Needle Type Research Articles

Objective evaluation of the resistance forces of 22-gauge EUS-FNA and fine-needle biopsy needles.

EUS-guided tissue acquisition is routinely performed for the diagnosis of gastrointestinal tract and adjacent organ lesions. Recently, various types of needles have been developed. However, how the shape of the needle tip and echoendoscope tip angle affect puncturability, has not been clarified. The aim of this experimental study was to compare the puncturability of several 22-gauge EUS-FNA and EUS-guided fine-needle biopsy (EUS-FNB) needles, and to evaluate the effects of the needle tip shape and echoendoscope tip angle on tissue puncturability. The following six major FNA and FNB needles were evaluated: SonoTip® ProControl, EZ Shot 3 Plus, Expect™ Standard Handle, SonoTip® TopGain, Acquire™, and SharkCore™. The mean maximum resistance force against needle advancement was evaluated and compared under several conditions using an echoendoscope. The mean maximum resistance force of the needle alone was higher for the FNB needles than for the FNA needles. The mean maximum resistance force of the needle in the echoendoscope with free angle demonstrated that the resistance forces were between 2.10 and 2.34 Newton (N). The mean maximum resistance force increased upon increases in angle of the tip of echoendoscope, particularly in the FNA needles. Among the FNB needles, SharkCore™ had the lowest resistance force (2.23 N). The mean maximum resistance force of the needle alone, the needle in the echoendoscope with free angle, and the needle in the echoendoscope with full-up angle for SonoTip® TopGain were all similar to that of Acquire™. SonoTip® TopGain had similar puncturability to Acquire™ in all tested situations. Regarding the puncturability, SharkCore™ is most suitable for insertion into target lesions, when tight echoendoscope tip angle is necessary.

Bending 30-gauge needles using a needle guide: fatigue life evaluation.

Dentists bend needles prior to certain injections; however, there are concerns regarding needle fracture, lumen occlusion, and sharps handling. A previous study found that a 30-gauge needle fractures after four to nine 90° bends. This fatigue life study evaluated how many 90° bends a 30-gauge dental needle will sustain before fracture when bent using a needle guide. Two operators at Element Materials Technology, an independent testing, inspection, and certification company tested 48 30-gauge needles. After applying the needle guide, the operators bent the needle to a 90° angle and expressed the anesthetic from the tip. The needle was then bent back to a 0° angle, and the functionality was tested again. This process was repeated until the anesthetic failed to pass through the end of the needle due to fracture or obstruction. Each operator tested 24 needles (12 needles from each lot), and the number of sustained bends before the needle fracture was recorded. The average number of sustained bends before needle failure was 40.33 (95% confidence interval = 37.41-43.26), with a minimum of 20, median of 40, and a maximum of 54. In each trial, the lumen remained patent until the needle fractured. The difference between the operators was statistically significant (P < 0.001). No significant differences in performance between needle lots were observed (P = 0.504). Our results suggest that using a needle guide increases the number of sustained bends before needle fracture (P < 0.000001) than those reported in previous studies. Future studies should further evaluate the use of needle guides with other needle types across a variety of operators. Furthermore, additional opportunities lie in exploring workplace safety considerations and clinical applications of anesthetic delivery using a bent needle.

Evaluation of non-modifiable factors associated with post-dural puncture headache following subarachnoid block utilising 26 G quincke spinal needle: Prospective, observational study

