Release Procedure Research Articles

Surface Functionalization of WS2 nanosheets with Poly(N-vinylcaprolactam) and vinylacetic acid for targeted drug release in prostate cancer

Stimuli-responsive nanocarriers have gained attention in cancer therapy as a promising strategy because of their ability to enhance treatment efficacy and minimize off-target medication effects. This study introduces a novel nanopolymer responsive to pH and near-infrared (NIR) light as an intelligent carrier for delivering bicalutamide (BCT) into cancer cells. For this, the surface of tungsten disulfide (WS2) nanosheets is modified with temperature-responsive (poly(N-vinylcaprolactam)) and pH-sensitive (vinylacetic acid) polymers and then characterized using TGA, FE-SEM, XRD, and FT-IR techniques. Experimental variables including pH (5.56), temperature (25 °C), and contact time (11.02 min) are optimized using response surface methodology (RSM) and central composite design (CCD), yielding an adsorption efficacy of 99.45 %. The RSM-CCD model’s capability is analyzed using the correlation coefficient (R2) and several statistical error functions, including average relative error (ARE), root mean square error (RMSE), hybrid fractional error function (HYBRID), and Chi-square test (χ2). The in vitro drug release procedure is evaluated at different pH levels (5.6 and 7.4) and temperatures (37 and 50 °C). The results showed a maximum BCT release of 87.2 % within 6 h at 50 °C and pH 5.6, compared to 13.3 % at 37 °C and pH 7.4. Moreover, the BCT-loaded carrier demonstrates complete BCT release (100 %) following 10 min of NIR irradiation at pH 5.6. The kinetic data confirm that the best fit belongs to the zero-order model, and the drug release followed the supercase II transport mechanism.

Clinical-applied anatomy of the carpal tunnel regarding mini-invasive carpal tunnel release.

Carpal tunnel release is a widely performed procedure. Despite a high success rate, iatrogenic neurovascular injuries can occur which lead to a painful and unsatisfying outcome. This study conducted a detailed examination of the anatomy of the carpal tunnel and the proximity of neurovascular structures that are particularly susceptible to injury, especially in the context of minimally invasive carpal tunnel release procedures. The anatomy of the carpal tunnel of 104 wrists of 52 body donors was examined. The precise anatomical location and the presence of variations were recorded for the median nerve, ulnar nerve, ulnar artery and Berrettini branch. The distance between the median nerve, the ulnar artery, the ulnar nerve, and the Berrettini branch was measured in a proximo-distal and radio-ulnar direction in relation to the distal ulnar end of the carpal tunnel. The authors identified four main dangerous anatomical situations. (1) A proximal separation of the Long-Finger/Ring-Finger branch of the median nerve together with a narrow safe-zone; (2) an ulnar take-off of the recurrent muscle branch of the median nerve with a close radio-ulnar distance to the distal ulnar end of carpal tunnel; (3) an ulnar arterial arch lying close to the transverse carpal ligament; and (4) a proximal Berrettini branch also lying close to the latter. All situations are illustrated by photographs. Additionally, the authors present a sonographic carpal tunnel assessment protocol in order to reduce the risk of injury of any neurovascular structure in the proximity of the carpal tunnel. Certain patients may inherently face an increased risk of neurovascular injuries during minimally invasive carpal tunnel releases due to their anatomical variations. Four potentially risky scenarios were clearly illustrated. Consequently, one may consider conducting a preoperative ultrasound assessment of neurovascular structures at risk, when endoscopic or ultrasound-guided tunnel release are planned. In high-risk patients, open surgery should be preferred. II.

