Removal Procedure Research Articles

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

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

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

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

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

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

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

Arm morbidity and postoperative complications following sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) are common problems in patients with breast cancer. The de-escalating axillary surgery is increasing; however, there is a lack of patients with suspicious nodes. This study aimed to reduce the need for SLNB in suspicious lymph node cases. A prospective cohort study of women with invasive breast cancer who underwent surgery between January 2021 and December 2022. The study included two cohorts: Cohort A comprised patients with stage cT1-2N0-1M0 cancer who planned upfront surgery, while Cohort B included patients with stages cT1-4N2M0, cT3-4N1M0, or cT1-2N0-1M0 who received neoadjuvant systemic treatment. During the study, a clip was inserted into the suspicious lymph node on imaging to determine whether it could serve as a sentinel node and potentially replace SLNB or reduce the need for axillary surgery. In cohort A, 22 surgeries were performed, while in cohort B, seven surgeries were performed. The median follow-up time was 15 months. In cohort A, 71% of the patients had cN0 disease, while 28% had cN1 disease. A suspicious node correlated to a sentinel node was noted in 66.67% of cohort A. The false-negative rate (FNR) was 14.28%. However, when the clip node removal procedure was performed instead of the sentinel node procedure, the FNR was 10%. In early breast cancer, suspicious nodes in imaging studies could not currently represent sentinel lymph nodes, and the FNR was still high. Nevertheless, more studies with larger populations will provide a better understanding due to the limited number of patients.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ID: 344721 Removal Procedure of a Helical Wire Structure Electrode from Benchtop and Chronic Porcine Models

ID: 344721 Removal Procedure of a Helical Wire Structure Electrode from Benchtop and Chronic Porcine Models

Custom‐made surgical guide with mucoperiosteal flap elevation function for the removal of multiple impacted supernumerary teeth: A case report

AbstractBackgroundSurgical guides manufactured with computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology are effective tools for oral surgeries.Case presentationA new type of surgical guide with mucoperiosteal flap elevation function was custom designed, printed, and applied for the safe and accurate removal of six impacted supernumerary teeth in a 12‐year‐old male patient. The surgical guides were designed with access holes corresponding to the positions of the impacted teeth and the elevation structures of the mucoperiosteal flap.ConclusionThe novel custom‐made surgical guide system introduced in the present report was successfully utilized for minimally invasive teeth removal procedures.

Efficacy of antimicrobial-impregnated catheters in preventing sepsis post epicutaneo-caval catheter (ECC) removal in neonates: A retrospective study.

Epicutaneo-caval catheters (ECC) are vital in neonatal intensive care units (NICU) in enabling prolonged venous access. Despite their benefits, central line-associated bloodstream infections (CLABSI) pose a potential risk. The ECC removal procedure may contribute to an increased risk of post removal sepsis through biofilm release. Antimicrobial-impregnated ECCs have been proposed as a potential solution to prevent this complication, but research on their effectiveness in neonates is limited. To compare post-ECC or neonatal peripherally inserted central catheter (n-PICCs) removal sepsis rates when using conventional or antimicrobial-impregnated catheters in neonates. A retrospective, single center cohort analysis using 2019 data from 421 neonates after successful ECC insertion at the Women's Wellness and Research Center, a large tertiary level NICU in Qatar. The study systematically collected data on demographics, insertion, and removal as well as microbiology, and infection data. Statistical analyses compared conventional and antimicrobial ECCs, with a focus on the incidence of sepsis within 72 hr post-removal. After excluding non-eligible, 349 cases were included in the analysis (138 conventional, 211 antimicrobial-impregnated). There were no significant demographic differences between the two groups. The CLABSI incidence was higher amongst the antimicrobial ECC group (4% vs 0.6%, p = 0.031). Among the included neonates, the confirmed post-removal sepsis incidence was 4.3% (6 cases) for the conventional and 10% (21 cases) for the antimicrobial ECC groups, which was not statistically significant (p = 0.055). The study noted a higher, but statistically insignificant, incidence of post removal sepsis when using antimicrobial-impregnated ECCs. This finding raises questions about the effectiveness of antimicrobial ECCs in preventing post-removal sepsis in this patient population. Further randomized trials are needed to assess the role of antimicrobial ECCs amongst neonates and to refine neonatal ECC care strategies.

Combined Upper Fornix Transconjunctival and Endoscopic Transnasal Approach for Frontoethmoidal Osteoma with Orbital Extension - A Case Report

Abstract Rationale: Intraorbital osteomas are incidentally found and occasionally require surgical treatment. Depending on their localisation, a single technique may not provide a sufficient surgical field. Patient Concerns: We report a 16-year-old male with a left upper medial palpable mass. Diagnosis: Computed tomography revealed a dense bony mass extending from the ethmoid sinus to the superior wall of the frontal sinus, with protrusion into the orbital cavity. Treatment: The combination of upper fornix transconjunctival and endoscopic transnasal approaches was chosen for the surgical removal procedure. Outcomes: The two-pathway approaches resulted in the clear removal of the mass. Post-operative recovery was rapid, although a slight restriction of the inferomedial duction remained at three months. Take-away Lessons: This combination of techniques can provide a wide surgical field for the resection of frontoethmoidal osteomas with orbital extension.

