Search

Background: Traditional puncture skills training for refresher doctors faces limitations in effectiveness and efficiency. This study explored the application of generative AI (ChatGPT), templates, and digital imaging to enhance puncture skills training. Methods: 90 refresher doctors were enrolled sequentially into 3 groups: traditional training; template and digital imaging training; and ChatGPT, template and digital imaging training. Outcomes included theoretical knowledge, technical skills, and trainee satisfaction measured at baseline, post-training, and 3-month follow-up. Results: The ChatGPT group increased theoretical knowledge scores by 17–21% over traditional training at post-training (81.6 ± 4.56 vs. 69.6 ± 4.58, p < 0.001) and follow-up (86.5 ± 4.08 vs. 71.3 ± 4.83, p < 0.001). It also outperformed template training by 4–5% at post-training (81.6 ± 4.56 vs. 78.5 ± 4.65, p = 0.032) and follow-up (86.5 ± 4.08 vs. 82.7 ± 4.68, p = 0.004). For technical skills, the ChatGPT (4.0 ± 0.32) and template (4.0 ± 0.18) groups showed similar scores at post-training, outperforming traditional training (3.6 ± 0.50) by 11% (p < 0.001). At follow-up, ChatGPT (4.0 ± 0.18) and template (4.0 ± 0.32) still exceeded traditional training (3.8 ± 0.43) by 5% (p = 0.071, p = 0.026). Learning curve analysis revealed fastest knowledge (slope 13.02) and skill (slope 0.62) acquisition for ChatGPT group over template (slope 11.28, 0.38) and traditional (slope 5.17, 0.53). ChatGPT responses showed 100% relevance, 50% completeness, 60% accuracy, with 15.9 s response time. For training satisfaction, ChatGPT group had highest scores (4.2 ± 0.73), over template (3.8 ± 0.68) and traditional groups (2.6 ± 0.94) (p < 0.01). Conclusion: Integrating AI, templates and digital imaging significantly improved puncture knowledge and skills over traditional training. Combining technological innovations and AI shows promise for streamlining complex medical competency mastery. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. Methods: The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. Results: PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p < 0.05). Conclusions: The application of navigation system based on deep learning and mixed reality in PNL for kidney stones allows for real-time intraoperative navigation, with acceptable accuracy and safety. Most importantly, this technique is easily mastered, particularly by novice surgeons in the field of PNL. [ABSTRACT FROM AUTHOR]

This study explores the effect of chemical treatment on the physical, mechanical, and morphological properties of two kinds of sisal geotextiles treated with potassium hydroxide and coated with bitumen emulsion. Physical characteristics like mass per unit area, yarn properties, thickness, water absorption and mechanical properties, including tensile, tearing, and puncture strength, were examined. The findings showed significant enhancements in tensile strength (up to 54.90%), tearing strength (up to 103.81%), and puncture strength (up to 32.2%) of emulsion-coated untreated, emulsion-coated alkali-treated and alkali-treated geotextiles, respectively. Furthermore, the alkali-treated emulsion-coated geotextile had the highest mass per unit area with the least water absorption. Morphological, elemental, and crystallographic analyses complemented these outcomes. [ABSTRACT FROM AUTHOR]

The growth of e‐commerce trade has led to more parcel shipments, causing an increase in corrugated board box packaging. Individually shipped boxes often sustain more damage, like crushing or puncturing, compared to pallet‐transported boxes. In contrast to the known relationships between containerboard properties and box compressive strength, there is no standard method for designing corrugated board against puncturing, which can result in damages, customer dissatisfaction and costly returns. A hole is typically seen as a severe compromise to package integrity, whereas some crushed boxes can be acceptable for nonfragile items. Addressing this, this research has focused on developing design equations linking containerboard and corrugated board properties to resistance against puncturing. These equations give the energy loss of an impacting object that would cause a hole and define the energy absorbance limit of the material. The equations enable material design aimed at minimizing puncturing risks based on specific distribution chain conditions, like fall heights and velocities. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasonography is essential in pancreatic solid lesions in order to obtain pathological assessment. The use of new tools and their proper handling are essential to maximise the efficiency of sampling. The 2nd generation cutting needles are superior to fine aspiration ones used for 25 years, which must now be abandoned. The slow-pull technique and/or suction (more or less strong) should be used during sampling, which should be carried out using rapid, sharp penetration movements. Macroscopic assessment of the quality of the samples is necessary before deciding to stop the procedure. Contrast endoscopic ultrasonography allows better characterization of the lesion and prediction of its malignant nature, allowing the best choice of sampling technique according to its vascularization degree. It should be used routinely. Artificial intelligence should soon help improve the diagnostic efficiency of endoscopic ultrasonography. [ABSTRACT FROM AUTHOR]

Objective To summarize the occurrence of complications in renal graft biopsy, and to analyze the indications for puncture and types of pathological diagnosis. Methods The data of 703 samples of ultrasound-guided renal graft biopsy from 644 kidney transplant recipients from January 1, 2017, to December 31, 2022 was retrospectively analyzed. The puncture qualification rate, complications, indicative biopsy indications and pathological diagnosis types were analyzed. The application of surveillance biopsy and pathological diagnosis were also analyzed. Results The qualification rate of renal tissue puncture biopsy was 99.9%, and the complications of puncture bleeding included one sample of perinephric hematoma and one sample of hematuria. Increased serum creatinine (76.8%) and proteinuria (13.8%) were the main indications for puncture, and 48 samples (6.8%) were surveillance biopsy for the assessment of therapeutic effects. A total of 399 samples of pathological diagnosis of rejection, including 293 samples of cellular rejection reaction, 60 samples of antibody rejection reaction, and 46 samples of mixed rejection reaction. One hundred and ninety-five samples of recurrence or new-onset kidney disease, mainly including 144 samples of IgA nephropathy and 42 samples of focal segmental glomerulosclerosis. Fifty-seven samples of infection related kidney disease, including 56 samples of BK virus-associated nephropathy (BKVAN). Thirty-one samples of calcineurin inhibitor (CNI) nephrotoxicity injury, including 15 samples of acute CNI nephrotoxicity injury and 16 samples of chronic CNI nephrotoxicity injury. Forty-five samples for other diagnoses. Conclusions The success rate and safety of renal graft biopsy are high, and at present, cellular rejection reaction is still the main pathological diagnosis of indicative biopsy for renal graft. [ABSTRACT FROM AUTHOR]

