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Stereotactic frameless needle brain biopsy is a common neurosurgical procedure performed via twist drill or open burr hole approaches. We aim to compare diagnostic yields and surgical outcomes to delineate the safety and efficacy of both approaches. A retrospective database of all stereotactic needle biopsy procedures performed at a single institution over 30 months was conglomerated. Demographics, medical comorbidities, operative details/complications, immediate post-operative imaging, and pathology were abstracted. Two hundred and twenty-five needle biopsies were identified, of which 165 (73.3%) were open, and 60 (26.7%) were twist drill. Diagnostic pathology yield rates between open (84.8%) and twist drill (93.3%) approaches were similar (p = 0.15), with a median of 4 cores taken in each (p = 0.30). Diagnostic tissue yields with an intra-operative pause for pathology confirmation was 90.4% compared to 79.1% without pause (p = 0.036, OR 2.49). Median operative times for open versus twist drill procedures were 68.0 min (IQR 49–83) versus 35.5 min (IQR 26–54), respectively (Wilcoxon p < 0.001), which remained significant after controlling for awaiting intraoperative pathology using bivariable linear modeling (p < 0.001). Intraoperative bleeding through the needle cannula was noted in 22 patients (9.8%), including eight twist drill (13.3%) and 14 open needles (8.5%). Of 197 cases (87.6%) with post-operative cranial imaging (CT/MRI), 90 (45.7%) demonstrated some degree of post-operative hemorrhage characterized as superficial (n = 10, 11.1%), deep/intralesional (n = 64, 71.1%) bleeding, or both (n = 16, 17.9%). Bleeding rates between open (46.7%) and twist drill (43.3%) approaches were similar (p = 0.78). Post-operative clinical decline or neurological change was noted in 9 patients (4.0%), including one twist drill (1.7%) and eight open needles (4.8%), among which 7 (78%) had deep blood products identified on post-operative imaging. Stereotactic needle biopsy via twist drill approach has similar diagnostic yield rates, asymptomatic bleeding rates, and post-operative complications with significantly shorter operative time and smaller incision size than conventional open burr hole needle biopsy. Using intra-operative frozen histopathology for presumed sufficient diagnostic tissue may improve final pathologic diagnostic rates regardless of approach technique. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Medical residents learn how to perform many complex procedures in a short amount of time. Sequential learning, or learning in stages, is a method applied to complex motor skills to increase skill acquisition and retention but has not been widely applied in simulation-based training (SBT). Central venous catheterization (CVC) training could benefit from the implementation of sequential learning. CVC is typically taught with task trainers such as the dynamic haptic robotic trainer (DHRT). This study aims to determine the impact of sequential learning on skill gains and learning curves in CVC SBT by implementing a sequential learning walkthrough into the DHRT. METHODS: 103 medical residents participated in CVC training in 2021 and 2022. One group (N = 44) received training on the original DHRT system while the other group (N = 59) received training on the DHRTsequential with interactive videos and assessment activities. All residents were quantitatively assessed on (e.g. first trial success rate, distance to vein center, overall score) the DHRT or DHRTsequential systems. RESULTS: Residents in the DHRTsequential group exhibited a 3.58 times higher likelihood of successfully completing needle insertion on their first trial than those in the DHRT only group and required significantly fewer trials to reach a pre-defined mastery level of performance. The DHRTsequential group also had fewer significant learning curves compared to the DHRT only group. CONCLUSION: Implementing sequential learning into the DHRT system significantly benefitted CVC training by increasing the efficiency of initial skill gain, reducing the number of trials needed to complete training, and flattening the slope of the subsequent learning curve. [ABSTRACT FROM AUTHOR]

Needled preform and its composite using felt and base cloth stacked needled have small fiber volume fraction and relatively weak mechanical properties, which are difficult to meet the service requirements of structural and functional integrated components of high‐speed aircraft. Responding to this issue, this paper proposed a new method for preparing high load‐bearing needled composite preform based on ordered short fiber network needling. The high load‐bearing needled preforms were prepared by designing different structural parameters of ordered short fiber network and forming process parameters, and then preform structure was characterized and mechanical properties were tested. The results showed that using ordered short fiber network as carrier of the short fibers, the formed needled fiber bundles were longer and denser, volume content of needled fiber bundles and mechanical properties of needled preform were greatly improved, and needled fiber bundles volume content of ordered short fiber network reinforced needled preform was 1.5 times and 46.3 times that of half‐cut cloth and felt respectively. Compared with traditional felt needled preform and half‐cut cloth needled preform, the interlaminar peeling strength of the ordered short fiber network reinforced needled preform increased by up to 246.4% and 49.2%, respectively. The tensile strength of ordered short fiber network reinforced needled preform was 12.9% higher than that of half‐cut cloth in X‐axis direction. In addition, the effects of ordered short fiber network structure, short fiber length, areal density and needling density on the needled preform structure and properties were also revealed. Highlights: High load‐bearing needled composite preform was prepared based on novel ordered short fiber network needling method.The needled fiber bundles formed by using ordered short fiber network were longer and denser, and their volume content was 46.3 times that of felt needled preform.The interlaminar peeling strength of the ordered short fiber network reinforced needled preform increased by up to 246.4%.The tensile strength of ordered short fiber network reinforced needled preform was 12.9% greater than half‐cut cloth in the X‐axis direction. [ABSTRACT FROM AUTHOR]

Aim: To compare shock wave-enhanced emission photoacoustic streaming (SWEEPS) with sonic- and ultrasonically activated irrigation systems in removing Enterococcus faecalis biofilm from the root canal system. Methodology: Fifty human single-canalled mandibular premolars were included in the study. After access cavity preparation, the root canals were prepared to a standardized size and taper. Then, the entire root surface was covered with two layers of resin, and the root apices were sealed before sterilization. All root canals were inoculated with E. faecalis biofilm, and the samples were incubated aerobically for 2 weeks at 37 °C. Biofilm formation was confirmed by scanning electron microscopy. All samples were randomly divided into five groups (n = 10 each) based on their irrigation activation method as A (no treatment or negative control), B (no irrigation or positive control), C (sonically activated irrigation (SAI)), D (ultrasonically activated irrigation (UAI)), and E (needle irrigation activated by an Er: YAG laser device using a SWEEPS quartz tip (SWEEPS)). Then, dentine chips were retrieved, vortexed, and diluted for colony-forming unit counts. Data were analysed using analysis of variance and post-hoc Tukey tests (α = 5%). Results: All methods could significantly reduce E. faecalis biofilm compared with control so that the UAI, SWEEPS, and SAI groups indicated a 23.54%, 14.89%, and 7.81% biofilm reduction, respectively. UAI demonstrated a significantly more effective reduction of E. faecalis biofilm than SAI (p = 0.004). Conclusions: All irrigation activation methods significantly reduced E. faecalis biofilm, with ultrasonic use being the most effective. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Conclusion Percutaneous pedicle screw fixation (PPSF) technique requires a very precise entry point of the Jamshidi needle, which leads to repeated adjustments, damaging the pedicle and increasing radiation exposure. This study was designed to propose an improved percutaneous pedicle screw fixation technique‐trajectory dynamic adjustment (TDA) technique, and evaluate its feasibility and assess the clinical outcomes.A total of 445 patients with lumbar spondylolisthesis or lumbar spinal stenosis associated with instability from June 2017 to May 2022 were included in the retrospective study. They were randomly separated into two groups. Two hundred thirty‐one patients underwent TDA technique (TDA group). Two hundred fourteen patients underwent traditional PPSF technique (PPSF group). All patients underwent postoperative CT to assess the accuracy of screw placement, superior facet joint violation (FJV). The evaluated clinical outcomes were needle insertion time, radiation exposure, blood loss, hospital stay, the Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) scores for lower back pain (LBP), and leg pain, lumbar interbody fusion rate, and postoperative complications. The independent‐sample t test and paired t‐test were used for continuous data. The contingency table and Mann–Whitney U test were used for categorical data.The time of the insertion in TDA group was significantly lower than that in PPSF group (p < 0.05). Similarly, the fluoroscopy frequency in TDA group was significantly lower than that in PPSF group (p < 0.05). There was no difference in intraoperative blood loss and hospital stay between the two groups (p > 0.05). Overall, there was no significant difference in the proportion of clinically acceptable screws between the two groups (p > 0.05). In addition, the lateral screw misplacement in TDA group was higher. Moreover, FJV rate was significantly lower than that in PPSF group (p < 0.05). In both TDA group and PPSF group, postoperative back and leg pain and the JOA score were significantly improved (p < 0.05). However, there were no significant differences in the pre‐ and postoperative VAS score for back and leg pain and the JOA score, JOA recovery rate, intervertebral fusion rate, and complications rate between the two groups (p > 0.05).Compared to traditional PPSF technique, TDA technique is a safer and more effective procedure which has shorter surgical time, lower radiation exposure, and lower facet joint violation rate. [ABSTRACT FROM AUTHOR]

