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Journal of Experimental Orthopaedics Sep 2023The study aimed to compare the effect of mincing bovine articular cartilage with different shaver blades on chondrocyte viability.
PURPOSE
The study aimed to compare the effect of mincing bovine articular cartilage with different shaver blades on chondrocyte viability.
METHODS
Bovine articular cartilage was harvested either with a scalpel or with three different shaver blades (2.5 mm, 3.5 mm, or 4.2 mm) from a commercially available shaver. The cartilage harvested with a scalpel was then minced into fragments smaller than 1 mm with a scalpel. All four conditions were cultivated in a culture medium for seven days. After Day 1 and Day 7, the following measurements were performed: metabolic activity, RNA isolation, and gene expression of anabolic (COL2A1 and ACAN) and catabolic genes (MMP1 and MMP13), live/dead staining and visualization using confocal microscopy, and flow cytometric characterization of minced cartilage chondrocytes.
RESULTS
Mincing the cartilage with shavers significantly reduced metabolic activity after one and seven days compared to scalpel mincing (p < 0.001). Gene expression of anabolic genes (COL2A1 and ACAN) was reduced, while catabolic genes (MMP1 and MMP13) were increased after day 7 in all shaver conditions. Confocal microscopy showed a thin line of dead cells at the lesion side with viable cells beneath for the scalpel mincing and a higher number of dead cells diffusely distributed in the shaver conditions. After seven days, there was a significant decrease in viable cells in the shaver conditions compared to scalpel mincing (p < 0.05). Flow cytometric characterization revealed fewer intact cells and proportionally more dead cells in all shaver conditions compared to the scalpel mincing.
CONCLUSION
Mincing bovine articular cartilage with commercially available shavers reduces the viability of chondrocytes compared to scalpel mincing immediately after harvest and after seven days in culture. This suggests that mincing cartilage with a shaver should be considered a matrix rather than a cell therapy.
LEVEL OF EVIDENCE
Level II therapeutic study.
PubMed: 37768416
DOI: 10.1186/s40634-023-00661-5 -
Frontiers in Cardiovascular Medicine 2024The pulsed-electron avalanche knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates...
BACKGROUND
The pulsed-electron avalanche knife (PEAK) PlasmaBlade provides an atraumatic, scalpel-like cutting precision and electrocautery-like hemostasis. PlasmaBlade operates near body temperature, and its long, thin, and malleable tip can overcome the limitations of a surgical knife. In this study, we aimed to evaluate our clinical experience and histopathological outcomes of septal myectomy using PlasmaBlade.
METHODS
Electronic medical records were reviewed for preoperative, operative, and follow-up data of the patients who underwent septal myectomy using PEAK PlasmaBlade at our institute between January 2019 and December 2022. Histopathology of the myectomy specimens was reviewed for the depth of muscle necrosis and compared with the left atrial appendage (LAA) specimen.
RESULTS
Twenty-nine patients underwent septal myectomy using the PEAK PlasmaBlade. No mortality was reported. The mean age was 60.6 ± 12.5 years, and 58.6% of patients were male. Peak left ventricular outflow tract (LVOT) gradients were 40.5 ± 34.9 mmHg at rest and 56.5 ± 34.9 mmHg after provocation. Concomitant procedures performed were LAA ligation in 20 (69.0%), aortic valve replacement in 5 (17.2%), and coronary artery bypass grafting in 3 (10.3%) patients. Postoperative complications were complete heart block in one (3.4%) and ventricular septal defect in two (6.9%) patients. Both the ventricular septal defects were identified intraoperatively and repaired. Histopathology of myectomy specimens demonstrated cautery artifact limited to <50 µm depth compared to >1,000 µm with conventional electrocautery. At a mean follow-up of 8.4 ± 10.3 months, the mean LVOT gradient was 4.4 ± 5.8 mmHg at rest and 9.5 ± 3.3 mmHg after provocation. All patients were alive and in New York Heart Association class I/II. No patient developed complications or required reintervention or reoperation.
CONCLUSION
Adequate septal myectomy can be precisely and safely performed using the PEAK PlasmaBlade with minimal collateral damage.
PubMed: 38357514
DOI: 10.3389/fcvm.2024.1345540 -
Journal of Cutaneous and Aesthetic... 2024Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes.
BACKGROUND
Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes.
OBJECTIVE
The present study assessed efficacy and safety of combination therapy-surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids.
MATERIALS AND METHODS
This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported.
RESULTS
Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved.
CONCLUSION
Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids.