During the operation of jack-up offshore platforms, the complex and variable seabed geological conditions involved can lead to serious accidents, such as pile leg punctures and platform tilt. The aim of this study is to introduce an early warning method for punctures that ensures the operational safety of these platforms. To accomplish this, a real-time monitoring and controlling system is designed using a programmable logic controller that shares data from sensors measuring displacement, tilt, and pressure. In addition, an experimental device is constructed to simulate a jack-up offshore platform in order to assess the safety response of the control system. The working state of the platform under different working conditions (puncture of one independent pile, same side or diagonal piles, and three-pile linkage) is evaluated by analysing the structural motion response, including platform tilt and foundation pressure. The findings reveal that the system developed in this study accurately detects the tilt condition of the offshore platform, and can ensure the operational safety of jack-up offshore platforms. [ABSTRACT FROM AUTHOR]

Abstract Background Traditional puncture skills training for refresher doctors faces limitations in effectiveness and efficiency. This study explored the application of generative AI (ChatGPT), templates, and digital imaging to enhance puncture skills training. Methods 90 refresher doctors were enrolled sequentially into 3 groups: traditional training; template and digital imaging training; and ChatGPT, template and digital imaging training. Outcomes included theoretical knowledge, technical skills, and trainee satisfaction measured at baseline, post-training, and 3-month follow-up. Results The ChatGPT group increased theoretical knowledge scores by 17–21% over traditional training at post-training (81.6 ± 4.56 vs. 69.6 ± 4.58, p

Abstract Background This study was conducted to investigate the clinical value of a navigation system based on deep learning and mixed reality for the treatment of kidney stones with percutaneous nephrolithotomy (PNL), and to improve its theoretical basis for the treatment of kidney stones. Methods The data of 136 patients with kidney stones from October 2021 to December 2023 were retrospectively analyzed. All patients underwent PNL, and were categorized into a control group (Group 1) and a surgical navigation group (Group 2) according to puncture positioning method. Preoperative computed tomography (CT) was performed in both groups. In group 1, procedures were performed under standard ultrasound guidance. PNL was performed with navigation system fused with ultrasound to guide percutaneous puncture in group 2. The baseline information and procedural characteristics of both groups were compared. Results PNL was successfully performed in both groups. No significant difference was found in the baseline date between the two groups. In group 2, real-time ultrasound images could be accurately matched with CT images with the aid of navigation system. The success rate of single puncture, puncture time, and decrease in hemoglobin were significantly improved in group 2 compared to group 1. (p

Abstract Background Stalk lodging (the premature breaking of plant stalks or stems prior to harvest) is a persistent agricultural problem that causes billions of dollars in lost yield every year. Three-point bending tests, and rind puncture tests are common biomechanical measurements utilized to investigate crops susceptibility to lodging. However, the effect of testing rate on these biomechanical measurements is not well understood. In general, biological specimens (including plant stems) are well known to exhibit viscoelastic mechanical properties, thus their mechanical response is dependent upon the rate at which they are deflected. However, there is very little information in the literature regarding the effect of testing rate (aka displacement rate) on flexural stiffness, bending strength and rind puncture measurements of plant stems. Results Fully mature and senesced maize stems and wheat stems were tested in three-point bending at various rates. Maize stems were also subjected to rind penetration tests at various rates. Testing rate had a small effect on flexural stiffness and bending strength calculations obtained from three-point bending tests. Rind puncture measurements exhibited strong rate dependent effects. As puncture rate increased, puncture force decreased. This was unexpected as viscoelastic materials typically show an increase in resistive force when rate is increased. Conclusions Testing rate influenced three-point bending test results and rind puncture measurements of fully mature and dry plant stems. In green stems these effects are expected to be even larger. When conducting biomechanical tests of plant stems it is important to utilize consistent span lengths and displacement rates within a study. Ideally samples should be tested at a rate similar to what they would experience in-vivo.

Abstract Background Pain management is an important part of nursing care for children. The objective of this study was to systematically assess the impact of virtual reality (VR) technology on alleviating the pain and anxiety experienced by children during venipuncture procedures. Methods This study searched Pubmed, Web of Sciences, Scopus, The Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu and China biomedical databases on the randomized controlled trials (RCTs) of virtual reality technology for relieving pain and anxiety associated with venous puncture for children up to July 6, 2024. Risk of bias tool recommended by Cochrane library was used to evaluate the RCT quality. RevMan 5.3 software was used for statistical analysis. Results A total of 10 RCTs involving 874 children were included. 429 children received VR intervention during vein puncture. VR was beneficial to reduce the children’s self-reported pain scores [SMD=-0.48, 95% CI (− 0.61, − 0.35)], children’s caregivers reported needle-related pain level [SMD=-0.93, 95% CI (-1.45, − 0.42)], children’s self-reported anxiety scores [SMD=-0.45, 95% CI (− 0.65, − 0.25)], children’s caregivers reported needle-related anxiety level [SMD=-0.47, 95% CI (− 0.73, − 0.21)]. Egger regression tests indicated that there were no publication biases in the synthesized outcomes (all P > 0.05). Conclusions VR technology has been shown to effectively mitigate the pain and anxiety experienced by children during venipuncture. Despite the positive findings, more research is needed to better understand the role of VR in children undergoing venipuncture.