Background: Understanding the factors that contribute to variability in breast cancer-related lymphedema (BCRL) is an important first step in developing targeted interventions to improve quality of life in breast cancer patients. Although previous research studies have has identified many risk factors for BCRL, dietary habits and catheterization type have rarely been studied until the present. Aim: This study aims to explore the effects of nursing factors such as dietary habits and catheterization type on breast cancer-related lymphedema (BCRL). Methods: This retrospective cohort study included 1,476 breast cancer patients who underwent surgery between January 1, 2012, and September 1, 2020. Lymphedema was assessed with a validated self-report questionnaire. All research data were obtained from medical records and a follow-up database. Multivariate Cox regression was conducted to explore the effects of dietary habits and catheterization type on BCRL. Results: The results showed an increased risk for BCRL among breast cancer patients who followed a high-fat diet prehospitalization (HR = 2.47; 95% CI = 1.55–3.94; P < 0.001), indwelling totally implantable venous access ports (TIVAPs) compared with indwelling needles (HR = 0.56; 95% CI = 0.35–0.90;P = 0.017) or indwelling peripherally inserted central catheters (PICCs) (HR = 0.69; 95% CI = 0.45–1.05; P = 0.086). Conclusion: High-fat diet pre-hospitalization was an independent risk factor for lymphedema. The TIVAPs did not exert a protective effect on lymphedema compared with the PICC and indwelling needle. This study finding offers new insights to develop targeted interventions to decrease the incidence of lymphedema. [ABSTRACT FROM AUTHOR]

Background: The ability of socially assistive robots (SARs) to treat dementia and Alzheimer's disease has been verified. Currently, to increase the range of their application, there is an increasing amount of interest in using SARs to relieve pain and negative emotions among children in routine medical settings. However, there is little consensus regarding the use of these robots. Objective: This study aimed to evaluate the effect of SARs on pain and negative affectivity among children undergoing invasive needle-based procedures. Design: This study was a systematic review and meta-analysis of randomized controlled trials that was conducted in accordance with the Cochrane Handbook guidelines. Methods: The PubMed, CINAHL, Web of Science, Cochrane Library, Embase, CNKI, and WanFang databases were searched from inception to January 2024 to identify relevant randomized controlled trials (RCTs). We used the Cochrane Risk of Bias tool 2.0 (RoB2.0) to assess the risk of bias among the included studies, and we used RevMan 5.4 software to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of the evidence. Results: Ten RCTs involving 815 pediatric subjects were selected for this review and reported outcomes related to pain and emotions during IV placement, port needle insertion, flu vaccination, blood sampling, and dental treatment. Children undergoing needle-related procedures with SARs reported less anxiety (SMD= -0.36; 95% CI= -0.64, -0.09) and fewer distressed avoidance behaviors (SMD= -0.67; 95% CI= -1.04, -0.30) than did those receiving typical care. There were nonsignificant differences between these groups in terms of in pain (SMD = -0.02; 95% CI = − 0.81, 0.78) and fear (SMD = 0.38; 95% CI= -0.06, 0.82). The results of exploratory subgroup analyses revealed no statistically significant differences based on the intervention type of robots or anesthetic use. Conclusions: The use of SARs is a promising intervention method for alleviating anxiety and distress among children undergoing needle-related procedures. However, additional high-quality randomized controlled trials are needed to further validate these conclusions. Trial registration: The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023413279). [ABSTRACT FROM AUTHOR]

OBJECTIVES To evaluate the results of isolated left subclavian artery in-situ fenestration (ISF) during 'zone 2' thoracic endovascular aortic repair (TEVAR) using a new adjustable needle puncturing device system. METHODS It is a multicentre, retrospective, physician-initiated cohort study of patients treated from 28 July 2021 to 3 April 2024. Inclusion criteria were isolate left subclavian artery revascularization for elective or urgent/emergent 'zone 2' TEVAR. The primary outcome was technical success and freedom from ISF TEVAR-related reintervention or endoleak. RESULTS We treated 50 patients: 28 (56.0%) atherosclerotic thoracic aneurysms, 12 (24.0%) type B aortic dissection and 10 (20.0%) penetrating aortic ulcers. Elective intervention was carried out in 46 (92.0%) cases. ISF was successful in all cases, with a procedural primary technical success in 47 (94.0%) cases. The median time of intervention was 184 min (interquartile range 135–220) with a median fenestration time of 20 min (interquartile range 13–35). Operative mortality did not occur. We observed 1 case of spinal cord ischaemia and 2 cases of bilateral posterior non-disabling stroke. Mortality at 30 days occurred in 1 (2.0%) patient (not aorta-related). The median follow-up was 4 months (interquartile range 1–12.25). Bridging stent graft patency was 100% with no ISF-related endoleak. ISF-related reintervention was never required CONCLUSIONS ISF TEVAR using the Ankura™-II device with the self-centring adjustable needle system showed high technical success, promising stability and stable aortic-related outcomes. Owing to these results, it represents a safe and effective alternative for standard 'zone 2' TEVAR. [ABSTRACT FROM AUTHOR]

Background/Objectives: Microwave ablation (MWA) is the leading therapy method for treating patients with liver cancer. MWA simulation is used to further improve the therapy and to help develop new devices. Methods: A water-cooled ablation needle was reconstructed. MWA simulations of a polyacrylamide phantom were carried out and compared with a representative clinical example (tumor diameter: 8.75 mm). The Arrhenius damage model and a critical temperature approach of 60 °C were applied to assess the necrosis zones. Finally, the simulation results were compared to the corresponding MR measurements. Results: Most of the heating in the simulation took place at a distance of 5 mm along the transverse axis and 20 mm along the longitudinal axis above the needle tip. The calculated Dice scores for the Arrhenius model were 0.77/0.53 for the phantom/clinical case. For the critical temperature approach, Dice scores of 0.60/0.66 for the phantom/clinical case were achieved. Conclusions: The comparison between simulated and measured temperature increases showed an excellent agreement. However, differences in the predicted necrosis volume might be caused by omitting consideration of the heat sink effect, especially in the clinical case. Nevertheless, this workflow enables short MWA simulation times (approximately 3 min) and demonstrates a step towards possible integration into daily clinical use. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Patients/Methods Results Conclusions Skin biorevitalization involves multiple intradermal injections to enhance skin quality, but precise dermal targeting can be challenging due to variations in skin thickness smaller, less painful needles with fewer skin reactions are attractive options.This study evaluates a new Micro‐Needle device's performance and safety in comparison with the classic needle used in skin biorevitalization.Subjects with facial and neck skin aging were enrolled. Safety outcomes, including immediate and local tolerability, were assessed. Performance outcomes measured skin radiance, wrinkles and photoaging grade, hydration, subepidermal low echogenic band, dermis thickness, and skin elasticity. Both subjects and investigators recorded Global Aesthetic Improvement Scale scores.Micro‐Needle injections demonstrated superior performance compared to the classic needle, influenced by the specific skin zones and thickness. Micro‐Needle was superior for skin wrinkles at D49 for periorbital zone and nasolabial folds by −14.5% (p = 0.01) and −15% (p = 0.004), respectively, and for neck by 9.6% (p = 0.0008). The Nanosoft device showed a faster improvement for skin hydration at D42 for the cheek zone (p = 0.04) and at D75 for the neck area (p = 0.01); and for skin radiance at D75 (p = 0.03) and at D120 (p = 0.0098). Ex vivo studies confirmed the Micro‐Needle's accuracy in product placement in the dermis. Adverse events were milder with Micro‐Needle and no serious adverse events occurred.Both needles significantly improved skin quality, but Micro‐Needle enhanced the outcomes of skin biorevitalization procedures, particularly in terms of skin wrinkle reduction, elasticity, and overall skin hydration. [ABSTRACT FROM AUTHOR]

