Prolonged Procedures Research Articles

Impact of carotid artery tortuosity on mechanical thrombectomy outcomes: A systematic review.

Carotid artery tortuosity (CAT) may complicate mechanical thrombectomy (MT), potentially causing delays or preventing recanalization. However, the relationship between CAT and MT outcomes remains largely unexplored. This systematic review aims to evaluate the existing evidence regarding the impact of CAT on MT outcomes. Following PRISMA guidelines, a systematic literature search was conducted using MEDLINE, EMBASE, Web of Science, Cochrane, and Scopus databases. Studies providing data for MT outcomes based on CAT status were included. Outcomes of interest included successful recanalization, first-pass efficacy (FPE), procedure time, functional independence, and procedure-related complications. Our search identified nine studies with 2737 patients. Three studies employed DSA to assess tortuosity, whereas the remaining six studies preferred CTA. In seven studies, CAT was associated with prolonged procedure times. In five studies, successful recanalization rates were significantly lower in CAT patients as compared to patients with non-tortuous arteries. Two studies showed that CAT could alter FPE or successful recanalization rates of first-line MT techniques. No study found statistically significant relationships between CAT and functional independence. Three studies examined the association between CAT and safety outcomes, and only one study found increased intracranial hemorrhage rates in patients with CAT. All nine studies employed different CAT criteria. Despite the vast MT literature, the number of studies reporting CAT status remains low. CAT may affect procedure time and technical outcomes of MT. Therefore, employing a uniform CAT definition and reporting CAT more frequently can provide insights into management of patients with acute large vessel occlusions.

Recurrent cardiac tamponade as a complication of prolonged left bundle branch area pacing

Post-cardiac injury syndrome (PCIS) is one of the complications of cardiac interventional procedures. This condition has been postulated to be due to an immune reaction, especially with pacemaker lead implantation. Patients with PCIS can have uncomplicated pericardial effusion until they develop cardiac tamponade. The management of PCIS, which can be conservative management or require pericardiocentesis or surgery depends on the patient’s clinical symptoms. As the left bundle branch area pacing (LBBAP) implantation technique and technology are still new, it is associated with longer procedural time than conventional pacemaker implantation. Herein, we report a case of PCIS in a patient who had a prolonged LBBAP procedure due to difficult anatomy and presented with recurrent cardiac tamponade.

The effect of cervical length on procedure time and VAS pain score in office hysteroscopy

This study aimed to investigate the effect of cervical length on procedure time and VAS pain scores during office hysteroscopy. A cross-sectional study was conducted on 50 patients who underwent office hysteroscopy for various indications such as abnormal uterine bleeding and infertility. Exclusion criteria included active vaginal infection, previous cervical surgery, and chronic pelvic pain. Cervical length was measured via transvaginal ultrasound prior to the procedure. Procedure time and VAS pain scores were recorded and analyzed. Patients with a retroverted uterus had higher post-procedure VAS scores (7.6 ± 0.8) compared to those with an anteverted uterus (4.9 ± 1.9, p < 0.001). Cervical length was found to be a significant predictor of both procedure time (β = 5.711, p < 0.001) and VAS pain score change (β = 0.167, p < 0.001). Procedure time was significantly longer in patients with increased cervical length (R2 = 79.6%, p < 0.001). Additionally, an anteverted uterus was associated with a shorter procedure time (118.2 ± 49.2 s) compared to a retroverted uterus (142.7 ± 46.8 s, p < 0.001). Cervical length was a significant predictor of VAS pain scores (β = 0.167, p < 0.001), with each millimeter increase leading to a 0.167-unit rise. While univariate analysis showed a negative association between age and VAS scores (β = -0.299, p = 0.035), this was not significant in the multivariate model (p = 0.586). Cervical length also significantly prolonged procedure time (β = 5.711, R2 = 79.6%, p < 0.001). Cervical length is a significant factor influencing both the duration and pain experienced during office hysteroscopy. Consideration of cervical length can improve patient comfort and procedural efficiency in clinical practice.

