Small Needle Research Articles

Establishing a Percutaneous Infection Model Using Zebrafish and a Salmon Pathogen.

Simple SummaryThe epidermis and mucus layer of fish act as barriers that protect them against waterborne pathogens, and provide niches for symbiotic microorganisms that benefit the host’s health. However, our understanding of the relationship between fish skin bacterial flora and fish pathogen infection is limited. In order to elucidate this relationship, an experimental model for infection through fish skin is necessary. Such a model must also pose a low biohazard risk in a laboratory setting. We established a percutaneous infection model using zebrafish (Danio rerio), a typical fish experimental model, and Yersinia ruckeri, a salmon pathogen. Our experimental data indicate that Y. ruckeri colonizes niches on the skin surface generated by transient changes in the skin microflora caused by stress, dominates the skin bacterial flora, occupies the surface of the fish skin, invades the fish body through injury, and finally, causes fatal enteric redmouth disease. This percutaneous infection model can be used to study the interaction between fish skin bacterial flora and fish pathogens in water, or the relationship between pathogens and the host’s skin immune system.To uncover the relationship between skin bacterial flora and pathogen infection, we developed a percutaneous infection model using zebrafish and Yersinia ruckeri, a pathogen causing enteric redmouth disease in salmon and in trout. Pathogen challenge, either alone or together with pricking by a small needle, did not cause infection of the fish. However, cold stress given by water temperature shift from the optimum 28 °C for zebrafish to 20 °C caused fatal infection of injured fish following pathogen challenge. We investigated the effects of cold stress, injury, and pathogen challenge, alone and in combination, on fish skin bacterial flora using 16S rDNA metagenomics. We found that cold stress drastically altered the skin bacterial flora, which was dominated by Y. ruckeri on infected fish. In addition, fish whose intrinsic skin bacterial flora was disrupted by antibiotics had their skin occupied by Y. ruckeri following a challenge with this pathogen, although the fish survived without injury to create a route for invasion into the fish body. Our results suggest that the intrinsic skin bacterial flora of fish protects them from pathogen colonization, and that its disruption by stress allows pathogens to colonize and dominate their skin.

Comparison of Sample Adequacy and Diagnostic Yield of the 21-G and 25-G EBUS TBNA Needles.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS TBNA) of mediastinal lymphadenopathy has been shown to be equivalent and possibly even superior to mediastinoscopy. Since the original dedicated 22-G aspiration needle, 21-G, 25-G, and recently 19-G needles have been introduced. Smaller needles may be more flexible and adept at accessing more difficult nodes, and may have less blood contamination compared with larger needles. This is a prospective observational study of 50 consecutive patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration with a 21-G needle and a 25-G needle for a total of 100 biopsies. The study slides were examined by a dedicated lung cytopathologist, who was blinded to the needle size used for each slide. Demographic data, and lymph node size were recorded. Comparisons between the 2 needles with regards to sample adequacy and diagnostic yield was performed using the McNemar test for dichotomous variables and marginal homogeneity test for nondichotomous variables since samples were related. The majority of lymph nodes (96%) were at least >1 cm. Adequate specimens were obtained in 78% of cases with the 21-G needle and 86% of cases with 25-G needle (P-value=0.424). The overall diagnostic yield was 74% and 80% with the 21-G needle and 25-G needle, respectively (P-value=0.607). Our study demonstrates that the there is no difference in terms of specimen adequacy and diagnostic yield when the 25-G needle is compared with the 21-G needle.

The effect of needle size on cerebrospinal fluid collection time and post-dural puncture headache: A retrospective cohort study.