Preoperative halo-gravity traction combined with one-stage posterior spinal fusion surgery following for severe rigid scoliosis with pulmonary dysfunction: a cohort study

BackgroundTo assess the efficacy of preoperative halo-gravity traction (HGT) in treating severe spinal deformities, evaluating radiological outcomes, pulmonary function, and nutritional status.MethodsThis study retrospectively included 33 patients with severe spinal deformity who were admitted to our department from April 2018 to January 2022. All the patients underwent HGT prior to the posterior spinal fusion corrective surgery, with no patients having undergone anterior or posterior release procedures. The correction of deformity, pulmonary function tests (PFTs), and nutritional status data were collected and analyzed before and after HGT.ResultsA total of 33 patients (9 males, 24 females) were finally included in this study with an average age of 17.79 ± 7.96 (range 12–29) years. Among them, 20 patients were aged ≤ 16 years. The traction weight started from 1.5 kg and raised to 45.2 ± 13.2% of body weight on average progressively, with the average traction duration of 129 ± 63 days. After traction, the main curve was corrected from an average of 120.66 ± 3.89° to 94.88 ± 3.35°, and to 52.33 ± 22.36° (53%) after surgery(P < 0.05). PFTs also showed a significant increase in FVC%, FEV1%, and MEF% after traction [43.46 ± 14.76% vs. 47.33 ± 16.04%, 41.87 ± 13.68% vs. 45.19 ± 15.57%, and 40.44 ± 15.87% vs. 45.24 ± 17.91%, p < 0.05]. Total protein, albumin, and BMI were used as indicators of nutritional status. TP and albumin were significantly improved after traction, from 67.24 ± 5.43 g/L to 70.68 ± 6.98 g/L and 42.40 ± 3.44 g/L 45.72 ± 5.23 g/L, respectively(P < 0.05). No significant difference was found in deformity correction and lung function improvement between patients with traction for more or less than three months (p > 0.05). Two patients developed transient brachial plexus palsy during traction.ConclusionsHalo-gravity traction can partially correct spinal deformity, enhance pulmonary function. And HGT has been shown to facilitate an improved nutritional status in these patients. It could be used as a preoperative adjuvant treatment for severe spinal deformity. However, according to the study, a traction period longer than three months may not be necessary.

Revision Endoscopic Carpal Tunnel Release: An Update on Technique and Outcomes.

Carpal tunnel release is among the most frequently conducted upper extremity procedures. While it typically provides patients with improved sensation, decreased pain, and improved function, a small percentage of cases require revision due to failed initial surgery. Consequently, adoption of endoscopic techniques for carpal tunnel revision procedures is beginning to be explored. A retrospective analysis was conducted of postoperative clinical visits and patient-reported outcome measures for four patients who had undergone five endoscopic revision carpal tunnel release procedures (one patient had bilateral disease). All five cases had symptoms consistent with recurrent carpal tunnel syndrome. One hundred percent (5 of 5) of cases resulted in patients reporting symptom improvement. Postoperative clinical visits and improved patient-reported outcome measures (QuickDash, PROMIS Upper Extremity, VAS Pain, PSEQ, PHQ, and Surgery Satisfaction) scores from baseline to 6 weeks demonstrated successful postoperative function and symptom resolution. Five of five cases resulted in patients resuming normal activities without restrictions within 1-5 weeks, with an average of 3.4 weeks. Preliminary findings suggest the endoscopic revision procedure may be safe and effective for patients with recurrent carpal tunnel syndrome, extending the indications to include scars proximal to the wrist crease. Moreover, this minimally invasive procedure facilitates a transition back to normal activities and avoids incisions on weight-bearing surfaces of the palm. Adopting endoscopic revision may reduce the need for prolonged postoperative care and physical therapy. However, due to the limited sample size of five patients, further investigation with larger cohorts is warranted to confirm these observations.

ANATOMICAL STUDY OF PERCUTANEOUS TENOTOMY OF THE ILIOPSOAS TENDON GUIDED BY ULTRASOUND IN CADAVERS: A VIABLE TECHNIQUE?

