Safe Approach Research Articles

Biosynthesis of metal/metal oxide nanoparticles via Deverra tortuosa: characterization, GC/MS profiles, and biological potential

Since the beginning of humanity, people have used wild medicinal plants for the treatment of various diseases. Nowadays, researchers and scientists pay attention to exploring new tools to maximize the efficacy of natural products from natural resources, and among these tools formulation of nanoparticles is very promising. The green synthesis of metal/metal oxide nano-solutions using the Deverra tortuosa extract has still not been explored well. This study aims to prepare many metal/metal oxide nanoparticle solutions such as ZnO-NPs, SeO2-MNPs, and Ag-NPs via the methanol extract of D. tortuosa as safe, easy, green, and economic approach as well as characterize the chemical components of D. tortuosa plant by GC-MS spectroscopy analysis. The synthesized M-NPs solutions were characterized by UV–visible (UV–Vis) spectroscopy, Transmission Electron Microscope (TEM), zeta potential, Fourier Transform Infrared (FT-IR) spectroscopy, and phytochemical analyses. The potential antioxidant capacity was estimated for the methanol extract of this plant along with the metal/metal oxide nanoparticles solutions by DPPH assay. In addition, the cytotoxic activity was in vitro assessed for the inspected samples against various tumor and normal cell lines applying MTT assay. The application of the D. tortuosa methanolic extract resulted in NPs with a range of 11.79–85.9 nm which was characterized by UV-Vis spectroscopy, TEM, zeta potential, and FT-IR spectroscopy that revealed various functional groups of the tested samples. The GC-MS analysis of the D. tortuosa methanolic extract showed the presence of 31 chemical compounds with 2-methyl-3-oxocyclopent-1-ene-1-carboxylic acid, methyl oleate, and 6-allyl-4,5-dimethoxybenzo[d][1,3]-dioxole as major constituents. The extract showed considerable antioxidant activity as well as antimicrobial activity that was assessed also against varied bacterial and fungal species. Remarkable potencies for the investigated metal/metal oxide nanoparticle solutions hinder the growth of the tumor cell lines, in addition to the growth of the microbial species. Based on the determined biological activities of the produced NPs, future study is recommended to characterize the pure authentic compounds that are identified within the D. tortuosa as major compounds as well as evaluate their modes of action.

Clinical Outcome of Endoscopically Assisted Mini-open Carpal Tunnel Release.

Background: Carpal tunnel syndrome (CTS) can be treated surgically. Although the minimally invasive open surgical method is widely used, it is not possible to directly visualise the entire length of the carpal tunnel, especially the proximal end, which is on the side away from the skin incision. In this study, we performed a mini-open carpal tunnel release with endoscopic assistance to release the entire length of the carpal tunnel under direct vision and investigated the treatment outcomes. Methods: The surgical method included an incision of ≤2 cm in the palm, cutting of the transverse carpal ligament under direct vision and cutting of the forearm fascia under endoscopic vision. A uniquely designed sheath was used for the endoscopic resection. We investigated the sex, age, medical history, symptoms, examination findings, anaesthesia method, operation time, thenar motor branch variation, postoperative complications, presence or absence of pillar pain and final examination findings of the target patients. Results: A total of 100 hands (85 patients) were included. Anatomical variations of the thenar motor branches were observed in 19 hands. At the final follow-up, hand numbness improved in all patients, while mild numbness was observed in 25 hands. The abductor pollicis brevis muscle improved in all patients with paresis, but 8 of the 27 hands remained completely paralysed. Pillar pain was observed in 36 hands at 8 weeks postoperative, but the condition improved in all patients. The clinical outcomes of this study were good with no cases of major complications or reoperation. Conclusions: The minimally invasive open surgical method described here can be reliably used to release the forearm fascia proximal to the carpal tunnel. The thenar motor branch can also be confirmed under direct visualisation, making it a relatively safe and useful approach. Level of Evidence: Level Ⅳ (Therapeutic).

Outcomes of tunnelled cuffed centrally inserted central catheter removal: A retrospective cohort study.