Introduction. Teaching the skill of renal cavity puncture remains a pressing issue for both resident trainees and practicing physicians. Because patient-based training is ethically questionable and can be unsafe in terms of complications, training models have been created to practice skills.Objective. To compare two non-biological simulators for renal cavity puncture under ultrasound guidance: “UROSON”, GEOTAR, Russia and the kidney phantom “SafeToAct”, Estonia.Materials & methods. The study involved 40 young doctors with no experience in kidney puncture. Group 1 (20 people) practised on the UROSON simulator (GEOTAR, Russia). Group 2 (20 people) trained on a kidney phantom (SafeToAct, Estonia). Both simulators were evaluated by doctors before and after practice, as well as in the long-term period for 3 and 6 months. The assessment was carried out using a Likert scale.Results. The UROSON was rated higher (p < 0.05) according to the results of the comparison of the parameters (colour and consistency, visualisation of the cavity and calyx on ultrasound). Renal cavity visualisation of the UROSON simulator was rated as "good" throughout the study. Visualisation deteriorated by 6.9% after six months of use. Meanwhile, the SafeToAct kidney phantom showed a 64% deterioration in visualisation after one month of use. The SafeToAct kidney phantom was not evaluated later point because it became unusable. Both simulators had "tracks" after punctures. The UROSON had 30% and the SafeToAct kidney phantom 100% (p < 0.0001).Conclusion. The UROSON simulator can be used for training, master classes and accreditation of specialists. This simulator can be used for a long time.

Background: Stalk lodging (the premature breaking of plant stalks or stems prior to harvest) is a persistent agricultural problem that causes billions of dollars in lost yield every year. Three-point bending tests, and rind puncture tests are common biomechanical measurements utilized to investigate crops susceptibility to lodging. However, the effect of testing rate on these biomechanical measurements is not well understood. In general, biological specimens (including plant stems) are well known to exhibit viscoelastic mechanical properties, thus their mechanical response is dependent upon the rate at which they are deflected. However, there is very little information in the literature regarding the effect of testing rate (aka displacement rate) on flexural stiffness, bending strength and rind puncture measurements of plant stems. Results: Fully mature and senesced maize stems and wheat stems were tested in three-point bending at various rates. Maize stems were also subjected to rind penetration tests at various rates. Testing rate had a small effect on flexural stiffness and bending strength calculations obtained from three-point bending tests. Rind puncture measurements exhibited strong rate dependent effects. As puncture rate increased, puncture force decreased. This was unexpected as viscoelastic materials typically show an increase in resistive force when rate is increased. Conclusions: Testing rate influenced three-point bending test results and rind puncture measurements of fully mature and dry plant stems. In green stems these effects are expected to be even larger. When conducting biomechanical tests of plant stems it is important to utilize consistent span lengths and displacement rates within a study. Ideally samples should be tested at a rate similar to what they would experience in-vivo. [ABSTRACT FROM AUTHOR]

Background: Pain management is an important part of nursing care for children. The objective of this study was to systematically assess the impact of virtual reality (VR) technology on alleviating the pain and anxiety experienced by children during venipuncture procedures. Methods: This study searched Pubmed, Web of Sciences, Scopus, The Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, Weipu and China biomedical databases on the randomized controlled trials (RCTs) of virtual reality technology for relieving pain and anxiety associated with venous puncture for children up to July 6, 2024. Risk of bias tool recommended by Cochrane library was used to evaluate the RCT quality. RevMan 5.3 software was used for statistical analysis. Results: A total of 10 RCTs involving 874 children were included. 429 children received VR intervention during vein puncture. VR was beneficial to reduce the children's self-reported pain scores [SMD=-0.48, 95% CI (− 0.61, − 0.35)], children's caregivers reported needle-related pain level [SMD=-0.93, 95% CI (-1.45, − 0.42)], children's self-reported anxiety scores [SMD=-0.45, 95% CI (− 0.65, − 0.25)], children's caregivers reported needle-related anxiety level [SMD=-0.47, 95% CI (− 0.73, − 0.21)]. Egger regression tests indicated that there were no publication biases in the synthesized outcomes (all P > 0.05). Conclusions: VR technology has been shown to effectively mitigate the pain and anxiety experienced by children during venipuncture. Despite the positive findings, more research is needed to better understand the role of VR in children undergoing venipuncture. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Under challenging common femoral artery access scenarios, the "wall PIERCE" technique, which utilizes a larger puncture needle to pierce the vessel wall along the guidewire, facilitates sheath insertion. This method proved successful in two cases without any complications, presenting a valuable addition to strategies for addressing challenging sheath insertion scenarios. [ABSTRACT FROM AUTHOR]

A 2.5‐year‐old spayed female Chihuahua dog was presented with chronic cervical pain and exhibited a "prayer‐like position" following a history of a 4‐meter fall. CT and MRI revealed a moderate right‐sided enlargement of the subdural space with cerebrospinal fluid, consistent with a subdural hygroma, appearing connected to a quadrigeminal cistern dilation. Percutaneous transfontanellar external drainage of the subdural fluid accumulation did not prevent its re‐accumulation, and the dog was managed medically, leading to the complete resolution of clinical signs. The subdural hygroma was suspected to be secondary to the previous trauma. [ABSTRACT FROM AUTHOR]