Isolated Sagittal Craniosynostosis and Open or Endoscopic Cranial Vault Remodeling: An Evaluation of Developmental Outcomes.

Craniosynostosis, a condition involving the premature fusion of cranial sutures, can impair brain development and potentially lead to developmental delays. This study compares open cranial vault remodeling versus endoscopic strip craniectomy treatment for isolated sagittal craniosynostosis, primarily focusing on development outcomes. A retrospective cohort study was conducted at a tertiary pediatric surgery center, involving all 45 patients treated surgically for isolated sagittal craniosynostosis from 2013 to 2024. Patients were categorized into 2 groups based on surgical intervention: open cranial vault remodeling (n=17) and endoscopic strip craniectomy (n=28). Data collected included patient demographics, intraoperative specifics, and postoperative outcomes. Developmental outcomes were assessed using postoperative progress notes. Of the 45 patients, those undergoing open surgery were older (10.7mo and 9.4kg versus 3.3mo and 6.4kg, P<0.001) and experienced higher use of intraoperative drains (65% versus 0%, P<0.001), more prolonged procedures (189 versus 58min, P<0.001), more significant blood loss (102 versus 62mL, P=0.009), longer stays (3.3 versus 2.6d, P=0.011), and higher opioid prescription rates (82% versus 43%, P=0.013) compared to the endoscopic group. Within 12 months postoperatively, social delays were more common in the open group (19 versus 0%, P=0.049), and, postoperatively in general, cognitive delays were more common in the open group (31% versus 4%, P=0.023) when compared to the endoscopic group. Endoscopic cranial vault remodeling produces preferentially better hemodynamic, postoperative, and hospital stay outcomes. Although inferences into long-term developmental delay outcomes were limited due to sample size, a preferential benefit toward endoscopic intervention may exist.

Venous Thromboembolism Subsequent to the Management of Panfacial Fracture- A Clinical Paper and Review.

Venous thromboembolism (VTE) is a major factor responsible for death in patients suffering from prolonged immobilisation due to various causes like old age, pregnancy, stroke, and prolonged surgical procedures to mention a few. Long-duration surgeries as in fixation and reconstruction in panfacial fractures and facial orthognathic surgeries can be potential cases predisposed for VTE in maxillofacial surgery. A fifty-eight-year-old patient suffered from pulmonary thromboembolism following long-duration surgery for panfacial fracture fixation and reconstruction under general anaesthesia. He was promptly managed via medical management and recovered well. Pulmonary thromboembolism is a severe complication that can lead to severe morbidity or even death. Owing to the characteristics of venous thrombosis, all collaborating healthcare team members should be trained to assess risk factors for efficient diagnosis which can facilitate specialised intervention that can result in better patient outcomes. Maxillofacial surgeons need to evaluate the risk of thromboembolism in patients and institute efficient diagnosis whenever required to deliver optimised and better patient care. Although thromboembolism is a preventable disease state, the key is to keep a close eye on the patient's clinical features to identify and treat them at the right time for better patient care and survival.

Hemoadsorption during cardiopulmonary bypass to absorb plasma-free hemoglobin in patients with acute type a aortic dissection: A randomized controlled trial.

