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Background and Objectives: This study introduced and evaluated the efficacy of an ultrasonic bony aspirator (UBA) in revision endoscopic sinus surgery and compared the outcomes to those of the traditional cold instrument approach.Methods: This retrospective study enrolled 57 patients who underwent revision endoscopic sinus surgery between June 2010 and December 2017, 17 patients with a UBA approach and 40 patients with traditional instruments.Results: Median Lund–Kennedy scores showed a statistically significant difference between the two groups at 3 months (p=0.004). Synechiae occurred in 17.6% and 35% of cases in the UBA and traditional groups, respectively. The mean operative time was significantly shorter in the traditional group (p=0.001).Conclusion: The use of a UBA in revision endoscopic sinus surgery was safe and effective.

IgG4-related diseases are immune-mediated diseases associated with fibroinflammatory lesions and are known to invade almost all organs of the human body. In the head and neck area, it rarely occurs in the nasal cavity and sinuses. Diagnosis is made by combining clinical features, serological, imaging, and histopathological findings, and glucocorticoids are known as the main treatment. In general, surgical resection is not regarded as a curative treatment option. Here we report a case with literature review of IgG4-related diseases with sino-nasal involvement experiencing prominent nasal symptom relief and remission with surgical treatment, which did not respond well to oral steroid in a 70-year-old male patient.

Purpose: To evaluate the long-term clinical outcomes of vitrectomy with internal limiting membrane (ILM) removal for patients with macular hole retinal detachment (MHRD).Methods: We retrospectively reviewed the medical records of patients with MHRD who underwent vitrectomy with ILM removal. The incidence of retinal re-attachment and MH closure at 1 month were calculated. Factors associated with RD recurrence were investigated. Visual acuity before surgery was compared to that at the final visit.Results: Forty-two eyes were included; the mean follow-up period was 38.5 ± 19.1 months. Twenty-three eyes received gas injections and 19 silicone oil injections. Retinal re-attachment occurred in 41 (97.6%). Type 1 closure was noted in 21 eyes (51.2%) and type 2 in 20 (48.8%). Recurrent RD was noted in five eyes (14.6%) within 3 months of initial surgery. Type 2 closure was a risk factor for recurrence (p = 0.021). The logarithm of the minimum angle of resolution best-corrected visual acuity improved significantly from 1.79 ± 0.79 before surgery to 1.30 ± 0.75 after surgery (p < 0.001).Conclusions: Retinal re-attachment was noted in most patients and the MH closed in approximately half of all patients after vitrectomy with ILM removal to treat MHRD. RD did not recur later than 3 months after initial surgery. Further efforts to increase the rate of type 1 closure are required.

Purpose: To report six cases of exogenous fungal endophthalmitis developed after cataract surgery.Case summary: Over about 1 month, eight patients were referred to our hospital under suspicion of fungal endophthalmitis arose after cataract surgery. We performed vitrectomy and intraocular lens removal. We intraoperatively sampled the anterior chamber, vitreous cavity, or intraocular lens surface, and performed staining and culture tests. Before the culture test results were available, we commenced empirical treatment under suspicion of fungal endophthalmitis (based on the clinical features). Five eyes were male and three female (eight eyes of eight patients); the mean patient age was 64 years. The time from cataract surgery to the commencement of appropriate treatment ranged from 13 to 36 days (average 28 days). The culture tests revealed Fusarium species in six of the eight patients. At the 1-month postoperative follow-up of these six patients, the best-corrected visual acuities were 20/20 (one eye), 20/40 (two eyes), 20/50 (one eye), and 20/100 (two eyes).Conclusions: Fungal endophthalmitis is very rare after cataract surgery but is associated with poor visual prognosis and requires long-term treatment. If fungal endophthalmitis is suspected, aggressive treatment with an appropriate selection of medication is important.