411.6: Retrograde fluoroscopy guided double J stent removal procedures in kidney transplant patients.

411.6: Retrograde fluoroscopy guided double J stent removal procedures in kidney transplant patients.

Comprehensive analysis of substernal lead removal: experience from EV ICD Pilot, Pivotal, and Continued Access Studies.

The extravascular implantable cardioverter-defibrillator (EV ICD) has been shown to be safe and effective for patients at risk of sudden cardiac death, but little is known about EV ICD lead removal in humans. This analysis aimed to characterize the EV ICD lead removal experience thus far. This was a retrospective analysis of lead removals from the EV ICD Pilot, Pivotal, and Continued Access Studies. Patients with a successful EV ICD implant who underwent lead removal were included. The main objective was lead removal success. Ancillary objectives included characterizing technique used, procedure complications, and reimplantation status. An EV ICD system was successfully implanted in 347 patients across the 3 studies (25.9% female; 53.4 ± 13.3 years; left ventricular ejection fraction: 39.7 ± 15.9). Of these patients, 29 (8.4%) underwent lead removal with a mean lead dwell time of 12.6 ± 14.3 months (0.2-58.4). The main reason for lead removal was lead dislodgement (n = 9, 31.0%). Lead removal was successful in 27/29 (93.1%) cases [100% (19/19) success rate <1 year and 80% (8/10) success rate >1 year post-implant]. Simple traction was used in 22/26 (84.6%) and extraction tools in 4/26 (15.4%) successful cases where technique was known. No complications were reported for any of the removal procedures. All 11 EV ICD reimplant attempts were successful. Complete removal of the EV ICD lead was successful in 93.1% of cases, and simple traction was sufficient in most instances. Based on these results, lead removal from the substernal space was safe and achievable up to 3 years post-implant.

Distal Radius Osteotomies for Kienbock's Disease—A Minimally Invasive Approach

Abstract Background Negative ulnar variance is a recognized predisposing factor for Kienbock's disease (KD). Radial shortening osteotomy (RSO) reduces radial height, thereby alleviating stress on the lunate. Conversely, radial closed wedge osteotomy (RCWO) involves removing a distal radius wedge to not only decrease radial height but also reduce radial inclination, thereby enhancing lunate coverage. Description This article outlines a straightforward and minimally invasive approach to RSO utilizing a single cut and stabilization with a single screw. Additionally, it introduces a technique for RCWO comprising two cuts, wedge removal from the distal radius, and fixation using a single headless screw. Literature Review Traditionally, RSO and RCWO procedures include a volar approach consistent with distal radius fracture fixation techniques. However, the reliance on “free-hand” cuts may necessitate larger hardware for stabilization. Overcorrection poses risks of suboptimal outcomes and often mandates subsequent hardware removal procedures. Clinical Relevance Both RSO and RCWO techniques offer minimally invasive solutions, which preserve the periosteum, and maintain stability. These techniques only require a single screw and a removable splint. RSO is indicated for KD wrists with negative ulnar variance, while RCWO is preferable for cases with negative ulnar variance and increased radial inclination.

Artificial intelligence-empowered assessment of bile duct stone removal challenges

The aim of this investigation was to unravel the complexities inherent in endoscopic retrograde cholangiopancreatography (ERCP) procedures for bile duct stone removal by leveraging advanced artificial intelligence (AI) methodologies to support clinical decision-making and optimize patient outcomes. We introduced the Assessment of Stone Removal Challenges (ACRS) system, a novel integration of Data-efficient Image Transformers (DeiT) for image data analysis and eXtreme Gradient Boosting (XGBoost) for clinical data interpretation. Our study included a patient cohort of 2,129 individuals, focusing on training the ACRS system to achieve high diagnostic precision. Using logistic regression, we identified pivotal predictors affecting the complexity of bile duct stone removal. These findings were visually represented through forest plots and nomograms. Analytical and visualization processes were conducted using the Python and R programming languages, adhering to a p value significance threshold of less than 0.05. By utilizing DeiT enhanced by transfer learning and XGBoost for clinical data interpretation, the system achieved an accuracy of 0.83 and a perfect recall rate on a test set of 2,129 patients. Gradient-weighted class activation mapping (Grad-CAM) and SHapley Additive exPlanations (SHAP) provided in-depth diagnostic insights. Logistic regression was applied to identify crucial clinical predictors for stone removal difficulty, as visualized through forest plots and nomograms. These tools facilitated measurable assessments of procedural complexity, making significant strides in gastroenterology diagnostics and decision-making. By adopting causal inference techniques, the system effectively quantifies the influence of various clinical entities on stone removal difficulty, thereby augmenting both diagnostic precision and procedural strategies in ERCP.