This study aimed to investigate the effect of hemoadsorption (HA) on plasma-free hemoglobin (pfHb) levels during cardiopulmonary bypass (CPB) and the clinical outcomes in patients with acute type A aortic dissection (ATAAD). In this single-center randomized trial, patients were assigned to either a group using the HA380 device or a control group without it. The primary outcome was changes in pfHb levels during CPB and within the first 48 hours after surgery. The study concentrated on comparing compared the data between the two groups using analysis of variance for repeated measures. Concurrently, both correlation and linear regression analyses were employed to identify the factors influencing pfHb levels. The mean pfHb concentration was lower in the HA380 group than in the control group,but there were no significant differences between the two groups (F = 2.883, 95% confidence interval CI: -0.006 to 0.072, p = .093) using a repeated measures analysis of covariance model. Linear regression analysis identified body mass index (BMI) as the primary factor influencing the adsorption effect (B = 0.01, 95% CI: 0.36-1.24, p = .001). Additionally, the major postoperative complications within the first 48 hours did not show significant differences between the groups, including acute kidney injury (AKI) (25% HA380 group vs 36% control group, p = .261) and postoperative liver dysfunction (PLD) (5% HA380 group vs 16% control group, p = .106). The use of the HA380 device in CPB during cardiac operations may contribute to reduced pfHb levels. However, the difference was statistically non-significant because pfHb adsorption was notably influenced by the patient's BMI. Consequently, BMI should be considered when deploying HA380 in prolonged CPB procedures, including ATADD repair. Enhancing either the number of devices or the duration of HA in patients with overweight or obesity may potentially improve postoperative clinical outcomes.

COMPARISON OF THE EFFECT OF DEXMEDETOMIDINE AND TRAMADOL AS AN ADJUNCT WITH BUPIVACAINE ON THE DURATION OF SPINAL ANESTHESIA

Spinal anesthesia is a commonly employed technique for infra-umbilical surgeries, but its duration is often insufficient for prolonged procedures. Adjuvants such as dexmedetomidine and tramadol are used to enhance its efficacy. Objective: This study aimed to compare the effects of dexmedetomidine and tramadol as adjuvants to bupivacaine in spinal anesthesia. Methods: This randomized controlled trial was conducted at the Department of Anesthesia, AIMC, Jinnah Hospital, Lahore, over one year From 2021 to 2022. 68 patients undergoing elective infraumbilical surgeries were randomized into two groups. Group A received 7 µg dexmedetomidine with 12 mg bupivacaine, and Group B received 25 mg tramadol with 12 mg bupivacaine. Outcomes assessed included the onset of sensory block, total duration of analgesia, time to first rescue analgesia, and intraoperative and postoperative pain scores. Statistical analyses were performed using SPSS version 25, with a p-value &lt;0.05 considered significant. Results: The mean onset of sensory block was significantly shorter in the dexmedetomidine group (6.6 ± 0.603 minutes) compared to the tramadol group (7.2 ± 0.825 minutes; p = 0.002). The total duration of analgesia was significantly longer in the dexmedetomidine group (14.4 ± 1.16 hours) compared to the tramadol group (10.6 ± 1.02 hours; p &lt; 0.001). Similarly, the mean time to first rescue analgesia was significantly prolonged in the dexmedetomidine group (11.8 ± 0.967 hours) compared to the tramadol group (7.9 ± 0.924 hours; p &lt; 0.001). Intraoperative and postoperative pain scores were consistently lower in the dexmedetomidine group, with statistically significant differences at 2, 3, 5, and 6 hours. Conclusion: Dexmedetomidine is a more effective adjuvant than tramadol in spinal anesthesia, offering a shorter onset of sensory block, prolonged analgesic duration, and delayed rescue analgesia with better pain control. These results support the use of dexmedetomidine as a preferred adjuvant for extended surgical procedures under spinal anesthesia. Future studies with larger sample sizes are recommended to validate these findings further.

