Search Results (60)

Background/Objectives: This study aimed to evaluate the effectiveness of core needle biopsy (CNB) by comparing its diagnostic yield to fine needle aspiration cytology (FNAC) across primary and secondary examinations. Methods: This retrospective review analyzed medical records of patients who visited Soonchunhyang University Cheonan Hospital between January 2021 and August 2023 for thyroid nodule evaluation. Demographic data and the malignancy risk of thyroid nodules were collected based on the 2021 Korean Thyroid Imaging Reporting and Data System. FNAC and CNB results, classified using the Bethesda system for reporting thyroid cytopathology and diagnostic categories for thyroid CNB, were categorized as either “conclusive” or “inconclusive.” The rates of conclusive results in the primary examination and nodules transitioning from inconclusive to conclusive results during the secondary examination were analyzed. Finally, the diagnostic yields of FNAC and CNB were assessed using histopathological findings from surgically excised nodules. Results: The rate of nodules classified as “conclusive” was significantly higher in the CNB group than that in the FNAC group. Among nodules subjected to secondary examination, only the group with FNAC followed by CNB demonstrated a significant improvement in the rate of transition from inconclusive to conclusive results. Although FNAC and CNB showed comparable sensitivity and accuracy, the specificity of CNB was greater than that of FNAC. Conclusions: This study confirms the clinical utility of CNB by demonstrating its higher rate of conclusive results than FNAC. Future prospective studies, including cost–benefit analyses, are warranted to further define the indications for CNB. Full article

Background/Objectives: Cervicogenic headache (CeH) is linked to upper cervical dysfunctions. The obliquus capitis inferior (OCI) muscle may contribute to restricted cervical rotation at the C1–C2 level, altered proprioception and pain. Dry needling (DN) of the OCI is hypothesized to target these dysfunctions. The aim of this study was to investigate whether a single intervention combining DN and manual therapy (MT) compared to sham needling (SN) and MT, improves C1–C2 rotation, functional, headache-related and psychological outcomes in a subgroup of CeH patients with a positive cervical flexion–rotation test (CFRT). Methods: Thirty-four participants were randomly assigned to (1) DN or (2) SN. The primary outcome was C1–C2 rotational mobility. Secondary outcomes included headache-related parameters (frequency, intensity, duration and perceived effect), functional parameters (cervical mobility, pain pressure thresholds, motor control and proprioception) and psychological parameters (central sensitization, pain catastrophizing, coping strategies and kinesiophobia). Outcomes were re-evaluated at one-week follow-up. Results: Linear mixed-effects models showed a significant and clinically relevant increase of C1–C2 rotation in the DN group compared to the SN group post-intervention (mean difference [MD]: 4.51°; 95% confidence interval [CI]: 1.74; 7.28), which was maintained at the 1-week follow-up (MD: 5.44°; 95% CI: 2.55; 8.33). No clinically relevant changes were observed in other secondary outcome measures. Conclusions: Targeting the OCI may be of added value in restoring atlanto-axial dysfunction. While short-term mobility gains were observed, a single intervention appears insufficient as a stand-alone treatment to impact functional or psychological outcomes. Future research involving larger samples should examine DN effects as part of a multimodal approach with long-term follow-up. Full article

Background/Objectives: Patients with non-small cell lung cancer (NSCLC) being evaluated for stereotactic body radiation therapy (SBRT) are frequently staged non-invasively with positron emission tomography/computed tomography (PET/CT). Performing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in addition to PET/CT scanning may increase clinical certainty in lymph node staging, but the magnitude of added benefit of EBUS-TBNA over non-invasive staging methods is unclear. Methods: A single-center prospective cohort study involving patients with suspected or confirmed Stage I or IIa NSCLC referred for EBUS-TBNA prior to SBRT was performed. The primary outcome was concordance between PET/CT and EBUS-TBNA for nodal metastases. Secondary endpoints included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PET/CT, and clinical outcomes based on staging results. Results: Among 115 patients, the concordance between PET/CT and EBUS-TBNA was 84.3% (95% CI: 0.76 0.90). EBUS-TBNA led to a stage shift in 15.7% of cases: 4 of 98 PET/CT N0 patients (4.1%) had nodal metastases, while 14 of 17 PET/CT N1 patients (82.4%) were downstaged to N0. PET/CT sensitivity was 42.9% (95% CI: 0.09–0.81), specificity 87% (95% CI: 0.79–0.93), PPV 17.6% (95% CI: 0.04–0.43), and NPV 95.9% (95% CI: 0.90–0.99). PET/CT-positive, EBUS-TBNA-negative patients had worse survival (HR 4.25, 95% CI: 1.24–14.53, p = 0.021) compared with double-negative patients. Conclusions: EBUS-TBNA improves staging accuracy over PET/CT in early-stage NSCLC, impacting SBRT candidacy. However, PET/CT-positive, EBUS-TBNA-negative patients had worse outcomes in comparison to double-negative patients, suggesting a need for additional therapy or surveillance in that population. Full article