The objective of this study is to evaluate the effectiveness and safety of percutaneous tenotomy of the iliopsoas tendon with the aid of ultrasound in cadavers.An anatomical and descriptive study of the technique of percutaneous tenotomy of the iliopsoas tendon guided by ultrasound and to share our experience in performing it and its reproducibility in clinical practice.Out of 20 tenotomies, 17 were total, performed at the level of the superior border of the acetabulum. Three tenotomies were partial, with more than 75% of the tendon being sectioned in all three. During one of the tenotomies, there was a partial injury to the femoral nerve. Measurements were made of the distance between the site where the blade was inserted and the femoral nerve, a noble structure that would be at greater risk during the procedure, with an average distance of 8.4 millimeters.Ultrasound-guided iliopsoas tendon release procedures have the ability to be performed in a cadaveric model, consistently achieving complete tendon release, except in cases of obesity, with minimal repercussions on adjacent structures, and require approximately 4 minutes to complete.

Manual Inter-Structural Release Procedure Can Alter Muscle Shear Modulus.

Inter-structural release (ISR) procedure to skeletal muscles is believed to attenuate adhesion between neighboring muscles and alleviate subjective symptoms, including perceived stiffness and associated pain. However, objective evidence about the effect of ISR on the mechanical properties of the muscles is limited. The purpose of this study was to test the acute effect of ISR on the shear modulus of adjacent muscles. It was hypothesized that ISR applied to the border between synergistic muscles would acutely reduce the resting shear modulus of the involved muscle. To assess the effect of ISR, the shear modulus of the resting peroneus longus (PL) and soleus (SOL) muscles was measured at various ankle joint positions (inversion/eversion) before and after interventions in nine non-symptomatic male individuals (age: 21.9 ± 1.4 years, height: 170 ± 6.6 cm, body mass: 64.3 ± 4.0 kg). Potential muscle activity during the measurement was assessed by recording surface electromyogram from these muscles. The interventions were ISR to the lower leg between the deep fascia of the PL and SOL and sham (massage). As the ankle joint position was passively varied toward inversion, the shear modulus increased substantially in PL and decreased moderately in SOL. Shear modulus of the proximal PL in the most inverted position increased acutely after ISR (by 11.4 ± 5.8%, P < 0.001), but not after the sham, without any change in the amplitude of electromyogram. These results provide objective evidence that the ISR procedure can acutely alter shear modulus, at least in a specific site in a resting muscle.

Response surface test simulation of locking system reliability considering kinematic pair wear evolution

The concentrated load endured by the locking system during the weapon mounting and release procedures may lead to mechanical wear in hinges and kinematic pairs, thereby influencing the functional reliability of the weapon rack mechanism system. This study aims to investigate the impact of kinematic pair wear evolution on the reliability of the locking system. Firstly, a rigid-flexible coupling multi-body dynamics model of the locking system was established to simulate the dynamic behaviors of the rack under different loading conditions. Moreover, the wear amounts of the main kinematic pairs were precisely calculated by the Archard wear model to provide data support for the subsequent reliability analysis. Subsequently, the response surface method was employed to design the orthogonal experiments for the reliability analysis of the locking system, and the reliability degradation law of the locking system within the design lifespan was obtained through the Monte Carlo method simulation. The research findings indicate that the wear of kinematic pairs has a significant effect on the motion function and accuracy of the mechanism. The motion reliability of the mechanism can be maintained above 99% within the design lifespan. Nevertheless, when the usage time exceeds twice the design lifespan, the reliability drops significantly to approximately 85%, and the influence degrees of different wear positions on the reliability were obtained through the sensitivity analysis. The research results not only provide a scientific basis for the optimal design of the locking system but also offer a novel perspective and method for the reliability assessment and maintenance strategy of the weapon rack locking system.

Comparative Analysis of Efficacy of Endoscopic versus Open Carpal Tunnel Release

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction. Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.