Radionuclide release from spent nuclear fuel in sealed glass ampoules

Radiation from spent nuclear fuel affects the redox chemistry of water in the proximity of the fuel surface. The overall effect of the radiolysis is oxidizing so that U(IV) in the spent nuclear fuel is oxidized to U(VI). The dissolution of U(VI) is relatively fast, especially when the water contains bicarbonate. Based on this, radiolytic oxidation is considered the main driving force for spent fuel dissolution and radionuclide release in a spent fuel repository environment, and many studies over the years have aimed to further our understanding of this process and how it is influenced by available redox active components in open and closed systems. Here, data from sealed glass ampoules in which spent fuel is leached for one and five years, are compared with published data from a previous similar experiment. With regards to evolution of radiolytic gases, the results are comparable to the results from the previous experiments: a steady state with regards to oxygen and hydrogen composition is observed. An unexpected observation is that some ampoules with old, pre-oxidized fragments produced less radiolytic gases. These older fragments release a larger fraction of the radionuclide inventory of the samples, yielding concentrations that are on the same level as previously published data. The data from the old fragments presented here are affected by the pre-oxidation and prolonged washing procedure, which confounds the interpretation of those data. New, recently prepared fragments yield data that are easier to interpret. The radionuclide concentrations in the ampoules with new fragments are much lower; uranium concentrations of ca 5E-6 M after one year, and ca 3E-5 M after five years. Using the calculated radionuclide inventory in the fuel samples, an apparent radionuclide release rate in these initially anoxic systems, based on U release, is ca 3E-5 per year.

Abstract 4135092: Prolonged Procedure Time and Its Association with Peri-Procedural Complications in Endovascular Therapy for Symptomatic Lower Extremity Arterial Disease

Background: Prolonged operative times in surgical procedures have been significantly associated with an increased risk of complications. However, the impact of prolonged procedure time of peri-procedural complications in patients undergoing endovascular therapy (EVT) for symptomatic lower extremity arterial disease (LEAD) has not been systematically evaluated. Aims: To determine the association between prolonged procedure time and peri-procedural complications in patients undergoing EVT for symptomatic LEAD. Methods: Data from a nationwide EVT registry in Japan (J-EVT) between 2021 and 2022 were analyzed. The outcome measure was peri-procedural complications defined as a composite of perioperative death, major bleeding, contrast nephropathy, myocardial infarction, ischemic stroke, and major amputation. Procedure time was categorized into four clinically relevant groups (≤59, 60–119, 120–179, and ≥180 minutes). The logistic regression model was developed to investigate the risk of peri-procedural complications across subgroups of procedure time with the shortest subgroup (≤59 minutes) set as the reference category. Results: A total of 47,301 patients (average age: 75±9 years, male: 69.0%, chronic limb-threatening ischemia [CLTI]: 51.0%) undergoing EVT for symptomatic LEAD were analyzed. Notable comorbidities included diabetes mellitus at 60.6% and dialysis at 29.9%, respectively. A history of coronary artery disease was noted in 40.7% of the participants. The median procedure time (interquartile range) was 110 (74–161) minutes. A total of 431 patients (0.9%) experienced perioperative complications. The perioperative complications included 48 deaths, 277 cases of major bleeding, 28 cases of contrast nephropathy, 10 myocardial infarctions, 16 ischemic strokes and 72 major amputations. After adjusting for patient and limb characteristics, and hospital and operator volumes, the odds ratios for perioperative complications were 1.21 (P=0.45) for 60–119 minutes, 2.36 (P=0.001) for 120–179 minutes, and 5.31 (P&lt;0.001) for ≥180 minutes with the shortest subgroup (&lt;59 min) set as the reference. Conclusions: Prolonged procedure time of EVT for symptomatic LEAD was significantly associated with an increased risk of perioperative complications.

Association of Reperfusion and Procedural Characteristics with Endovascular Thrombectomy Outcomes in Large Core Stroke: Sub-Analysis from the SELECT2 Trial.