Most children with cancer will require a central venous access device (CVAD) to administer cancer treatment. A commonly used CVAD is a tunnelled cuffed centrally inserted central catheter (TC-CICC). There is little information available to guide best practice when removing this type of CVAD. At our institution, TC-CICCs are removed by using either the traction or dissection methods. This study will describe the outcomes associated with each technique. A retrospective cohort study was undertaken at a quaternary children's hospital in Melbourne, Australia. Data related to characteristics of TC-CICC removal success, post-removal complications and an economic evaluation were carried out. There were 149 patients who underwent traction removal and 100 who had their TC-CICC removed using the dissection technique. In the traction group, 136/149 (91%) patients had their device successfully removed on the first attempt, whereas 99/100 (99%) were removed on the first attempt with dissection. Of the 136 successful traction removals, cuff status was documented in 72 cases. The cuff remained in situ in 46/72 (64%) cases, and six of 72 (8%) patients experienced a complication. There were no documented cases of cuff retention in the dissection group. In the 2019-2020 financial year, the estimated average cost of traction removal was A$387, whereas the estimated average cost of day case surgery was A$2560. This study has highlighted that the traction technique is a safe, efficient and cost-effective approach to TC-CICC removal. Further research is required to understand the patient and family experience of TC-CICC removal.

Laparoscopic Management of Acute Small Bowel Obstruction: A Retrospective Study at a Tertiary Center in the United Kingdom.

Objectives To present a single-center experience of laparoscopic management of acute small bowel obstruction (ASBO) based on seven years of data and demonstrate its suitability for the United Kingdom (UK). Methods A retrospective review of case notes to evaluate postoperative outcomes was conducted. All emergency small bowel obstructions treated laparoscopically were included. The cases that were converted to a laparotomy were excluded. Demographics (age, sex), American Society of Anesthesiologists (ASA) grade, indication for surgery, duration of stay, complications, requirement of stoma, requirement of intensive treatment unit/high dependency unit (ITU/HDU), reoperation/readmissions, and 30-day mortality were noted. The results were tabulated and analyzed accordingly. Results There were 119 patients studied, with a median age of 66 (range: 17-97). The sex ratio was 62 females to 57 males. Primary etiologies of adhesion bands (49.5%, 59) and hernia (31.9%, 38) werethe most common. Minor and majorcomplications were 15 (12.6%) and 37 (31%),respectively. Three (2.5%) patients passed away within 30 days of surgery. The medianlength of stay (LOS) was eight days. ThemedianLOS subgroup analysis showed nine days for adhesiolysis and six days for hernias. Discussion This study shows that there is significant heterogeneity in outcomes regarding small bowel obstruction around the world. We have demonstrated similar to better results in our center relative to other prominent centers in the UK. This can be attributed to the patient cohort, presentation, and physiological status on admission, delay to surgery, and associated co-morbidities to name a few. Conclusion This study indicates that laparoscopic surgery is a safe approach to treating ASBO, provided adequate expertise and infrastructure are available.

Current evidence on the use of sugammadex for neuromuscular blockade antagonism during electroconvulsive therapy - a narrative review.

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ- cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

The Use of Remote Presence Robotic Tele-Presentation in Rural and Remote Canada: A Systematic Review.

Objective: One potential solution to limited health care in rural and remote regions is remote presence robotic tele-presentation to allow health care providers to care for patients in their home community via a robotic interface. We synthesized evidence regarding the use of remote presence robotic tele-presentation in rural and/or remote Canadian health settings. Methods: Medline, PubMed, and Embase were searched up to August 2023. Remote presence robotic tele-presentation refers to any robotic device used for the purpose of presenting and/or collecting patient information. Primary research was included if the patient was located in remote and/or rural Canada, featured remote presence robotic tele-presentation, and assessed patient, family, or clinician satisfaction, patient transport to nearby regional or urban center, health care costs, clinical outcomes, infrastructure outcomes, adverse events, or telementoring. Results: Six studies were included. Patients, nurses, and physicians all reported high levels of satisfaction when using the remote presence robotic tele-presentation. Fifty to sixty-three percent of patients were managed in their home community and did not require transfer to another center. Remote presence robotic sonography resulted in adequate imaging in 81% of first trimester ultrasound limited exams but was less useful for second trimester complete obstetric ultrasounds (20% adequate imaging). Two of eight laparoscopic colorectal surgeries had to be converted to open surgeries. Telerobotic ultrasound clinics resulted in a diagnosis in 70% of cases. Conclusions: Evidence suggests remote presence robotic tele-presentation is a safe and cost-effective approach to providing care in distant communities and can prevent some transfers and evacuations to tertiary hospitals.

Video-assisted retroperitoneal debridement for necrotizing pancreatitis: a single center experience in Colombia.

