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Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (−0.3 versus −0.6, p < 0.001) and median sodium drop (−0.3 versus −0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique. [ABSTRACT FROM AUTHOR]

We retrospectively examined the initial experience and learning curve after the introduction of thrombectomy with the combined technique using an aspiration catheter and a stent retriever as first-line attempt for acute ischemic stroke. Consecutive patients undergoing thrombectomy for acute ischemic stroke at our institution between January 2020 and December 2022 were divided into 3 groups according to the year of thrombectomy. Patient characteristics and procedural, safety, and clinical outcomes were compared between the three year periods to determine predictors of favorable clinical outcome. In 2020, 2021, and 2022, the numbers of patients were 74, 70, and 90, respectively, with similar patient characteristics across the three years; successful recanalization rates were 79.7%, 97.1%, and 93.3%, respectively (P < 0.01 for the first 2 years); median procedure times were 67, 43, and 32 minutes, respectively (P < 0.01 for the first 2 years and P = 0.018 for the last 2 years); first pass effect rates were 20.3%, 41.4%, and 44.4%, respectively (P < 0.01 for the first 2 years); symptomatic intracranial hemorrhage rates were 14.9%, 2.9%, and 1.1%, respectively (P = 0.018 for the first 2 years); and percentages of modified Rankin Scale score 0–2 at 90 days were 24.3%, 42.9%, and 41.1%, respectively (P = 0.022 for the first 2 years). Procedure time (P = 0.038) and successful recanalization (P = 0.041) were independent predictors of favorable clinical outcome. The learning curve effect of the combined technique may be associated with better clinical outcome due to increased successful recanalization rates, shortened procedure time, and reduced symptomatic intracranial hemorrhage. [ABSTRACT FROM AUTHOR]

This extensive review explores the intricacies of the three principal mechanical thrombectomy techniques: the stent retriever technique, contact aspiration technique, and a combined approach, and their application in managing acute ischemic stroke. Each technique operates uniquely on the thrombus, leading to differences in their efficacy. Factors including clot size, clot stiffness, vessel tortuosity, and the angle of interaction between the aspiration catheter and the clot significantly influence these differences. Clinical trials and meta-analyses have shown the overall equivalency of these techniques for the treatments of large vessel occlusion and distal medium vessel occlusions. However, there are nuanced differences that emerge under specific clinical circumstances, highlighting the absence of a one-size-fits-all strategy in acute ischemic stroke management. We emphasize the need for future investigations to elucidate these nuances further, aiming to refine procedural strategies and individualize patient care for optimal outcomes.

Purpose: The study aimed to evaluate preliminary clinical and radiographic results of patients with Cierny-Mader type IV chronic femoral osteomyelitis and augmented with a non-vascularized fibular autograft as a salvage procedure because of the poorly regenerated new bone after bone transport over an intramedullary nail (BTON). Methods: Patients diagnosed with CM type IV chronic femoral bone infection and treated with BTON procedure between 2003 and 2020 were retrospectively reviewed. Seven patients were included in the study whose distraction gap was poorly regenerated and then augmented with a non-vascularized fibular autograft. A three-stage treatment was administered. First, the infection was eradicated. Second, BTON was performed. Third, the poorly regenerated distraction gap was augmented with a fibular autograft before removing the external fixator (EF). Clinical and radiological results were evaluated based on the criteria described by Paley-Maar and Li classification. Results: The mean patient age was 52 years. The mean treatment time was 24.8 months, with a mean femoral lengthening of 12.6 cm. The mean EF and bone healing indexes were 0.57 months/cm and 0.8 months/cm, respectively. The mean length of the fibular graft was 13 cm. The bone healing of new bones was achieved in all patients with good quality after grafting. Functional scores were excellent in four patients. No patients experienced any sequelae. Conclusions: Non-vascularized fibular autograft augmentation may be an effective salvage procedure for poorly regenerated new bone after BTON to manage chronic femoral bone infection. [ABSTRACT FROM AUTHOR]

Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (−0.3 versus −0.6, p < 0.001) and median sodium drop (−0.3 versus −0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.