WALANT office based endoscopic cubital tunnel release

Background: Cubital tunnel syndrome is a common condition caused by compression of the ulnar nerve around the medial elbow. Surgical treatment usually involves open in situ ulnar nerve decompression unless ulnar nerve instability is noted. Endoscopic techniques for cubital tunnel release have been developed and implemented with excellent patient and surgeon satisfaction. Endoscopic cubital tunnel release can be performed in an office based procedure room under wide awake local anesthesia no tourniquet principles. We present our setup and technique for performing an endoscopic cubital tunnel release procedure in an office based setting under local anesthesia. Methods: Local anesthesia is injected along the course of the ulnar nerve on the medial arm and forearm extending 10 cm proximal and distal to the medial epicondyle. After allowing approximately 30 min for appropriate vasoconstriction, the patient is placed in a supine position with the arm abducted and externally rotated position. The endoscopic cubital tunnel release is then performed. Discussion: Our described technique eliminates the need for placement of a prophylactic tourniquet and thereby the need for the procedure to be performed within an OR setting. It also utilizes a single-stage anesthetic administration, which facilitates ease of completion and performance in an office based setting. There is a significant cost savings when endoscopic cubital tunnel release is performed in an office-based procedure room compared to in the operating room. Conclusions: Office-based endoscopic cubital tunnel release can be safely performed utilizing WALANT techniques, leading to high patient satisfaction and decreased overall cost of care. Level of Evidence: Therapeutic IV

An Efficient Distributed Task Allocation Method for Maximizing Task Allocations of Multirobot Systems

This paper addresses the distributed task allocation problem for maximizing the total number of successfully executed tasks of multirobot systems. Due to the deadline time of tasks and fuel limits of robotic vehicles, not all tasks can be successfully executed sometimes. Based on the performance impact (PI) algorithm, an effective and efficient performance impact (EEPI) algorithm is proposed, its novelty lies in its cost function and task release procedure. The fundamental ideas of the proposed cost function are as follows. First, the traveling time from the initial position of each vehicle to the positions of its tasks is minimized, so that more time can be left for the vehicle to execute more tasks due to the limited fuel. Second, the start time of each task should be close enough to its deadline, so that tasks with earlier deadlines can be assigned earlier than those with later deadlines. To avoid invalid removal performance impacts (RPIs) and inclusion performance impacts (IPIs), the tasks assigned to a vehicle are all released if the number of tasks removed by the vehicle during the task removal phase is the most, which further increases the total number of successfully executed tasks. Both simulations and hardware-in-the-loop experiments suggest that compared with the state-of-the-art distributed task allocation algorithms, the proposed EEPI is not only effective in maximizing the number of successfully executed tasks but efficient in saving the number of iterations and time to converge. <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Note to Practitioners</i> —This work was motivated by the limitations of the existing distributed task allocation algorithms for maximizing the total number of successfully executed tasks. The consensus-based bundle algorithm (CBBA) has been proven to guarantee convergence and 50% optimality under the diminishing marginal gain (DMG) assumption in previously published works. Based on CBBA, a performance impact (PI) algorithm was proposed, and simulations show that it can assign more tasks than CBBA when applied to time-critical scenarios with low task-to-vehicle ratios. Starting from the results of PI, a rescheduling method named PI for maximizing assignments (PI-maxAss) was proposed, which has been demonstrated to assign more tasks than PI with high task-to-vehicle ratios. However, much more iterations and time are required by PI-maxAss to converge to globally consistent assignments because of the rescheduling. Due to the above considerations, an effective and efficient performance impact (EEPI) algorithm is proposed in this paper to maximize the number of successfully executed tasks without any rescheduling. Both simulations and hardware-in-the-loop experiments suggest that compared with the algorithms mentioned above, the proposed EEPI is effective in maximizing the number of successfully executed tasks and efficient in saving the number of iterations and time to converge. In future work, the distributed task allocation problem in which several vehicles execute a task at the same time cooperatively or a vehicle executes several tasks simultaneously will be further addressed.