Acute pancreatitis (AP) is a common and potentially lethal disease. Approximately 10-20% of the patients progress to necrotizing pancreatitis (NP). The step-up approach is the gold standard approach to managing an infected necrotizing pancreatitis with acceptable morbidity and mortality rates. Video-assisted retroperitoneal debridement (VARD) has been described as a safe and feasible approach with high success rates. Multiple studies in the American, European, and Asian populations evaluating the outcomes of VARD have been published; nevertheless, outcomes in the Latin American population are unknown. This study aims to describe a single-center experience of VARD for necrotizing pancreatitis in Colombia with a long-term follow-up. A prospective cohort study was conducted between 2016 and 2024. All patients over 18 years old who underwent VARD for necrotizing pancreatitis were included. Demographic, clinical variables, and postoperative outcomes at 30-day follow-up were described. A total of 12 patients were included. The mean age was 55.9 years old (SD 13.73). The median follow-up was 365 days (P25 60; P75 547). Bile origin was the most frequent cause of pancreatitis in 90.1% of the patients. The mean time between diagnosis and surgical management was 78.5 days (SD 22.93). The mean size of the collection was 10.5cm (SD 3.51). There was no evidence of intraoperative complications. The mean in-hospital length of stay was 65.18 days (SD 26.46). One patient died in a 30-day follow-up. One patient presented an incisional hernia one year after surgery, and there was no evidence of endocrine insufficiency at the follow-up. According to our data, the VARD procedure presents similar outcomes to those reported in the literature; a standardized procedure following the STEP-UP procedure minimizes the requirement of postoperative drainages. Long-term follow-up should be performed to rule out pancreatic insufficiency.

Feasibility of Double-Deployment Small-Diameter Covered Metallic Stent for Malignant Distal Biliary Obstruction (with Video)

Background/Objectives: Covered self-expandable metallic stents (CSEMS) are commonly used to treat malignant distal biliary obstructions. A 10-mm CSEMS carries the risk of obstructing the pancreatic and cystic duct orifices by adhering to the bile duct; therefore, postoperative pancreatitis and cholecystitis are reported to occur at a certain frequency. We have adopted a new drainage technique for malignant distal biliary obstruction called ‘‘double-slim SEMS stenting” (DSS), where two small-diameter CSEMS are placed side-by-side. We aimed to compare the efficacy and safety of biliary drainage using DSS with those of conventional CSEMS. Methods: In total, 50 patients who underwent endoscopic biliary drainage for malignant distal biliary obstructions between April 2019 and March 2022 at Hyogo Medical University Hospital were enrolled. Patients were divided into DSS and Conventional groups, and the technical success rate, clinical success rate, adverse events, success rate for reintervention, recurrent biliary obstruction (RBO) rate, and time to RBO (TRBO) were evaluated. Results: There were no significant differences in patient characteristics between the DSS (n = 20) and Conventional groups (n = 30). The technical and clinical success rates were 100% in the DSS group. The incidence of adverse events was not significantly different between the two groups (DSS/Conventional: 10.0% [2/20]/20.0% [6/30]) (p = 0.34). No acute cholecystitis was observed in the DSS group. The incidence rates of RBO were 30% (6/20) and 43% (13/30) in the DSS and Conventional groups, respectively (p = 0.92). The median TRBO in the DSS group was 378 days, while the TRBO in the Conventional group was 195 days (p = 0.03), resulting in significantly longer TRBO in the DSS group. Conclusions: DSS emerges as a viable and safe approach for biliary drainage in malignant distal biliary obstruction, demonstrating a lower incidence of adverse events and longer TRBO compared to conventional CSEMS.

Umbilical Cord Blood Platelet Lysate Eyedrops for the Treatment of Severe Ocular Surface Disorders in Graft vs. Host Disease Patients: Clinical Study