Simple Summary: Chronic use of totally implantable venous access devices (TIVADs) in pediatric oncology patients can be challenging in terms of pain and anxiety. Our aim is to evaluate the usefulness of virtual reality (VR) goggles to reduce anxiety and pain in children and to facilitate the work of the nursing team. We conducted a clinical trial with two groups randomized to use the goggles or not, and for the intervention group we used a relaxation video in the Raja Ampat environment (Ecosphere app by Phoria®) for Oculus Quest 2 goggles (Meta Platforms®, Menlo Park, CA, USA). Our results highlighted that the use of VR goggles could be a simple addition to clinical practice to reduce anxiety and pain in oncology children using TIVADs, and could also facilitate the work of the nursing team, helping to achieve a more efficient use of time. Introduction: Pediatric oncology patients use totally implantable venous access devices (TIVADs) to enable central venous access. Anxiety, pain and/or discomfort are common despite anesthesia. Virtual reality (VR) is a non-pharmacological approach that may reduce pain and anxiety in these patients. We aimed to assess the use of VR for reducing anxiety/pain in patients with TIVADs while facilitating the task of healthcare providers when accessing a TIVAD. Methods: patients 4–18 years old with a TIVAD were prospectively randomized to an intervention group (IG) or a control group (CG). In the IG, VR goggles (Oculus Quest 2, Meta Platforms®, Menlo Park, CA, USA) were used displaying a relaxing video in the Raja Ampat environment (Ecosphere app from Phoria®) while the TIVAD was accessed. The CG was managed as per standard of care. Satisfaction and pain were measured by FPS-R and STAIC scales, respectively. Results: this is the report of a prospective, randomized (60 per group)—unblinded—, single institution study of 120 pediatric oncology patients enrolled from January to April 2022. Median ages for IG and CG were 9.22 and 10.52 years, respectively. Satisfaction was higher in the IG (4.80) compared to the CG (3.92), p ≤ 0.0001. Regarding pain, mean FPS-R scores were 1.79 for the CG and 0.83 for the IG. Significantly different scores were found in the 12 to 18 years group, p ≤ 0.05. The healthcare professionals index of satisfaction was high (4.50 mean Likert score) for the IG compared to accessing the TIVAD without VR (3.73 mean Likert score). Conclusion: The use of VR helped reduce pain and/or discomfort in pediatric oncology patients, mainly in the older age group as they can better interact with VR. Healthcare providers were satisfied with the help of VR for TIVAD management. [ABSTRACT FROM AUTHOR]

Diagnosis of pulmonary sarcoidosis can be difficult and strongly dependent on clinical experience, especially when necrotizing granulomas are present. Here we report an individual who, 3 years after onset of symptoms, was definitively diagnosed with pulmonary sarcoidosis based on percutaneous lung biopsy under the guidance of computed tomography, after he failed to receive a specific diagnosis at other tertiary hospitals based on cervical lymph node biopsy and transbronchial needle aspiration under the guidance of endobronchial ultrasonography. After his definitive diagnosis at our medical center, he was given corticosteroids, which led to remission. Clinicians, especially in areas lacking suitably experienced pathologists, should be aware of how to diagnose sarcoidosis in the presence of abundant necrotizing granulomas in order to ensure timely diagnosis.

The veins finder helps the operator clearly display the position, thickness and direction of the blood vessel, so as to improve the puncture efficiency. However, in the process of use, it is often encountered that the hand touches multiple control buttons at the same time, thus affecting the puncture effect. This study introduced the design and use of a medical handheld infrared veins finder. The anti-miscontact function was designed to improve the accuracy and portability in the veins localization procedure. (静脉血管显像仪是帮助操作者清晰地显示血管位置、粗细和方向, 从而提高穿刺效率的一种辅助装置。静脉血管显像仪的手持装置有诸多按键, 在操作过程中存在误触风险。本研究介绍一种医用静脉血管显像装置, 通过设计和制作新型防误触装置, 提高了操作精准度和操作便携性。)

A peripherally inserted central catheter (PICC) can provide long-term and safe intravenous access for cancer patients with chemotherapy and patients who need long-term infusion and parenteral nutrition. This paper reviews studies on causes and countermeasures of difficulties in PICC insertion under ultrasound guidance. Common actors influencing the PICC insertion includes vascular access selection, vasospasm, puncture position, puncture operator and so on. Targeted nursing interventions should be carried out to prevention risk factors and improve the success rate of PICC placement, therefore reducing the pain of patient during PICC insertion under ultrasound guidance. (经外周静脉置入中心静脉导管(PICC)具有安全、可靠、留置时间长、并发症少等优点, 在临床上得到了广泛应用, 特别适用于肿瘤化疗患者及需要长期输液、静脉高营养治疗的患者。本文对PICC置管过程中送管困难的原因及处理对策进行综述, PICC置管过程中送管困难的原因通常包括血管选择、血管痉挛、穿刺体位、操作者因素等, 护理人员应针对相关的因素开展预防及实施高效处理方法, 提高PICC置管的成功率, 减轻患者痛苦。)