Background and Aims: Post-dural puncture headache (PDPH) is one of the complications of the subarachnoid block (SAB), and the incidence of PDPH is influenced by various factors related to either patients or the type of spinal needle used. This study observed the incidence and severity of PDPH in relation to non-modifiable factors in the patients scheduled for surgeries under SAB. Methods: The study enrolled 302 obstetric and non-obstetric patients, aged 20–60 years, American Society of Anesthesiologists (ASA) I/II having body mass index (BMI) 18.5–29.9 kg.m-2 scheduled for surgeries under SAB utilizing 26 G Quincke spinal needle. Primary outcome was the incidence of PDPH in obstetric and non-obstetric patients. The secondary outcomes included onset, severity of PDPH, and association of age, BMI, and gender to PDPH. Results: The total incidence of PDPH was 5.6%, eight (7%) patients in obstetric and nine (4.8%) patients in non-obstetric group (P = 0.597). The onset of PDPH was comparable in obstetric 17.25 ± 3.69 and non-obstetric patients 18.0 ± 6.02 h (P = 0.663). None of the patient had severe PDPH. The BMI of the patients was not associated with the incidence of PDPH. The female patients among non-obstetric group had higher incidence of PDPH (P = 0.0002). The six patients having PDPH in non-obstetric group belonged to age-group of 31–40 yrs as compared to two above 40 years (P = 0.0173). Conclusion: Obstetric population had comparable incidence of PDPH to non-obstetric population. In the subgroup analysis of non-obstetric patients, the higher incidence of PDPH was observed in the female and younger patients.

Transesophageal endoscopic ultrasound-guided tissue acquisition of lung masses: a case series with systematic review and meta-analysis.

The diagnosis of intraparenchymal lung masses is challenging when lesions are located at sites inaccessible through bronchoscopy or endobronchial ultrasound. Endoscopic ultrasound (EUS)-guided tissue acquisition (TA)-fine-needle aspiration (FNA) or fine-needle biopsy-provides a potentially useful diagnostic tool for lesions located adjacent to the esophagus. This study was conducted to analyze the diagnostic outcome and safety of EUS-guided tissue sampling of lung masses. Data were retrieved for patients who underwent transesophageal EUS-guided TA between May 2020 and July 2022 at 2 tertiary care centers. A meta-analysis was performed after pooling these data with studies obtained from a comprehensive search of Medline, Embase, and ScienceDirect from January 2000 to May 2022. Pooled event rates across studies were expressed with summative statistics. After screening, 19 studies were identified and, after their data had been combined with those of 14 patients from our centers, a total of 640 patients were included in the analysis. The pooled rate of sample adequacy was 95.4% (95% confidence interval [CI] 93.1-97.8), while the pooled rate of diagnostic accuracy was 93.4% (95%CI 90.7-96.1). The pooled rate of adverse events with transesophageal EUS-guided TA from lung masses was 0.7% (95%CI 0.0-1.6%). There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. EUS-FNA offers a safe and accurate diagnostic modality for the diagnosis of paraesophageal lung masses. Future studies are needed to determine the needle type and techniques for improving outcomes.

Comparison of the Use of Peripheral Nerve Stimulator and Quincke Needle for Lumbar Transforaminal Epidural Steroid Injections.

To compare the procedural features of transforaminal epidural steroid injection (TFESI) performed using two different needles (Stimuplex® and Quincke) in terms of procedure time, exposed radiation dose and adverse effects and complications, thus providing preliminary data to aid needle selection for TFESI. Patients who received fluoroscopy-guided single-level lumbosacral TFESI between September 2020 and September 2021 were retrospectively included in this study. The patients were divided into two groups with respect to the needle type used for the procedure ? those treated with a Quincke needle were classified as Group Q and those treated with a Stimuplex® needle comprised Group S. Subsequently, the two groups were compared in terms of their demographic data, procedure time, radiation dose, amount of contrast use, first-hour numeric rating scale (NRS), intravascular flow and complication rates. The number of patients recruited for Groups Q and S was 65 and 61, respectively. No significant difference was observed between the groups regarding their demographic data, preprocedural NRS scores, procedure time, exposed radiation dose and the amount of contrast dye used. Notably, the first-hour NRS scores were found to be significantly lower in Group S (p=0.040) after the procedure. Moreover, the intravascular contrast spread was significantly different between the two groups (p < 0.05) ? it was encountered during four procedures in Group Q, but was altogether absent in Group S. The Stimuplex® needle may decrease the possibility of inadvertent intravascular leakages during TFESI and may also improve immediate pain scores after the procedure.

Role of endoscopic ultrasound-guided tissue acquisition for the diagnosis of gastric wall thickening: a retrospective study with meta-analysis.