Objective Thrombectomy may provide superior results compared to best medical care for acute posterior circulation strokes (PCS). Contact aspiration (CA), stent retriever (SR), and combined SR+CA (SRA) are commonly employed as first-line techniques. However, the optimal strategy and the role of SRA remain uncertain. Methods Systematic searching was conducted in three databases (PubMed, Embase, and Cochrane). Network meta-analyzes were performed using random-effects models. The reperfusion and clinical outcomes were compared. Pooled outcomes were presented as odds ratios (OR) with 95% confidence intervals (CI). Rankograms with surface under the cumulative ranking curve (SUCRA) were calculated. Results Seventeen studies were included, involving a total of 645 patients who received first-line CA, 850 patients who received SR, and 166 patients who received SRA. Regarding final recanalization outcomes, both first-line SRA (OR = 3.2, 95%CI 1.4--11.0) and CA (OR = 2.1, 95%CI 1.3--3.7) demonstrated superiority over SR in achieving successful reperfusion [modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3], with values of SUCRA 91.1, 58.5, and 0.4%, respectively. In addition, first-line SRA showed an advantage in achieving final mTICI 2c/3 compared to CA (OR = 3.6, 95%CI 0.99--16.0) and SR (OR = 6.4, 95%CI 1.3--35.0), with SUCRA value of 98.0, 44.7, and 7.2%, respectively. Regarding reperfusion outcome after the first pass, SRA also achieved a higher rate of mTICI 3 than SR (OR = 4.1, 95%CI 1.3--14.0), while CA did not (SUCRA 97.4, 4.6, 48.0%). In terms of safety outcomes, first-line CA was associated with a lower incidence of symptomatic intracranial hemorrhage (sICH) compared to SR (OR = 0.38, 95%CI 0.1--1.0), whereas the SRA technique did not (SUCRA 15.6, 78.6, 55.9%). Regarding clinical prognosis, first-line CA achieved a higher proportion of functional independence (modified Rankin Scale (mRS) 0--2) at 90 days than SR (OR = 1.4, 95%CI 1.1--1.9), whereas SRA did not (SUCRA 90.5, 17.4, 42.1%). Conclusion For acute PCS, a first-line CA strategy yielded better results in terms of final successful reperfusion and 90-day functional independence compared to SR. As the combined technique, first-line SRA was associated with superior first-pass and final reperfusion outcomes compared to SR. However, no significant difference was observed in functional independence achieved by first-line SRA compared to the other two strategies. Further high-quality studies are warranted. [ABSTRACT FROM AUTHOR]

This extensive review explores the intricacies of the three principal mechanical thrombectomy techniques: the stent retriever technique, contact aspiration technique, and a combined approach, and their application in managing acute ischemic stroke. Each technique operates uniquely on the thrombus, leading to differences in their efficacy. Factors including clot size, clot stiffness, vessel tortuosity, and the angle of interaction between the aspiration catheter and the clot significantly influence these differences. Clinical trials and meta-analyses have shown the overall equivalency of these techniques for the treatments of large vessel occlusion and distal medium vessel occlusions. However, there are nuanced differences that emerge under specific clinical circumstances, highlighting the absence of a one-size-fits-all strategy in acute ischemic stroke management. We emphasize the need for future investigations to elucidate these nuances further, aiming to refine procedural strategies and individualize patient care for optimal outcomes. [ABSTRACT FROM AUTHOR]