Arabinoxylan (AX)-based films can improve the mechanical characteristics of biodegradable materials when utilized for food packaging. However, the mechanical properties of AX films for food packaging applications require thorough investigation to establish their viability. In this study, AX was extracted from corn bran coproducts of dry-milling (DCB), wet-milling (WCB), and dried distiller's grains with solubles (DDGS) using an acid–alkali method. Packaging materials were produced using these AX extracts, each combined with laccase and sorbitol, forming the basis for three different films. These films were then modified by immersing the surface in a lipase–acetate solution. We evaluated their mechanical characteristics, including thickness, tensile properties, tear resistance, and puncture resistance. The thickness and tensile properties of the modified AX films derived from DCB and DDGS showed significant improvements (p < 0.05) compared to the unmodified AX films. In contrast, the modified AX films from WCB showed no significant changes (p > 0.05) in thickness and tensile properties compared to the unmodified WCB AX films. A significant increase in tear resistance (p < 0.05) was observed in all modified AX films after immersion in the lipase–acetate mixture. While puncture resistance was enhanced in the modified AX films, the improvement was not statistically significant (p > 0.05) compared to the unmodified films. The presence of hydroxyl (OH) and carbonyl (CO) groups on the surfaces of AX films from DCB and DDGS, modified by the lipase–acetate solution, suggests excellent biodegradability properties. The modification process positively affected the AX films, rendering them more bendable, flexible, and resistant to deformation when stretched, compared to the unmodified AX films. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intervertebral disc degeneration is an important cause of low back pain. At present, there are many modeling methods for disc degeneration in China and abroad, but there is not a model for low back pain due to disc degeneration. OBJECTIVE: To compare the effect of mechanical puncture combined with tumor necrosis factor α and complete Freund’s adjuvant with a conventional disc mechanical puncture alone. METHODS: A total of 18 male adult Sprague-Dawley rats were randomly divided into 3 groups, with 6 animals in each group. No treatment was given in the blank group. Animal models of intervertebral disc degeneration were made in the L4-5 segments of rats in the control using conventional mechanical puncture. In the experimental group, on the basis of mechanical puncture, tumor necrosis factor α+complete Freund’s adjuvant was injected into the L4-5 intervertebral discs using a microinjector to establish a model of disc degeneration induced by mechanical puncture combined with inflammatory factors. Four weeks after surgery, the pain threshold of rats was measured by the hot plate method for assessing the perception of heat injury in rats with intervertebral disc degeneration. MRI examination was performed to observe the disc degeneration in each group. ELISA was used to detect the levels of serum tumor necrosis factor α, interleukin 1β, interleukin 6 and prostaglandin E2. Hematoxylin-eosin and Safranin O-fast green staining were used to observe the morphological changes of the disc. RESULTS AND CONCLUSION: In terms of pain, the behavioral pain threshold of the experimental group was continuously decreased, and the levels of serum inflammatory factors were significantly higher compared with the control group. In terms of morphology, the MRI results showed that the L4-5 nucleus pulposus signal completely disappeared in the experimental group. Histopathological results showed that in the control group, the nucleus pulposus was intact, more notochord cells were visible, and some fiber rings were ruptured, while in the experimental group, there are fewer notochord cells and the structure of the nucleus pulposus and fibrous ring is disturbed, with the boundary disappearing. To conclude, mechanical puncture combined with tumor necrosis factor alpha and complete Freund’s adjuvant can successfully establish a discogenic low back pain model in rats. This operation is simple and economical to achieve obvious disc degeneration and low back pain, with greatly shortened molding cycle. This model can be used as a reference for studying discogenic low back pain models. [ABSTRACT FROM AUTHOR]

Introduction: Radial artery (RA) spasm is demonstrated to be one of the most common complications of transradial approach (TRA). Aim: We hypothesised that radial flow-mediated dilation (FMD) can be used as a preprocedural method to assess the likelihood of arterial spasm. Material and methods: The patients were divided into 2 groups: those with and without flow-mediated RA dilatation. A blood pressure cuff was placed on the upper part of the antecubital region of the patients in the FMD group and inflated for 10 min, allow- ing the pressure to rise to 30 mm Hg above the systolic blood pressure. RA diameters of the patients in both groups were measured via quantitive coronary angiography method before transradial coronary angiography. Results: A total of 165 patients were included in the study, of whom 64 (38.8%) were women. The median age of the patients was 56 years (48-63). The mean RA diameter was significantly larger in the FMD group (3.44 ±0.48 vs. 2.96 ±0.46 mm, p < 0.001), and the number of punctures required for successful transradial cannulation was found to be significantly higher in the group without FMD (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). Linear regression analysis revealed diabetes and FMD as independent predictors of RA diameter. In the diabetic subgroup, RA diameter remained larger in the FMD group (3.00 ±0.35 vs. 2.78 ±0.26, p = 0.036). Radial puncture attempts were significantly higher in the control group compared to the FMD group (1.55 ±0.7 vs. 1.20 ±0.64; p < 0.001). Conclusions: In our study, we demonstrated that FMD created by pressure application significantly increased RA diameter and reduced puncture attempt during TRA. [ABSTRACT FROM AUTHOR]

Traditional needles for haemodialysis access can cause complications and discomfort. Indwelling needles may have advantages, but their efficacy needs to be investigated. Our study sought to compare the safety and efficacy of indwelling needles to traditional needles for haemodialysis access. A single-center retrospective study at the Pingyang County Hospital of Traditional Chinese Medicine included 70 haemodialysis patients. The intervention group used indwelling needles, whereas the control group used traditional needles. The rate of complications, limb mobility, blood chemistry, puncture success rates, operation times, haemostasis times, pain and comfort scores, and internal fistula failure rates were all compared. Overall, complication rates were slightly higher in the control group, but not statistically significant. Both groups improved their limb mobility and blood chemistry, but there were no significant differences. The intervention group had significantly higher puncture success rates (88.4% vs. 80.0%), shorter operation times (65.4 vs. 72.3 seconds), and faster haemostasis times (23.7 vs. 28.2 seconds) than the control group. Patients in the intervention group experienced less pain (3.7 vs. 4.2) and more comfort (8.1 vs. 7.5). The intervention group had slightly lower internal fistula failure rates (2.9% vs. 5.7%), but the difference was not statistically significant. Indwelling needles appear to improve puncture efficiency and patient comfort during hemodialysis. [ABSTRACT FROM AUTHOR]

Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany). The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test. One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 ± 90s, MP: 104 ± 21s) and NPT (RP: 128 ± 40s, MP: 81 ± 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators' experience. The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system. [ABSTRACT FROM AUTHOR]