Tissue acquisition from a thickened gastric wall using biopsy forceps may not always lead to diagnosis, given the submucosal location of the pathology. Endoscopic ultrasound (EUS)-guided tissue acquisition (TA) may serve as a minimally invasive diagnostic tool in such cases. Hence, we aimed to assess the diagnostic outcome and safety of EUS-TA from thickened gastric walls. Data from patients with gastric wall thickening undergoing EUS-TA at 5 tertiary care centers from August 2020 to August 2022 were retrospectively analyzed. These data were pooled with studies obtained from a comprehensive search of Medline, Embase and Scopus from January 2000 to November 2022 and a meta-analysis was performed. Pooled event rates were calculated using an inverse variance model. The search strategy yielded 13 studies that were combined with data from 30 patients from our centers; a total of 399 patients were included in the analysis. The pooled rate of sample adequacy was 94.1% (95% confidence interval [CI] 90.0-98.2), while the pooled rate of diagnostic accuracy was 91.3% (95%CI 87.0-95.5). The pooled sensitivity and specificity for diagnosing malignant lesions with EUS-TA from gastric wall thickening were 94.8% (95%CI 91.3-97.2) and 100% (95%CI 93.6-100), respectively. There were no reported adverse events in any of the studies. EUS-TA offers a safe and accurate diagnostic modality for the etiological diagnosis of thickened gastric walls. Further research is required to identify the needle type and optimal technique for improving outcomes.

How to Perform Endoscopic Ultrasound-Guided Fine Needle Aspiration/Biopsy of Pancreatic Lesions?

A endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B) of pancreatic solid and cystic lesions is a modality, which huge numbers of articles has showed its high diagnostic accuracy. The degree of technical difficulty, size and type of needle, endoscopic technique, use of suction to aspirate tissue, use or not use of a stylet in the needle assembly, maneuvers to have high quality tissue, availability of an on-site cytopathologist, and, finally, end sonographer’s experience and skills who does the procedure have impact on the EUS-FNA results. Standard 19-G and 22-G fine-needle aspiration needles with or without high negative pressure have proven to be reliable in obtaining high-quality histologic samples in various indications. Twenty-five-gauge (25-gauge) needles provide better diagnostic yield when sampling pancreatic lesions compared with 22-G needles. The novel 19-G and 22-G ProCore™ needles have demonstrated a high yield in obtaining histologic samples, whereas 25-G. ProCore™ seems unsuitable for histology. A cytopathology service should be involved early in the planning process for establishing an EUS-FNA service. Data on the newly developed 20-G ProCore™, SharkCore® and Acquire® needles are limited, but appear very promising. Use of the stylet does not increase the yield of endoscopic ultrasonography-fine-needle aspiration and is more cumbersome to use. In perspective, endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is expected to refine differential diagnostic capabilities, favor widespread EUS utilization, and pave the road to targeted therapies and monitoring of treatment response. Approximately 3 to 5 passes should be sufficient to obtain a diagnosis. We need further studies for assessment of the use of Suction, Capillary (“Slow-Pull”), Wet and Fanning techniques.

The Effect of Interrupted Homogenization on β-Al5FeSi → α-Alx (Fe and Mn) Si Transformation in the A6063 Aluminum Alloy

The aluminum alloys corresponding to the 6000 series are mainly manufactured by mechanical forming processes. Their properties are enhanced by the homogeneous distribution of intermetallic phases such as β-Al5FeSi or α-Alx (Fe, Mn) Si. By thermal homogenization treatment, the intermetallic compound β-Al5FeSi changes its morphology from a needle type with a monoclinic structure to an acicular form known as α-Al12(Fe, Mn)3Si with an fcc structure. In the present study, samples of the 6063 alloy were subjected to different temperatures of homogenization (798, 823, and 848 K) and treatment times from 0 to 660 min (in intervals of 30 min) to evaluate their effects on the microstructures and morphologies of the intermetallic phases. For the kinetic study, the microstructures of the β and α intermetallic phases were quantified using the Image-Pro software. The results indicate that as the temperature and homogenization time increase, the percentage of phase α also increments. The results of the kinetic analysis revealed that the β → α transformation is controlled by two stages; the first corresponds to the diffusion of Mn atoms from the matrix to the interface of reaction for the formation of the intermetallic phases, while the second corresponds to the nucleation and growth of the iron- and manganese-rich intermetallic phases.