Robotic needle steering has become a topic of interest in intervention surgery. Yet, this surgical procedure poses challenges due to external disturbances and tissue movement. To address these challenges, several novel steering algorithms have been developed to guide the needle precisely from the entry point to the target point. However, some of these algorithms may cause additional trauma to patients. In this paper, we present a 3D optimal control algorithm for a curvature-controllable steerable (CCS) needle, aiming to achieve effective operations with minimal trauma. We derive a kinematics without duty cycle control strategy (needle shaft spin), propose a novel intraoperative motion planner for path replanning, and design a full-state feedback controller for accurate path tracking. A dynamic environment was simulated, and the optimal controller showed a better result (0.01 ± 0.01 mm) than the case (3.86 ± 1.32 mm) using a full-state feedback controller. The demonstration indicates that the optimal control system can safely, effectively, and accurately steer the needle to the target point in a dynamic environment. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the effect of needle insertion angle on pain during labial infiltration anesthesia in the anterior maxillary region. Material and Methods: In this parallel‐design randomized clinical trial, participants were randomly assigned to four groups for labial infiltration anesthesia of the anterior maxilla. Local anesthesia was performed with needle orientation parallel to the longitudinal axis of the tooth using a conventional syringe (Syringe‐0), needle at α angle with a conventional syringe (Syringe‐α), computer‐controlled local anesthetic delivery (CCLAD) device parallel to the longitudinal axis of the tooth (CCLAD‐0), and CCLAD at α angle (CCLAD‐α). The heart rate (HR), blood pressure (BP), and respiratory rate (RR) of participants were measured before needle insertion, immediately after needle insertion, and immediately after the injection by a vital signs monitor. The level of pain experienced by participants was quantified using a numerical rating scale (NRS). Data were analyzed by repeated‐measures ANOVA and regression models (α = 0.05). Results: Thirty‐six participants aged from 21 to 60 years, with a mean age of 35.36 years were recruited. The mean pain scores were 7.44, 4.67, 2.89, and 0.67 in groups Syringe‐0, Syringe‐α, CCLAD‐0, and CCLAD‐α, respectively (p < 0.001). Age and sex had no significant effect on pain scores (p = 0.914 and p = 0.702, respectively). The four groups had no significant difference in vital signs (p > 0.05). Conclusions: Injection at an α angle and the application of CCLAD can be used in clinical practice to decrease the pain experienced by participants during labial infiltration anesthesia of the anterior maxilla. Trial Registration: Iranian Registry of Clinical Trials: IRCT20230719058849N1. [ABSTRACT FROM AUTHOR]

Background: Patients with mediastinal lymph node enlargement (MLNE) are diagnosed depending on lymph node biopsy. Whereas, how to obtain larger tissue masses from mediastinal lymph nodes and improve the diagnostic yield of the disease remains to be investigated. Objectives: Aiming to assess the diagnostic value of endobronchial ultrasound-guided intranodal forceps biopsy via transbronchial laser photoablation (EBUS-IFB-TLP) in patients with MLNE. Design: A prospective, self-controlled study. Methods: This study was conducted on 67 MLNE patients requiring a lymph node biopsy for diagnosis at the Henan Provincial People's Hospital and the Fuwai Central China Cardiovascular Hospital in China, from January 2020 to December 2022. Each patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA group) and EBUS-IFB-TLP (EBUS-IFB-TLP group) on the same mediastinal lymph node for biopsies. The operation time, diagnostic efficiency, and complication rates of the two biopsy methods were compared. Results: The number of diagnosed patients in the EBUS-IFB-TLP and the EBUS-TBNA groups was 65 (97.0%) and 57 (85.1%), respectively (p = 0.021). In the EBUS-IFB-TLP group, 28 cases (96.6%) were diagnosed with lung cancer and were classified into different epithelial types. In the EBUS-TBNA group, there were 27 cases (93.1%) diagnosed with lung cancer, of which 26 (89.7%) were classified into different epithelial types. There were 37 (97.4%) and 30 (78.9%) non-lung cancer patients diagnosed in the EBUS-IFB-TLP and EBUS-TBNA groups, respectively (p = 0.039), while 27 cases (96.4%) of sarcoidosis in the EBUS-IFB-TLP group and 20 cases (71.4%) of sarcoidosis in the EBUS-TBNA group were diagnosed (p = 0.016). The percentages of intraoperative mild to moderate bleeding complications were 23.9% (16/67) and 14.9% (10/67) in the EBUS-IFB-TLP and in the EBUS-TBNA groups, respectively (p = 0.109). Conclusion: This study demonstrated that EBUS-IFB-TLP could be a feasible and effective method in the diagnosis of patients with MLNE, presenting an analogous safety profile compared with EBUS-TBNA. Further studies are needed to verify the diagnostic performance of EBUS-IFB-TLP for MLNE. Plain language summary: A new way of obtaining a larger biopsy sample in patients with enlarged lymph nodes in the chest Why was the study done? Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) allows doctors to look at a patient's lungs using a tiny camera (called a bronchoscope). A needle is found at the tip of the bronchoscope and is used to take samples (biopsies) from the lymph nodes in the chest. Lymph nodes are small structures that help filter foreign substances in the body, for example cancer cells. The enlarged (big) lymph nodes are often caused by cancer. Researchers are still trying to work out how to obtain large samples from the lymph nodes which could lead to a better diagnosis. What did the researchers do? We explored a new method called endobronchial ultrasound-guided intranodal forceps biopsy based on transbronchial laser photoablation (EBUS-IFB-TLP) to be used in diagnosing patients who have enlarged lymph nodes. EBUS-IFB-TLP is performed under the guidance of endndobronchial ultrasound, the laser fiber is inserted through the bronchoscope to act on the airway wall, creating a hole in the target lymph node, a biopsy forcep was inserted into the lymph node through the biopsy hole. We used both methods on each patient in this study and compared them. What did the researchers find? More patients were diagnosed with enlarged lymph nodes when using the EBUS-IFB-TLP method, but there were milder to moderate bleeding complications. What do the findings mean? This study shows that EBUS-IFB-TLP could be use in the diagnosis of enlarged lymph nodes. [ABSTRACT FROM AUTHOR]

Using steerable needles to enable course correction and curved trajectories can improve surgical outcomes in numerous clinical interventions including electrode placement for deep brain stimulation. In this work, a physically motivated kinematic model for an actively steered magnetic-tipped needle is used in closed-loop control to perform insertion trajectories. The applied control law is derived using the Lyapunov redesign. Simulation results show this control method to be accurate for a wide range of conditions including randomized target trajectories. Control is performed experimentally in a brain tissue phantom for both initial position offset recovery and curved trajectories. Converged error results average 0.52 mm from target trajectory. Simulation results demonstrate the robustness of the control implementation, while experimental results exceed the accuracy required for the target application, encouraging future use in a clinical setting. Beyond needle insertion, this work has implications in general vehicle steering, as this model and control can apply to systems with similar kinematics such as boats and wheeled vehicles that could benefit from a relaxed slip constraint. [ABSTRACT FROM AUTHOR]

Over the last few years, percutaneous procedures have undergone great advances, thanks to the ultrasound (US) guidance, due to the technical improvements in the US field, combined with the greater availability, good portability, and reduced cost of US devices. The direct target visualization and the real-time imaging performance enabled by US-guidance account for an improved accuracy in needle placement in several rheumatology interventions. So, ultrasound-guided procedures contribute to several diagnostic or therapeutic procedures such as fluid aspiration or treatment instillations of common joints, tendons, and bursas. In clinical practice, this fact is especially important in the case of depth areas like the hip, small anatomical structures as tendon sheaths or nerves in tenosynovitis or nervous blocks, or complex anatomical structures like the spine's facet joints. The US-guide is an essential tool for performing diagnostic procedures as synovial biopsy. US can also be combined with other imaging techniques, like the establishment portal arthroscopy for instance. Compared to older blind procedures, US-guided injections are more accurate and safer, and they result in better clinical outcomes in terms of joints improvement in function and decreased risk of damages caused by needle misplacement. With the ultrasound guided treatment, we can avoid the instillation of therapeutic products outside the predetermined target, which may be sometimes potentially harmful. The aim of this article is to describe the main generalities of ultrasound-guided procedures in rheumatology, their main advantages and disadvantages, and their particularities in joints where they are most frequently used, such as the shoulder, hip, and knee. [ABSTRACT FROM AUTHOR]

From May 2022 to June 2023, 42 patients used the same material and different types of needles were retrospectively analyzed. Twenty-one patients were in blunt needle group and 21 patients in sharp needle group. The injection pain, congestion and postoperative satisfaction of the two groups were evaluated. Results There was no significant difference in intraoperative and postoperative pain between the two groups (P>0.05). The intraoperative and postoperative incidences of congestion of blunt needle group were lower than those of sharp needle group, and the difference was statistically significant (P<0.05). There was no significant difference in postoperative satisfaction between the two groups (P>0.05). Conclusion Both groups achieved satisfactory results in intraoperative and postoperative pain and postoperative satisfaction, and the blunt needle was better than the sharp needle in preventing congestion. [ABSTRACT FROM AUTHOR]