In the US, Medicaid covers over 80 million Americans. Comparing access, quality, and costs across Medicaid programs can provide policymakers with much-needed information. As each Medicaid agency collects its member data, multiple barriers prevent sharing Medicaid data between states. To address this gap, the Medicaid Outcomes Distributed Research Network (MODRN) developed a research network of states to conduct rapid multi-state analyses without sharing individual-level data across states.To describe goals, design, implementation, and evolution of MODRN to inform other research networks.MODRN implemented a distributed research network using a common data model, with each state analyzing its own data; developed standardized measure specifications and statistical software code to conduct analyses; and disseminated findings to state and federal Medicaid policymakers. Based on feedback on Medicaid agency priorities, MODRN first sought to inform Medicaid policy to improve opioid use disorder treatment, particularly medication treatment.Since its 2017 inception, MODRN created 21 opioid use disorder quality measures in 13 states. MODRN modified its common data model over time to include additional elements. Initial barriers included harmonizing utilization data from Medicaid billing codes across states and adapting statistical methods to combine state-level results. The network demonstrated its utility and addressed barriers to conducting multi-state analyses of Medicaid administrative data.MODRN created a new, scalable, successful model for conducting policy research while complying with federal and state regulations to protect beneficiary health information. Platforms like MODRN may prove useful for emerging health challenges to facilitate evidence-based policymaking in Medicaid programs.

Medication for opioid use disorder (MOUD) reduces harms associated with opioid use disorder (OUD), including risk of overdose. Understanding how variation in MOUD duration influences overdose risk is important as health-care payers increasingly remove barriers to treatment continuation (e.g. prior authorization). This study measured the association between MOUD continuation, relative to discontinuation, and opioid-related overdose among Medicaid beneficiaries.Retrospective cohort study using landmark survival analysis. We estimated the association between treatment continuation and overdose risk at 5 points after the index, or first, MOUD claim. Censoring events included death and disenrollment.Medicaid programs in 11 US states: Delaware, Kentucky, Maryland, Maine, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia and Wisconsin. A total of 293 180 Medicaid beneficiaries aged 18-64 years with a diagnosis of OUD and had a first MOUD claim between 2016 and 2017.MOUD formulations included methadone, buprenorphine and naltrexone. We measured medically treated opioid-related overdose within claims within 12 months of the index MOUD claim.Results were consistent across states. In pooled results, 5.1% of beneficiaries had an overdose, and 67% discontinued MOUD before an overdose or censoring event within 12 months. Beneficiaries who continued MOUD beyond 60 days had a lower relative overdose hazard ratio (HR) compared with those who discontinued by day 60 [HR = 0.39; 95% confidence interval (CI) = 0.36-0.42; P 0.0001]. MOUD continuation was associated with lower overdose risk at 120 days (HR = 0.34; 95% CI = 0.31-0.37; P 0.0001), 180 days (HR = 0.31; 95% CI = 0.29-0.34; P 0.0001), 240 days (HR = 0.29; 95% CI = 0.26-0.31; P 0.0001) and 300 days (HR = 0.28; 95% CI = 0.24-0.32; P 0.0001). The hazard of overdose was 10% lower with each additional 60 days of MOUD (95% CI = 0.88-0.92; P 0.0001).Continuation of medication for opioid use disorder (MOUD) in US Medicaid beneficiaries was associated with a substantial reduction in overdose risk up to 12 months after the first claim for MOUD.

The present study evaluated the cultural and functional characteristics of six strains of acetic-acid bacteria (AAB), namely, GHUR-A11-2, SR-A24, GY-A26, GHF-A37, JS-B7, and JS-C1, which were isolated from farm-made fermented vinegars. The six bacterial strains exhibited high acetic acid production capability via the decomposition of CaCO3, and they were identified as Acetobacter pasteurianus based on the 16S rDNA sequences. The initial pH and optimal growth temperature for acetic acid production were determined to be 4.0 and 30°C, respectively; however, some strains of AAB presented reasonable growth even at 40°C. Four bacterial strains (except SR-A24 and GHF-A37) exhibited alcohol degradation activities of more than 90%. Bacillus cereus presented high susceptibility to the antibacterial activity of the six strains of AAB. The antioxidant activity evaluated using DPPH and ABTS was 5–15 times and 4–5 times higher for the six strains of AAB than that for the control group, respectively. GHUR-A11-2, SR-A24, and JS-C1 exhibited higher ACE activities, with inhibition rates of 154%-175%, as compared to those exhibited by the positive control of 0.1% captopril (inhibition rate of 138%). Furthermore, the fibrinolysis activity of SR-A24 (93.3%) was markedly higher than that of 0.5 U plasmin. Four bacterial strains (except GHF-A37 (75.3%) and JS-B7 (68.0%)), exhibited α-glucosidase inhibition activities of more than 100%. It was concluded that the six strains of AAB exhibited excellent physiologically active characteristics, which facilitated their use as seed strains for the synthesis of high-efficiency functional vinegar by harnessing the functional characteristics that fit the scientific basis.