Legal framework and practical implications of vessel arrest and release: a study on limitation periods and maritime claims in Bangladesh

ABSTRACT This study delves into the intricate legal framework governing vessel arrest and release in Bangladesh, with a specific focus on the practical implications concerning limitation periods and maritime claims. The maritime industry plays a pivotal role in Bangladesh’s economy, yet the complexities surrounding vessel arrest and release often pose challenges for stakeholders involved. Through a comprehensive examination of relevant laws, regulations, and case studies, this research elucidates the legal mechanisms underpinning vessel arrest and release procedures. Moreover, it scrutinises the applicability and enforcement of limitation periods in maritime claims, shedding light on the intricacies of pursuing legal remedies within prescribed timeframes. By exploring practical implications, including procedural hurdles and judicial interpretations, this study offers insights into navigating the dynamic landscape of vessel arrest and release in Bangladesh. Ultimately, it aims to provide stakeholders, including shipowners, operators, insurers, and legal practitioners, with a deeper understanding of the legal intricacies and practical considerations inherent in maritime operations within Bangladeshi waters.

Trends and impact of comorbidities on Guyon's Canal release for the treatment of Guyon's Canal syndrome: A decade long nationwide analysis

BackgroundGuyon's Canal Syndrome (GCS) is a rare nerve entrapment condition with limited studies exploring the trends of GCS patients undergoing Guyon's Canal release. The aim of this study is to examine the trends associated with GCS: (1) Guyon's Canal release procedures performed; (2) surgically relevant comorbidities; (3) 90-day readmissions; and (4) same-day and 90-day reimbursement. MethodsA retrospective query was performed on the PearlDiver Mariner Database from 2010 to 2020 by CPT code 64719 to identify patients who underwent Guyon's Canal release. A total of 33,3764 patients were identified. Linear regression models were used to analyze trends in procedures performed, comorbidities, readmission, and reimbursement over this period. A P-value less than 0.05 was considered statistically significant. ResultsBetween 2010 and 2020, there was an overall significant decreasing trend in the number of Guyon's Canal release procedures performed (RC, −127.50; p < 0.001). There was an increase in number of GCS patients that had undergone Guyon's Canal release who drink alcohol (RC, 0.33; p < 0.001), are obese (RC, 0.81; p < 0.001), and use tobacco (RC, 0.56; p < 0.004), and decrease number of GCS patients with a history of diabetes (RC, −0.82; p < 0.001), hypothyroidism (RC, −0.56; p < 0.001), PVD (RC, −0.71; p < 0.001), and RA (RC, −0.33; p < 0.001). We also found an overall increasing trend in 90-day readmissions (RC, 0.09; p = 0.019) and increased same-day (RC, 68.09; p < 0.001) and 90-day average reimbursement (RC, 257.15; p < 0.001) from 2010 to 2020. ConclusionThe study demonstrated a decreasing trend in Guyon's Canal release performed in GCS patients but increasing cost of care implicated by the increased 90-day readmissions and same day and 90-day reimbursement. This may be attributed to the comorbidities present in GCS patients undergoing Guyon's Canal release. Therefore, it is imperative when consulting GCS patients with surgically relevant comorbidities to weigh the risk and benefits of the procedure.

Elbow Flexor Release Combined With Selective Neurectomy of Musculocutaneous Nerve for Spastic Elbow Flexion Deformity in Children and Adolescents.