Introduction: Subarachnoid block is the most commonly used anaesthetic technique for caesarean sections. Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anaesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. The aim of this study is to assess the incidence of postdural puncture headache in the median and paramedian approach using 25G Whitacre spinal needle in pregnant females undergoing caesarean section. Materials and methods: After obtaining institutional ethical committee approval,100 patients of ASA I and ASAII of pregnant women undergoing caesarean section belonging to age group of 18-35 years randomized by computer generated numbers into two groups (50 each) after fulfilling inclusion criteria. The patients were randomized to receive spinal anaesthesia by either a median (n=50) approach or paramedian approach (n=50). After informed written consent, all patients were premedicated with Inj.Metoclopromide 10mg and all patients received 500ml of Normal saline intravenously over 30minutes before the procedure. Each patient received 9-12mg of hyperbaric bupivacaine with 25G Whitacre spinal needle either through median approach(group M, n=50) or paramedian approach(group PM, n=50).The patients were followed for 48 hours for PDPH, presence of PDPH was assessed by visual numerical analogue scale. Results: Out of total 100 caesarean section patients, six patients developed PDPH. 4/50(8%) had PDPH in median approach and 2/50(4%) had PDPH in paramedian approach. However the difference in incidence of PDPH in both median and paramedian approaches is not statistically significant (p value=0.4000) and the severity of PDPH in both groups was of mild degree. Conclusion: Even though we noticed the incidence of PDPH is less with 25G Whitacre spinal needle in paramedian approach compared to median approach, but there was no significant statistical difference on incidence of PDPH using 25 G Whitacre spinal needle between median and paramedian approach in caesarean section patients. [ABSTRACT FROM AUTHOR]

Anticoagulation is common in patients undergoing routine musculoskeletal interventional maneuvers. Previous retrospective studies have established the safety of continuing anticoagulation with novel oral anticoagulants (NOACs) when performing this kind of interventions. Indeed, ultrasound (US)-guided interventional maneuvers have shown a superior safety profile compared to blind anatomical maneuvers. To evaluate prospectively the periprocedural bleeding events in NOAC-anticoagulated patients undergoing interventional articular or periarticular procedures. Consecutive patients diagnosed with inflammatory or degenerative rheumatologic pathology requiring interventional maneuvers were prospectively recruited. Group 1 was treated with NOACs, group 2 was treated with vitamin K antagonists, and group 3 was not anticoagulated. Prior to the international maneuver, NOAC therapy was continuously administered, in regimens dictated by the underlying anticoagulation indication. Demographics, comorbidities, laboratory parameters, locally administered medication (corticosteroids or viscosupplementation), interventional maneuver location, needle size, and local bleeding events were recorded. Post-procedural control was performed at 30 min, 48 h, and 7 days. No articular/periarticular bleeding event occurred in patients treated with NOACs, regardless of their type and dosage, locally administered medication, needle size, location, and number of interventions per individual. Several patients in all groups developed small superficial ecchymoses at the injection site. Our results suggest that NOACs are safe to be used in a continuous regimen prior to US-guided injections, even as dual antithrombotic therapy (in combination with aspirin). The use of lower gauge needles, chosen for viscosupplementation therapy, was not burdened with adverse effects on the procedural outcome. Key Points • Currently, no prospective studies have been performed to establish the safety of continuous NOAC anticoagulation when performing routine intra- or periarticular interventional maneuvers. • The study offers an extensive view on a wide spectrum of intra- and periarticular interventional maneuvers including anatomic targets and needle sizes that were not previously assessed. • The study offers a perspective into performing repetitive maneuvers in the same patient, both over a short time and at longer intervals. • The zero periprocedural bleeding risk observed in our study may reassure practitioners and suggest that US-guided interventional therapeutic interventions are safe in patients treated with a continuous regimen of different NOACs. [ABSTRACT FROM AUTHOR]

Introduction: The nasal region plays a pivotal role in both facial esthetics and functionality. The use of volumizing fillers has emerged as a potential means to enhance nasal appearance. Preliminary findings from cadaveric studies have highlighted potential risks associated with deeper needle injection, leading to cartilage damage and lateral migration of filler material. Understanding the subcutaneous tissue depth is crucial to prevent such complications and ensure safe filler placement guided by anatomical knowledge. Methods: This study aimed to employ ultrasonographic assessment to precisely measure the depth of soft tissue in the nasal area. Fifty‐two participants without prior nasal surgery or filler injections underwent detailed ultrasonographic evaluation, focusing on seven key anatomical points: Glabellar, Sellion, Rhinion, between Rhinion and Pronasal, Pronasal, between Pronasal and Subnasal, and Subnasal. Results: The ultrasonographic observation revealed varying depths of subcutaneous tissue across these points: Glabellar (4.11 ± 0.79), Sellion (5.21 ± 0.97), Rhinion (2.02 ± 0.74), Rhinion to Pronasal midpoint (6.45 ± 3.1), Pronasal (9.5 ± 2.2), between Pronasal and Subnasal (8.8 ± 0.8), and Subnasal (8.5 ± 0.5). Discussion: The discussion underscores the significance of understanding subcutaneous tissue depth in guiding needle length and approach angles during filler injections. This knowledge aids in achieving effective filling while ensuring safe placement within the subcutaneous tissue. [ABSTRACT FROM AUTHOR]

The Airy beam has attracted great attention since it was proposed in 2007 due to its novel properties, such as non-diffraction, self-healing, and self-acceleration. However, the spin angular momentum (SAM), which is an intrinsic nature of light, has rarely been studied by the Airy beam. Here, we propose a kind of binary circular Airy beam (BCAB) with space-variant polarizations and vortex phases and study the SAM evolution of the BCAB during propagation. We find the effects of appearance and annihilation of SAM during the propagation of BCAB, and the SAM can be further manipulated by adjusting the initial phase and polarization distribution of BCAB. Moreover, the optical tube, optical needle, and optical cage carrying different SAMs are achieved in propagation, which can be applied in various regions, such as optical trapping and manipulation. The BCAB significantly enriches the family of structured light and provides a flexible control scheme of SAM, which can further promote the application of SAM in many fields. [ABSTRACT FROM AUTHOR]

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Conjugated electrospinning is an exciting way to prepare nanoyarns. However, all currently reported preparations of nanofiber yarns by conjugated electrospinning use needles, which can cause discontinuous yarn production due to plugging needles during the preparation process. Herein, a novel disc treated with rounded corners as the spinneret of conjugated electrospinning was developed to spin continuously twisted nanofiber yarn to overcome the existing problems. First, finite element analysis was used to optimize the parameters of the disc. The disc exhibited the optimal field strength distribution on the spinning surface when the disc rounding angle was 0.7, and the coefficient of variation value of the field strength was only 12.6%. After that, we optimized the effect of spinning parameters on yarn yield by central composite design. In addition, the impact of spinning parameters on fiber morphology was also investigated. Under the optimized parameters, it is possible to spin continuously at a 360 m/h speed for at least 1 h without breaking. This innovative approach provides a novel idea for continuously producing nanofiber yarns. [ABSTRACT FROM AUTHOR]

To investigate the feasibility and efficacy of combining ultrasound-guided sharp needle technique with percutaneous transluminal angioplasty (PTA) for treating outflow stenosis or dysfunction in arteriovenous fistula (AVF) among hemodialysis patients. From October 2021 to March 2023, patients with occluded or malfunctional fistula veins not amenable to regularly angioplasty were retrospectively enrolled in the study. They underwent ultrasound-guided sharp needle intervention followed by PTA. Data on the location and length between the two veins, technical success, clinical outcomes, and complications were collected. Patency rates post-angioplasty were calculated through Kaplan-Meier analysis. A total of 23 patients were included. The mean length of the reconstructed extraluminal segment was 3.18 cm. The sharp needle opening was performed on the basilic vein (60.9%), brachial vein (26.1%), or upper arm cephalic vein (13%) to create outflow channels. Postoperatively, all cases presented with mild subcutaneous hematomas around the tunneling site and minor diffuse bleeding. The immediate patency rate for the internal fistulas was 100%, with 3-month, 6-month, and 12-month patency rates at 91.3%, 78.3%, and 43.5%, respectively. Sharp needle technology merged with PTA presents an effective and secure minimally invasive method for reconstructing the outflow tract, offering a new solution for recanalizing high-pressure or occluded fistulas. [ABSTRACT FROM AUTHOR]