Atraumatic spinal needle indicates correct CSF opening pressure

The accurate assessment of cerebrospinal fluid opening pressure during spinal puncture provides important medical information in diagnosis, prognosis and therapy of several neurological conditions. However, purpose-specific spinal needle choice is debated. While atraumatic needles are associated with lower incidence of post-puncture headache and re-hospitalisation, some clinicians believe that they lack in accuracy of CSF opening pressure assessment. Our primary objective was to investigate different needle types on correctly assessing CSF opening pressure. We compared typical clinically utilised traumatic (0.9 mm outer diameter) and atraumatic (0.7 mm; 0.45 mm) spinal needles with regards to the assessment of the opening pressure in an experimental spinal puncture model testing experimental and cerebrospinal fluids in predefined pressures. Our goal was to measure the time until indicated pressure levels were correctly shown. Atraumatic needles of at least 0.7 mm diameter had a similar accuracy as traumatic needles without significant differences in time-to-equilibrium. These results were independent of protein and glucose concentration and the presence of haemoglobin. This study demonstrates that atraumatic needles can be used to accurately measure CSF opening pressure. This knowledge might guide clinicians in their choice of needle and help to reduce post-puncture headaches and re-hospitalisation.

Intratympanic Substance Distribution After Injection of Liquid and Thermosensitive Drug Carriers: An Endoscopic Study.

In the treatment of inner ear conditions, intratympanic injection emerges as an important drug delivery method. Novel compounds designed for intratympanic injection are routinely loaded in viscous drug carriers. To date, it is unclear if they can freely distribute in the middle ear. The aims of this study were to investigate the middle ear distribution of different drug carriers during intratympanic injection and to determine an optimal injection method for thermosensitive hydrogels. Twenty-one human temporal bones were intratympanically injected with fluid drug carriers or poloxamer-407 hydrogels at different tympanic membrane injection sites (inferior, anterior-superior) using different needle types (Whitacre, Quincke). Fluid distribution was evaluated via an endoscopic view. Injection volume, duration, backflow, and overall safety were analyzed. Liquid drug carriers distribute effortlessly in the middle ear, whereas an additional ventilation hole is advantageous when applying thermosensitive hydrogels. The round window is coated with required volumes between 150 and 200 μl, irrespective of the injection position. Required volumes to also coat the stapedial footplate ranged from 310 to 440 μl. Use of the Whitacre-type needle reduced backflow to the ear canal and enabled longer tympanic membrane visibility when no additional ventilation hole was placed. Intratympanic injection is a safe and reliable method for the application of thermosensitive hydrogels. The round window niche is readily filled regardless of the injected formulation and injection position. Although fluid drug carriers distribute effortlessly in the middle ear, the placement of an additional ventilation hole might facilitate the application of viscous hydrogels.

Actual pressure generated by various suction technique and suctioning liquid weight through endoscopic ultrasound-guided aspiration needles.

Suction pressure is one of the most important factors influencing the amount of tissue obtained during endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB). In this study we aimed to elucidate actual suction pressure generated by various suction methods and the weight of suctioning liquid. Different types of fine needles and suction techniques were used, including the slow pull technique (SPT), dry suction technique (DST), wet suction technique (WST), neutralizing negative pressure technique (NNPT), and residual negative pressure technique (RNPT). Actual suction pressure was measured and the amount of suctioning liquid was weighed. Actual suction pressure and weight of the suctioning liquid were lower using SPT than using DST, while they were higher when using WST compared with those using DST. In general, the actual suction pressure increased and the weight of suctioning liquid decreased as the diameter of the FNA needles decreased. While weight of the suctioning liquid using FNB needles was significantly larger than that using FNA needles. In general, the actual suction pressure generated using RNPT was larger than that using NNPT. WST is superior to SPT and DST in terms of actual suction pressure and weight of suctioning liquid. Diameter of the FNA needle was an important factor that may affect the actual suction pressure and weight of suctioning liquid. FNB needles are superior to FNA needles when it comes to the weight of suctioning liquid. Actual suction pressure obtained by novel suction methods (NNPT and RNPT) may provide a basis for future research.