Spasticity of the elbow flexors causes a dynamic and/or static elbow flexion deformity. This position interferes with the functional use of the hand, is aesthetically unpleasant and can cause problems with hygiene and comfort. A lengthening procedure of elbow flexor muscles can improve elbow posture and range of motion. However, causal spasticity is not addressed directly. Selective neurectomy of the musculocutaneous nerve has a direct effect on underlying spasticity but is not sufficient when contracture is present. In this study, we examine the long-term results of a combined surgical approach: a release procedure of the elbow flexors and selective neurectomy of the musculocutaneous nerve. A retrospective study of 14 patients with spastic flexion deformity of the elbow was performed. After a mean follow-up of 52.6 months (SD 33, range 12 to 113), the results of the combined surgical approach were evaluated. Spontaneous position of the elbow and active and passive range of motion were assesses using goniometry. Spasticity was assessed using the Modified Ashworth Scale. Function of the affected upper limb before and after surgery was assessed by the House functional classification. Patient and caretaker's satisfaction were assessed using a visual analogue scale. The mean decrease of passive elbow extension deficit was 34 degrees (SD 21.3, P <0.05). Active elbow extension increased with a mean of 41 degrees (SD 16.5, P <0.05). Spontaneous position elbow flexion decreased by a mean of 40 degrees (SD 21.1, P <0.05).The Modified Ashworth score decreased significantly ( P <0.05) from 3.27 (range 1 to 4) preoperatively to 0.64 (range 0 to 4) postoperatively.The difference between the House score preoperatively and postoperatively was not significant ( P =0.180). Mean patient satisfaction was 8.2/10 (SD 2.7, range 2 to 10) and mean caregiver satisfaction was 7.1/10 (SD 2.7, range 1 to 10). A combined surgical approach to elbow flexion deformity in the form of a lengthening procedure and selective neurectomy of the elbow flexors result in a significant and sustained improvement of the spontaneous position, active and passive elbow extension and elbow flexor spasticity and high patient and caregiver satisfaction. Case series, level IV.

Comparison of kinematics and pedobarography findings between the unaffected foot of patients with unilateral clubfoot and controls.

Idiopathic clubfoot (ICF) involves structural abnormalities in the lower extremities. Approximately half of patients have unilateral ICF, which could be due to differences in limb formation. The contralateral unaffected foot may have subclinical ICF. The objectives were to compare ankle and foot kinematics and pedobarography findings between the unaffected foot of patients with unilateral ICF and controls. Eleven children with unilateral ICF (11 unaffected feet, 11.7 ± 3.8years) and 15 age-matched controls (30 control feet, 11.1 ± 3.0years) were enroled. Five complete gait trials were performed. Data were collected using ten cameras and a twom long Footscan system and compared between groups using the Wilcoxon rank sum test. All children with ICF underwent the selective soft tissue release procedure. The unaffected feet showed limited ranges in inversion-eversion and dorsiflexion-plantar flexion on kinematic analysis. There was a delay in landing time in all regions of the foot during heel rise and propulsion. The peak time was achieved significantly later in the unaffected feet compared to the controls. Although plantar pressure parameters were comparable, unaffected feet showed a larger contact area in the midfoot region. Gait data on the unaffected foot in unilateral ICF patients do not correspond to those of controls despite an indistinguishable clinical appearance. This could be due to the effect of treatment, the process of foot development, or a combination. The relationship between genetics and gait deviation in patients with unilateral ICF needs further evaluation. The unaffected foot should receive similar attention during follow-up.

Direct Glycan Analysis of Biological Samples and Intact Glycoproteins by Integrating Machine Learning-Driven Surface-Enhanced Raman Scattering and Boronic Acid Arrays.

Frequent monitoring of glycan patterns is a critical step in studying glycan-mediated cellular processes. However, the current glycan analysis tools are resource-intensive and less suitable for routine use in standard laboratories. We developed a novel glycan detection platform by integrating surface-enhanced Raman spectroscopy (SERS), boronic acid (BA) receptors, and machine learning tools. This sensor monitors the molecular fingerprint spectra of BA binding to cis-diol-containing glycans. Different types of BA receptors could yield different stereoselective reactions toward different glycans and exhibit unique vibrational spectra. By integration of the Raman spectra collected from different BA receptors, the structural information can be enriched, eventually improving the accuracy of glycan classification and quantification. Here, we established a SERS-based sensor incorporating multiple different BA receptors. This sensing platform could directly analyze the biological samples, including whole milk and intact glycoproteins (fetuin and asialofetuin), without tedious glycan release and purification steps. The results demonstrate the platform's ability to classify milk oligosaccharides with remarkable classification accuracy, despite the presence of other non-glycan constituents in the background. This sensor could also directly quantify sialylation levels of a fetuin/asialofetuin mixture without glycan release procedures. Moreover, by selecting appropriate BA receptors, the sensor exhibits an excellent performance of differentiating between α2,3 and α2,6 linkages of sialic acids. This low-cost, rapid, and highly accessible sensor will provide the scientific community with an invaluable tool for routine glycan screening in standard laboratories.