Rice blast is the most destructive disease threatening stable rice production in rice-growing areas. Cultivation of disease-resistant rice cultivars is the most effective way to control rice blast disease. However, the rice blast resistance is easy to breakdown within years by blast fungus that continually changes to adapt to new cultivars. Therefore, it is important to continuously monitor the incidence of rice blast disease and race differentiation of rice blast fungus in fields. In 2020, a severe rice blast disease occurred nationwide in Korea. We evaluated the incidence of rice blast disease in Yeoju and compared the weather conditions at the periods of rice blast disease in 2019 and 2020. We investigated the races and avirulence genes of rice blast isolates in Yeoju to identify race diversity and genetic characteristics of the isolates. This study will provide empirical support for rice blast control and the breeding of blast-resistant rice cultivars.

Background and Objectives Interposition using acellular allograft between perforated septal flaps is a popular procedure among surgeons because of its usefulness. However, allograft dermal matrix itself tends to become infected sometimes, and can easily undergo necrosis or be displaced from the implanted site. Here, the authors would like to introduce a newly devised interposition graft made up of allograft and cartilage, which is easy to manipulate and can be fixed in the desired position.Subjects and Method We performed a retrospective chart review from January 2018 to August 2020. A total of 12 patients with septal perforation who received surgical treatment were included in this study. Acellular human dermal allograft (MegaDerm® ; L&C Bio) was used as an interposition allograft piled up by autologous cartilage, and it was positioned between the mucoperichondrial flaps via the endonasal approach.Results The most common etiology was previous septal surgery (n=8); in one case, the etiology was repeated electrocauterization due to frequent epistaxis; the etiology was not verified for three cases. All 12 cases achieved the result of complete septal perforation closure. All patients on follow-up inquiry reported marked improvements in the visual analogue scale score (mean value, 4.1 to 1) and Nasal Obstruction Symptom Evaluation scale (mean value, 7.3 to 1.8).Conclusion Composite graft made up of cartilage and allograft dermal matrix achieved successful results without having to fix the graft. It can be an alternative technique to treat septal perforation for inexperienced surgeons and with a limited operation field.

Various treatment modalities for obstructive sleep apnea (OSA) patients were introduced including continuous positive airway pressure (CPAP), lifestyle modification, and surgery. Numerous factors such as compliance, treatment failure, and preference should be considered when deciding the treatment. In general, patients for whom CPAP or other conservative treatment modalities failed become candidates for surgical treatments. Uvulopalatopharyngoplasty is one of the most generally performed surgeries, of which success rate is relatively low. Recently, numerous techniques that can correct lateral pharyngeal obstruction for OSA patients were introduced. However, some of them are technically difficult and aggressive. In this article, we introduce a novel surgical method for OSA called palatopharyngeal muscle suspension suture technique.

Electrochemical CO2 conversion to fuel molecules is an attractive strategy towards atmospheric carbon attenuation. In the fuel conversion catalysis of carbon dioxide, surface adsorbed CO was often identified as a...

Posterior shoulder instability occurs when the labrum detaches posteriorly from the glenoid owing to significant trauma and is a relatively uncommon type of shoulder dislocation. Although posterior instability has often been treated with open shoulder stabilization, modern arthroscopic procedures are being rapidly pursued by surgeons as an improved option because of decreased invasiveness and reduced operative times. Arthroscopic stabilization of the posterior glenoid labrum typically involves 2 working portals, but the procedure still yields successful results when performed with a single posterior portal and a suture passer. Our technique involves 1 less portal to reduce invasiveness, lower the risk of nerve damage, and decrease the operative time and postoperative pain. The purpose of this article is to describe an arthroscopic posterior stabilization technique with a single working portal., Technique Video Video 1 Single-portal arthroscopic posterior shoulder stabilization. The patient is in the lateral decubitus position for treatment of the left shoulder. A stab incision using a No. 11 blade creates a posterior portal for initial posterior visualization. Diagnostic arthroscopy looking from posterior to anterior shows a tear of the posterior labrum. The site for the anterior portal is located using a spinal needle. An 8.25-mm cannula is inserted posteriorly with the aid of a switching stick before the arthroscope is moved to the anterior portal for further visualization. A bite of the posterior capsule and healthy labral tissue is taken using a loaded suture passer. After unreeling of the No. 0 polydioxanone sulfate monofilament suture, No. 2 FiberWire is shuttled to create a racking-hitch suture knot. A pilot hole is drilled using an Arthrex drill guide, and a 2.9-mm PushLock suture anchor loaded with SutureTape is impacted into the pilot hole to stabilize the posterior labrum. A suture cutter is used to cut the residual suture. The process is repeated in another position to sufficiently reduce the posterior labrum.