PubMed: 38800820
DOI: 10.4103/JCAS.JCAS_40_23 -
Anaesthesia, Critical Care & Pain... Aug 2023The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
The preferential use of a scalpel (SCT) or puncture techniques (PCT) for cricothyrotomy remains a controversial topic.
OBJECTIVE
We performed a systematic review and meta-analysis comparing puncture cricothyrotomy with scalpel cricothyrotomy using overall success rate, first-time success rate, and time taken to perform the procedure as the primary outcome together with complications as a secondary outcome.
EVIDENCE REVIEW
Pubmed databases, EMBASE databases, MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, from 1980 to October 2022.
FINDINGS
A total of 32 studies were included in the systematic review and meta-analysis. It also showed that PCT was close to SCT in terms of overall success rate (82.2% vs. 82.6%, Odd Ratios OR = 0.91, [95%CI: 0.52-1.58], p = 0.74) as well as first-performance success rate (62.9% vs. 65.3%, OR = 0.52, [0.22-1.25], p = 0.15). PCT does not compare favorably with SCT in terms of required time for the procedure (the mean time required for PCT versus SCT incision in the intervention groups was 0.34 standard deviations higher (Mean Difference MD = 17.12, [3.37-30.87], p = 0.01) as well as complications (21.4% vs. 15.1%, Relative Risk RR = 1.49, [0.80-2.77], p = 0.21).
CONCLUSIONS AND RELEVANCE
The results show that SCT has an advantage over PCT in terms of time required for the procedure, while there is no difference in overall success rate, first-time success rate after training, and complications. The superiority of SCT may be the result of fewer and more reliable procedural steps. However, the level of evidence is low (GRADE).
Topics: Humans; Airway Management; Punctures; Surgical Wound
PubMed: 36871625
DOI: 10.1016/j.accpm.2023.101211 -
Plant Disease Aug 2023Nageia nagi (Thunb.) Kuntze belongs to the family Podocarpaceae with shiny green branches and leaves, which is widely distributed in East Asia and the Southern...
Nageia nagi (Thunb.) Kuntze belongs to the family Podocarpaceae with shiny green branches and leaves, which is widely distributed in East Asia and the Southern Hemisphere. The leaves, roots and fruits of N. nagi have been used as herbal medicine to treat rheumatism, arthritis and venereal diseases (Abdillahi et al. 2011). In September 2022, leaf spot symptoms were found on approximately 30% of the leaves of N. nagi trees in a community located at the Economic and Technological Development Zone, Nanchang City, Jiangxi Province, China. Following the initial infection, the leaf lesions extended outwards from the top in a circular pattern, appearing as a dark brick color, and later changed to yellow and became dry, with a darker brown margin surrounding them. Ten symptomatic leaves were randomly selected, and a small piece of leaf tissue (5mm ×5mm) located between the health and infected tissues was cut and surface-desinfected with 70% ethanol for 30 s and 1% sodium hypochlorite (NaClO) for 30 s sequentially. After rinsing three times in sterile distilled water, all the small pieces of leaves were placed on potato dextrose agar (PDA) plates, followed by incubation at 28℃ for 3 days. Ten isolates, cultured on each PDA plate, appeared olive green with a granular surface, and an uneven white edge, and finally turned greenish black. The conidia were hyaline, with ellipsoidal to subglobose shapes and spore sizes of 5.5-8.3 × 7.2-12.0 μm (width × length) (=7.2±0.71 × 9.9±1.3 μm, n=40). These morphological characteristics are consistent with those of Phyllosticta species. To confirm the species, three representative isolates, JFRL 03-768, JFRL 03-769 and JFRL 03-770 were selected for further identification. The internal transcribed spacer (ITS) region, actin (ACT), translation elongation factor 1-alpha (TEF1-a), and glyceradehyde-3-phosphate dehydrogenase (GPD) genes of the three isolates were amplified and sequenced with the primers V9G/ITS4 (Carbone and Kohn 1999), ACT-512F/ACT-783R (Carbone and Kohn 1999), EF-728F/EF-2 (O´Donnell et al. 1998) and Gpd1-LM/Gpd2-LM (Myllys et al. 2002; Guerber et al. 2003), respectively. All sequences had been deposited into GenBank (ITS: OQ195332, OQ195333 and OQ195334; ACT: OQ207621, OQ207622 and OQ207623; TEF1-a: OQ207624, OQ207625 and OQ207626; GPD: OQ207627, OQ207628 and OQ207629). A maximum likelihood phylogenetic tree was constructed using the IQtree V1.5.6 (Ngugen et al. 2015) based on the concatenation of multiple sequences (ITS, ACT, TEF1-a and GPD). In the cluster analysis, the representative isolates (JFRL 03-768, JFRL 03-769 and JFRL 03-770) were positioned within a clade comprising of Phyllosticta styracicola. Subsequently, the pathogenicity of P. styracicola was determined by wound inoculation of healthy 2 year-old N. nagi plants, and this experiment was repeated for three times. Briefly, for each isolates, six disinfected leaves were wounded with a sterile scalpel, and then inoculated with 10-μl drop of the conidial suspension (1 × 106 conidia/ml). Another six disinfected leaves were inoculated with 10-μl drop of sterile water as a control group, and all plants were incubated at 28°C with 80% humidity. After 15 days, a similar spot lesion appeared on the leaves of the experimental group. P. styracicola was successfully re-isolated, and then subjected to morphological identification and molecular sequencing (ITS, ACT, TEF1-a and GPD genes). Whilst, the control leaves showed no symptoms. Previous studies have reported that P. styracicola could result in the development of lesions on Styrax grandiflorus leaves in China (Zhang et al. 2013). To our knowledge, this is the first report that P. styracicola can cause leaf spot on N. nagi in China.
