Comparison of insertion time, pull-out strength, and screw-media interface area of customized pedicle screw with different core and thread design against commercial pedicle screw: a pilot study on Indonesian Population

Objective This research aimed to developing customized pedicle screw based on Indonesian vertebral anatomy and compare the insertion time, pull-out strength, and screw-media interface area of different screw design. We have developed 3 different types of pedicle screws (v-thread cylinder-core, square-thread cylinder-core and square-thread conical-core). The thread diameter was calculated from pedicle width of Indonesian population (6 mm). We used commercially available pedicle screw as control group (6.2 mm). Result The insertion time were significantly difference between v-thread cylinder-core pedicle screw (22.94 s) with commercially available pedicle screw (15.86 s) (p < 0.05). The pull-out strength was significantly difference between commercially available pedicle screw (408.60 N) with square-thread conical pedicle screw (836.60 N) (p < 0.05). The square-thread conical-core group have the highest interface area (1486.21 mm2). The data comparison showed that the square-thread conical-core customized pedicle screw group has comparable insertion time and has better pull-out strength than commercially available pedicle screw.

Is a small-caliber or large-caliber endoscope more suitable for colonic self-expandable metallic stent placement? A randomized controlled study

Objectives: The colonic self-expandable metallic stent (C-SEMS) with a 9-French (Fr) delivery system allows for a small-caliber endoscope (SCE) to be used to treat malignant colonic obstruction. Despite the lack of evidence, the SCE has become popular because it is considered easier to insert than the large-caliber endoscope (LCE). We aimed to determine whether the SCE is more suitable than the LCE for C-SEMS placement. Methods: Between July 2018 and November 2019, 50 consecutive patients who were scheduled to undergo C-SEMS for colon obstruction were recruited in this study. Patients were randomized to the SCE or LCE group. The SCE and LCE were used with 9-Fr and 10-Fr delivery systems, respectively. The primary outcome was the total procedure time. Secondary outcomes were the technical success rate, complication rate, clinical success rate, insertion time, guidewire-passage time, stent-deployment time, and colonic obstruction-scoring-system score. Results: Forty-five patients (SCE group, n = 22; LCE group, n = 23) were analyzed. The procedure time in the LCE group (median, 20.5 min) was significantly ( p = 0.024) shorter than that in the SCE group (median, 25.1 min). The insertion time in the LCE group (median, 2.0 min) was significantly ( p = 0.0049) shorter than that in the SCE group (median, 6.0 min). A sub-analysis of the procedure difficulties showed that the insertion time in the LCE group (median, 5.0 min) was significantly shorter than that in the SCE group (median, 8.5 min). Conclusion: Both LCE and SCE can be used for C-SEMS; however, LCE is more suitable than SCE as it achieved a faster and equally efficacious C-SEMS placement as that of SCE. Clinical trial registration number: University Hospital Medical Information Network Clinical Trials Registry (UMIN 32748)

Comparison of two insertion techniques for I-Gel placement in paediatric patients: standard vs rotational methods

: I-Gel has found increasing favour amongst anaesthesiologists for securing and maintaining a patent airway during routine as well as emergency surgeries in the paediatric population. The present prospective randomized study was conducted to compare the two techniques (standard and rotational methods) for I-Gel insertion in children; by assessing the first attempt success rate, insertion time and ease of insertion.: ASA I and II paediatric patients (1-6 years old) scheduled for brief elective surgical procedures lasting less than one hour were randomly allocated into two groups viz. Group A (n= 30) employing the standard technique, and Group B (n= 30) utilizing the rotational technique for I-Gel placement.: Group B subjects depicted a significantly higher first-attempt success rate vis a vis Group A subjects (P=0.040). The mean insertion time during the first attempt was longer in Group A (standard technique) as compared to Group B (rotational technique), but the difference was not statistically significant.: This study lends credence to the fact that the placement of I-Gel by employing the rotational method culminates in an increase in the first attempt success rate, suggestive of its potential superiority to the standard method

Augmented reality navigation for cranial biopsy and external ventricular drain insertion

OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room–based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16–104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87–233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135–400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.