ObjectiveThe main objective of this study was to compare cerebrospinal fluid (CSF) collection time and patient's discomfort between 20G (a)traumatic and 22G atraumatic needles.BackgroundRisk of post‐dural puncture headache (PDPH) is decreased using atraumatic needles. Smaller needles may give lower risk but possibly at the cost of increased CSF collection time (due to lower flow), leading to additional patient's discomfort.MethodsWe performed a retrospective study of lumbar puncture data from a research program on CSF metabolomics and compared traumatic 20G (n = 210) with atraumatic 20G (n = 39) and 22G (n = 105) needles. In this cohort, incidence of PDPH was prospectively registered with other procedure details. Primary outcome was CSF collection time (time to fill the tube). Secondary outcomes were pain and stress scores during procedure, and incidence of PDPH.ResultsThe time to collect 10 mL of CSF was longer for 22G needles (6.1 minutes; 95% CI 5.8–6.5) than for 20G traumatic (2.2 minutes; 95% CI 2.1–2.2) and 20G atraumatic needles (2.9 minutes; 95% CI 2.8–3.1). There were no differences in pain and stress scores. PDPH was lower for 22G atraumatic needles: odds ratio 0.41 (95% CI 0.25–0.66) versus 20G traumatic needles and 0.53 (95% CI 0.40–0.69) versus 20G atraumatic needles. Absolute PDPH rates were 69/210 (32.9%) for 20G traumatic, 13/39 (33.3%) for 20G atraumatic, and 19/105 (18.1%) for 22G atraumatic needles.ConclusionsCSF collection time is slightly longer for smaller 22G needles, but this does not lead to more discomfort for the patient.

Fundamental and essential techniques for supermicrosurgical lymphaticovenular anastomosis: the art of Isao Koshima’s supermicrosurgery

Lymphaticovenular anastomosis (LVA) is a highly effective, minimally invasive surgical treatment for lymphedema. The effect of LVA appears immediately after the creation of lymph-to-venous pathway. However, the long-term outcome of LVA is not always promising when the lymph-to-venous anastomosis has any potential risk of occlusion. The reasons of postoperative LVA occlusions are considered both a technical matter in performing LVA and a strategic matter in preoperative planning. This report focuses on intraoperative techniques of LVA to avoid postoperative occlusions. Depending on the types of undesirable surgical procedures, lymphaticovenular anastomoses are at risk of future occlusions in early, mid-, or late-postoperative course. The authors describe fundamental and essential techniques to perform supermicrosurgical LVA, and the true concept of Isao Koshima’s supermicrosurgery, in which the pith and marrow of the doctrine is not only the way of handling the small vessels or needles, but also the surgeons’ skills to feel intima of the vessels and lymphatic flow itself.

Management of temporomandibular joint disorders using acupuncture: A case report

Background: Temporomandibular joint disorder (TMD) is a term for disease of the TMJ and the muscles attached to it. The symptoms and signs of TMD are clicking, crepitation, headache, and pain in and around the TMJ. Management of TMD includes dental approaches (e.g., splints, bite plates, and jaw exercises) and surgical approaches. Acupuncture is a Chinese medicine that consists of insertion of small solid stainless-steel needles into many acupoints on the body to improve health and relieve pain in the surrounding areas. Case Report: A 34-year-old male patient reported with severe pain in the right and left TMJ region and difficulty in opening of his mouth for the past 6 months. Extra-oral examination revealed tenderness on both sides of the face, deviation of the mouth toward the right side, the mouth opening was two finger breadths, and mild early-opening click. Intra-oral examination revealed the presence of 28 teeth. Orthopantogram did not show any changes in the condyle and articular eminence. The patient was initially treated with palliative therapy and then treated with acupuncture. Conclusion: Acupuncture is an alternative mode of treatment for persons with muscular TMD.

Treatment of lumbar intervertebral disc herniation with small needle knife combined with hot compress powder of the Clinical effect observation

Objective: To observe the efficacy of small needle knife combined with hot compress powder in the treatment of lumbar disc herniation. Method: A total of 78 patients with lumbar disc herniation in the Department of Orthopedics, Affiliated Hospital of Shaanxi University of Chinese Medicine from May 2020 to November 2020 were selected and randomly divided into treatment group and control group, with 39 cases in each group. The treatment group was treated with small needle knife combined with hot compress powder, while the control group was treated with physiotherapy combined with hot compress powder. After 4 courses of treatment (1 course was 7 days), the clinical efficacy, VAS score, and the changes of flexion and retrograde Angle were compared between 2 groups. Results: After treatment, the clinical efficacy, flexion Angle and retrograde Angle of the treatment group were significantly better than those of the control group, and the VAS score of the treatment group was significantly lower than that of the control group. Conclusion: Small needle knife combined with hot compress powder has obvious curative effect in the treatment of lumbar disc herniation, worthy of clinical promotion.