Revision anterior cruciate ligament reconstruction (R-ACLR) has become more common as the number of failed primary ACLRs increase. Although increasingly common, R-ACLR has a greater failure rate than a primary reconstruction. Technical errors, particularly in tunnel placement, account for a large proportion of graft failure in R-ACLR as well as re-revision cases. Tunnel placement and trajectory is particularly important in R-ACLR and becomes more challenging with each additional revision attempt. This is in part because any tunnels created for revision may converge with formerly drilled tunnels or face interference hardware creating, complicating proper graft fixation. While there are many approaches to revision ACL surgery, our technique describes a simple, tibial tunnel-first graft-sizing method initially reaming tunnels with very small diameters and sequentially working your way up to more anatomic diameters., Technique Video Video 1 Revision anterior cruciate ligament (ACL) reconstruction using the tibial tunnel sizing technique. Diagnostic arthroscopy showing few fibers of the remnant ACL. An electrocautery wand is used to clean the back wall. The lateral femoral condyle notch is clear. The tibial tunnel sizing technique is accomplished by firing a guide pin using a tip aiming guide to confirm a good guide pin trajectory for the new tibial tunnel. Once the position and trajectory of the pin is satisfactory, the smallest reamer available, size 6-mm reamer, is used to ream the new tibial tunnel. An arthroscope is then used to confirm a sufficient bony wall throughout the tibial tunnel before proceeding. The next size up reamer, a size 7-mm reamer, is reinserted into the same tibial tunnel that is created using the size 6-mm reamer and is positioned using a straight clamp from the anteromedial portal. This process is repeated until the size 10-mm reamer is inserted while each time looking up the tibial tunnel to confirm a sufficient bony circumferential wall. At the graft preparation station, the Achilles tendon is cut down to a size 10, loaded on the TightRope (Arthrex), and confirmed with a sizing block. The TightRope button with Achilles allograft is passed up the femoral socket and flipped in the cortex. The Achilles allograft is cinched up, the FastThread Biocomposite Interference Screw (Arthrex) is used, and graft is probed to check for proper tension. The graft is retensioned and then a final check is completed.

Perioperative stroke is one of the most fatal complications for patients as well as for doctors. It is defined as a brain infarction or hemorrhage, occurring during or within 30 days after a surgical procedure. Most of the perioperative strokes have ischemic etiology while only 1% has hemorrhagic etiology, according to one study. The incidence of perioperative stroke is influenced by the complexity and type of the surgery. Generally, its incidence is very low, being about to 0.1-1.9%, with majority of the cases pertaining to cardiac, vascular, neurological surgeries. Based on our research, most cases are perioperative strokes that occur after cardiac and vascular surgeries. Here we report two cases of cerebral infarction after endoscopic sinus surgery, which are very rare.

Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor., Technique Video Video 1 Arthroscopic single portal and single anchor subscapularis repair and biceps tenodesis. Patient is in the lateral position for the left shoulder with posterior portal visualization. Biceps has a lipstick sign and shows inflammation. Through a single anterior portal, a grasper is used to create a hitch knot, and the BirdBeak grasper is used to pierce the long head of the biceps tendon and retrieve the No. 2 FiberWire. The construct is now a luggage tag racking suture around the biceps tendon to create the Loop ‘N’ Tack. A wand is used to anatomize the biceps off of the biceps-labral junction. For the upper one-third subscapularis tear, a Scorpion is used to fire in a FiberWire and create a luggage tag racking hitch suture. The first suture is used to pull traction to allow for a larger bite of the upper one-third subscapularis. Then a second luggage tag is made using the Scorpion. A 4.75-mm SwiveLock punch was used to punch a hole at the lesser tuberosity footprint. All 3 pairs of the FiberWire tails are loaded onto the SwiveLock suture anchor. The SwiveLock is gently malleted in until it engages the bone, after which the anchor is advanced by turning the inserter in a clockwise direction. After making sure that the anchor is flush to the cortex, a suture cutter is used to cut the excess suture.