Background: Accidental dural puncture (ADP) is the most frequent major complication when performing an epidural procedure in obstetrics. Consequently, loss of pressure in the cerebrospinal fluid (CSF) leads to the development of post‐dural puncture headache (PDPH), which occurs in 16%–86% of cases. To date, the efficacy of epidural fibrin patches (EFP) has not been evaluated in a controlled clinical trial, nor in comparative studies with epidural blood patches (EBP). Methods: The objective of the present study was to compare the efficacy of EFP with respect to EBP for the treatment of refractory accidental PDPH. This prospective, randomized, open‐label, parallel, comparative study included 70 puerperal women who received an EBP or EFP (35 in each group) after failure of the conventional analgesic treatment for accidental PDPH in a hospital. Results: A higher percentage of women with EFP than EBP achieved complete PDPH relief after 2 (97.1% vs. 54.3%) and 12 h (100.0% vs. 65.7%) of the patch injection. The percentage of patients who needed rescue analgesia was significantly lower with EFP after 2 (2.9% vs. 48.6%) and 12 h (0.0% vs. 37.1%). After 24 h, PDPH was resolved in all women who received EFP. The recurrence of PDPH was reported in one woman from the EBP group (2.9%), who subsequently required a second patch. The mean length of hospital stay was significantly lower with EFP (3.9 days) than EBP (5.9 days). Regarding satisfaction, the mean value (Likert scale) was significantly higher with EFP (4.7 vs. 3.0). Conclusions: EFP provided better outcomes than EBP for the treatment of obstetric PDPH in terms of efficacy, safety, and patient satisfaction. [ABSTRACT FROM AUTHOR]

Background & Methods: The aim of the study is to evaluate of postdural puncture backache in cases of lscs under subarachnoid block given by resident doctors. Successful identification of the subarachnoid space with one skin puncture and no redirection of the spinal needle was considered as first pass success. The subarachnoid block was given by resident doctor. Results: The mean duration of backache was 2 ± 1.5days. All patients responded to treatment with paracetamol and diclofenac. Factors affecting the incidence of PDPB. The factors did not affect the incidence of PDPB: age (P = 0.606), elective or emergency LSCS (P = 0.324) or parturient in labour (P = 0.709), previous spinal anaesthesia (P = 0.389), body habitus (P = 0.125), bony deformity (P = 0.875), occurrence of paraesthesia (P = 1.000), contact of spinal needle with bone (P = 0.078), duration of surgery (P = 0.058), time to sitting (P = 0.346) and time to ambulation (P = 0.748), occurrence of PDPH (P = 0.628). Conclusion: The incidence of PDPB was 10% in patients undergoing LSCS under subarachnoid block given by resident doctor. The onset of backache was within 24 hour of spinal anaesthesia and the pain was mild to mod intensity and responded to treatment with paracetamol and diclofenac. Factors associated with PDPB included increased weight, poor quality of spinal landmarks, increased number of attempts and spinal needle redirections and occurrence of bloody tap. Association was also noted between PDPB and provider experience. It was noted that the patients who are complaining of backache after subarachnoid block mostly primigravida, unco-operative or obese patients due to poor positioning during SAB given by resident doctors. This resulted in multiple skin punctures, spinal needle redirections, needle passes, first pass failure, change in intervertebral space level, more than 2 attempt by resident doctor, bloody CSF tap taking over by a second provider and the SAB was given by second provider. [ABSTRACT FROM AUTHOR]

BACKGROUND: Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time. OBJECTIVE: To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants. METHODS: A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People's Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n = 90 cases) and observation group (n = 90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children. RESULTS: The success rate of one puncture in the observation group was significantly higher than that in the control group (P < 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group's 34.00% (27/80) (P < 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray. CONCLUSION: The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective. [ABSTRACT FROM AUTHOR]

Key Clinical Message Under challenging common femoral artery access scenarios, the “wall PIERCE” technique, which utilizes a larger puncture needle to pierce the vessel wall along the guidewire, facilitates sheath insertion. This method proved successful in two cases without any complications, presenting a valuable addition to strategies for addressing challenging sheath insertion scenarios.

We report a clinical observation of intramuscular myxoma, mimicking a psoas abscess. Surgical minimally invasive treatment of the disease has been suggested. This clinical observation shows an example of the effective use of minimally invasive treatment methods in surgical practice, as an alternative to open surgery.

Abstract To investigate the relationship between stem puncture mechanical characteristics and NK stress diagnosis, the microstructure, surface morphology, cellulose and lignin content, puncture mechanical characteristics, and epidermal cell morphology of cucumber stems were measured herein. The results indicated that the middle stem, which had a diameter of approximately 7000 μm, was more suitable for puncturing due to its lower amount of epidermal hair, and its gradual regularity in shape. Further, the cucumber stems were protected from puncture damage due to their ability to rapidly heal within 25 h.. The epidermal penetration of the cucumber stems increased with the increase in cellulose and lignin, though cellulose played a more decisive role. The epidermal break distance increased with an increase in N application and decreased with an increase in K+ application, but the change in intercellular space caused by K+ supply was the most critical factor affecting the epidermal break distance. In addition, a decrease in K+ concentration led to a decrease in epidermal brittleness, whereas the factors affecting epidermal toughness were more complex. Finally, we found that although the detection of epidermal brittleness and toughness on nutrient stress was poor under certain treatment, the puncture mechanical characteristics of the stem still had a significant indicative effect on N application rate. Therefore, elucidating of the relationship between the puncture mechanical characteristics of the stems and crop nutritional stress is not only beneficial for promoting stem stress physiology research but also for designing on-site nutritional testing equipment in the future.