Structure formation of titanium alloys during vacuum-arc surfacing

The work is based on wire vacuum-arc surfacing as one of the technologies for additive manufacturing. The results of the formation of structure and properties of a high-temperature titanium alloy of the Ti-Al-V-Mo-Zr system during vacuum-arc surfacing are presented. The structure of the surfaced materials consists of dendritic grains that are oriented in the direction opposite to heat removal. Some banding of the structure is observed. There is no porosity in the deposited layers for all surfacing modes. It was determined that a decrease in the surfacing current promotes an increase in the dispersion of the α-phase plates, which is accompanied by an increase in microhardness. With such a thermal cycle of surfacing, conditions are created for the formation of a favorable fine-dispersed martensitic structure with narrow α-colonies of small needles of the α-phase, providing a high microhardness at the level of 400HV.

Development of Scheelite Tailings-Based Ceramic Formulations with the Potential to Manufacture Porcelain Tiles, Semi-Stoneware and Stoneware.

New ceramic formulations based on scheelite tailing were developed, and their potential in the ceramic industry was evaluated. Green bodies with different contents of scheelite tailing (0–8 wt%) were sintered (1150 °C, 1200 °C, and 1250 °C) and characterized in terms of the main mineralogical phases, microstructure, and physico-mechanical properties. The mullite was the main phase identified in all sintered temperatures. This result was also ratified with the aid of scanning electron microscope (SEM) images, in which small needles of the mullite were detected. The presence of mullite is required because it contributes to increasing the mechanical resistance of the material. The physico-mechanical properties measured (water absorption, linear shrinkage, apparent porosity, and flexural strength) were compared to the ISO 13006, and the samples sintered at 1150 °C presented potential to be used as semi-stoneware, while those sintered at 1200 °C and 1250 °C can be employed stoneware and porcelain tiles, respectively.

Incidence and risk factors of postdural puncture headache: prospective cohort study design

BackgroundPostdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache.MethodsThis prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow-up were performed. Data were entered into Epi info version 7 software and transported to SPSS version 20 for analysis. The odds ratio and 95% confidence interval were computed. The findings of the study were reported using tables, figures, and narrations. Variables that were found to be candidates (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache.ResultsOne hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p < 0.05). In addition, twenty-five needles were identified as the strongest preoperative independent predictor of postdural puncture headache (AOR = 4.150, CI = 1.433–12.021)ConclusionsA recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

Melt Electrospinning of Nanofibers from Medical-Grade Poly(ε-Caprolactone) with a Modified Nozzle.

Melt electrospun fibers, in general, have larger diameters than normally achieved with solution electrospinning. This study uses a modified nozzle to direct-write melt electrospun medical-grade poly(ε-caprolactone) onto a collector resulting in fibers with the smallest average diameter being 275±86nmunder certain processing conditions. Within a flat-tipped nozzle is a small acupuncture needle positioned so that reduces the flow rate to ≈0.1µL h-1 and has the sharp tip protruding beyond the nozzle, into the Taylor cone. The investigations indicate that 1-mm needle protrusion coupled with a heating temperature of 120°C produce the most consistent, small diameter nanofibers. Using different protrusion distances for the acupuncture needle results in an unstable jet that deposited poor quality fibers that, in turn, affects the next adjacent path. The material quality is notably affected by the direct-writing speed, which became unstable above 10mm min-1 . Coupled with a dual head printer, first melt electrospinning, then melt electrowriting could be performed in a single, automated process for the first time. Overall, the approach used here resulted in some of the smallest melt electrospun fibers reported to date and the smallest diameter fibers from a medical-grade degradable polymer using a melt processing technology.

Performance of a clinical and imaging-based multivariate model as decision support tool to help save unnecessary surgeries for high-risk breast lesions.

To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic) CONCLUSION: Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.