Efficacy of Macrogol 4000 Plus Electrolytes in Bowel Preparation for Colonoscopy in Patients with Chronic Constipation

Background: Chronic constipation is a significant factor in poor bowel preparation for colonoscopy. Macrogol 4000 plus electrolytes (Movicol, EA Pharma, Tokyo, Japan), containing polyethylene glycol (PEG) and electrolytes, have been used recently to treat patients with constipation. However, prospective studies on the use of macrogol 4000 for bowel cleansing for colonoscopy are lacking. This study aimed to investigate the efficacy and safety of macrogol 4000 in addition to PEG administered in patients with chronic constipation.Methods: This single-center, single-arm prospective study enrolled patients with chronic constipation who were scheduled to undergo colonoscopy. The primary endpoint was the proportion of good bowel preparation assessed using the Boston Bowel Preparation Scale (BBPS) (6 or more points). The secondary endpoints were the time from when pPEG (MoviPrep, EA Pharma, Tokyo, Japan) was taken until colonoscopy could be started, amount of PEG taken, number of defecations, whether additional PEG doses were taken, and adverse events. Endoscopy-related endpoints included cecal intubation rate, insertion time, observation time, adenoma detection rate (ADR), and polyp detection rate (PDR). The tolerability of PEG and macrogol 4000 was assessed using a questionnaire.Results: Forty patients were included in the analysis. The median BBPS was 7 (range, (3–9)) and ³6 points in 37 cases (92.5%). The median time until colonoscopy can be started was 210 min (90–360 min), the median volume of PEG taken was 1500 mL (1000–2000 mL), and the median number of defecations was 7 (3-20). No adverse events were observed. Fourteen patients required an additional dose of PEG. Cecal intubation was achieved in all cases, the median insertion time was 6.0 min (range, 2.3–22 min), and the median observation time was 8.8 min (range, 4.0–16.0 min). The ADR and PDR were 60.0% and 75.0%, respectively. A greater proportion of patients rated the tolerability of macrogol 4000 as good compared with that of PEG (95.0% vs. 50.0%, p < 0.01).Conclusions: Intake of macrogol 4000 in addition to PEG is effective and safe for colonoscopy in patients with chronic constipation.

LTR-retrotransposon dynamics in common fig (Ficus carica L.) genome

Background Long Terminal Repeat retrotransposons (LTR-REs) are repetitive DNA sequences that constitute a large part of the genome. The improvement of sequencing technologies and sequence assembling strategies has achieved genome sequences with much greater reliability than those of the past, especially in relation to repetitive DNA sequences. Results In this study, we analysed the genome of Ficus carica L., obtained using third generation sequencing technologies and recently released, to characterise the complete complement of full-length LTR-REs to study their dynamics during fig genome evolution. A total of 1867 full-length elements were identified. Those belonging to the Gypsy superfamily were the most abundant; among these, the Chromovirus/Tekay lineage was the most represented. For the Copia superfamily, Ale was the most abundant lineage. Measuring the estimated insertion time of each element showed that, on average, Ivana and Chromovirus/Tekay were the youngest lineages of Copia and Gypsy superfamilies, respectively. Most elements were inactive in transcription, both constitutively and in leaves of plants exposed to an abiotic stress, except for some elements, mostly belonging to the Copia/Ale lineage. A relationship between the inactivity of an element and inactivity of genes lying in close proximity to it was established. Conclusions The data reported in this study provide one of the first sets of information on the genomic dynamics related to LTR-REs in a plant species with highly reliable genome sequence. Fig LTR-REs are highly heterogeneous in abundance and estimated insertion time, and only a few elements are transcriptionally active. In general, the data suggested a direct relationship between estimated insertion time and abundance of an element and an inverse relationship between insertion time (or abundance) and transcription, at least for Copia LTR-REs.