Background: Graft-versus-host disease (GvHD) is an overactive systemic inflammatory response that can arise following allogeneic hematopoietic stem cell transplantation (HSCT). This condition occurs when the transplanted donor immune cells recognize the recipient’s tissues as foreign and trigger an immune response against them. The ocular surface (eyelids, conjunctiva, meibomian glands, lacrimal glands, and cornea) is particularly involved in GvHD, and its response to existing treatments, including potent immunosuppressants and new targeted therapies, is undesirable, with such treatments often being ineffective. Human allogeneic umbilical cord blood platelet lysate stands out as a potent adjunct to conventional therapies for ocular surface disorders related to severe Dry Eye Disease. This study aimed to evaluate the safety and efficacy of umbilical cord blood platelet lysate eyedrops for the treatment of severe ocular surface disorders in graft-versus-host disease patients who have received previous unsuccessful treatments. Methods: This study was a prospective, non-comparative, interventional case series study involving 22 patients (10 females and 12 males) aged 25–46 years with severe ocular surface disorders that were unresponsive to standard treatments. The GvHD patients were categorized based on the severity of their ocular surface disorders into three groups: Group I: five patients with severe Dry Eye Disease and filamentary keratitis; Group II: eight patients suffering from severe blepharo-kerato-epitheliopathy; Group III: nine patients with corneal ulcers. Fresh umbilical cord blood (UCB) was obtained from healthy donors and subjected to centrifugation using a novel PRP preparation kit provided by Sciacca (AG) Cord blood bank, Italy in a one-step process. In all groups, the outcomes before and after treatment were evaluated by means of the OSDI (Ocular Surface Disease Index), SANDE (Symptom Assessment in Dry Eye) questionnaire, VAS (Visual Analogue Scale), slit lamp examination, Esthesiometry, Lissamine Green Staining, the NIBUT (Non-Invasive Break-Up Time) and BUT, fluorescein staining with digital photography and Oxford classification, the Schirmer Test, the Best Corrected Visual Acuity (BCVA), and Meibography. In Group III at each evaluation time, the size of the ulcer and its relative reduction compared to the baseline size were recorded. Clinical variables, such as corneal inflammation, conjunctivalization, corneal neovascularization, or pain, were also considered individually. Results: We observed a significant improvement in the SANDE, VAS, and OSDI scores; Schirmer Test; BUT; BCVA; and Oxford classification after treatment with allogeneic cord blood serum eyedrops. Nevertheless, pain and inflammation reduced markedly over time until complete healing in all cases. The mean reduction in the ulcer surface area (compared to baseline values) was significantly higher at all assessment points (p = 0.001 for day 7 and p < 0.001 for subsequent time points every 30 days for 90 days). At the last check-up (after 90 days of treatment), the number of ulcers (Group III, nine patients) with a reduction in size of greater than 50% was eight (88.8%), of which seven ulcers were completely healed. None of the patients experienced treatment-related local or systemic adverse events. In this study, using a relatively large number of cases, we demonstrated that the use of umbilical cord blood platelet lysate eyedrops is a safe, feasible, and effective curative approach for severe ocular surface disease in patients with GvHD. Conclusions: Our pilot study highlights the remarkable effectiveness of allogeneic cord blood serum eyedrops in patients with severe ocular surface disorders following GvHD who have shown an inadequate response to the usual treatments. It is mandatory to design future studies on the efficacy of this therapeutic approach for acute ocular, mucosal, and cutaneous GvHD.

Reintroduction of excluded food triggers as a crucial step in managing patients with food allergies

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

Real-time indocyanine green fluorescence imaging and navigation for cone unit laparoscopic hepatic resection of intrahepatic duct stone: a case series study

Background Intrahepatic bile duct stones, although common and benign, require varying therapeutic strategies due to their recurrent nature. Inadequate management can escalate to liver cirrhosis or cholangiocarcinoma. A surgical method merging indocyanine green fluorescence imaging (ICG-FI) with liver cone unit resection is optimal, ensuring complete lesion removal and healthy liver tissue conservation. Method A retrospective descriptive study was conducted on 15 patients with intrahepatic bile duct stones who were admitted to Sichuan Provincial People’s Hospital from January 2021 to December 2023. All patients underwent laparoscopic anatomical liver resection guided by ICG-FI. Results Among the 15 patients included in the study, ten were male and five were female, with an average age of 52 years. All patients were free from underlying medical conditions. Intraoperatively, ICG-FI was good, with clear boundaries, and all patients successfully underwent surgery without any conversions to open surgery. The mean operative time was 236 ± 56 min, and the estimated blood loss was 320 ± 75 ml. Patients had a postoperative hospital stay of 5.5 ± 1.5 days. No severe complications occurred. Conclusions Real-time ICG-FI with anatomical liver resection is a safe and effective approach for managing intrahepatic bile duct stones.