In Video S1, a new surgical technique for hybrid primary tracheoesophageal (TE) puncture in stapler‐assisted total laryngectomy is shown. The video describes the surgical steps of the procedure and illustrates some tips and tricks. The procedure incorporates an upper mini‐pharyngotomy to enable retrograde placement of the voice prosthesis (VP), eliminating the need for rigid esophagoscopy. This has made it possible to exploit, without additional risks, the potential of the stapler combined with primary TE puncture and VP placement. In our experience, this hybrid procedure in stapler‐assisted total laryngectomy is not related to adverse events such as pharyngocutaneous fistula (PCF), hypertonicity, and functional complications. Therefore, it can be considered a valid technique that allows for easy insertion of a primary voice prosthesis also in case of mechanical sutures. [ABSTRACT FROM AUTHOR]

Purpose: Controversy exists regarding the treatment of recurrent stenosis in vascular access at cannulation sites with a covered stent as repeated cannulation may damage the stent. The purpose of this study was to review covered stent placement at cannulation sites to salvage failing vascular access. Materials and methods: A total of 11 patients were included for the purpose of this study. Eight patients (72.7%) received a covered stent due to recurrent stenosis, 2 (18.2%) due to an acute occlusion, and in 1 case (9.1%), the covered stent was used to repair a damaged polytetrafluoroethylene arteriovenous graft (PTFE AVG). Results: Primary patency after stent placement was 40.9% at 6 months, primary-assisted patency was 79.5% at 12 months, and secondary patency was 80% at 24 months. No significant problems were observed during the dialysis sessions after stent placement. The intervention rate per patient-year was not significantly different before or after covered stent placement, at 3.8 (IQR=9.5) interventions per year versus 2.5 (IQR=3.0) interventions per year (p=0.280). Conclusion: In conclusion, treating failing vascular access with problems at cannulation sites with covered stents can be considered. Clinical Impact: Treating vascular access stenosis at cannulation sites with covered stents can successfully prolong vascular access life. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

Purpose: Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats. Methods: 36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content). Results: Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points (P < 0.05). DD progressed over time in the Punct and Punct+OVX groups (P < 0.05). The changes were more severe in the Punct+OVX group compared to the Punct group and the OVX group. Conclusion: The combination of puncture and ovariectomy induced rapid and progressive DD in the lumbar discs of rats without spontaneous recovery. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this study was to investigate the utility of contrast-enhanced ultrasound (CEUS) in percutaneous renal space-occupying lesion puncture biopsy. Methods Ultrasound (US)-guided percutaneous needle biopsies were performed on 55 patients with renal space-occupying lesions, and the results were analyzed retrospectively. The US group included 36 patients receiving conventional US, and the contrast-enhanced ultrasound (CEUS) group included 22 patients, including 19 patients receiving CEUS directly and 3 patients receiving additional enhanced ultrasound due to the first conventional ultrasound puncture failure. The relevant data were subjected to statistical analysis. Results The results of this study showed that the successful rate of obtaining effective tissue (100% vs. 75%) and the puncture accuracy (100% vs. 88.89%) in CEUS group were significantly higher than those in US group (P

Arterial puncture and catheterization, by providing accurate information for diagnosis and treatment, is often used in critically ill patients or those undergoing major surgery. Improper procedure and maintenance of indwelling arterial catheters may lead to complications. This paper summarized the clinical application and nursing practice of indwelling arterial catheters in critical care medicine, and provided reference for improving success of puncture and making high-quality interventions. (动脉穿刺置管常用于危重或拟行大手术患者, 有助于为治疗提供准确的信息。动脉留置导管为创伤性的治疗措施, 若操作或维护不当则容易产生并发症。本文通过阐述重症医学科动脉留置导管的临床应用及其护理进展, 以期为提高穿刺成功率和制定优质的干预策略提供理论依据。)

Introduction. The skill of puncture of the kidney pelvicalyceal system is one of the basic urological skills, as it is used for various surgical interventions. There are different training models, from laboratory animals to virtual reality simulators.Objective. To evaluate a non-biological model of the pelvicalyceal system puncture simulator UroATOM (“Alfa-Rhythm”, Russian Federation) and to compare it with a virtual reality simulator PERC MentorTM (“Simbionix”, Beit Golan, Israel).Materials & methods. The results of fluoroscopic guided puncture training were analyzed among 50 physicians. The specialists were divided into two equal groups by experience: group 1 — beginners, group 2 — experienced urologists. In phase 1, both simulators were evaluated by the physicians using Likert questionnaires. In phase 2, the puncture results in beginners were evaluated before and after the UroATOM simulator practise.Results. Comparing the indices of both simulators showed that UroATOM was rated as more convenient to use (p = 0.0001) and cheaper (p < 0.0001). The analysis of the puncture performance by "beginners" before and after UroATOM training revealed a statistically significant improvement in the performance. The puncture time index improved by 79 seconds. The index of fluoroscopy duration decreased by 40.9 seconds. The number of puncture attempts decreased by 1.4 times. The amount of contrast decreased by 5.4 ml.Conclusions. The UroATOM simulator is effective for training young specialists in fluoroscopy-guided renal cavity puncture.

Sixty-three patients admitted to 5 hospitals in 2014–2020 for the treatment of severe hypertensive brainstem hemorrhage by CT-guided and bone marker-oriented transcerebellar aspiration were enrolled in this study. The puncture accuracy, duration of hematoma removal, tracheal decannulation, postoperative complications, postoperative consciousness recovery time, Glasgow Outcome Scale (GOS) score, and prognosis outcome at follow-up were retrospectively analyzed. Additionally, the relationship between admission Glasgow Coma Scale (GCS) score and GOS score, and between hematoma volume and prognosis of patients was analyzed at follow-up. Results showed that CT localization–based and bone marker oriented transcerebellar hematoma aspiration in the treatment of severe hypertensive brainstem hemorrhage ensures high puncture accuracy, relatively low surgery risk, and good prognosis. The prognosis relates to the state of consciousness and hematoma volume.