From the SELECT2 trial, we evaluated the association between reperfusion status, first-pass effect (near-complete or complete reperfusion [extended thrombolysis in cerebral infarction (eTICI) 2c-3] in 1 pass), procedure time and primary technique (aspiration vs stent-retriever) with functional outcomes in patients receiving EVT across ASPECTS (3 vs 4 vs 5) and core estimate strata (<70 vs ≥70ml, <100 vs ≥100ml, and <150 vs ≥150ml). Of 180 patients who received thrombectomy, 144 (80%) achieved successful reperfusion (eTICI 2b-3) and demonstrated better clinical outcomes (adjusted generalized odds ratios [aGenOR]: 1.48, 95% confidence interval [CI]: 1.01-2.15), compared with unsuccessful reperfusion. Results were consistent across ASPECTS and core estimate strata. Additionally, complete or near-complete reperfusion (eTICI 2c-3) was associated with better functional outcome (aGenOR: 1.99, 95% CI: 1.33-2.97) in patients achieving successful reperfusion. Functional outcome point estimates favored those with first-pass-effect (42 of 167 (25%), aGenOR: 1.46, 95% CI: 0.96-2.24). Longer procedure time was associated with worse modified Rankin scale (mRS) distribution (aGenOR: 0.92, 95% CI: 0.87-0.96, p-value = 0.001 for 10 minutes increment). Aspiration-first technique was used in 43 of 154 (25%) patients and was not associated with higher reperfusion (88% vs 78%, p = 0.18) or better functional outcome (aGenOR: 0.74, 95% CI: 0.50-1.10) as compared with stent-retriever first. Successful reperfusion resulted in improved clinical outcomes in large core patients across baseline ischemic core strata. Near complete or complete reperfusion was further associated with better outcomes, whereas prolonged procedures were associated with worse outcomes. Results were consistent regardless of the technique used. ANN NEUROL 2024.

Prognosis of Proximal and Distal Vertebrobasilar Artery Stent Placement.

Vertebrobasilar artery stent placement (VBS) is potentially effective in preventing recurrent posterior circulation strokes; however, the incidences of in-stent restenosis and stented-territory ischemic events based on the location of stent placement have rarely been investigated. We aimed to investigate the characteristics and prognosis of VBS between intracranial and extracranial. This study was single-center retrospective cohort study, and we obtained medical records of patients who underwent VBS. We compared clinical and periprocedural factors between extracranial and intracranial VBS. The primary outcomes included the incidence of in-stent restenosis (>50% reduction in lumen diameter) and stented-territory ischemic events. We compared the incidence of in-stent restenosis and stented-territory ischemic events by using Kaplan-Meier curves. Of the 105 patients, 41 (39.0%) underwent extracranial VBS, and 64 (61.0%) underwent intracranial VBS. During the follow-up, the incidences of in-stent restenosis and stented-territory ischemic events were 15.2% and 22.9%, respectively. The procedure time was longer (47.7 ± 19.5 minutes versus 74.5 ± 35.2 minutes, P < .001), and the rate of residual stenosis (≥30%) just after VBS was higher (2 [4.9%] versus 24 [37.5%], P < .001) in intracranial VBS than in extracranial VBS. Also, the incidences of in-stent restenosis were significantly higher in intracranial VBS than in extracranial VBS (4.9% versus 21.9%, P = .037). On the other hand, the incidences of stented-territory ischemic events (7.3% versus 32.8%, P < .001) were significantly higher in intracranial VBS than in extracranial VBS. The main mechanisms of stroke were artery-to-artery embolism (2 [66.7%]) in extracranial VBS, and artery-to-artery embolism (9 [42.9%]) and branch atheromatous disease (8 [38.1%]) in intracranial VBS. The Kaplan-Meier curve demonstrated a higher incidence of in-stent restenosis and stented-territory ischemic events in intracranial VBS than in extracranial VBS (P = .008 and P = .002, respectively). During the follow-up, the incidence of in-stent restenosis and stented-territory ischemic events was higher in patients with intracranial VBS than in those with extracranial VBS. The higher rates of postprocedural residual stenosis might have contributed to the increased risk of in-stent restenosis. Furthermore, prolonged procedure time and additional stroke mechanism, including branch atheromatous disease, might be associated with a higher risk of stented-territory ischemic events in intracranial VBS.