Standardized Tendon Fenestration with Injection of Autologous Blood for Treatment of Lateral Epicondylitis

Lateral epicondylitis (LE) of the elbow is often treated with conservative methods. Several techniques including injections with different substances are widely performed. No standardization exists. This prospective study describes the results of the short-term follow-up of 56 patients with mean age 48 years (range: 30–68 years) treated with the Instant Tennis Elbow Cure Medical device, which fenestrates the injured tendon in a standardized way through a holder of 12 small needles. Depth and position of the needles are determined beforehand by ultrasonography. Unprepared autologous blood was injected through the holder in the tendon. Visual analog pain scale (VAS) decreased significantly in rest by 61% and during activity by 47% after 6 weeks. VAS decreased significantly in rest by 79% and during activity by 66% after 3 months. VAS did not remain significantly different after 6 months. Satisfaction rates were 71% after 6 weeks and 82% after 6 months. This suggests that the therapeutical effect sustains and in some cases increases over time. Patient Related Tennis Elbow Evaluation score ameliorated after 3 months by 71%. Comparative studies are needed to confirm this effect versus other techniques as physiotherapy, shockwave therapy, and injections with other substances.

Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA.

BackgroundThe external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively.Questions/purposesIn this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study.MethodsTwo-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed.ResultsThe lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6).ConclusionsWe suggest templating a 6.4-mm circle with its bottom on the intersection described above.Clinical RelevanceThe distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evaluation of stem depth and leg length. Future work will investigate the usability, validity, and reliability of the proposed methodology in daily clinical practice.

"Outcomes of arteriovenous fistulae cannulation in the first 6 weeks of use: A retrospective multicenter observational study".

Arteriovenous fistula (AVF) management for haemodialysis (HD) is one of the most challenging aspects of clinical care. A successful cannulation outcome when an AVF or arteriovenous graft (AVG) is used for the first time can be influenced by many factors, including access maturity, staff skill, and patient factors. This study examined AVF/AVG outcomes at initiation of HD across two major metropolitan public hospitals. Electronic medical records were reviewed to collect data retrospectively for a cohort of all newly commencing ESRD HD starts during 2018 to identify cannulation outcomes in the first 6 weeks. Of the 117 patients included, AVG use was low (5%). Twenty-four percent of patients required a surgical intervention to salvage a poorly functioning AVF prior to commencing HD. About 32.5% of the cohort had an uneventful start with all successful cannulations. For the remainder of the cohort the number of treatments with unsuccessful cannulation ranged from 1 to 4 or more. About 36% required a surgical intervention for a poorly functioning AVF after commencing HD. Commencing HD with a CVC is associated with a lower likelihood of subsequent successful cannulation (p < 0.001). Even in experienced centres, a subset of patients experienced complicated cannulation in the first 6 weeks of HD. Several areas of improvement could be considered for these patients; timely referral for access creation, post-operative surveillance to ensure AVF maturation inclusive of duplex ultrasonography, gentle induction using small gauge needles and low blood flows, and consideration of a single needle HD initiation pathway.

Long Noncoding RNA Expression in Adrenal Cortical Neoplasms.

Long noncoding RNAs (lncRNAs) consist of nucleic acid molecules that are greater than 200 nucleotides in length and they do not code for specific proteins. A growing body of evidence indicates that these lncRNAs have important roles in tumorigenesis. Separating adrenal cortical adenomas from carcinomas is often a difficult problem for the surgical pathologist. This is especially true when only small needle biopsies are available for examination. We used in situ hybridization (ISH) analysis to study normal adrenal cortical tissues and adrenal cortical tumors to determine the role of specific lncRNAs in tumor development and classification. The lncRNAS studied included metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), psoriasis susceptibility-related RNA gene induced by stress (PRINS), and HOX antisense intergenic RNA myeloid 1 (HAM1). We constructed a tissue microarray (TMA) for the studies and also analyzed a subset of cases by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Two 1-mm duplicate cores of normal adrenal cortex (NAC) (n= 23), adrenal cortical adenomas (ACAs) (n= 95), and adrenal cortical carcinomas (ACCs), (n= 20) were used on the TMA. The results of ISH were analyzed by image analysis. ISH showed predominantly nuclear expression of lncRNAs in adrenal cortical tissues. MALAT1 showed more expression in ACCs than in NAC and ACA (p< 0.05). PRINS had higher expression in NACs and ACAs than in ACCs. The lncRNAs MALAT1, PRINS, and HAM1 are all expressed in normal and neoplastic adrenal cortical tissues. MALAT1 had the highest expression in ACC compared to ACAs and may have a role in ACC development.