Pelvic exenteration (PE) is an aggressive surgical procedure that implies a large hard-to-fill pelvic defect. Different reconstruction techniques were proposed to improve abdominal organ support and reduce complications (infections, pelvic organs herniation, vaginal stump dehiscence, bowel prolapse and obstruction) [ 1 ], with conflicting results [ 2 ]. Because of young age and survival greater than 50% at 5 years in patients with no residual tumor after surgery [ 3 ], a new approach with better clinical results to pelvic reconstruction is needed. The aim of this surgical film is to present an unusual presentation of vaginal sarcoma, successfully managed with a minimally invasive approach, and to illustrate our contextual multilayer technique of pelvic reconstruction using a combination of pedicled omental flap (POF) and human acellular dermal matrix (HADM). Tertiary level academic hospital. A 42-year-old obese patient with recurrent and symptomatic myxoid leiomyosarcoma, previously underwent vaginal-assisted laparoscopic surgery at a primary care center for the removal of a vaginal swelling. The multidisciplinary board determined anterior PE as the optimal therapeutic approach. Given the patient's body mass index (33 kg/m2), young age, and the favorable outcomes of robotic surgery in obese patients compared with other approaches [ 3 , 4 ], we proposed a combined robotic and vaginal surgery for both exenteration and reconstructive procedures [ 5 ]. During surgery, we initially explored the abdominal cavity to exclude macroscopic metastasis, followed by anterior PE. Urinary diversion was achieved with a Bricker ileal conduit by means of an ileoileal laterolateral anastomosis and an uretero-ileo-cutaneostomy. The pelvic dead space was partially filled with a POF on the left gastroepiploic artery. Subsequently, the pelvic defect was covered by a 15 × 10 mm HADM inlay inserted circumferentially at the pelvic brim, fixed with a barbed thread suture on residual pelvic structures. The final pathology confirmed the recurrence of myxoid leiomyosarcoma and indicated tumor-free resection margins. The intraoperative and postoperative periods were uneventful. The patient was discharged 14 days after surgery and underwent adjuvant doxorubicin- and dacarbazine-based chemotherapy, which was initiated 45 days after the surgery. Currently the patient is asymptomatic and disease free at the sixth month of follow-up. Robotic PE proves to be a feasible technique in obese patients, reducing postoperative hospital stay and complications. The contextual pelvic floor reconstruction with a POF and HADM supports abdominal viscera, diminishing interorgan adhesions and bowel prolapse. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify factors related to the incidence of post-thrombectomy subarachnoid hemorrhage (PTSAH). Methods: This retrospective, observational cohort study enrolled consecutive patients with acute ischemic stroke (AIS) due to the internal carotid artery (IC) top or middle cerebral artery (MCA) M1 or M2 segment occlusion who underwent single-pass stent retriever (SR) treatment between January 2015 and May 2022 at two acute care hospitals. Results: Of the 54 included patients, 10 were in the PTSAH group (18.5%). The occlusion sites were IC top (31.5%), M1 segment (48.1%), and M2 segment (20.4%). Aspiration catheters (ACs) were used in 32 (59.3%) patients; however, the combined technique (AC advancement at least to the most proximal marker of SR) was actually used in 26 (48.1%) patients because a ledge effect at the ophthalmic artery origin from the IC interfered with distal navigation of the ACs. The baseline patient characteristics did not differ between the groups. M2 segment occlusion in the PTSAH and non-PTSAH groups were 40.0% and 15.9%, respectively (p = 0.19). More ACs were used in the non-PTSAH group (65.9% vs. 30.0%, p = 0.07). Significantly fewer combined techniques were performed in the PTSAH group (10.0% vs. 56.8%, p = 0.01). In multivariate analysis adjusted by variables with M2 segment occlusion and the combined technique, the combined technique (odds ratio 0.098; 95% confidence interval, 0.011–0.887; p = 0.039) was identified as a significantly associated factor for PTSAH. There was one PTSAH case (1.9%) with symptom worsening. Conclusion: The combined technique significantly influenced PTSAH occurrence as a preventive factor. [ABSTRACT FROM AUTHOR]

Transradial mechanical thrombectomy (MT) is increasingly used because it is associated with a low incidence of vascular access site complications. However, transradial carotid cannulation can be technically challenging to perform in patients with an unfavorable supra-aortic takeoff. In this study, the feasibility and safety of a new transradial MT system with a radial-specific neurointerventional guiding sheath—6F Simmons guiding sheath was evaluated—in patients with anterior circulation large-vessel occlusions. Additionally, a literature review was performed. We retrospectively analyzed data from our institutional database about consecutive patients who underwent transradial MT for anterior circulation large-vessel occlusion. After the 6F Simmons guiding sheath was engaged into the target common carotid artery, a triaxial system (Simmons guiding sheath/aspiration catheter/microcatheter), was established. MT using the continuous aspiration prior to intracranial vascular embolectomy technique was performed. Then, procedural success rate, successful revascularization, and procedure-related complications were assessed. A total of 13 patients who had transradial MT were included in the analysis. All 13 patients underwent successful thrombectomy without catheter kinking or system instability, and 12 of them achieved successful revascularization (modified Thrombolysis in Cerebral Infarction score of ≥2b). No complications occurred. To the best of our knowledge, this is the first case series on transradial MT using a radial-specific neurointerventional system for anterior circulation large-vessel occlusions. This method may increase the success rate of transradial MT. Based on our initial experience, transradial MT, using this system, was feasible and safe for anterior circulation large-vessel occlusions. [ABSTRACT FROM AUTHOR]

Cerebral venous thrombosis (CVT) is a rare cause of stroke, and the first-line treatment is systemic anticoagulation. Patients unresponsive to standard therapy for CVT present with rapid neurological deterioration and require endovascular treatment. We encountered two patients with severe CVT who underwent endovascular treatment. In our cases, the thrombus was too hard and extensive to pass through using currently existing techniques. We performed the “digging through thrombus technique” using an aspiration catheter and stent retriever and achieved rapid sinus recanalization and favorable outcomes.