Background: Ultrasound-guided identification of the cricothyroid membrane is more accurate than traditional palpation techniques. Additionally, real-time ultrasound-guided puncture is more precise than ultrasound alone. However, no dedicated device currently exists for ultrasound-guided needle cricothyroidotomy. In this study, we aimed to develop and evaluate a novel ultrasound-guided cricothyroidotomy device. Methods: A randomized, prospective, crossover simulation study was conducted using a porcine larynx model. Sixteen anesthesiologists and six anesthesia residents participated after receiving video-based and hands-on training. Each participant performed cricothyroidotomy using three methods: ultrasound-guided needle cricothyroidotomy using the novel device (US-G), needle cricothyroidotomy using a commercial cricothyroidotomy kit (QuickTrach^®), and scalpel incisional cricothyroidotomy after conventional palpation identifying the cricothyroid membrane (Pal-SI). The primary outcome was the puncture success rate. Secondary outcomes included procedure time and tracheal wall injury rates. Results: Cricothyroidotomy of the porcine larynx had a success rate of 100% for US-G and Pal-C and 95% for Pal-SI. The US-G procedure time was significantly longer (median: 80 s) than for Pal-C (22 s) or Pal-SI (51 s). No significant differences in the tracheal wall injury rates were noted across methods, and no severe injuries were reported in the US-G group. Conclusions: US-G demonstrated a high success rate and good safety profile. Although the procedure time was longer than other methods, its precision may still be beneficial in cases involving anticipated difficult airways. Further clinical validation is warranted. Full article

Background/Objectives: This study aims to compare the safety of tenecteplase versus alteplase for acute ischemic stroke. Methods: This was a multicenter, retrospective cohort study including 11 Memorial Hermann Health System hospitals in Houston from 7 December 2022 to 7 June 2023. Adults presenting with an acute ischemic stroke who received alteplase or tenecteplase were included in this study. The primary outcome was the incidence of hemorrhagic conversion after 24 h of thrombolytic administration. Secondary outcomes included door-to-needle time, incidence of a major or minor bleed, length of hospital stay, incidence of any adverse effect, modified Rankin score at discharge, patient discharge disposition, medication cost, and mortality. Results: A total of 173 patients were reviewed, with 87 patients in the tenecteplase group and 86 patients in the alteplase group. Gender, actual body weight, and use of aspirin or dual antiplatelet therapy within 24 h of thrombolytic administration were statistically disproportionate between both groups. Hemorrhagic conversion occurred in seven patients in the tenecteplase group and eight patients in the alteplase group (p = 0.79). Medication cost was statistically significant between both groups. All other secondary outcomes were similar between tenecteplase and alteplase. Conclusions: In this underpowered study, we did not observe a statistically significant difference in the rate of 24 h hemorrhagic conversion between the tenecteplase and alteplase groups. Further studies with a large sample size are warranted to assess safety outcomes. Full article

Background/Objectives: This study aims to evaluate the long-term efficacy and safety of ab interno techniques using minimally invasive glaucoma surgery (MIGS), specifically XEN gel stent implantation, by evaluating its 2-year outcomes in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Methods: This retrospective single-center study consecutively included 31 eyes of 31 patients with POAG or PXG who underwent XEN gel stent implantation. Patients were followed for 24 months, with assessments at multiple time points. Success was defined as achieving an IOP of less than 14 mmHg and a reduction of more than 20% from preoperative IOP without additional glaucoma surgery. Bleb morphology was evaluated using anterior segment optical coherence tomography (AS-OCT) and slit-lamp photographs. Postoperative interventions and complications were also recorded. Results: At 24 months, complete success and qualified success rates were 35.5% (11/31) and 51.6% (16/31), respectively. There was no difference in surgical success rates at 2 years based on the tip location (intraconjunctiva, intratenon, and uviform) on the 1st postoperative day. Patients with high sparse wall on AS-OCT imaging or avascular bleb morphology via slit-lamp photography at 6 months postoperatively had higher complete success rates at 2 years than those without (p = 0.007, p = 0.009, respectively). Patients with avascular bleb types at 6 months postoperatively had higher qualified success rates at 2 years compared with the vascular types (p = 0.038). Needling was performed in 32.3% of eyes, with secondary surgical procedures required in 16.1% of eyes. The most common adverse event was hypotony, occurring in 67.7% of eyes on the 1st postoperative day but resolving within 6 months. Conclusions: The ab interno XEN gel stent is an effective and minimally invasive option for managing POAG and PXG, with long-term success predicted by the AS-OCT assessment of bleb morphology at 6 months. Proactive postoperative management, emphasizing early intervention and monitoring, is crucial for maintaining optimal outcomes. Full article