Small Needle Knife-Assisted Aluronic Acid Combined with Botulinum Toxin Injection in the Treatment of Glabellar Frown Line

Small Needle Knife-Assisted Aluronic Acid Combined with Botulinum Toxin Injection in the Treatment of Glabellar Frown Line

Current Role and Importance of USG Guided FNAC for Rapid Diagnosis of Suspicious Mass Lesions

Background: Ultrasound guided Fine needle aspiration is a diagnostic procedure that inserts a small needle into a suspicious mass to extract some cells which are then visualized under the microscope. The aim of the present study was to determine utility and safety of ultrasound guided FNAC in rapid evaluation of various mass lesions. Subjects and Methods: In this study, 120 patients of age between 20-60 years with various mass lesions referred for ultrasonography guided FNAC to the department of radiodiagnosis, PDU Medical College and Civil hospital, Rajkot, Gujarat over a period of 1.5 years from 1/5/2018 to 1/11/2019are included. Results: Ultrasonography guided FNAC was performed by the same investigator, an experienced radiologist, using a real time scanner (logicP9; GE Healthcare) under standard septic precautions. Conclusion: Our study contributes to the conclusion that USG guided FNAC can easilybe used for the aspiration of lesion of the breast, thyroid, lymph nodes, liver, lung, musculoskeletal system etc. It does not use ionizing radiation, has no known harmful effects, and provides rapid diagnosis of the suspicious mass lesions &amp;a firm diagnosis of impalpable lesions can be made preoperatively. Advantages of USG guided FNAC:- 1. Cost effectiveness, 2. No radiation hazards, 3. Easy to perform, 4. Dynamic evaluation of vessels, 5. Perfect real time Localization of the target lesion,

The Combination of Platelet Rich Plasma with Skin Needling or Subcision for Postacne Scaring: a Serial Case Study

Scaring in acne remains a common problem and became therapeutic challenges for the clinician. Several modalities were introduced, and combination therapies are required to achieve satisfactory results. Skin needling and subcision reported as effective methods for treating acne scar. The skin needling technique involves puncturing the skin multiple times with a small needle to induce collagen growth, while subcision worked by tunneling the connective tissue and scattered the fibrosis scar. Platelet-rich plasma (PRP) influences wound-healing by stimulating an intense inflammatory response and growth factors, these increase in the production of extracellular matrix and granulation tissue occurs, with vascular in-growth, fibroblastic proliferation, and collagen production also accelerated. Three male patients enrolled in the study, with grades 2-3 acne scar. There are three different methods of treatment were used to see the effect of the treatment. The first patient used the combination of topical PRP and skin needling, and the second patient received a combination of PRP injection and subcision, while the third patient obtains combination between topical PRP and skin needling continued with PRP injection and subcision. Our study revealed that PRP and skin needling or subcision is a simple technique and has the potential for improvement of acne scars. Three weeks after treatment, all three patient had smoother facial skin and reduction of acne scar severity. The combination of PRP and skin needling or and subcision is a simple, safe and rapid method for acne scars treatment.

The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study

Objective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. Design: Pilot randomised, controlled trial. Setting: Rehabilitation hospital. Subjects: In-patients with osteo-arthritis of the knee. Interventions: Either 1 to 3 small needle-knife treatments over seven days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation. Measures: Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at three weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded. Results: 83 patients were randomized: 44 into the control group, of whom 10 were lost by three weeks and 12 at 3 months; 39 into the experimental group of whom eight were lost at three weeks and three months. The mean (SE) OKS scores at baseline were Control 35.86 (1.05), Exp 38.38 (0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0.03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (P < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months Conclusions: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.

Two Layers of Melting Ice Particles Within a Single Radar Bright Band: Interpretation and Implications

AbstractDual‐frequency dual‐polarization radar observations of the melting of two ice populations in a stratiform rainfall event are presented. The observed phenomenon occurs as a two‐layer linear depolarization ratio (LDR) signature in a single radar bright band. Doppler spectra observations show that the upper LDR layer is caused by the melting of ice needles, potentially generated by the rime‐splintering process, while the lower one is mainly due to the melting of background ice particles formed at the cloud top. The melting signal of small needles acts as a unique benchmark for detecting the onset of melting and is used to verify the current methods for the identification of melting layer boundaries. The radar‐derived characteristics of the melting layer are found to be dependent on the radar variable and frequency used. The implications of the presented findings for radar‐based studies of precipitation properties in and above the melting layer are also discussed.