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal–Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment. [ABSTRACT FROM AUTHOR]

Synchrotron radiation based combined technique can provide multiple structural information simultaneously, which is an important development direction of structural detection. In this study, a novel small-angle X-ray scattering/X-ray diffraction/X-ray absorption fine structure (SAXS/XRD/XAFS) combined setup was constructed, where an area detector, a curved detector, and a point detector are, respectively, used for the measurements of SAXS, XRD, and XAFS signals. A detailed description about the combined setup was given. A minitype diamond detector coupled to a SAXS beamstop was used to record the transmitted X-ray intensity, making the scattering (SAXS and XRD) signal measurement compatible with the absorption (XAFS) signal measurement, avoiding mechanical switching. The two-way sampling strategy was used to acquire XAFS signals, shortening the non-counting time. The two-way and one-way sampling strategies were discussed. High-frequency sampling scheme was used to collect experimental signals, improving the measurement efficiency and signal-to-noise ratio. A detailed description and discussion about the high-frequency scheme were also given in this paper. Except the rotation of monochromator, there is no mechanical movement in measurements, time resolution may reach the level of seconds. Using this SAXS/XRD/XAFS combined setup, SAXS, XRD, and XAFS signals can be acquired simultaneously. With some in-situ sample environment system, the newly-developed combined technique can be used to track the structure evolution in complex fluids. During the formation processes of (BiO)2CO3 and ZnAPO-34 particles, the changes of in-situ experimental data with reaction time demonstrate that SAXS/XRD/XAFS combined technique is feasible to track the dynamic process. [ABSTRACT FROM AUTHOR]

In this study, a combined strengthening technique is used to improve the flexural performance of prestressed concrete beams using CFRP sheets as EBR and prestressed steel strands as NSM. Seven prestressed beams were tested under four-point loading with one control specimen, one EBR CFRP sheet strengthened specimen, one NSM steel strand without prestress strengthened specimen and four specimens strengthened with a combination of EBR CFRP sheet and NSM steel strands prestressed from 0% to 70% of their tensile strength. The flexural responses and failure modes of the specimens were investigated and the variations due to the level of prestressing force in the PNSM steel strands were also assessed. A finite element model (FEM) was developed using ABAQUS to verify the flexural responses of the strengthened specimens. The test results revealed that the combined strengthening technique remarkably enhanced the flexural performance of the specimens. The serviceability, first crack, yield, and ultimate load capacities improved up to 44%, 49%, 55% and 70%, respectively when compared with the control specimen. The combined technique also ensured the flexural failure of the specimens with significant enhancement in stiffness and energy absorption. The results of the FEM model exhibited excellent agreement with the experimental results.

Introduction: Post-traumatic nonunion of the femur remains a challenging problem even for experienced orthopedic surgeons. The main question is the choice of the optimal surgical tool. Materials and methods: Management of 20 patients with nonunion of the femoral diaphysis associated with anatomical shortening was retrospectively analyzed. Group A (n = 14) was treated with a hybrid technique that combined the Ilizarov external fixation and intramedullary nailing. The Ilizarov bone transport was used in group B (n = 6). Patients of both groups had aseptic post-traumatic nonunion. Mean shortening was 4.5 ± 0.4 cm in group A and 4.8 ± 1.0 cm in group B (p = 0.459959). Results: Union was achieved in 85.7% of group A and 100% of group B patients. External fixation was repeated in two cases of group A and achieved consolidation. Deep infection developed in one case of group A after 15 months post-frame with the nail in. It was resolved by nail removal, surgical debridement and external fixation. Limb shortening was fully eliminated in eleven cases of group A and four patients of group B. The average duration of distraction was 35.3 ± 1.7 days in group A and 47.8 ± 9.3 days in group B. The total duration of external fixation was 49.1 ± 3.5 and 177.2 ± 21.9 days with an external fixation index of 13.1 ± 1.2 and 52.4 ± 6.4 days/cm, respectively. Distraction regenerate consolidated in all the cases. Conclusion: Hybrid technique provides bone union with compensation of limb shortening and reduces the treatment period as compared with the Ilizarov method used alone. However, deep infection may happen. [ABSTRACT FROM AUTHOR]