PubMed: 37528341
DOI: 10.1094/PDIS-02-23-0345-PDN -
Endoscopy International Open Oct 2023We have previously reported on the effectiveness of colonoscopy-assisted percutaneous sigmoidopexy (CAPS) for sigmoid volvulus treatment. This study describes the CAPS...
We have previously reported on the effectiveness of colonoscopy-assisted percutaneous sigmoidopexy (CAPS) for sigmoid volvulus treatment. This study describes the CAPS application to treat complete rectal prolapse by straightening and fixing the rectum. Complete rectal prolapse is common in older women. Due to their comorbidities, management must comprise a simple, safe, and reliable surgical method not involving general anesthesia or colon resection. We enrolled 13 patients in our outpatient department diagnosed with complete rectal prolapse between June 2016 and 2021. The endoscope was advanced into the anterior proximal rectal wall, straightening the intussuscepted sigmoid colon and rectum to approximate the puncture site. The fixation sites were anesthetized with 1% xylocaine, and a 2-mm skin incision was made using a scalpel. A two-shot anchor was used to fix the sigmoid colon to the abdominal wall (Olympus, Tokyo, Japan). The median patient age was 88 years (range: 50-94). The median CAPS procedure time was 30 minutes (range: 20-60). In one patient, the transverse colon was accidentally punctured and interposed between the abdominal wall and sigmoid colon, requiring a laparotomy to remove the causative fixation thread and provide re-fixation. Fecal incontinence was resolved in 10 of 13 cases. CAPS is a quick and simple procedure. In addition, it is a treatment option for complete rectal prolapse that can be performed under local anesthesia.
PubMed: 37818456
DOI: 10.1055/a-2131-5037 -
Computational and Structural... Dec 2024AI has revolutionized the way we interact with technology. Noteworthy advances in AI algorithms and large language models (LLM) have led to the development of natural...
AI has revolutionized the way we interact with technology. Noteworthy advances in AI algorithms and large language models (LLM) have led to the development of natural generative language (NGL) systems such as ChatGPT. Although these LLM can simulate human conversations and generate content in real time, they face challenges related to the topicality and accuracy of the information they generate. This study aimed to assess whether ChatGPT-4 could provide accurate and reliable answers to general dentists in the field of oral surgery, and thus explore its potential as an intelligent virtual assistant in clinical decision making in oral surgery. Thirty questions related to oral surgery were posed to ChatGPT4, each question repeated 30 times. Subsequently, a total of 900 responses were obtained. Two surgeons graded the answers according to the guidelines of the Spanish Society of Oral Surgery, using a three-point Likert scale (correct, partially correct/incomplete, and incorrect). Disagreements were arbitrated by an experienced oral surgeon, who provided the final grade Accuracy was found to be 71.7%, and consistency of the experts' grading across iterations, ranged from moderate to almost perfect. ChatGPT-4, with its potential capabilities, will inevitably be integrated into dental disciplines, including oral surgery. In the future, it could be considered as an auxiliary intelligent virtual assistant, though it would never replace oral surgery experts. Proper training and verified information by experts will remain vital to the implementation of the technology. More comprehensive research is needed to ensure the safe and successful application of AI in oral surgery.