This work presents the effect of interpillar distance in a two-step dry reactive ion etching DRIE process for microneedle fabrication. The two-step DRIE process consists of a pillar creation followed by the pillar etching till turning it into a needle. The effect was carried out in a dumbbell-well pattern. The employed dumbbell-well pattern was adjusted to produce 650-µm microneedle height. The microneedle density was fixed at 657/cm2, and the interpillar distance was increased by reducing the pillar area. At a short interpillar distance, 25 µm, the etching rate is higher on the surface; for a wider distance, 75–100 µm, the etching produces triangular needles. At an interpillar distance of 200 µm or greater, the pillar etch rate becomes uniform along the microneedle height, producing a thin, sharp micropillar. The obtained silicon microneedles were employed to fabricate polymeric microneedles via micro-molding. The polymeric microneedles obtained by micro-molding showed the exact geometry of the original one. The obtained polymeric microneedles showed the capacity to penetrate the skin with a 0.5 N. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate the targeting accuracy of a novel robot-assisted guidance technique relying on one pair of 2D C-arm images. Material and Methods: In total, 160 punctures were carried out semi-automatically by using a novel robotic device. The needle's paths were planned based on one pair of 2D fluoroscopic images from different angles. Conically shaped aluminum tips inside a gelatin-filled plexiglass phantom served as targets. The accuracy of the needle placement was assessed by taking control CTs and measuring the Euclidean distance (ED) and normal distance (ND) between the needle and the target point. In addition, the procedural time per needle placement was evaluated. Results: The accomplished mean NDs at the target for the 45°, 60°, 75° and 90° angles were 1.86 mm (SD ± 0.19), 2.68 mm (SD ± 0.18), 2.19 mm (SD ± 0.18) and 1.86 mm (SD ± 0.18), respectively. The corresponding mean EDs were 2.32 mm (SD ± 0.16), 2.68 mm (SD ± 0.18), 2.65 mm (SD ± 0.16) and 2.44 mm (SD ± 0.15). The mean duration of the total procedure, including image acquisition, trajectory planning and placement of four needles sequentially, was 12.7 min. Conclusions: Robotic guidance based on two 2D fluoroscopy images allows for the precise placement of needle-like instruments at the first attempt without the need for using an invasive dynamic reference frame. This novel approach seems to be a valuable tool for the precise targeting of various anatomical structures that can be identified in fluoroscopic images. [ABSTRACT FROM AUTHOR]

Introduction: Automated skills assessment can provide surgical trainees with objective, personalized feedback during training. Here, we measure the efficacy of artificial intelligence (AI)-based feedback on a robotic suturing task. Materials and Methods: Forty-two participants with no robotic surgical experience were randomized to a control or feedback group and video-recorded while completing two rounds (R1 and R2) of suturing tasks on a da Vinci surgical robot. Participants were assessed on needle handling and needle driving, and feedback was provided via a visual interface after R1. For feedback group, participants were informed of their AI-based skill assessment and presented with specific video clips from R1. For control group, participants were presented with randomly selected video clips from R1 as a placebo. Participants from each group were further labeled as underperformers or innate-performers based on a median split of their technical skill scores from R1. Results: Demographic features were similar between the control (n = 20) and feedback group (n = 22) (p > 0.05). Observing the improvement from R1 to R2, the feedback group had a significantly larger improvement in needle handling score (0.30 vs −0.02, p = 0.018) when compared with the control group, although the improvement of needle driving score was not significant when compared with the control group (0.17 vs −0.40, p = 0.074). All innate-performers exhibited similar improvements across rounds, regardless of feedback (p > 0.05). In contrast, underperformers in the feedback group improved more than the control group in needle handling (p = 0.02). Conclusion: AI-based feedback facilitates surgical trainees' acquisition of robotic technical skills, especially underperformers. Future research will extend AI-based feedback to additional suturing skills, surgical tasks, and experience groups. [ABSTRACT FROM AUTHOR]

Aim: Incisional herniation (IH) is a frequent complication following midline abdominal closure with significant associated morbidity. Randomized controlled trials have demonstrated that the small bites technique (SBT) and prophylactic mesh augmentation (PMA) may reduce IH compared to mass closure techniques, but data are lacking on their implementation in contemporary surgical practice. This survey aimed to evaluate the use of the SBT and PMA and to identify factors associated with their adoption. Method: Between 22 January 2023 and 16 March 2023, consultant surgeons across the UK were asked to complete a 25‐question survey on closure of an elective primary midline incision. Results: Responses were received from 267 of 675 eligible surgeons (39.6%) in 38 NHS Trusts. Respondents were evenly split between tertiary centres (47.6%) and district general hospitals (49.4%). SBT and PMA were used by 19.9% and 3.0% of respondents, respectively. Compared to other techniques, surgeons using the SBT were more likely to close the anterior aponeurotic layer only, use single suture filaments, 2–0 gauge sutures and sharp needle points and routinely dissect abdominal layers to aid closure (all p < 0.001). Attendance at lectures/conferences on SBT (p = 0.043) and basing practice on available evidence (p < 0.001) were independently associated with use of the SBT. The commonest barriers to adopting SBT were a perceived lack of evidence (23.8%) and belief that personal IH rates were low (16.8%). Conclusion: A minority of UK consultant surgeons have adopted the SBT or PMA. Practice change should be driven by more widespread dissemination of current evidence and procedural information. [ABSTRACT FROM AUTHOR]

Water droplets of varying volumes exhibit distinct behaviors at the tip of a needle under the influence of gravitational force: larger droplets fall from the needle tip, while smaller droplets adhere to the needle tip. By integrating a superhydrophobic hole, which allows the needle to pass through but hinders droplets' passage, a method to allow smaller droplets to fall from the needle was evaluated. The interaction between water droplets and a superhydrophobic hole was studied experimentally, and two phenomena were observed: either the droplet detached from the needle tip or the needle pulled it through the superhydrophobic hole. A critical detachment volume V cri d 0 , D , dependent on the needle diameter d 0 and the superhydrophobic hole diameter D , determines droplet behavior. When the volume of the droplet V droplet > V cri d 0 , D , the droplet detaches from the needle tip. When the V droplet < V cri d 0 , D , the droplet penetrates through the superhydrophobic hole. The results show that the critical detachment volume V cri d 0 , D increases with an increase in d 0 for a given superhydrophobic hole and with an increase in D for a given needle. To enable a 0.25 μl droplet to fall from a 32G needle, a superhydrophobic hole of 0.48 mm diameter was employed. Furthermore, a mechanical model based on force equilibrium was developed to describe the interaction between water droplets and a superhydrophobic hole. [ABSTRACT FROM AUTHOR]

Aim: We conducted a meta‐analysis comparing the invasiveness of automatic lancet devices, which can collect adequate amount of blood at shallow puncture depths, with conventional manual lance devices (lancet or needle) to statistically identify less invasive instruments for neonatal heel lance. Methods: We searched PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and Ichushi databases for studies comparing the invasiveness between automatic lancet and manual lancet or needle in term and preterm neonates in neonatal intensive care unit. Results: This review included 9 out of 449 searched articles, with 673 neonates. Automatic lancet had significantly lower pain scores (standardised mean difference: −2.0, 95% confidence interval: −3.3 to −0.7), heart rate (mean difference: −8.0, 95% confidence interval: −13.8 to −2.1), cry duration (mean difference: −21.5, 95% confidence interval: −32.5 to −10.4), number of punctures (mean difference: −0.6, 95% confidence interval: −1.1 to −0.2), and duration of procedures (mean difference: −37.7, 95% confidence interval: −75.2 to −0.2) than manual lancet or needle. Furthermore, peripheral oxygen saturation was significantly higher in automatic lancet than in manual lancet or needle (mean difference: 4.5, 95% confidence interval: 0.5–8.5). Conclusion: Automatic heel lancet devices were less invasive than manual heel lance devices (lancet or needle). [ABSTRACT FROM AUTHOR]

