was applied for fixation treatment. There were 15 males and 10 females in the control group, with an average age of (53.32±5.28) years old. These patients were treated with manualreduction combined with traditional splinting. The clinical efficacy of the two groups was assessed in terms of fracture reduction quality, fracture healing time, Gartland-Werley wrist joint score and X-ray parameters (palminclination angle, ulnar deviation angle, radius height) at 6 weeks post-operatively. Results The treatment group exhibited a shorter duration for achieving clinical healing compared to the control group (P<0.05). Six weeks post-operatively, the treatment group demonstrated higher wrist joint function scores, and a higher proportion of excellent and good outcomes than the control group(P<0.05). The treatment group was superior to the control group in terms of imaging parameters 6 weeks post-operatively (P<0.05). Conclusion By quantifying skin contours through digital simulation prescription reduction, a personalized 3D printed splint is developed to effectively stabilize fractures, enhancing localized fixation while ensuring greater adherence, stability, and comfort. This innovative approach offers personalized treatment for AO type-A distal radius fractures and presents a novel, precise treatment strategy for consideration.

Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic

The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents. We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors. Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P=.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P=.001). COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic's impact.

Screen space shape manipulation by global structural optimization

Existing structure-aware shape manipulation frameworks have greatly facilitated the shape manipulation procedure. However, they still require users to possess the necessary 3D modeling experience since the manipulation, e.g., positioning shape handles, is performed in 3D space. For novice users without such experience, this procedure remains tedious. On the other hand, performing manipulation in screen space is more natural to novice users, especially with 2D input and display devices. This paper presents a novel interactive framework for manipulating 3D man-made shapes in screen space. Users only need to edit abstract proxies of input shapes in 2D to obtain desired deformed shapes without considering their 3D geometries. This is achieved by first analyzing the structures of the shapes and then estimating the deformed shapes with a structure-preserving optimization method. Our efficient algorithm can produce real-time shape manipulation results as previews, thus avoiding a trial-and-error editing procedure. To verify the effectiveness of our framework, we conducted a user study that contained four shape manipulation tasks. In this study, we compared our framework with a baseline framework that requires users to edit shape’s geometry in 3D space and does not provide previews for the manipulation results. The statistics and the user feedback confirm that our framework is more intuitive and efficient for shape manipulation.

Air‐Processed Blue Perovskite Light‐Emitting Diodes Enabled by Manipulation of Adsorbed‐Moisture‐Dominated Crystallization Kinetics

AbstractThe fabrication of blue perovskite light‐emitting diodes (PeLEDs) in air conditions promises to liberate the manipulation procedures from the protection of inert atmosphere in the glovebox, which will remarkably promote the commercialization proceeding of perovskite‐based optoelectronic devices in display applications. However, achieving air‐processed blue PeLEDs in the interference of moisture meets great challenges in crystallization kinetics control. Herein, it is proposed that substrate‐adsorbed moisture dominates the perovskite crystallization kinetics during the fabrication in air, and the limited moisture from nonhygroscopic substrate inhibits the nucleation of the large‐n phase and allows the growth of the small‐n phase, thus yielding blue quasi‐2D perovskite films in a wide moisture range of 10–50% relative humidity. Then, air‐processed blue PeLEDs are successfully achieved for the first time, showing a brightness of 968 cd m−2, external quantum efficiency of 2.54% at stable peak emission of 483 nm, as well as an outstanding operating stability of 546 s at a peak brightness of 45 cd m−2, which are favorably competitive with PeLEDs fabricated in the glovebox. This work provides a guideline for air‐processed blue PeLEDs fabrication, which paves the way for air‐processed PeLEDs in further application of commercialization display.

Tape-Releasing Suture with "Long Loop" on Mid-Urethral Sling: A Novel Procedure for Management of Iatrogenic Urethral Obstruction.

To report our experiences of a tape-releasing suture with "long-loop" in women with iatrogenic urethral obstruction following the mid-urethral sling procedure. A total of 149 women underwent a tape-releasing suture with "Long Loop" during the operation. Post-void residual volume was evaluated after Foley removal. Lower urinary tract symptoms and urodynamic studies were assessed before and six months postoperatively. Nine women out of 149 who underwent mid-urethral sling surgery were found to have iatrogenic urethral obstruction post-operatively based on their urinary symptoms and ultrasound findings. There was no apparent difference between tested groups in mid-urethral sling products and concomitant procedures. 77.8% had successful releases after the first Long-loop manipulation procedure, and 22.2% required two or more releases. However, the SUI cure rate is similar in groups receiving the Long-loop manipulation or not (88.9% and 87.1%, respectively). We are convinced of the practicability and efficacy of the tape-releasing suture "Long-loop." We adopted subjective and objective means to evaluate both groups before and after a six-month follow-up. The Long-loop manipulation procedure can successfully resolve the iatrogenic urethral obstruction without compromising the effectiveness of mid-urethral sling for the treatment of SUI.

Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study.

Inflation of the endotracheal tube cuff is needed for providing ventilation. Cuff pressure should be maintained inside the appropriate range to prevent critical airway complications. The purpose of this study is to evaluate the pressure changes in the endotracheal tube cuff during otorhinolaryngologic surgery. This single-center observational study was conducted at Severance Hospital in Korea between April 2020 and November 2020. Patients aged >20 years scheduled to undergo otorhinolaryngological surgical procedures were enrolled. Patients undergoing planned tracheostomy and those who were slated for uncuffed endotracheal tube use were excluded. Intubation was performed after the induction of general anesthesia. A pressure transducer was connected to the pilot balloon of the endotracheal tube, and cuff pressure was continuously monitored until extubation. If the cuff pressure was not appropriate for more than 5 min, it was adjusted to the appropriate range by injecting or removing air. The percentage of time for which the cuff pressure remained within the appropriate range was calculated and defined as the time in the therapeutic range (TTR). The presumed cause for the rise or fall in cuff pressure was identified. In total 199 patients, alterations in cuff pressure outside the appropriate range occurred in 191 patients (96.0%). The mean TTR was 79.7% (SD 25.0%), and head and neck surgery had the lowest mean TTR of 69.0% compared to ear and nose surgeries (94.2 and 82.1%, respectively). Sixty-eight patients (34.2%) demonstrated inadequate endotracheal tube cuff pressure for more than 20% of the total anesthesia time. Twenty-six patients (13.1%) demonstrated optimal endotracheal tube cuff pressure for less than 50% of the total anesthesia time. The causative factors inducing inappropriate cuff pressure were found to vary, including positional changes, surgical procedure, anatomical manipulation, and anesthetic procedure. In otorhinolaryngologic surgery, cuff pressure increased or decreased outside the appropriate range due to various factors. Therefore, we suggest close continuous monitoring of cuff pressure during anesthesia for otorhinolaryngologic surgery. clinicaltrials.gov, identifier NCT03938493.