Objective To investigate the checklist –based nursing in management of pediatric intravenous infusion via scalp vein set. Methods Totally 200 pediatric patients who visited the clinic between March 2022 to June 2022 were selected as the control group, another 200 pediatric patients who visited the clinic between July 2022 to October 2022 were selected as the observation group. All pediatric patients received routine nursing during intravenous infusion treatment, and those in the observation group were given checklist –based nursing interventions. The nursing defect events and intravenous infusion-related complications were observed and analyzed, and parents’ satisfaction with nursing was measured. Results The incidences of nursing defect events such as repeated puncture, omission of infusion fluid, improper infusion speed and delayed infusion fluid change in the observation group were lower than those in the control group (P＜0. 05). The incidences of complications such as leakage, catheter-related infection and phlebitis in the observation group were lower than those in the control group (P＜0. 05). The parents’ satisfaction rate in the observation group was higher than that in the control group. Conclusion The checklist –based nursing is potentially effective to reduce the adverse influence on pediatric patients with intravenous infusion via scalp vein set, and improve the quality of pediatric nursing. (目的 探讨清单式护理在小儿头皮静脉输液中的应用效果。方法 选取2022年3月—6月行头皮静脉输液200例患儿作为对照组, 选取2022年7月—10月收治的200例患儿为观察组。对照组采用常规护理, 观察组在对照组基础上启用清单式护理模式。观察两组输液缺陷和输液并发症发生情况, 评价患儿家属输液满意度。结果 观察组反复穿刺、漏输液体、输液速度不当、输液更换不及时发生率低于对照组, 差异有统计学意义(P＜0. 05)。观察组药物渗出、导管相关性感染、静脉炎发生率低于对照组, 差异有统计学意义(P＜0. 05)。观察组输液满意度高于对照组。结论 清单式护理应用于小儿头皮静脉输液, 能减少患儿头皮静脉输液不良影响, 提升护理质量。)

Objective To investigate the clinical efficacy and application value of an improved 3D-printed guide plate for the treatment of primary trigeminal neuralgia (PTN) by percutaneous microballoon compression (PMC). Methods This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stomatology, Xuzhou Central Hospital, from September 2019 to January 2022. The group was divided by the random number table method into the experimental group (adopting 3D printing technology to make guide plates to guide the puncture, 22 cases) and the control group (adopting the traditional Hartel anterior approach to position the puncture, 20 cases). The intraoperative success rate of the first puncture, puncture time, operative time, radiation exposure of patients and postoperative complications were compared between the two groups. Postoperative Barrow Neurological Institute Scale (BNI) scores, facial numbness, diminished corneal reflexes and chewing weakness were recorded. The t-test, rank-sum test and chi-square test were used for statistical analysis, with P0.05). In the experimental group, 16 patients had postoperative masseter weakness, 1 had keratitis and 10 had perilabial herpes, while in the control group, 18 patients had postoperative masseter weakness, 2 had keratitis, 11 had perilabial herpes and 1 had monocular blindness. There was no significant difference in postoperative complications between the two groups (P>0.05). At 12 months of follow-up, there was no recurrence in either the experimental or control group. Conclusions 3D digital guide plate-guided percutaneous microballoon compression for primary trigeminal neuralgia can improve the accuracy and safety of puncture to a certain extent, obviously shorten the operation time, reduce radiation exposure of the patients, improve the success rate of the operation, meaning it has a high clinical application value.

Introduction: PCNL is the most common surgical technique used for the management of renal stones, particularly for those with more than 2 cm stones. The aim of this study is to identify which kidney calyx—upper, middle, or lower—when punctured achieves the highest stone clearance rate. Methods: This was a prospective non-randomised study performed in department of urology, KIST medical college from September 1, 2021 to November 16, 2022. Patients who underwent PCNL were evaluated with detailed history, examination, and investigation. All the patients who fulfill the inclusion criteria during study period were included in the study. After preoperative investigation PCNL was done according to standard protocol. Perioperative complication recorded in Performa. Stone-free status was checked after 2 months of surgery with ultrasonography. Results: 100 patients were included in this study among which 59 were male. The mean age of patients was 33.35 years [range 18-65 years]. Upper, middle and lower pole puncture was done in 23%, 33% and 44% patients respectively. The mean stone burden of the patient was 380.680 mm2. The average time for surgery according to access was 67.34 mins, 63.12mins, and 64.07 mins for the upper calyx, mid-calyx and for the lower calyx respectively. 84.33% of patients had complete stone clearance after 2 months in the USG examination. 91.3% [21] had stone clearance when approached through the upper calyx. It was 87.8%[29] by mid calyx and 75%[33] by lower calyx. Upper calyx puncture had statistical significance in stone clearance rate [P=0.43, P=0.021, P=0.002]. 11 had CRIF ≤4mm stone in PCS, and the remaining 6 had residual stone >4mm. In our study, thoracic complications were significantly higher in upper calyx puncture 8[30.4%, 8[24.24% in the middle calyx, and 3[6.8%] in lower calyx [P=0.02, P=0.98, P=0.03] respectively. Conclusion: Upper calyceal puncture can produce the highest stone clearance rate, but it has been associated with significant postoperative morbidity, particularly in the chest. Lower calyx punctures have less intraoperative and postoperative morbidity, but their stone removal rates are lower than those of other procedures. Therefore, the balance between stone clearance rate and morbidity has been achieved using middle calyx puncture.

ABSTRACTPurpose: Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats.Methods: 36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content).Results: Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points (P