Introduction: Vitiligo is a common depigmenting skin disorder. This work is performed to systematically evaluate the efficacy and safety of fire needles combined with 308 nm excimer laser therapy in treating vitiligo. Methods: We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases. Randomized controlled trials (RCTs) on fire needles combined with 308 nm excimer laser therapy with 308 nm excimer laser therapy alone for vitiligo were included. The Cochrane Collaborative Network Tool was used to assess the risk of bias. Statistical analysis was completed using RevMan5.3 software and Stata 15.0 software. The GRADE system was used to evaluate the quality of evidence for outcomes. Results: In this study, 10 RCTs and 1333 patients were included. The results showed that compared with 308 nm excimer laser therapy alone, fire needle combined with 308 nm excimer laser therapy is more effective in improving clinical effective rate (RR = 1.36, 95% CI [1.24, 1.50], p < 0.00001), serum CD4+ level (MD = 3.12, 95% CI [2.50, 3.74], p < 0.00001), CD4+/CD8+ ratio (MD = 0.24, 95% CI [0.09, 0.39], p = 0.001), and quality of life measured by the Dermatology Life Quality Index (DLQI) (MD = 3.76, 95% CI [3.33, 4.19], p < 0.00001), and reducing the Vitiligo Area Score Index (VASI) (MD = −5.47, 95% CI [−6.56, −4.37], p < 0.00001). The reported adverse events, including redness, swelling, pain, blisters, and itching, were controllable, and all these events were well tolerated. Conclusion: The current evidence indicates that fire needle combined with 308 nm excimer laser therapy is effective and safe for vitiligo. However, owing to the suboptimal quality of the included studies, more high‐quality and large‐scale RCTs are needed for comprehensive analysis and further validation. [ABSTRACT FROM AUTHOR]

Introduction: Intramuscular (IM) midazolam is indicated for the treatment of status epilepticus. Administration must be efficient to rapidly terminate prolonged seizures and prevent complications. The objective of this study was to compare, in terms of relative bioavailability and bioequivalence, IM midazolam injection by needle-free auto-injector, in different settings, to IM midazolam injection by a conventional syringe and needle. Methods: In this open-label, randomized, four-period crossover study, healthy adults received single doses of midazolam (10 mg) under fasting conditions. The reference treatment (conventional syringe) was administered once, on bare skin in the thigh. The tested treatment (the needle-free auto-injector ZENEO®) was administered three times: on bare skin in the thigh, on bare skin in the ventrogluteal area, and through clothing in the thigh. Repeated plasma samples were collected to obtain 36-h pharmacokinetic (PK) profiles. Primary PK parameters were area under the plasma concentration–time curve, from time zero to the last measurable time point (AUC0−t) and from time zero to infinity (AUC0–∞), and the maximum observed plasma concentration (Cmax). Results: Forty adults were enrolled and included in the PK analysis set. In all comparisons, the 90% confidence interval (CI) of the least-squares geometric mean ratios for AUC0−t and AUC0−∞ were within the bioequivalence range of 80–125%, with low intra-individual coefficients of variation (< 20.5% for all parameters in all comparisons). Bioequivalence was also met for Cmax in all comparisons except when comparing the tested treatment through clothing versus the reference treatment, where the 90% CI lower limit was slightly outside the bioequivalence range (78.8%). With all tested treatments Cmax was slightly lower, but early mean plasma concentrations (first 10 min post-dosing) were higher when compared to the reference treatment. In general, all treatments were well tolerated, with maximum sedation 0.5–1 h post-injection. Discussion/Conclusion: This study establishes that IM midazolam injection on bare skin in the thigh with the ZENEO® is bioequivalent to IM midazolam injection with a syringe and needle. An acceptable relative bioavailability, compatible with emergency practice, was also shown in multiple settings. Higher mean concentrations within the first 10 min with the ZENEO® device, and quicker two-step injection suggest a faster onset of action, and thereby an earlier seizure termination, thus preventing the occurrence of prolonged seizure and neurological complications. Trial Registration Information: ClinicalTrials.gov identifier: NCT05026567. Registration first posted August 30, 2021, first patient enrolled May 9, 2022. Plain Language Summary: Seizures require urgent treatment when they last longer than 5 min. Indeed, when prolonged, seizures can lead to damage to the brain, coma, and ultimately death. Midazolam injected in the muscle (i.e., intramuscular (IM) injection) has become the first-line treatment of choice for long-lasting seizures and is usually administered with a syringe and 30-mm needle. The ZENEO® needle-free auto-injector is an innovative, pre-filled, single-dose, disposable, ready-to-use, two-step device that could become an alternative method for midazolam IM administration. This study therefore compared midazolam IM injections with the ZENEO® auto-injector versus IM injections with a conventional syringe and needle. The ZENEO® auto-injector was tested in different conditions (on bare skin, through clothing, in the thigh, and in the hip) in healthy volunteers. The study showed, with a pharmacokinetic analysis (how much and how fast a drug is taken in the bloodstream), that midazolam absorption was similar in all tested conditions, indicating that the ZENEO® auto-injector is a suitable method for midazolam administration. In addition, the study showed that in the first 10 min of the injection, the amount of midazolam in the blood seemed to be higher when injections were performed with the ZENEO® auto-injector, suggesting that seizure treatment may start working sooner if injected with the device. This is particularly important and relevant in emergency situations and prehospital settings in order to prevent long-lasting seizures and irreversible damage to the brain (which can occur when a crisis lasts for 30 min) and ultimately improve the patient's outcome. [ABSTRACT FROM AUTHOR]

Previous studies indicate an implication of the terminal complement complex (TCC) in disc degeneration (DD). To investigate the functional role of TCC in trauma-induced DD in vivo, the model of endplate (EP) drilling was first applied in rabbits using a C6-deficient rabbit strain in which no TCC formation was possible. In parallel the model of needle puncture was investigated. Using a minimally invasive surgical intervention, lumbar rabbit intervertebral discs (IVDs) were treated with EP drilling or needle puncture. Degenerative effects of both surgical interventions were assessed by Pfirrmann grading and T2 quantification of the IVDs based on high-resolution MRI (11.7 T), as well as radiographic determination of disc height index. Pfirrmann grading indicated significant degenerative effects after EP drilling. Contrary to our assumption, no evidence was found that the absence of TCC formation in C6-deficient rabbits reduces the development of DD compared to C6-sufficient animals. EP drilling was proven to be suitable for application in rabbits. However, results of the present study do not provide clear evidence of a central functional role of TCC within DD and suggest that TCC deposition in DD patients may be primarily considered as a marker of complement activation during DD progression. [ABSTRACT FROM AUTHOR]

Background: Performing spinal anaesthesia in elderly patients with ligament calcification or hyperostosis is challenging for novice practitioners. This pilot study aimed to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) by novice practitioners in elderly patients. Methods: In this pilot study, 36 patients (aged ≥ 65 years) scheduled for elective surgery under spinal anaesthesia by anaesthesiology residents were included. Patients were randomly assigned to the MRasp group (n = 18) or the LGsp group (n = 18). The outcomes included the number of needle insertion attempts, redirection attempts, passes, the rate of successful first-attempt needle insertion, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. Results: The median number of needle insertion attempts was significantly fewer in the MRasp group than in the LGsp group (1.0 vs 2.0, P = 0.023). The proportion of patients with successful first-attempt needle insertion was 72.2% in the MRasp group and 44.4% in the LGsp group (P = 0.176). The incidence of perioperative complications did not significantly differ between the two groups. Conclusion: This pilot study found that novice practitioners made significantly fewer needle insertion attempts in the MRasp group compared to the LGsp group when performing spinal anaesthesia on elderly patients. A future randomized controlled trial (RCT) is warranted to validate its effectiveness. Trial Registration: This trial was registered at https://www.chictr.org.cn/showproj.html?proj=178960 (ChiCTR-IPR-2300068520). Public title: Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: a randomized controlled pilot study. Principal investigator: Lei Gao. The registration date was February 22, 2023. The date of the first participant enrolment was February 27, 2023. Plain Language Summary: We developed virtual spine-presenting technology and patented optimal trajectory design technology to assist in spinal puncture and reported that the median number of needle insertion attempts was significantly fewer in the mixed reality-assisted spinal puncture group than in the landmark-guided spinal puncture group. [ABSTRACT FROM AUTHOR]