Objective To explore the value of triple mirror combination technique in patients with dilated choledocholithiasis. Methods A retrospective analysis of 81 patients with dilated common bile duct stones （common bile duct diameter 0.8cm） were admitted to the Second Affiliated Hospital of Kunming Medical University from December 2019 to October 2021.Depending on the surgical method, patients were divided into three-mirror group group A （n = 40）, sequential laparoscopic cholecystectomy LC + laparoscopic-choledotoscopy combined exploration lithotomy LCBDE + endoscopic nasal bile duct drainage ENBD + primary common biliary suture PS.Double-mirror Group B （n = 41）, sequential rows of LC + LCBDE + PS. The observation indexes included preoperative indexes （stone size, total bile duct diameter）, intraoperative indexes （bleeding amount, operation time） and postoperative indexes （near-term complication rate, residual stone rate） and statistical treatment. Results Both groups of preoperative indicators, and the intraoperative indicators had no statistically significant differences. Operation time and bleeding volume were better in group B than in group A. Postoperative residual rate had no significant difference between the two groups. In terms of recent complications, the incidence of bile leakage in group A was lower than that in group B, and the long-term complications were relatively insignificant. Conclusions Application of triple oscopy combined primary suture in patients with cholangiogenic cholelithiasis can reduce the incidence of bile leakage in the first-phase bile duct suture technique, reduce the pain of patients, improve the patient compliance, and does not increase the incidence of complications and tube wearing time. It is worthy of clinical promotion and use. [ABSTRACT FROM AUTHOR]

In this study, a combined strengthening technique is used to improve the flexural performance of prestressed concrete beams using CFRP sheets as EBR and prestressed steel strands as NSM. Seven prestressed beams were tested under four-point loading with one control specimen, one EBR CFRP sheet strengthened specimen, one NSM steel strand without prestress strengthened specimen and four specimens strengthened with a combination of EBR CFRP sheet and NSM steel strands prestressed from 0% to 70% of their tensile strength. The flexural responses and failure modes of the specimens were investigated and the variations due to the level of prestressing force in the PNSM steel strands were also assessed. A finite element model (FEM) was developed using ABAQUS to verify the flexural responses of the strengthened specimens. The test results revealed that the combined strengthening technique remarkably enhanced the flexural performance of the specimens. The serviceability, first crack, yield, and ultimate load capacities improved up to 44%, 49%, 55% and 70%, respectively when compared with the control specimen. The combined technique also ensured the flexural failure of the specimens with significant enhancement in stiffness and energy absorption. The results of the FEM model exhibited excellent agreement with the experimental results. [ABSTRACT FROM AUTHOR]

Introduction: Predictive factors for successful reperfusion in mechanical thrombectomy for acute ischemic stroke, and especially technical factors, remain controversial. We investigated various techniques for better angiographic outcomes., Methods: In this retrospective study, acute ischemic stroke patients with large vessel occlusion treated with mechanical thrombectomy with combined technique were included. Scoring of the reperfusion grade for each attempt was conducted, and each attempt was divided into two groups based on successful reperfusion, which was defined using the presence or absence of modified thrombolysis in cerebral infarction 2b-3. The following characteristics were evaluated: the choice of stent-retriever, its length, occlusion site, thrombus position relative to deployed stent-retriever, methods of thrombectomy, and successful advancement of the distal access catheter to the proximal end of the thrombus., Results: Among 251 patients who underwent mechanical thrombectomy, 154 patients (255 attempts: mTICI 0-2a group, n = 119; mTICI 2b-3 group, n = 136) were included in the analysis. The thrombus position relative to the deployed stent-retriever was likely associated with successful reperfusion, although it was not statistically significant (proximal two-thirds 56.8 %; distal one-third 44.3 %, p = 0.09). Successful advancement of the distal access catheter was related to successful reperfusion both in univariate analysis (success 57.9 %; fail 35.8 %, p < 0.01) and in multivariate regression analysis (odds ratio 2.45; 95 % confidence interval: 1.30-4.61, p < 0.01)., Conclusions: Successful advancement of the distal access catheter to the proximal end of thrombus might be a key component for successful reperfusion in mechanical thrombectomy., (Copyright © 2024 Elsevier B.V. All rights reserved.)