A-356 A hand-held microfluidic platform for rapid and sensitive identification of respiratory viruses from nasal swab samples

Abstract Background Identifying the infected individual with a fast and accurate test is essential to constrain the spread of viruses and provide the proper treatment. Antigen rapid test (ART) provides quick screening of infection for patients; however, it shows less promising in the detection of early infection and patent’s full recovery as its inferior sensitivity to the nucleic acid detection method. On the other hand, bulky and costly instrument, tedious and prolonged procedures in traditional nucleic acid testing is also unfavorable for the screening. Delta is developing a fully automated hand-held POC using molecular technology to simultaneously detect 4 targets in 20 mins. The POC can be stand-alone or linked to mobile or PC app for different application scenarios. The proprietary recipe of the lysis buffer could neutralize the inhibition in the sample with effective pathogen lysis in seconds. The microfluidic cartridge containing lyophilized reagent can be stored at room temperature. The amplification signal is detected via the optical system from the colorimetric LAMP. This study is to evaluate the performance of the POC system in detecting SARS-CoV2 (SC2), FluA and B viruses in nasal swab. In addition, the assay performance was further compared with other commercial products available. Methods The attenuated SC2 virus, FluA and B viruses were diluted with 1xTE into different concentrations. The diluted viruses were spiked into the lysis buffer in 5% v/v ratio. Nasal samples collected from donors were soaked and swirled inside the cartridges containing lysis buffer according to the manufacturers’ instructions. For commercial products without lysis buffer, direct swabs were used. The cartridges were then put into the respective devices for further testing. Results The lyophilized SC2 assay consistently detected the viruses at 1000 copies/ml (20 out of 20) in real nasal samples in the presence of Delta Lysis Buffer (containing lyophilized neutralizer). However, without Lysis buffer, there was no signal detected even in the presence of 240x LoD viruses. The whole workflow sensitivity was tested with SC2 positive samples at 1x, 4x, 10x LoD and negative samples in the nasal sample matrix on Delta hand-held system. The results were processed via embedded algorithm and displayed on device as well as on PC and mobile app respectively. Out of 79 positive samples tested, the detection rate was 100%. There was no false positive detection for 31 negative samples tested. Positive internal control indicated the valid runs. 5 major SC2 subtypes (99.8% in silico analysis of 366,707 strains), 10 FluA and 9 FluB subtypes were successfully detected. Further, Delta hand-held platform outperformed in the LoD of SC2 with 500 copies/swab comparing to the ≥50,000 copies/swab of the benchmarked commercial platforms. Conclusions The performance of the hand-held molecular detection system we developed demonstrated a rapid, sensitive, and competitive analytical performance in the respiratory panel detection. The capability of device linking to apps and clouds for data management and the extendable docking system for multiple devices to run samples simultaneously and independently, make it applicable for the infectious diseases screening in both clinical settings and for home-use.

Scaling and aspect ratio effects on the frequency-modulated ultrasonic signal generated via fluidic oscillator

Traditional ultrasonic non-destructive testing methods in civil engineering require the use of coupling agents, leading to prolonged and labor-intensivemeasurement procedures along with the risk of surface damage. To alleviate these concerns, air-coupled ultrasonic actuation has been introduced as an effective alternative. However, the power loss due to impedance mismatchs at the interfaces remains an important limitation. To mitigate the power losses at the interfaces while characterizing the specimen thickness, we employ the fluidic oscillator as an ultrasonic source, wherein air acts as both the operating and coupling medium. The fluidic oscillator generates signals through self-sustained oscillations of the exiting air jet under continuous pressurized air supply, and therefore, eliminates the need for intricate design and manufacturing processes. The frequency spectrum characteristics and time-averaged acoustic fields of the fluidic oscillators are shown for the several configurations that were designed by varying the aspect ratio and scaling. Our preliminary investigations highlighted the dependence of the dominant spectral characteristics of a given fluidic oscillator on the mass flow rate of input air. Leveraging this observation, frequency-modulated chirp signals are produced by rapidly varying the flow rate, enhancing the signal-to-noise ratio for a reliable assessment of material characteristics.