PubMed: 38162955
DOI: 10.1016/j.csbj.2023.11.058 -
Cureus Nov 2023This study evaluated the safety and feasibility of a technique of liver resection named dual-wield parenchymal transection technique (DWT), using cavitron ultrasonic...
A Multicenter, Open-Label, Single-Arm Phase I Trial of Dual-Wield Parenchymal Transection: A New Technique of Liver Resection Using the Cavitron Ultrasonic Surgical Aspirator and Water-Jet Scalpel Simultaneously (HiSCO-14 Trial).
PURPOSE
This study evaluated the safety and feasibility of a technique of liver resection named dual-wield parenchymal transection technique (DWT), using cavitron ultrasonic surgical aspirator (CUSA) and water-jet scalpel simultaneously.
METHODS
This multicenter, prospective, open-label, and single-arm phase I trial included patients aged 20 years or older with hepatic tumors indicated for surgical resection and scheduled for open radical resection. This study was conducted at two institutions affiliated with the Hiroshima Surgical Study Group of Clinical Oncology (HiSCO). The primary endpoint was the proportion of massive intraoperative blood loss (≥ 1000 mL). The secondary endpoints were the amount of blood loss, operative time, parenchymal transection speed, postoperative complications, and mortality. The safety endpoints were device failure and adverse events associated with devices.
RESULTS
From June 2022 to May 2023, 20 patients were enrolled; one was excluded and 19 were included in the full analysis set (FAS). In the FAS, segmentectomy was performed in nine cases, sectionectomy in four cases, and hemihepatectomy in six cases. Radical resection was achieved in all patients. Intraoperative blood loss greater than 1000 mL was observed in five patients (26.3%). The median amount of blood loss was 545 mL (range, 180-4413), and blood transfusions were performed on two patients (10.5%). The median operative time was 346 minutes (range, 238-543) and the median parenchymal transection speed was 1.2 cm/minute (range, 0.5-5.1). Postoperative complications of Clavien-Dindo classification ≥ Grade 3 occurred in four patients (21.1%). No mortalities occurred in this study. In the safety analysis, there were no device failures or adverse events associated with devices.
CONCLUSIONS
This study demonstrated the safety and feasibility of DWT for liver resection. The efficacy of the DWT will be evaluated in future clinical trials.
PubMed: 38116351
DOI: 10.7759/cureus.49028 -
Cureus Mar 2024The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the...
The frenum is a mucous membrane fold that connects the lip and cheek to the gingiva, periosteum, and alveolar mucosa. When the frena are linked too closely to the gingival border, there may be issues with plaque removal, and the overall gingiva may be affected. In addition, the maxillary frenum may provide aesthetic difficulties or interfere with the aesthetic outcome in cases of midline diastema, which may result in a recurrence after treatment. A labial frenectomy, a frequently performed surgical operation in the specialty of dentistry, is used to address such an abnormal frenum. This article describes a case study of a maxillary labial frenectomy using a traditional scalpel approach and topical application of ozonated olive oil.
PubMed: 38576654
DOI: 10.7759/cureus.55522 -
Journal of Neurosurgery. Case Lessons Mar 2024Spinal arachnoid webs (SAWs) are rare pathologies of the spinal meninges often associated with syringomyelia and the radiographic "scalpel sign." Patients can experience...
BACKGROUND
Spinal arachnoid webs (SAWs) are rare pathologies of the spinal meninges often associated with syringomyelia and the radiographic "scalpel sign." Patients can experience pain, numbness, gait disturbances, or no symptoms at all. They are typically diagnosed via magnetic resonance imaging and treated with laminectomy and excision.
OBSERVATIONS
A 61-year-old male presented after a mechanical fall and had an incidentally discovered SAW on imaging. He was initially asymptomatic and was therefore conservatively managed. Several years later, however, the patient experienced new-onset back pain, paresthesia, and balance problems, with interval imaging demonstrating worsening of the edema surrounding his SAW. The patient subsequently underwent resection of the SAW, which led to significant resolution of his symptoms.
LESSONS
An SAW can be asymptomatic or can manifest with a wide variety of symptoms. When this condition is incidentally discovered in asymptomatic patients, neurosurgeons should guide these patients to follow-up urgently if they develop any neurological symptoms. At that time, further imaging can be performed to determine if surgical treatment is indicated. Although SAW is rare, clinicians should be aware of the signs and symptoms, because prompt surgical intervention can significantly improve neurological symptoms.
PubMed: 38467042
DOI: 10.3171/CASE23701