Microstructure and tensile properties of bulk AISI D2 tool steel fabricated by direct energy deposition

This study investigated the microstructure and tensile properties of AISI D2 tool steel manufactured by direct energy deposition (DED). The effect of standard post-heat treatment on the mechanical properties and deformation behavior of DED AISI D2 was also examined. The as-built AISI D2 manufactured through the DED process showed the eutectic structure in the interdendrite area in addition to dendrites about 4–5 μm wide. After heat treatment, the carbides in eutectic lamellar structure were transformed into the network and needle type secondary carbides. The DED-built material was interestingly composed of austenite, which transformed into martensite after heat treatment. Hardness value for DED-built material was 486.2 ± 10.6 HV, while for heat-treated material the value was 720.1 ± 10.0 HV. Furthermore, post heat treatment led to tremendous increases in yield strength (784 ± 7.7 MPa to 1480 ± 43.0 MPa) and tensile strength (1054 ± 2 MPa to 1794 ± 69.0 MPa). The hardness value, yield and tensile strengths for DED-built AISI D2 were similar to those of heat-treated conventional wrought AISI D2. In addition, brittle fractures were observed in the tensile fracture surfaces regardless of whether heat treatment was applied. In particular, tensile deformed specimen before heat treatment showed deformation-induced martensite transformation in the areas close to the eutectic structures, while after heat treatment interdendritic cracking as well as transdendritic cracking within the matrix were mainly detected. Based on the above results, the deformation behavior and fracture mechanism of AISI D2 manufactured by direct energy deposition were also discussed.

Characterization and single track analysis of a metal-ceramic composite laser cladding over Ti6Al4V alloy

The present experimental investigation is dealt with the formation of composite cladding on Ti6Al4V alloy using laser melting and deposition (LMD) technique. The reinforcement consisting of ilmenite (Fe-TiO3), CeO2, La2O3, cubic boron nitride (cBN) and Ti6Al4V in different compositions ratio are considered as cladding materials to fabricate a dense composite clad surface. Single tracks are formed using 15.92 × 104 w/cm2 laser power density and three different laser scanning speeds of 200,400 and 600 mm/min to analyze the clad height, aspect ratio, dilution rate and average contact angle of the track. Further, area clads are fabricated for different powder compositions of the cladding materials. The clad layer thickness are found to be decreases with increase in laser scanning speed and rise in the percentage of ilmenite (Fe-TiO3). The formation of different microstructure in the clad as well as interface zone are observed. With the increase in the percentage composition of ilmenite with cerium and lanthanum leads to the refined and coarser grain microstructure with unique structure are found which enhance mechanical properties like wear and hardness of the clad. Some of the important microstructure like dendritic, lamellar, flower, grit type and long needle type are found on the clad surface. The formation of unique chemical compound such as Ti3O, La2O3, Ti2B5, LaTi21O38, Ce3B2N4, Fe4N, TiN, La3BO6, and Fe-TiO3 are observed through the XRD analysis. Micro hardness of the clad surface are found to be increases approximately five times to the substrate at the clad with the increase in percentage composition of RE element, but found to be decrease drastically as passing through the intersection zone due to intermixing phenomena of clad and the substrate. It is observed that with higher percentage composition of RE result decrease in the reduction of the coefficient of friction approximately thrice to that of the cladded sample as compare to base (Ti6Al4V), which improve the wear resistance of the clad material. However there are minor amount of defects like micro crack are found on the clad and wear at the disk are occurred due to ploughing and cutting observed through track analysis.