Stimulation of inactivated Metschnikowia bicuspidata promotes the growth, and immunity of Eriocheir sinensis larvae

The Chinese mitten crab (Eriocheir sinensis) is an economically essential crustacean specie in China. The outbreak of disease caused by Metschnikowia bicuspidata has resulted in high mortality and huge economic loss in the E. sinensis aquaculture industry. Immune priming can protect invertebrates against pathogens in the second exposure, which has been reported in adult E. sinensis and provides a novel approach for disease control. This study evaluated the effects of treatment with formalin-killed M. bicuspidata on the growth, development, and immunity of E. sinensis embryos and larvae. Stimulation of E. sinensis embryos with inactivated M. bicuspidata (Mb group) did not significantly affect the mass and size of embryos. While the carapace width, abdominal length, and tail length of larvae in the Mb group were significantly longer than those of control group in most stages. At 120 h and 144 h after embryo hatching, the metamorphosis rate of larvae in the Mb group was 24.59-fold (p < 0.05) and 16.07-fold (p < 0.001) higher than that in the control group. Moreover, after the larvae suffered alive M. bicuspidata challenge, the mortality in the Mb group significantly decreased (0.48-fold, p < 0.05) compared with that in the control group, and the mRNA expression levels of genes related to immunity (MAPK, Toll2, and STAT), growth (ATGL, Chi, Chymotrypsin, and mTOR), and development (Ubx) were significantly increased in the Mb group. These results suggested that stimulation of E. sinensis embryos with inactivated M. bicuspidata significantly promoted the growth and development of larvae and endowed them with stronger resistant capacity to M. bicuspidate. This finding may provide a novel and safe approach for preventing disease and improving larvae quality in E. sinensis aquaculture.

Online Mindfulness-Based Intervention (eMBI) in management of dyspnea in patients with interstitial lung disease: A randomized clinical trial.

Dyspnea and cough are frequent symptoms in ILD patients. The management of these symptoms is challenging, and evidence-based therapies are lacking. To evaluate the effect of an online Mindfulness-Based Intervention (eMBI) on reducing dyspnea in patients affected by different ILDs. This study was a prospective, open-label, controlled trial that included patients ≥18 years and a modified Medical Research Council (mMRC) dyspnea scale score of ≥ 1. Patients were randomized into either the eMBI or the control group (CG) for 8 weeks. The primary outcome was the change in the dyspnea mMRC scale. The Leicester Cough Questionnaire (LCQ), King's Brief Interstitial Lung Disease (K-BILD) questionnaire, and Depression, Anxiety, and Stress Scale (DASS-21) were performed before and after the eight weeks. All analyses were conducted on an intention-to-treat basis. The study was registered at the Brazilian Registry of Clinical Trials (ReBEC), RBR-3s4mf9y. 24 patients in the eMBI and 25 in the CG completed the intervention. In the eMBI group, compared to the control group, there was a greater proportion of patients with a reduction in dyspnea according to the mMRC scale score (48.9% versus 15.4%, p = 0.001). There was no significant difference between the groups in the LCQ (p = 0.666), or in the K-BILD (p = 0.108), depression (p = 0.08), or anxiety (p = 0.869 or stress (p = 0.789). No moderate or severe adverse events were observed in either group. Eight weeks eMBI is a potentially viable and safe approach, that can help manage dyspnea in ILD patients.

Laparoscopic adrenalectomy performed with the Endo GIA™ Stapler as an easy and safe approach.

The purpose of this study was to determine whether the application of the Endo GIA™ Stapler (Medtronic, Dublin, Ireland) could be helpful in the dissection of adrenal tumors in complicated cases. We retrospectively reviewed the records of patients who underwent laparoscopic adrenalectomy between 2012 and 2022 at the College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea (Seoul, Republic of Korea). We adopted the Endo GIA™ Stapler (Medtronic) to seal vessels around adrenal gland and separate adrenal gland completely when it was difficult to perform meticulous dissection and isolation with laparoscopic instruments. Thirteen patients who underwent laparoscopic adrenalectomy with Endo GIA™ staplers were reviewed and compared with 45 other patients who underwent laparoscopic adrenalectomy without Endo GIA™ staplers. There were no statistical differences between the two groups in demographic, tumor-related, and diagnostic variables. Surgical outcomes such as margin involvement, bleeding, operation duration, rate of conversion to open surgery, blood transfusion, complications, and recurrence were not different between the two groups. In our experience, applying of the Endo GIA™ Stapler (Medtronic) in laparoscopic adrenalectomy is a feasible and acceptable approach.