3D printing and electrospinning are versatile techniques employed to produce 3D structures, such as scaffolds and ultrathin fibers, facilitating the creation of a cellular microenvironment in vitro. These two approaches operate on distinct working principles and utilize different polymeric materials to generate the desired structure. This review provides an extensive overview of these techniques and their potential roles in biomedical applications. Despite their potential role in fabricating complex structures, each technique has its own limitations. Electrospun fibers may have ambiguous geometry, while 3D-printed constructs may exhibit poor resolution with limited mechanical complexity. Consequently, the integration of electrospinning and 3D-printing methods may be explored to maximize the benefits and overcome the individual limitations of these techniques. This review highlights recent advancements in combined techniques for generating structures with controlled porosities on the micro-nano scale, leading to improved mechanical structural integrity. Collectively, these techniques also allow the fabrication of nature-inspired structures, contributing to a paradigm shift in research and technology. Finally, the review concludes by examining the advantages, disadvantages, and future outlooks of existing technologies in addressing challenges and exploring potential opportunities., (© 2024 Wiley‐VCH GmbH.)

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal–Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

An experimental examination was conducted to consider the impact of convective heat transfer and airflow characteristics through an impingement jet solar heat collector (SHC) with indented dimple roughness geometry on the absorber plate. The experimental results included the arc angle (α d) from 30° to 75°, the relative indented roughness pitch (p/D h) from 0.269 to 0.810, the relative indented roughness height (e/D h) from 0.016 to 0.0267. The comprehensive performance of SHC was adequately assessed by fluctuating the Reynolds number (Re) from 3000 to 21000. The Nusselt number (Nu ct) increases with the increase in Re , as predicted. It is observed that the value of Nu ct is a vigorous function of α d. However, the values of Nu ct for the indented dimples on the absorber plate are significantly higher than the values for the smooth absorber plate. The maximum value of the combined friction factor (ff ct) takes place at an e/Dh of 0.0267, while the minimum value is at 0.016. The experimental outcomes confirm that the maximum thermohydraulic performance (η ct) enhancement value of 2.15 was obtained at α d = 60°, p/D h = 0.269, and e/D h = 0.0267 compared to conventional SHC. These experimental values were used to generate the correlations for the Nu ct and friction factor ff ct as a function of the indented dimpled roughness parameters. • Investigate the effect of indented dimples absorber plate on SHC with jet impingement. • Provide thermohydraulic performance for jet impingement SHC duct with indented dimples. • Obtain thermohydraulic performance of 2.15 at α d = 60°, p/D h = 0.269, and e/D h = 0.0267. • Correlations were developed for Nusselt number and friction factor as a function of geometrical parameters. [ABSTRACT FROM AUTHOR]

Natural gas hydrate (NGH) is a source of energy that has attracted significant interest for the secure and effective extraction of CH 4 gas from permafrost and marine regions. CH 4 gas can be produced and greenhouse gases (GHG) sequestrated by injecting flue gas into NGH, minimizing environmental threats. This paper provides a complete summary of the advancement of CH 4 recovery from NGH by CO 2 replacement. The CH 4 –CO 2 exchange mechanisms are examined in different types of hydrates concerning their cage structure and formation in geological layers. The gas composition of CO 2 injected with H 2 , N 2 , and air, thermodynamic pressure and temperature, hydrate and water saturations, and concentration of CO 2 are factors influencing the efficiency of the CH 4 –CO 2 exchange. The structural integrity of the sedimentary film throughout the exchange process is evaluated, and the evaluation indicates that the hydrate formed by CO 2 gas is stronger than the layer formed by CH 4 gas and that the mechanical integrity of the reservoirs can be maintained after the exchange process. The replacement effect of CH 4 –CO 2 combined with depressurization, thermal stimulation, and other factors is discussed. Restrictions and further studies of the CH 4 –CO 2 exchange process are also analyzed in light of current findings. This article offers information for future NGH extraction and CO 2 storage applications by providing an overview of recent advances in CH 4 –CO 2 replacement. • Mechanism of CH 4 –CO 2 replacement comprises CH 4 extraction and CO 2 sequestration. • Using different compositions of N 2 and H 2 gases with CO 2 enhances CH 4 –CO 2 exchange. • Combination of thermal stimulation with CO 2 exchange improves CH 4 recovery rate. • Mechanical properties of CH 4 –CO 2 hydrates maintain the mechanical integrity of rock. [ABSTRACT FROM AUTHOR]