Does follicular flushing increase oocyte number in poor responders? An update of a systematic review

Research questionDoes flushing of the follicles at ovum retrieval increase the number of retrieved oocytes in poor-response IVF patients? DesignAn update of an electronic literature search was performed to identify randomized controlled trials (RCT) investigating follicular flushing versus no flushing in women with a poor response to IVF treatment. No exclusion criteria for type of needle, stimulation or protocol were applied. A meta-analysis was conducted using the software RevMan 5.4. ResultsSix RCT were identified that had the primary objective of testing for an increase in mean number of cumulus–oocyte complexes or/and metaphase II oocytes between flushing and no flushing. A double-lumen needle was used in five trials, one study investigated a pseudo-double-lumen needle, and a conventional single-lumen needle was used in all the control groups. The main risk of bias in all the included studies is a lack of blinding of the physicians performing the puncture and incomplete data in four trials. A heterogeneity of direction and size of effect of follicular flushing on mean oocyte number retrieved was detected (I2 = 80, P = 0.0001), which precludes a synthesis of the data. Two studies showed a decrease or tendency towards a decrease in oocyte numbers, one study showed similar oocyte numbers, and one study showed a strong tendency towards increased oocyte numbers with flushing. A similar picture was seen for metaphase II oocytes (I2 = 73, P = 0.002). ConclusionsIt is uncertain whether follicular flushing in poor-response IVF patients affects the number of retrieved oocytes. Larger pragmatic trials are warranted to clarify the effect of flushing on oocyte numbers and clinical outcomes in poor responders and monofollicular patients.

Preconditions that facilitate cannulation in arteriovenous fistula: A mixed-methods study.

Nurses have a great responsibility in the daily care of arteriovenous fistulae, which entails the potential to affect patency. However, good cannulation technique involves more than placing a needle in the vessel and relies on different skills to facilitate needling. To describe the preconditions for cannulation in arteriovenous fistulas. Descriptive statistics and qualitative content analysis were used in a mixed-methods design. Haemodialysis units in Sweden. Local guidelines regarding arteriovenous fistula cannulation were analysed in parallel with responses to a questionnaire that contained open-ended and closed-ended questions on cannulation technique. Preconditions that facilitate cannulation fall into five stages, each with relevant factors in relation to the cannulation, as follows: planning cannulation-maturation and planning the cannulation, patient record, education and experience, and patient information; precannulation-physical examination, hygiene routines, arm position, tourniquet, choosing the cannulation site, and preventing pain; during cannulation-how to needle, type of needle, angle during cannulation, fixation, and adjusting; evaluating cannulation-blood flow rate and arterial and venous pressure; and postcannulation-needle withdrawal and haemostasis. The majority of dialysis units identified implementation of most of these preconditions, but the units handle several practical aspects differently. Tracing the chain of cannulation led to identification of necessary preconditions for facilitating good cannulation technique. The findings also show the need for a better understanding of how different preconditions affect arteriovenous fistula and patency.

Software Packages and Tools for the Analysis of Continuous Glucose Monitoring Data.

The advancement of technology in the field of glycemic control has led to the widespread use of continuous glucose monitoring (CGM), which can be nowadays obtained from wearable devices equipped with a minimally invasive sensor, that is, transcutaneous needle type or implantable, and a transmitter that sends information to a receiver or smart device for data storage and display. This work aims to review the currently available software packages and tools for the analysis of CGM data. Based on the purposes of this work, 12 software packages have been identified from the literature, published until December 2021, namely: GlyCulator, EasyGV (Easy Glycemic Variability), CGM-GUIDE© (Continuous Glucose Monitoring Graphical User Interface for Diabetes Evaluation), GVAP (Glycemic Variability Analyzer Program), Tidepool, CGManalyzer, cgmanalysis, GLU, CGMStatsAnalyser, iglu, rGV, and cgmquantify. Comparison of available software packages and tools has been done in terms of main characteristics (i.e., publication year, presence of a graphical user interface, availability, open-source code, number of citations, programming language, supported devices, supported data format and organization of the data structure, documentation, presence of a toy example, video tutorial, data upload and download, measurement-units conversion), preprocessing procedures, data display options, and computed metrics; also, each of the computed metrics has been analyzed in terms of its adherence to the American Diabetes Association (ADA) 2017 international consensus on CGM data analysis and the ADA 2019 international consensus on time in range. Eventually, the agreement between metrics computed by different software and tools has been investigated. Based on such comparison, usability and complexity of data management, as well as the possibility to perform customized or patients-group analyses, have been discussed by highlighting limitations and strengths, also in relation to possible different user categories (i.e., patients, clinicians, researchers). The information provided could be useful to researchers interested in working in the diabetic research field as to clinicians and endocrinologists who need tools capable of handling CGM data effectively.