Copyright of Istanbul Gelisim University Journal of Health Sciences / İstanbul Gelişim Üniversitesi Sağlık Bilimleri Dergisi is the property of Istanbul Gelisim Universitesi Saglik Bilimleri Yuksekokulu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary Background Objectives Study design Methods Results Main limitations Conclusions Equine dermal melanoma is a skin tumour most commonly seen in grey horses. Most grey horses will develop at least one tumour if they live long enough. Dermal melanoma and dermal melanomatosis are histologically identical, but dermal melanoma can present as either isolated single or multiple discreet lesions, while dermal melanomatosis presents as multiple coalescing lesions. These tumours are slow growing and have a predilection for the base of the tail, perineum, prepuce, parotid salivary gland and commissures of the lips. This report describes 980‐nm diode laser photothermal ablation as a non‐invasive treatment for equine dermal melanoma.To report the results of a series of horses that underwent laser photothermal ablation of equine dermal melanomas with a 980‐nm diode therapy laser.Retrospective case series.Horses were sedated for a standing procedure and restrained in stocks. A thermocouple needle was inserted deep to/into each lesion and the laser was applied either in contact or non‐contact fashion at 4–6 watts until a temperature of 50°C was reached. Masses that were significantly thicker than 1 cm had thermocouple needles placed at multiple levels. After 1 month, treatment sites were re‐evaluated. Lesions in which the planned treatment and follow‐up were completed were included.Fifty‐one individual melanomas in seven horses were included. Fifty lesions were classified as ‘Complete Response’ (CR). One thicker lesion had a ‘Partial Response’ (PR) but there was CR to the depth that temperature was reached.Only tumours approximating 1 cm in thickness are practical.Laser photothermal ablation using a 980‐nm therapy laser is a practical, non‐invasive and readily available modality for treating smaller equine dermal melanomas. Thickness rather than surface area is the main limitation for a single application. [ABSTRACT FROM AUTHOR]

The conventional round suture needle poses a significant risk of needle stick injuries among surgical physicians, identified as a global occupational hazard by the World Health Organization, increasing hospital costs and exposure to bloodborne pathogens. While novel blunt suture needles have shown promise in reducing these risks, their adoption is limited domestically, prompting a study to compare their efficacy against traditional sharp needles in reducing needle stick injuries among surgical physicians. To investigate suture needle stick injuries among surgical doctors during operations and assess the application effectiveness of a novel blunt suture needle. A total of 106 surgical department physicians from March 2021 to February 2023 participated in the study. After completing a questionnaire survey on suture needle injuries during surgery, the participants were divided into two groups. Over a 6-month intervention period, the control group used regular round needles while the study group utilized novel blunt suture needles. Subsequently, suture needle injury incidence rates and economic hygiene benefits were compared between the two groups. The suture needle injury questionnaire survey showed that over the past 6 months, among 106 surgical department physicians, 20 needle stick injuries occurred, yielding an incidence rate of 18.87%. The highest incidence (65.00%) was during suturing incisions longer than 10 cm, primarily when visibility was poor (70.00%). Surgeons linked most injuries (60.00%) to prolonged surgical duration causing fatigue. Although 85.00% detected injuries within 1 minute, only 40.00% were reported, often due to perceived reporting complexity. Following intervention, the study group had significantly fewer injuries per surgery and lower occupational exposure costs compared to the control group (p< 0.05). Surgical department physicians commonly sustain suture needle injuries while suturing incisions of 5–10 cm length under poor visibility, exacerbated by prolonged surgical duration. Despite detecting most injuries within 1 minute, only 40% are reported. The implementation of novel blunt suture needles significantly decreases injury rates, resulting in reduced occupational exposure costs and favorable safety and economic hygiene outcomes. [ABSTRACT FROM AUTHOR]

Due to the high fiber volume fraction of carbon fiber spread tow plain weave fabrics, it is difficult for short fibers to be brought into the thickness direction to form needled fiber bundles during the needling process. The interlaminar performance of the carbon fiber spread tow needled preform is weak, and the in‐plane damage is also severe. Responding to this issue, this article proposed a new method for preparing carbon fiber spread tow needled preform based on short yarn needling, which was expected to manufacture high‐performance carbon fiber spread tow needled preform and composite. We conducted experimental research on the preparation and structural characterization of the preform, as well as the Mode I interlaminar mechanical properties and in‐plane tensile properties of composites. The results showed that the fiber volume fraction of the preform significantly increased, reaching to 55.7%–56.1%, which was 25.5%–25.9% higher than that of traditional needled preform. The Mode I interlaminar property of carbon fiber spread tow needled composite reached to 905–4376 J m−2, which was improved by 29.3%–525.1% and 125.8%–1054.6% compared to traditional needled composite and laminated composite, respectively. At the same time, the tensile strength and tensile modulus were also improved by 191.5%–212.2% and 66.2%–78.1% compared to traditional needled composites. The preparation method of carbon fiber spread tow needled preform based on short yarn needling has laid the foundation for the 3D printing molding of dry fiber fabrics and is expected to be applied to high‐quality needling of high thickness and large curvature‐shaped fabric preforms. Highlights: A novel method was proposed for preparing high‐performance carbon fiber spread tow needled preform based on short yarn needling.The fiber volume fraction of novel carbon fiber spread tow needled preform significantly increased, reaching to 55.7%–56.1%.The GIc of the novel carbon fiber spread tow needled composite was improved by 29.3%–525.1% compared to the traditional needled composite.The tensile strength and tensile modulus were also improved by 191.5%–212.2% and 66.2%–78.1%, compared to traditional needled composites. [ABSTRACT FROM AUTHOR]

Transperineal laser ablation is a minimally invasive thermo-ablative treatment for prostate cancer that requires the insertion of a needle for accurate optical fiber positioning. Needle insertion in soft tissues may cause tissue motion and deformation, resulting in tissue damage and needle positioning errors. In this study, we present a wasp-inspired self-propelled needle that uses pneumatic actuation to move forward with zero external push force, thus avoiding large tissue motion and deformation. The needle consists of six parallel 0.25-mm diameter Nitinol rods driven by a pneumatic actuation system. The pneumatic actuation system consists of Magnetic Resonance (MR) safe 3D-printed parts and off-the-shelf plastic screws. A self-propelled motion is achieved by advancing the needle segments one by one, followed by retracting them simultaneously. The advancing needle segment has to overcome a cutting and friction force, while the stationary needle segments experience a friction force in the opposite direction. The needle self-propels through the tissue when the friction force of the five stationary needle segments overcomes the sum of the friction and cutting forces of the advancing needle segment. We evaluated the prototype's performance in 10-wt% gelatin phantoms and ex vivo porcine liver tissue inside a preclinical Magnetic Resonance Imaging (MRI) scanner in terms of the slip ratio of the needle with respect to the phantom or liver tissue. Our results demonstrated that the needle was able to self-propel through the phantom and liver tissue with slip ratios of 0.912–0.955 and 0.88, respectively. The prototype is a promising step toward the development of self-propelled needles for MRI-guided transperineal laser ablation as a method to treat prostate cancer. [ABSTRACT FROM AUTHOR]

To investigate the efficacy of formalin disinfection of the needle tip in transrectal prostate biopsy (TRB) procedure to reduce infectious complications. The primary aim is to assess the impact of formalin on bacterial contamination of biopsy needle tips and its association with post-biopsy infective events. We have employed a bacterial culture-based observational cohort design in this study. Two groups, formalin disinfection and non-formalin group, both underwent systematic 12-core TRB. In the formalin group, the biopsy needle tip was immersed in 10% formalin solution after each core, while in the non-formalin group, no formalin solution immersion was used. The primary outcomes include bacterial growth on biopsy needle tips and post-biopsy infective events. Formalin disinfection significantly reduced bacterial growth on needle tips (P <.001). The formalin group had no post-biopsy infections or sepsis, while the non-formalin group experienced a 7.5% infective event rate after TRB. Formalin disinfection of biopsy needle tip significantly reduces bacterial growth on biopsy needle and urinary tract infectious complications developed secondary to TRB. Further multicenter randomized controlled studies with larger cohorts are warranted to validate and establish formalin disinfection as a routine practice in TRB procedures. [ABSTRACT FROM AUTHOR]