Outcomes of posterior sheath supplementation with Vicryl mesh in TAR-a single-center study.

In the Transversus Abdominis Release (TAR) procedure, ideally, the posterior sheath is completely reapproximated to establish an interface isolating the polypropylene mesh from visceral contents. When primary closure of the posterior sheath is unachievable, Vicryl mesh is commonly used to supplement the posterior sheath closure and an uncoated polypropylene mesh is placed superficial to the Vicryl mesh. The long-term implications of utilizing Vicryl mesh as an antiadhesive barrier are poorly understood. In this study, we aimed to assess our outcomes when utilizing Vicryl mesh to supplement the posterior sheath defects when placed underneath polypropylene mesh in patients undergoing posterior component separation. Adult patients who underwent VHR with concurrent TAR procedure with a permanent synthetic mesh and posterior sheath supplementation with Vicryl mesh in the Cleveland Clinic Center for Abdominal Core Health between January 2014 and December 2022 were queried retrospectively from a prospectively collected database in the Abdominal Core Health Quality Collaborative. We evaluated 30-day wound morbidity, perioperative complications, long-term mesh-related complications, and pragmatic hernia recurrence. 53 patients who underwent TAR procedure with posterior sheath supplementation using Vicryl mesh and had a minimum 12-month follow-up were identified. Of the53 patients, 94.3% presented with recurrent hernias, 73.6% had a midline hernia, 7.5% had a flank hernia, and 18.9% had concurrent parastomal hernia. The mean hernia width was 24.9 cm (± 8.8 cm). No Vicryl mesh-related operative complications were identified in our study, with no instances of mesh erosion, fistulas, or interventions for small bowel obstruction. Skin necrosis requiring reoperations was observed in three patients (5.7%), leading to permanent mesh excision in two cases (3.8%) without intraabdominal visceral involvement. Throughout the 12-month follow-up, 23 incidences (43.4%) of surgical site occurrences (SSOs) and surgical site occurrences requiring procedural intervention (SSOPI) were documented. Our findings suggest that posterior sheath supplementation with Vicryl mesh is a feasible approach to achieve posterior sheath closure in challenging abdominal wall reconstruction cases. Given the absence of notable mesh-related complications and a similar hernia recurrence rate to cases without posterior sheath supplementation, Vicryl mesh can be used to safely achieve posterior sheath closure in complex reconstructions with insufficient native tissue.

The Outcomes of 2,154 Endoscopic Trigger Finger Releases

BackgroundTrigger finger is one of the most frequent causes of hand pain and disability. Recently, an endoscopic trigger finger release technique was developed, but outcomes have rarely been reported. Here, we present the outcomes of 2154 endoscopic trigger finger release procedures in a single center. MethodsIn this retrospective study, 2154 endoscopic trigger finger release procedures were performed on 2034 patients. Outcome assessment at 90 days after surgery was classified as excellent, good, fair or poor according to a combination of patient satisfaction with the scar and pain at rest or under load on a numeric rating scale. ResultsThe therapeutic outcomes were: 1027 excellent, 607 good, 400 fair, and none poor. No major surgical complications were observed. Minor complications occurred in 231 fingers (10.7%). ConclusionsAll patients were satisfied with their outcome after endoscopic trigger finger release. Endoscopic release can be an effective and efficient therapeutic method for the treatment of trigger finger.