High-value terminal treatment: Utilizing copper slag heat in the manufacture of copper-containing weathering steel

Copper slag, a bulk non-ferrous solid waste, is critical in establishing a closed-loop cycle in the copper metallurgy industry. Currently, the processing techniques for copper slag are characterized by prolonged procedures, secondary waste discharge, limited value utilization, and high energy consumption. A novel approach was proposed to harness the thermal energy inherent in molten copper slag for producing copper-bearing weathering steel and cement while simultaneously synergistically recovering lead and zinc. The results indicate that under the conditions of smelting temperature of 1500 °C, alkalinity of 1.06, smelting time of 60 min, and mechanical stirring, the recovery rates of copper, iron, lead, and zinc in copper slag reached 98.83%, 99.59%, 97.45%, and 98.51%, respectively. Furthermore, the feasibility of this approach was validated by laboratory-scale preparation of Q355GNH-grade copper-bearing weathering steel and S95-grade cement clinker. Computational analysis for the direct carbothermal reduction of molten copper slag in its thermal state reveals that, compared to the traditional flotation process, this approach saved 1177 MJ of thermal energy per metric ton of copper slag, equivalent to a reduction of 147 kg of carbon dioxide emissions. This study facilitates the zero-waste, high-value, and sustainable development of the copper smelting industry.

Early inhibition of BRD4 facilitates iPSC reprogramming via accelerating rDNA dynamic expression

BackgroundiPSC reprogramming technology exhibits significant promise in the realms of clinical therapeutics, disease modeling, pharmaceutical drug discovery, and various other applications. However, the extensive utilization of this technology has encountered impediments in the form of inefficiency, prolonged procedures, and ambiguous biological processes. Consequently, in order to improve this technology, it is of great significance to delve into the underlying mechanisms involved in iPSC reprogramming. The BET protein BRD4 plays a crucial role in the late stage of reprogramming; however, its precise function in the early stage remains unclear.ResultsOur study aims to investigate BRD4’s role in the early stages of iPSC reprogramming. Our investigation reveals that early inhibition of BRD4 substantially enhances iPSC reprogramming, whereas its implementation during the middle-late stage impedes the process. During the reprogramming, ribosome DNA expression initially increases before decreasing and then gradually recovers. Early inhibition of BRD4 improved the decline and restoration of rDNA expression in the early and middle-late stages, respectively. Additionally, we uncovered the mechanism of BRD4’s regulation of rDNA transcription throughout reprogramming. Specifically, BRD4 interacts with UBF and co-localizes to both the rDNA promoter and enhancer regions. Ultimately, BRD4 facilitates rDNA transcription by promoting the enrichment of histone H3 lysine 27 acetylation in the surrounding chromatin. Moreover, we also discovered that early inhibition of BRD4 facilitates cells’ transition out of the somatic cell state and activate pluripotent genes.ConclusionsIn conclusion, our results demonstrate that early inhibition of BRD4 promotes sequential dynamic expression of rDNA, which improves iPSC reprogramming efficiency.

Sedative effects of propofol and risk factors for excessive sedation in the endoscopic treatment of biliary and pancreatic diseases.

The safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation. We retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty. Distal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time. Obesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

Incidence and Risk Factors of Arytenoid Dislocation Following Endotracheal Intubation: A Systematic Review and Meta-Analysis.

Endotracheal intubation carries risks, including arytenoid dislocation (AD), a rare but severe complication. Due to small sample sizes, the incidence of AD varies considerably among studies. Proposed risk factors for AD include difficult intubation, prolonged intubation, certain surgeries, patient positioning, female sex, and BMI. This review aims to investigate the incidence of AD and explore the various predisposing risk factors. We retrieved relevant studies up to April 2024 from PubMed, Scopus, Web of Science, and the Cochrane Library. Using OpenMeta v5.26.14 software (Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, USA), we pooled AD incidence rates from individual studies. Other outcomes, reported in fewer studies and thus not suitable for meta-analysis, were synthesized manually. Study selection yielded 16 eligible articles. A random-effects model analysis of nine studies found a significant AD incidence rate of 0.093% (confidence interval (CI): 0.045% to 0.14%), but the results were highly heterogeneous (I2 = 91%). Older age was associated with prolonged hoarseness, while younger age and female sex increased the risk of AD. Additionally, AD risk factors included taller stature, higher BMI, specific surgeries, esophageal instrumentation, prolonged procedure durations, head-neck movement, and inexperienced intubators. However, intubation with a stylet reduced the AD risk. AD post-endotracheal intubation is rare (incidence: 0.09%), with potential underdiagnosis in larger datasets. Many risk factors may contribute to the condition, but the small number of studies per risk factor limits the ability to draw robust conclusions. Subjective diagnoses and retrospective studies further restrict comprehensive understanding. Further research is needed to explore AD risk factors effectively.