Objectives: For patients with acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best technique for the first attempt at mechanical thrombectomy remains a matter of debate. In this study, we evaluated the efficacy of a modified version of a stent-retrieving into an aspiration catheter with a proximal balloon (ASAP) technique. Materials and Methods: Modification 1: After stent deployment, the microcatheter was not removed immediately. Modification 2: After the withdrawal of the stent retriever into an aspirator and its removal from the entire system, we focused on the drainage of fluid into a pump. The aspirator was withdrawn slowly until the fluid appeared to be draining continuously into the pump. Before the removal of the aspirator, we performed angiography through the aspirator. We carried out a retrospective analysis of 30 consecutive patients with acute ischemic stroke caused by occlusion of the anterior circulation who were treated with the modified ASAP technique at our institution. Results: A thrombolysis in cerebral infarction score of 2B or 3 was achieved in 29/30 patients (96.7%). The average number of passes was 1.2 ± 0.5. The mean time from puncture to recanalization was 17.6 ± 6.84 min. Twenty-three (76.7%) patients achieved a modified Rankin Scale score of 0-2 at 3 months after the procedure. Conclusions: We found that the modified ASAP technique yielded fast recanalization, minimal complications, and good clinical outcomes of mechanical thrombectomy in this case series. [ABSTRACT FROM AUTHOR]

Akihiro Kuwahata,1,* Muneer Ahmed,2,* Kohei Saeki,3 Shinichi Chikaki,1 Miki Kaneko,1 Wenqi Qiu,1 Zonghao Xin,1 Shinji Yamaguchi,3 Akiko Kaneko,1 Michael Douek,2 Moriaki Kusakabe,3,4 Masaki Sekino1 1Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan; 2Division of Cancer Studies, King’s College London, Guy’s Hospital Campus, Great Maze Pond, London, UK; 3Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan; 4Matrix Cell Research Institute Inc., Ibaraki, Japan *These authors contributed equally to this work Background: Sentinel node biopsy using radioisotope and blue dye remains a gold standard for axillary staging in breast cancer patients with low axillary burden. However, limitations in the use of radioisotopes have resulted in emergence of novel techniques. This is the first in vivo study to assess the feasibility of combining the two most common novel techniques of using a magnetic tracer and indocyanine green (ICG) fluorescence.Materials and methods: A total of 48 mice were divided into eight groups. Groups 1 and 2, the co-localization groups, received an injection of magnetic tracers (Resovist® and Sienna+®, respectively) and ICG fluorescence; distilled water was used as the solvent of ICG. Groups 3 and 4, the diluted injection groups, received an injection of magnetic tracers (Resovist and Sienna+, respectively) and saline for dilution. Groups 5, 6, and 7, the control groups, received magnetic tracer (Resovist, Sienna+) and ICG alone, respectively. Fluorescent intensity assessment and iron quantification of excised popliteal lymph nodes were performed. Group 1', a co-localization group, received an injection of magnetic tracers (Resovist) and ICG' fluorescence: saline was used as the solvent for ICG.Results: Lymphatic uptake of all tracers was confined to the popliteal nodes only, with co-localization confirmed in all cases and no significant difference in fluorescent intensity or iron content of ex vivo nodes between the groups (except for Group 1'). There was no impact of dilution on the iron content in the diluted Sienna+ group, but it significantly enhanced Resovist uptake (P=0.005). In addition, there was a significant difference in iron content (P=0.003) in Group 1'.Conclusion: The combination of a magnetic tracer (Resovist or Sienna+) and ICG fluorescence is feasible for sentinel node biopsy and will potentially allow for precise transcutaneous node identification, in addition to accurate intraoperative assessment. This radioisotope-free “combined technique” warrants further assessment within a clinical trial. Keywords: sentinel node biopsy, combined technique, fluorescence dye, magnetic nanoparticles, dilutional effect