“We wish we had the option”: a qualitative study of women’s perspectives and experiences with contraception in a provincial prison in Ontario, Canada

BackgroundEvidence suggests that women who are incarcerated desire access to contraception while incarcerated, and that this need is not currently being met. Our objective in this study was to explore the perspectives and experiences of women in prisons regarding contraception and contraception access using data from focus groups with women in a provincial prison. We analyzed focus group data collected in a provincial prison in Ontario, Canada using content analysis and a constructivist epistemology.ResultsWe conducted three focus groups, each approximately one hour in length. Discussions revolved around (1) knowledge and decision making about contraception, (2) accessing contraception, and (3) ideas for increasing access to contraception in the prison setting. Decision making about contraception was mainly related to concerns about side effects, consistent access to care, impacts on future fertility, and autonomy around decision-making. Participants discussed a wide range of experiences with contraception. Ideas for increasing access to contraception included information sessions, inclusion of discussions about contraception as a component of admission and release planning, and time spent in prison as a crucial juncture for decision-making about contraception.ConclusionsMore qualitative research is needed to better understand the needs of women in prisons related to contraception. The findings of this study suggest that programs should focus on consistency and continuity of access to care, education opportunities, and integration of discussions about contraception into official admission and release procedures.

Magnetic multilayer hydrogel oral microrobots for digestive tract treatment.

Oral administration is a convenient drug delivery method in our daily lives. However, it remains a challenge to achieve precise target delivery and ensure the efficacy of medications in extreme environments within the digestive system with complex environments. This paper proposes an oral multilayer magnetic hydrogel microrobot for targeted delivery and on-demand release driven by a gradient magnetic field. The inner hydrogel shells enclose designated drugs and magnetic microparticles. The outer hydrogel shells enclose the inner hydrogel shells, magnetic microparticles, and pH neutralizers. The drug release procedure is remotely implemented layer-by-layer. When the required gradient magnetic field is applied, the outer hydrogel shells are destroyed to release their inclusions. The enclosed pH neutralizers scour the surrounding environment to avoid damaging drugs by the pH environment. Subsequently, the inner hydrogel shells are destroyed to release the drugs. A set of experiments are conducted to demonstrate the wirelessly controllable target delivery and release in a Petri dish and biological tissues. The results demonstrated attractive advantages of the reported microrobot in microcargo delivery with almost no loss, remote controllable release, and drug protection by the pH neutralizers. It is a promising approach to advance next-generation precision oral therapies in the digestive system.

Prospective evaluation of a novel device for ultrasound-guided percutaneous treatment of carpal tunnel and trigger finger disease. Efficacy and safety of sono-instruments®.

To evaluate the safety and effectiveness of percutaneous release procedures under sonography using Sono-Instruments® in the treatment of carpal tunnel syndrome (CTS) and trigger finger (TF). Prospective study involving 30 patients, divided into two groups (15 CTS, and 15 TF). The primary outcomes were surgical performance-related outcomes (visibility, ease of use, satisfaction, duration) using Sono-Instruments® and patient-related outcomes (pain, activity limitations, time to return to work, functional scores). Secondary outcomes included complications. Patients were followed for two months post-operatively. In the CTS group, the average age of the patients was 58.7years. The percutaneous release of the transverse carpal ligament was effectively completed in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 80% could perform activities of daily living, and 80% of those working had returned to their activities. At two months, all patients had resumed all activities. Pillar pain was still present in 53.3%. In the TF group, the patients had an average age of 57.9years. The percutaneous release of the A1 annular pulley was successful in all cases, with excellent device performance and no adverse events. At one week, all patients could wash their hands, 93.3% could do all activities of daily living, and 75% of those working were back to their professional activities. At two months, all patients were back to all activities of daily living and work. The DASH score was significantly improved at two months, compared to preoperative, for both groups (p < 0.001). Percutaneous sono-guided release using Sono-Instruments® is safe and efficient, and associated with quick functional recovery. II.