Surgical Technique for Repair of Tegmen Dehiscence with Encephalocele: A Retrospective Study

Tegmen dehiscence with encephalocele presents certain surgical challenges, necessitating innovative approaches to improve patient outcomes and minimize complications. Here we aim to evaluate the safety and efficacy of a novel middle cranial fossa craniotomy technique. Nineteen adult patients with radiographically confirmed tegmen dehiscence with encephalocele were included. Patients underwent a middle cranial fossa craniotomy technique for tegmen dehiscence repair, utilizing a split thickness bone graft, pedicled pericranial flap, and hydroxyapatite for extradural repair and with an inlay graft for the intradural repair. The primary outcome measured was major perioperative complications or need for revision surgery while secondary outcome measured was the resolution or improvement of preoperative symptoms associated with tegmen dehiscence. Our series encompassed tegmen dehiscence repairs in 19 patients, with an average age at surgery of 51 years (range 24 to 82). The average follow-up time was 8.80 months (range 0.43 to 27.62 months). Patients commonly presented with symptoms such as hearing loss (n=8), otorrhea (n=8), fullness or ear pressure (n=6), dizziness or imbalance (n=6), or a history of meningitis (n=4), among others. Postoperatively, symptoms resolved completely in 42% of patients (n=8) and partially in 58% of patients (n=11). Notably, no patients required revision surgery or developed new dehiscences in the follow-up period. Our middle cranial fossa craniotomy technique for tegmen dehiscence with encephalocele repair demonstrated promising postoperative outcomes, with complete or partial symptom resolution in all patients and no major complications. Our findings suggest that this technique is a safe and effective approach for tegmen dehiscence repair.

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.

Accelerated Return To Sport Following Hip Arthroscopy For Femoroacetabular Impingement Syndrome: A Safe And Effective Approach

Accelerated Return To Sport Following Hip Arthroscopy For Femoroacetabular Impingement Syndrome: A Safe And Effective Approach

Controllable H2S supply via membrane contactors for safe and efficient arsenic precipitation from acidic wastewater

Sulfide precipitation is a popular technique for the treatment and resource recovery of arsenic-containing dirty acid wastewater. However, this approach frequently suffers from toxic hydrogen sulfide (H2S) escape and agent wastage issues. Herein, a safe and efficient technique is proposed based on a polytetrafluoroethylene membrane contactor wherein the mass transfer resistance of the gas, membrane, and liquid phases can be easily and independently regulated to control the H2S supply. Additionally, H2S is transferred in bubble-free form, fundamentally avoiding the issue of gas escape, and uniform membrane distribution contributes to evenly distributed H2S delivery. The results demonstrated that 99.3% arsenic precipitation could be achieved and the H2S emission ratio was limited to <0.12%, which was significantly better than traditional methods. Thus, highly efficient separation and resource recovery of heavy metals in wastewater can be achieved using this unique and controllable low-dose H2S supply method. The separation factor between copper and arsenic was as high as 7490.9. This study provides a safe, reliable, and promising new approach for the treatment of arsenic-containing acidic wastewater.

The demonstrated step-by-step RATS 1ˢᵗ rib resection has shown to be a safe and effective approach for 1ˢᵗ rib resection in thoracic outlet syndrome.

The demonstrated step-by-step RATS 1ˢᵗ rib resection has shown to be a safe and effective approach for 1ˢᵗ rib resection in thoracic outlet syndrome.

Uterus Didelphys with Hematocervix in the Unilateral Obstructed Hemivagina and Ipsilateral Renal Agenesis: A Case Report of Herlyn–Werner–Wunderlich Syndrome

Background: Mullerian duct anomalies include a broad spectrum of genital tract defects that arise from developmental abnormalities of the genital tract. Herlyn–Werner–Wunderlich syndrome (HWWS) refers to the combination of uterus didelphys, blind hemivagina and ipsilateral renal agenesis. In the literature, the syndrome often appears as a few sporadic case reports. Case: We report a case of symptomatic Herlyn–Werner–Wunderlich syndrome diagnosed by transavaginal scan and MRI and successfully treated with a laparoscopic-assisted hysteroscopic vaginal septum resection. The postoperative course was without complications, and clinical symptoms completely resolved the surgery. Summary and Conclusions: Combination of laparoscopy and hysteroscopy was found to be an easy, safe, effective and appropriate approach for patients with HWWS.