One task facing by the geotechnical engineers is to protect the workspace in an underground construction/excavation site from various forms of geological disasters, such as the water inrush, rock burst, and collapse of the surrounding rock/soil. In this paper, a combined controlling measure was proposed based on underground mining and water environment: the method of strip mining has been initially proposed as an effective measure against underground workspace floor failure when mining above confined aquifer in the Bucun coal mine, China, and however, its ability to avoid floor water inrush has yet to be demonstrated; in the next step, field trials using caving zone backfill technology to prevent underground workspace floor failure and excavate retained strip coal pillars were implemented based on the theoretical calculation and numerical simulation results. Engineering practice showed that the failure depth of the underlying strata of the workspace had no growth without the possibility of water inrush, and the safety of the underground space was achieved. Thus, this study represents a successful attempt to develop the combined strip mining and caving zone backfilling technique to ensure the safety of the underground workspace and control surface subsidence when excavating the retained strip coal pillars above confined aquifer. The proposed combined technique can also be used in other underground excavation activities with similar problems. [ABSTRACT FROM AUTHOR]

We investigated the efficacy of a combined approach with stent retriever-assisted aspiration catheter for distal intracranial vessel occlusion (distal combined technique [DCT]). We evaluated consecutive patients with acute ischemic stroke with distal occlusion in anterior circulation, including occlusions of the M2/M3 or A2/A3 segments, who received endovascular therapy (EVT) in a single center. Modified Thrombolysis in Cerebral Infraction (mTICI) score including TICI 2C category, processing time from puncture to reperfusion, proportion of a favorable clinical outcome at discharge (modified Rankin Scale [mRS] score ≤2), and incidence of symptomatic intracranial hemorrhage (sICH) were compared between the DCT and single device approach technique (non-DCT) groups. Of 65 patients, 28 were treated with EVT using the DCT and 37 were treated with EVT with a single device approach (non-DCT). In the DCT group, a higher reperfusion rate at the first pass (mTICI score ≥2B, 92% vs. 54%; P = 0.0008; mTICI score ≥2C, 71% vs. 16%; P < 0.0001; mTICI score 3, 57% vs. 14%; P = 0.0004) and shorter time from puncture to successful reperfusion (median, 31 vs. 43 minutes; P = 0.0006) were achieved, respectively. The final successful reperfusion rate was also higher in the DCT group than in the non-DCT group (mTICI score ≥2C, 85% vs. 51%; P = 0.004; mTICI score 3, 75% vs. 43%; P = 0.012), respectively. sICH occurred in 2 patients in the non-DCT group. Patients with mRS score ≤2 at discharge were more prevalent in the DCT than in the non-DCT group (57% vs. 27%, respectively; P = 0.021). This retrospective analysis indicated that the DCT is a useful and safe strategy for patients with distal anterior intracranial vessel occlusion. [ABSTRACT FROM AUTHOR]

Summary Background Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive esthetics and fully functional genitals. This study aimed to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort. Methods We included 40 MTF transgender patients who underwent a two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic examination following the standardized protocol. Results Measured vaginal depth was 11.77–14.99 cm depending on the size of the dilator used (25–40 mm). Vaginal, clitoral, and labial sensitivities were intact and favorable in all examined patients. Nineteen women (47.5%) opted for breast augmentations to achieve a feminine cosmesis, making it the most common nongenital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections ( n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost, and no secondary reconstructive approaches were required. Conclusion Satisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development, whose research is aiming to establish a state-of-the-art surgical technique. [ABSTRACT FROM AUTHOR]

Surface-enhanced Raman spectroscopy (SERS) is an emerging analytical technique with high speed and sensitivity, despite some shortcomings. Combined with other techniques can overcome these limitations and enhance the capability for detection and characterization with SERS, and has been successfully in many recent studies. Various SERS combined techniques are systematically summarized in this review for the first time. SERS can be combined with diverse techniques, such as chemical separation, biological capturing, colorimetry, microfluidic devices, and labeling techniques, to enhance detection capabilities. Moreover, combinations of SERS and other chemical analytical techniques such as mass spectroscopy, nuclear magnetic resonance, Infrared spectroscopy, and X-ray photoelectron spectroscopy, can enable more precise characterization. The theories and applications of these SERS combined techniques as well as their pros and cons are compared, and further perspectives are proposed. This review provides new insights into advances in SERS combined techniques and their use in real-life studies. [ABSTRACT FROM AUTHOR]