This pilot study aimed to evaluate safety and tissue sampling from subepithelial lesions (SEL) in the upper gastrointestinal tract with a novel electric motor driven endoscopic ultrasonography (EUS)-guided 17-gauge (G) size core needle biopsy (CNB) instrument. An investigator-led prospective open label, performance and safety control study, including seven patients (female n = 4, median 71 y, range 28–75) with a determined SEL (median size 30 mm, range 17–150 mm) in the upper digestive tract (stomach n = 6, duodenum n = 1) were eligible and later followed up 14 days after index procedure. All investigations were completed according to protocol with three FNB 22-G passes with four fanning strokes and two EndoDrill® 17-G passes with three fanning strokes. Quality of samples as 'visible pieces' (>5 mm): FNB (n = 5/7) (fragmented/blood imbibed n = 1, poor tissue quantity n = 1) compared with 17-G CNB (n = 7/7). Histological result which led to final diagnosis (leiomyoma n = 2, adenocarcinoma n = 1, schwannoma n = 1, neuroendocrine tumour n = 1, desmoid tumour n = 1 and gastrointestinal stromal tumour (GIST) n = 1) could be obtained with the 17-G CNB instrument in all seven patients. FNB technique reached correct diagnosis in six patients. No serious adverse event were recorded. By using an electric driven 17-G biopsy device, a true cylinder of core tissue can be obtained in one single puncture from the area of interest reducing the need for a second sampling. The absolute benefit of EUS-guided CNB is that the sample can be handled and histologically prepared in the same manner as standard percutaneous core needle sample, e.g., breast and prostate cancer. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of needle position on the laterality of contrast flow in CT-guided lumbar interlaminar epidural steroid injections. Materials and methods: A retrospective review of consecutive CT-guided interlaminar lumbar epidural steroid injections was performed. The terminal needle tip position (midline or lateral) and the laterality of epidural contrast were evaluated by two readers. Contrast flow pattern was classified as ipsilateral to needle trajectory, bilateral, or contralateral. Bilateral flow was further divided into asymmetric, symmetrical, or asymmetric to the contralateral side. Inter-reader agreement was calculated with the kappa statistic. The relationship of needle position to contrast laterality was calculated with the chi statistic. Pain scores were compared for bilateral and unilateral flows with a two-tailed T test for independent means. Results: A total of 250 injections were included in 204 patients, with an age range of 24 to 93 years. The most commonly injected level (145/250) was L4–L5. Agreement between the two readers was almost perfect and substantial (kappa 0.751–0.880). The majority of injections (154/250) demonstrated contrast flow ipsilateral to the needle trajectory, 90/250 demonstrated bilateral flow, and 6/250 had contralateral flow. Of the 90 cases with bilateral flow, 80% were performed with a midline terminal needle position (p < 0.001). There was no difference in immediate post-procedure pain scores between patients with ipsilateral or bilateral contrast flow. Conclusion: For interlaminar epidural steroid injections, a midline terminal needle tip position has a greater probability of producing bilateral contrast flow compared to a lateral terminal needle tip position. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the performance of an optically tracked robot for computed-tomography (CT)-guided needle placements in a phantom study. Methods: In total, 240 needle punctures were carried out with the help of an optically tracked robotic device (Micromate) based on CT image datasets at three different slice thicknesses (1, 3, and 5 mm). Conically shaped targets inside a gelatin-filled plexiglass phantom were punctured. The target positioning error between the planned and actual needle trajectory was assessed by measuring the lateral positioning error (ND) between the target and the puncture needle and the Euclidean distance (ED) between the needle tip and target in control CTs. Results: The mean ND and ED for the thinnest CT slice thickness were 1.34 mm (SD ± 0.82) and 2.1 mm (SD ± 0.75), respectively. There was no significant impact of target depth on targeting accuracy for ND (p = 0.094) or ED (p = 0.187). The mean duration for the planning of one trajectory and for needle positioning were 42 s (SD ± 4) and 64 s (SD ± 7), respectively. Conclusions: In this ex vivo study, the robotic targeting device yielded satisfactory accuracy results at CT slice thicknesses of 1 and 3 mm. This technology may be particularly useful in interventions where the accurate placement of needle-like instruments is required. [ABSTRACT FROM AUTHOR]

The new advancement in percutaneous intervention procedures, which provides more accurate needle placement compared to other modalities, is Augmented Reality (AR). It provides the operator with 3-dimensional (3D) or 2-dimensional (2D) structures of the anatomy along with the target during surgery to get a precise needle placement into the target. The review highlights that using AR systems for needle navigation and placement can become productivity in various interventional procedures. The AR navigation system reduces radiation exposure, procedural time, risk to the patient, and ensures higher accuracy of needle placement than conventional Computed Tomography (CT)-guided percutaneous procedure systems. The AR system can provide precisely guided needle insertion and reduce the risk of complications. As technology and research are increasing, new techniques, such as automatic image-hologram registration, can be brought into the picture. This review compares conventional image-guided procedure systems with the AR system in the interventional radiology field. This review also provides detailed information about AR as a promising tool for optimising needle placement in interventional procedures, paving the way for safer and more effective clinical practices. [ABSTRACT FROM AUTHOR]

In this study, the effects of defoliation caused by fungal pathogens on the tree vitality and growth of a 33-year old Douglas-fir (Pseudotsuga menziesii) provenance plantation in northwestern Bulgaria was presented. The results of the conducted surveys in 2011 and 2020 showed that there were significant differences between the individual provenances of Douglas-fir concerning their susceptibility to the needle cast diseases, caused by the fungal pathogens Rhabdocline pseudotsugae and Phaeucryptopus gaeumannii. The extent of damage, expressed as the amount of Douglas-fir needles cast, varied among provenance groups in individual years. A serious degree of defoliation was assessed among all continental provenances. In 2011, all examined trees from the group of continental provenances had severe symptoms of the needle cast disease. In 71.5% of them, the defoliation of the crowns was over 25% – moderately to severely affected. The average degree of defoliation varied from 18.3% (32 Wаrm Springs) to 89.3% (55 Alamogordo). In 2020, severe defoliation was found among all continental provenances. Both fungal pathogens were found as causes of the defoliation of 64.3% of the trees. The growth indicators: average height, average diameter at breast height, average height- and diameter increment for survived provenances in 2011 (at age 24) and 2020 (at age 33) were evaluated. The loss of needles and the reduced physiological function of the trees affected their vitality in the following years. Relationships between the average current annual height and diameter increment by provenance groups for 2003–2011 and 2011–2020 were calculated. It was found that with an increase in the degree of defoliation, the height and diameter increment of the provenances decreases. [ABSTRACT FROM AUTHOR]

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 — TMJ arthrocentesis with the classic concentric needle; and group 2 — TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale — VAS, 0–10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months. [ABSTRACT FROM AUTHOR]

Purpose: To introduce alternating current‐controlled, conductive ink‐printed marker that could be implemented with both custom and commercial interventional devices for device tracking under MRI using gradient echo, balanced SSFP, and turbo spin‐echo sequences. Methods: Tracking markers were designed as solenoid coils and printed on heat shrink tubes using conductive ink. These markers were then placed on three MR‐compatible test samples that are typically challenging to visualize during MRI scans. MRI visibility of markers was tested by applying alternating and direct current to the markers, and the effects of applied current parameters (amplitude, frequency) on marker artifacts were tested for three sequences (gradient echo, turbo spin echo, and balanced SSFP) in a gel phantom, using 0.55T and 1.5T MRI scanners. Furthermore, an MR‐compatible current supply circuit was designed, and the performance of the current‐controlled markers was tested in one postmortem animal experiment using the current supply circuit. Results: Direction and parameters of the applied current were determined to provide the highest conspicuity for all three sequences. Marker artifact size was controlled by adjusting the current amplitude, successfully. Visibility of a custom‐designed, 20‐gauge nitinol needle was increased in both in vitro and postmortem animal experiments using the current supply circuit. Conclusion: Current‐controlled conductive ink‐printed markers can be placed on custom or commercial MR‐compatible interventional tools and can provide an easy and effective solution to device tracking under MRI for three sequences by adjusting the applied current parameters with respect to pulse sequence parameters using the current supply circuit. [ABSTRACT FROM AUTHOR]

Purpose: The present study reviews the available scientific literature on artificial intelligence (AI)‐assisted ultrasound‐guided regional anaesthesia (UGRA) and evaluates the reported intraprocedural parameters and postprocedural outcomes. Methods: A literature search was performed on 19 September 2023, using the Medline, EMBASE, CINAHL, Cochrane Library and Google Scholar databases by experts in electronic searching. All study designs were considered with no restrictions regarding patient characteristics or cohort size. Outcomes assessed included the accuracy of AI‐model tracking, success at the first attempt, differences in outcomes between AI‐assisted and unassisted UGRA, operator feedback and case‐report data. Results: A joint adaptive median binary pattern (JAMBP) has been applied to improve the tracking procedure, while a particle filter (PF) is involved in feature extraction. JAMBP combined with PF was most accurate on all images for landmark identification, with accuracy scores of 0.83, 0.93 and 0.93 on original, preprocessed and filtered images, respectively. Evaluation of first‐attempt success of spinal needle insertion revealed first‐attempt success in most patients. When comparing AI application versus UGRA alone, a significant statistical difference (p < 0.05) was found for correct block view, correct structure identification and decrease in mean injection time, needle track adjustments and bone encounters in favour of having AI assistance. Assessment of operator feedback revealed that expert and nonexpert operator feedback was overall positive. Conclusion: AI appears promising to enhance UGRA as well as to positively influence operator training. AI application of UGRA may improve the identification of anatomical structures and provide guidance for needle placement, reducing the risk of complications and improving patient outcomes. Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]