Advancements in Cardiac Catheterization Safety: Novel Radiation Protection Approaches Redefining Occupational Health.

Radiation exposure poses a substantial occupational risk for healthcare professionals in the catheterization laboratory (cath lab). The escalating complexity and frequency of interventional procedures, such as cardiac catheterizations and percutaneous coronary interventions, underscore the need for innovative strategies to mitigate radiation exposure. While traditional measures like lead aprons, thyroid collars, and goggles have been pivotal in reducing radiation exposure, they have limitations, especially during prolonged and intricate procedures. Consequently, there is a growing demand for advanced radiation protection methods that prioritize safety without compromising procedural efficacy. Recent strides in radiation protection technology have given rise to novel shielding devices and zero-radiation approaches tailored for cath lab use. The novel shields leverage innovative materials and designs to achieve superior attenuation of both scattered and direct radiation. Their ergonomic and adjustable features also ensure optimal shielding coverage without impeding the operator's skill or workflow. Multiple studies have validated the effectiveness of these advanced radiation protection methods in diminishing occupational radiation exposure in the cath lab. Initial findings suggest a significant reduction in doses for operators and staff, potentially lowering the risk of radiation-induced health complications over the long term. This article provides a comprehensive review of the current landscape of radiation protection shields in the cath lab, emphasizing the efficacy and potential of these cuttingedge shielding technologies.

Maximizing Degumming Efficiency for Firmiana simplex Bark Using Deep Eutectic Solvents.

Degumming is a critical process in the purification of natural fibers, essential for enhancing their quality and usability across various applications. Traditional degumming methods employed for natural fibers encounter inherent limitations, encompassing prolonged procedures, excessive energy consumption, adverse environmental impact, and subpar efficiency. To address these challenges, a groundbreaking wave of degumming technique has emerged, transcending these constraints and heralding a new era of efficiency, sustainability, and eco-friendly techniques. This study represents the Firmiana simplex bark (FSB) fiber's delignification by using deep eutectic solvents (DESs). The study explores the application of deep eutectic solvents, by synthesizing different types of DES using a hydrogen bond acceptor (HBA) and four representative hydrogen bond donors (HBDs) for FSB fiber degumming. This study investigates the morphologies, chemical compositions, crystallinities, and physical properties of Firmiana simplex bark fibers before and after the treatment. Furthermore, the effects and mechanisms of different DESs on dispersing FSB fibers were examined. The experimental results showed that choline chloride-urea (CU)-based DES initiates the degumming process by effectively disrupting the hydrogen bond interaction within FSB fibers, primarily by outcompeting chloride ions. Following this initial step, the DES acts by deprotonating phenolic hydroxyl groups and cleaving β-O-4 bonds present in diverse lignin units, thereby facilitating the efficient removal of lignin from the fibers. This innovative approach resulted in significantly higher degumming efficiency and ecofriendly as compared to traditional methods. Additionally, the results revealed that CU-based DES exhibits the utmost effectiveness in degumming FSB fibers. The optimal degumming conditions involve a precise processing temperature of 160 °C and a carefully controlled reaction time of 2 h yielding the most favorable outcomes. The present study presents a novel straightforward and environmentally friendly degumming method for Firmiana simplex bark, offering a substantial potential for enhancing the overall quality and usability of the resulting fibers. Our findings open new pathways for sustainable fiber-processing technologies.

Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings.

Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations.Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.