Protocol for double-blind RCT of acupuncture for vulvodynia

BackgroundVulvodynia, vulvar pain of unknown origin lasting at least 3 months, affects 7% of American women. Dyspareunia, its frequent companion, renders sexual intercourse virtually impossible. Although few therapies are efficacious and rapid pain relief is rarely possible, there have been no sham/placebo-controlled studies of acupuncture for vulvodynia. Aims are to: 1) determine efficacy of acupuncture for vulvodynia, 2) explore duration of the acupuncture effect. MethodsIn a pretest/posttest randomized controlled, double-blind (practitioner-patient) efficacy trial of a standardized acupuncture protocol, we will randomize 80 participants 1:1 to either penetrating needle or skin-touch placebo needle groups. Both types of needles are designed to blind both the acupuncturist and participant. Participants with vulvodynia will insert and remove a tampon as a standardized stimulus and complete primary measures of vulvar pain (pain intensity) and secondary measures of dyspareunia (Female Sexual Function Index, FSFI dyspareunia subscale score) and sexual function (FSFI total score) pretreatment, after the 10th acupuncture session, and pain measures weekly until return to pretest levels. Upon study completion control group participants will be offered 10 free real acupuncture sessions. DiscussionThis is the first multi-needle multi-session RCT using double-blind acupuncture needles as a reliable sham. We hypothesize that controlling for baseline, at posttest there will be statistically significant less vulvar pain and dyspareunia and more sexual function over five weeks in the penetrating needle group compared to the skin touch placebo group. ConclusionThis study is responsive to the need for efficacious pain management for women with vulvodynia.ClinicalTrials.gov Identifier: NCT03364127.

PHSPP06 Presentation Time: 3:20 PM: A New Way to Visualize Needles for Ultrasound Prostate Brachytherapy Using Color Doppler and Needle Surface Modifications

<h3>Purpose</h3> Brachytherapy applicator conspicuity during ultrasound (US) imaging can be impaired by bowel gas, tissue interfaces, or when the applicator is far or angled with respect to the ultrasound probe. Without adequate conspicuity, applicators can be inaccurately reconstructed, leading to decreased tumor control or increased normal tissue dose due to a geometrically inaccurate treatment plan. To improve the conspicuity of titanium high-dose rate (HDR) brachytherapy needles under US imaging, the surface of needles can be modified, and color-Doppler can be utilized to highlight the surface patterns. Color-Doppler imaging can produce a twinkling signature, also referred to as a ‘twinkling artifact,' when ultrasound waves reflect from a surface with a rough or patterned structure. The twinkling signature highlights the modified applicator as variegated pixels atop a grayscale B-mode US image, enhancing conspicuity. This research was a preliminary investigation into the types of surface modifications that can produce a twinkling signature, based upon a review of prior literature that has associated surface roughness with twinkling. <h3>Materials and Methods</h3> The surfaces of 17-gauge, 25 cm titanium HDR brachytherapy needles were modified using three methods of surface modification: sandblasting with an 80-grit media, laser-etching of thin grooves, and application of a polymethyl methacrylate (PMMA)-based bone cement. Laser-etches were created on the surface of the needles using a 343 nm femtosecond laser (Pharos, Light Conversion, Lithuania) on a machining system (Photomachining Inc., USA) and were created at variable widths (0.1-1 mm) and depths (10-100 μm) without penetrating the inner lumen of the applicator. Unmodified and modified needles were imaged with a bk3000 (BK Medical, USA) with an E14CL4b transrectal probe and Logiq E9 (General Electric, USA) with a 9L linear-array transducer under B-mode and color-Doppler imaging. Needle conspicuity between needle types was assessed qualitatively in the axial and sagittal planes within a prostate phantom (CIRS, Inc., USA). <h3>Results</h3> Color-Doppler imaging in combination with surface-modified needles produced a twinkling signature with select laser-etched and PMMA-cement surface modifications. The twinkling signature appeared as a color signal atop the applicator, overlaid on grayscale B-mode ultrasound images. The twinkling signature was observed with both transrectal and linear-array ultrasound transducers. Twinkling was observed at laser-etched scribe depths >20 μm and widths >0.1 mm, and it was observed that the magnitude of the twinkling signature was dependent upon the total surface area of the etched region. It was also demonstrated that needles can be laser-etched or coated with PMMA-cement to mark a reference location with respect to the needle tip (2 cm distal). The hand-roughened needles produced a faint twinkling signature with the linear-array transducer and negligible twinkling with the transrectal transducer. Sandblasted and unmodified needles produced a negligible twinkling signature. Generally, the twinkling signature was observed to be transient in nature and dependent on the pressure between the probe and the phantom. Future work is planned to study the mechanisms underlying the color-Doppler signal and to establish an optimal surface modification and signal strength. <h3>Conclusions</h3> Color-Doppler ultrasound combined with brachytherapy applicator surface modifications may be used to enhance applicator conspicuity and aid with applicator placement and digitization. HDR brachytherapy needles may be modified for color-Doppler imaging via laser-etching or coating with a PMMA-based bone cement.