Several factors affect the success of an anterior cruciate ligament reconstruction, including graft origin, type, and morphology. Hamstring and bone–patellar tendon–bone autografts are the most widely used, and there are many different techniques of graft preparation with each. In this Technical Note and accompanying video, a 4-strand hamstring autograft technique is described that uses a simple diamond-type braid to produce a more ovoid morphology with increased cross-sectional area. Increased graft diameters have been associated with higher success rates and more positive long-term outcomes. Therefore, this braiding construct may provide additional tensile strength with increased resistance to failure than grafts that are otherwise undersized using conventional techniques., Technique Video Video 1 Right 4-strand diamond braiding technique for hamstring autograft in anterior cruciate ligament reconstruction. Autograft hamstring gracilis and semitendinosus tendons were harvested. At the graft preparation station, the muscles were removed from the tendons. Both ends of the tendons were whipstitched, and then both strands of the hamstring were loaded onto the tightrope. The final length was measured to be 100 mm, and the diameter was sized to be 6.5 mm. A 0-Vicryl suture (Arthrex) was used to secure one end so the strands did not move or shift. Strand 1 was passed under strands 2 and 3 and then passed back over strand 3. After each braid, the strands were pulled taut. The steps were repeated for strand 4 by passing it under strands 1 and 3 and then back over strand 1. An additional suture was put halfway down the graft to keep the braid tensioned. The braid was continued to the end of the graft, and then a suture was put at the end. The length was measured to be 90 mm, and the diameter was measured to be 8 mm. Then the graft was passed arthroscopically and the button flipped in the cortex. The graft was then dunked into the socket and the tension was checked with the probe. The graft was retensioned and then a final check was done.

Acromioclavicular joint separations are common shoulder injuries, yet standard treatment practices vary. Popular surgical techniques include reconstruction using allografts or neighboring ligaments as well as repair using screws and sutures. This Technical Note and accompanying video describe both an acromioclavicular and coracoclavicular joint reconstruction using an allograft to replace native acromioclavicular ligament along with an AC joint reduction using a Suture Cerclage System to precisely control reduction and restore anatomic alignment., Technique Video Video 1 Right combined acromioclavicular and coracoclavicular joint reconstruction with allograft using a cerclage tensioning system. Preoperative radiographs of the right shoulder in the anteroposterior view confirm a type V acromioclavicular joint separation. A curved AC Joint Graft Passing Instrument (Arthrex) shuttles a nitinol wire around the coracoid. The nitinol wire is then used to pass a #2 FiberWire suture around the coracoid. Electrocautery is used to mark the anatomic positions of the conoid and trapezoid coracoclavicular ligaments. A drill is used to create bone tunnels at these anatomic positions on the right clavicle. Nitinol wires are used to shuttle one #2 FiberWire suture tail through each bone tunnel whilst it remains passed under the coracoid. The Suture Cerclage System is opened on the back table and the FiberTape Cerclage Suture is unwound. The FiberTape Cerclage Suture is then passed through the conoid drill hole, under the coracoid, and out of the trapezoid drill hole. This suture tail is passed through the FiberTape Cerclage System Card (Arthrex) and the card is discarded. A guide pen is drilled into the right distal clavicle and acromion and reamed with a 4-mm reamer to create bone tunnels. The allograft is passed through the bone tunnels. The ends of the FiberTape Cerclage Suture are trimmed and then placed through the roller adjacent to the handle of the FiberTape Cerclage Tensioner. The FiberTape Cerclage Tensioner is then dialed in to 80 lbs of tension on the coracoclavicular joint reconstruction construct to reduce the acromioclavicular joint. The allograft is tied down over the acromioclavicular joint and #2 FiberWire Sutures are passed to secure the tied graft. Final fluoroscopic imaging confirms the anatomic reduction of the right acromioclavicular and coracoclavicular joint reconstruction.