Size selection of the Ambu AuraOnce laryngeal mask in Chinese men weighing >70 kg: a pilot study

Objective To collect computed tomography data of the laryngeal anatomy of Chinese men and to determine the feasibility of using the size 4 Ambu AuraOnce laryngeal mask (Ambu A/S, Copenhagen, Denmark) in Chinese men weighing >70 kg. Methods This prospective study involved men who underwent surgery from May 2018 to January 2019 at Jinshan Hospital. Pharyngeal and laryngeal parameters were measured by computed tomography. The laryngeal mask insertion success rate, requirement for tracheal tube insertion, laryngeal mask insertion time, fiberoptic bronchoscopy grading, air leakage pressure, and pharyngeal complications were analyzed. Results In a comparison of the size 4 and 5 Ambu AuraOnce devices, the first insertion success rate was 100% and 87% and the three-times insertion success rate was 100% and 93%, respectively, with no significant differences. However, the insertion time was significantly different at 19.6 ± 5.9 versus 31.1 ± 11.2 s, respectively, and the proportions of fiberoptic grading levels were also significantly different. There were no significant differences in the air leakage pressure or pharyngeal complications. Conclusion The size 4 Ambu AuraOnce is more adequate than the size 5 for Chinese men weighing >70 kg, with a shorter insertion time and higher fiberoptic bronchoscopic grading.

Comparison of Insertion Time, Pull-out Strength, and Screw-media Interface Area of Customized Pedicle Screw With Different Core and Thread Design Against Commercial Pedicle Screw

Objective: This research aimed to developing customized pedicle screw based on Indonesian vertebral anatomy and compare the insertion time, pull-out strength, and screw-media interface area of different screw design. We have developed 3 different types of pedicle screws (v-thread cylinder-core, square-thread cylinder-core and square-thread conical-core). The thread diameter was calculated from pedicle width of Indonesian population (6 mm). We used commercially available pedicle screw as control group (6.2 mm). Result: The insertion time were significantly difference between v-thread cylinder-core pedicle screw (22,94 s) with commercially available pedicle screw (15.86 s) (p<0.05). The pull-out strength was significantly difference between commercially available pedicle screw (408.60 N) with square-thread conical pedicle screw (836.60 N) (p<0.05). The square-thread conical-core group have the highest interface area (1486.21 mm2). The data comparison showed that the square-thread conical-core customized pedicle screw group has comparable insertion time and has better pull-out strength than commercially available pedicle screw.

Efficacy of two-person technique for I-gel insertion: a prospective observational study

Background: Recently anesthesiologists favoring I-gel over ET in securing airway during general anaesthesia because of better haemodynamic response and post-operative complications. In this study, we have assessed the efficacy of two -person technique for insertion of I- gel in paralysed patients.Methods: I- gel is insertion was done in 40 patients undergoing general anaesthesia. Insertion time, number of attempts, air leaks, Tidal volume (TV) and expired tidal volume (ETV), emergence from anaesthesia, post-operative complications were assessed.Results: Mean insertion time was 14.02±1.99 seconds. Insertion was successful in 37 patients (92.5%) in first attempt. 3 (7.5%) patients needed second attempts. Emergence from anaesthesia was satisfactory in all cases (100%).3 patients (7.5%) had mild cough and there were blood stained in the device in 2 cases (5%).6 patients (15%) had mild, 5 patients (12.5%) had moderate sore throat in first 24 hours. 4 patients (10%) had mild pain during swallowing.Conclusions: Two- person technique for insertion of I-gel is easier and lower insertion time with fewer complications.

The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy

Background: The aim of this study was to evaluate the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy.Methods: We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Comparisons between patients with prior abdominal surgery and with no prior abdominal surgery were based on perioperative outcomes. Furthermore, patients underwent transperitoneal robot-assisted partial nephrectomy was compared between those with and without prior abdominal surgery. The Mann–Whitney U test and the chi-square test were used for statistical analyses of variables. Results: Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58 %) had no prior abdominal surgery, whereas 66 patients (42 %) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (38.8 %) had prior abdominal surgery, whereas 49 patients had no prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, p = 0.031). The other perioperative outcomes were no significant differences. In the conversion rate, no significant difference was observed between the two groups (p = 0.556).Conclusions: Prior abdominal surgery does not appear to affect Robot-assisted partial nephrectomy. Robot-assisted partial nephrectomy can be a safe procedure for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. The conversions to radical nephrectomy and open partial nephrectomy were not associated with prior abdominal surgery. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.