Comparison of the effectiveness of anchoring needles and coils in localizing multiple nodules in the lung

BackgroundRecently, a new type of pulmonary nodule positioning needle has been adopted clinically. We aimed to evaluate the efficacy and safety of a new type of localization needles compared with coils for the simultaneous localization of multiple pulmonary nodules guided by computed tomography (CT) prior to video-assisted thoracoscopic surgery (VATS).Materials and methodsFrom January 2021 to March 2022, 87 pulmonary nodules from 40 patients were localized using the new localization needle. From January 2020 to December 2020, 68 pulmonary nodules in 31 patients were localized using coils. The relative outcomes were compared.ResultsThe success rate of pulmonary nodule localization in the needle group was 97.7% while that in the coil group was 98.5%. In the needle group, the time needed to locate the first nodule was significantly shorter than in the coil group (10.9 min vs. 17.2 min, P = 0.001). Moreover, the time needed per patient was also significantly shorter for the needle group compared with the coil group (23.7 min vs. 30 min, P = 0.017). The incidence of pneumothorax in the needle group was 25.0% vs. 12.9% in the coil group (P = 0.204). The rate of pulmonary hemorrhage in the needle group was 40.0% vs. 32.3% in the coil group (P = 0.502). The success rate of VATS wedge resection was 100% in both groups.ConclusionBoth disposable pulmonary nodule localization needles and coils are safe and effective for CT-guided localization of multiple pulmonary nodules of the same stage prior to VATS. However, the use of needles is time-saving compared with the use of coils. The coil localization may exhibit better safety than needle localization.

Some complications of the radiofrequency ablation method in patients with non-small cell lung cancer at Nghe An Oncology Hospital

Background/Purpose: To describe some complications of the radiofrequency ablation method in patients with non-small cell lung cancer at Nghe An Oncology Hospital.&#x0D; Methods: The non-controlled clinical intervention study, compared the results before and after on 43 non-small cell lung cancer patients at Nghe An Oncology Hospital.&#x0D; Results: 16 complications occurred, accounting for 37.2%. Complications after radiofrequency ablation include hemoptysis, pneumothorax, pneumothorax that must be drained, hemothorax, and pneumonia. The rate of complications in pneumothorax was the highest at 25.6, lower was hemoptysis at 11.6%, followed by post-procedural pneumonia at 4.7% in 1st and 14.3% in 2nd, the remaining complications accounted for a small rate.&#x0D; Conclusion: No statistically significant differences were found in age, sex, RFA frequency, RFA duration, and needle type used with complications after RFA.