Objectives: Low tidal volume ventilation (LTVV) is a ventilatory strategy with the advantages of minimizing diaphragm movements and reducing hypercapnia and barotrauma risks. This preliminary study aims to report on the safety and effectiveness of LTVV applied during percutaneous US-guided liver ablations of focal malignancies. Methods: Patients affected by focal liver malignancies treated with percutaneous microwaves ablation were retrospectively included in this single-center analysis. Arterial gas analysis was performed immediately before and after ablation to evaluate the arterial pH, partial pressure of carbon dioxide (pCO₂), partial pressure of oxygen (pO₂), and plasma lactate levels. The primary endpoint of this study was to evaluate the safety and efficacy of LTVV during percutaneous liver cancer ablation. The secondary endpoint was to assess the procedural technical success in terms of correct needle probe targeting without the need for repositioning. Results: Ten patients affected by a single liver lesion had been analyzed. The ASA score was three in all patients, with three patients also suffering from COPD. The procedural technical success was 100%: ablations were performed with a single liver puncture without the need for changing access or repositioning the needle. No variations in post-ablation arterial gas analysis requiring anesthesiological management remodulation occurred. Lactate levels remained stable and hemodynamic balance was preserved during all procedures. No switch to standard volume ventilation was required. Conclusions: In this preliminary study, LTVV was a safe and effective anesthesiological protocol in patients treated with percutaneous ablations of liver malignancies, offering an ideal balance between patient safety and percutaneous needle probe positioning precision. Larger prospective studies are needed to confirm these findings. Full article

Background: This study aimed to assess the efficacy and safety of the 30G needle mediated ab externo open conjunctiva approach for the XEN 63 µm implant in primary open-angle glaucoma. Methods: A retrospective and non-randomized study was conducted on consecutive cases of medically refractory primary open-angle glaucoma treated with standalone ab externo open conjunctiva XEN^® 63 µm (North Chicago, Illinois) with one-year follow-up. Results: Twenty-two eyes were included. The mean preoperative intraocular pressure was 21.9 ± 7.2 mmHg, and the mean number of glaucoma medications was 2.4 ± 0.9. All patients underwent mitomycin 0.02% application for 2 min, and Healaflow^® (MedicalMix, Spain), was implanted in 11 cases (50%). Complete surgical success was achieved in 14 cases (63.6%). No statistical differences in complete surgical success were noted based on the use of Healaflow^®. A significant reduction in intraocular pressure (11.8 ± 3.4 mmHg) and in the number of hypotensive medications (0.2 ± 0.5 mmHg) was observed 1 year after the procedure. Transient hypotony was detected in 31.8% of cases. Complications secondary to hypotony included four cases of serous choroidal detachment and one case of localized hemorrhagic choroidal detachment, the latter associated with hypotonic keratopathy and hypotonic maculopathy. All these complications evolved favorably with conservative management and adjusted topical treatment. Conclusions: This study highlights the efficacy and safety of this approach for the XEN 63 µm implant in medically refractory primary open-angle glaucoma. Full article

Background: Chemotherapy-induced peripheral neuropathy (CIPN) affects 20–85% of individuals exposed to neurotoxic chemotherapeutic agents. Perineural electrical dry needling (PEDN) and neural mobilization (NM) interventions may be beneficial in the management of chronic neurogenic pain; however, there is a paucity of research on the efficacy of both interventions for CIPN. Methods: Three patients were referred to an outpatient physical therapy clinic with chronic neuropathic pain associated with CIPN. Each underwent PEDN and NM twice weekly until goals were met or progress stalled. The primary outcome measure was the Numeric Pain Rating Scale (NPRS). Secondary outcomes included the Global Rating of Change (GROC) and the Lower Extremity Functional Scale (LEFS). All outcome measures were assessed at evaluation and discharge. Results: At discharge, patients A and B exceeded the minimum clinically important difference (MCID) for the primary and secondary outcome measures, indicating decreased neuropathic pain and improved lower extremity function. Patient C improved in all outcome measures but only experienced clinically meaningful changes in the NPRS and LEFS, not the GROC. Conclusions: Following 4–8 sessions of PEDN and NM, three patients with CIPN demonstrated clinically meaningful improvements in chronic lower extremity neuropathic pain and function. PEDN and NM may be beneficial in the management of patients presenting with chronic neuropathic pain secondary to CIPN. Full article

Background: Facial aging involves soft and hard tissues with changes that can affect an individual’s self-esteem and aesthetic appearance. Techniques used to counteract these changes include the use of solutions to be injected into the dermis, such as dermal matrix, vitamins, and antioxidants. B vitamins and choline are vital nutrition for humans and many other animals (vitamin B4), required to produce acetylcholine (ACh). It is considered a neurotransmitter universal methyl donator and of the major membrane constituent phosphatidylcholine (PC) and is crucial for the functioning of cell membranes, including those in skeletal muscle cells. The aim of this study is to evaluate the efficacy and safety of a fragment of HA amino acid and choline in a solution of phosphate buffer system used via mesotherapy. Specifically, state that the primary endpoint was the efficacy assessment using the Scientific Assessment Scale of Skin Quality (SASSQ), while secondary endpoints included safety assessments and patient-reported outcomes. Methods: Forty (40) subjects completed the study. In total, 40 subjects were screened and included in the study. The total duration of the study was 14 months. The first subject was included on 12 January 2019, and the last subject’s last visit was on 14 March 2020. All patients received the SKIN Colin^® products by mesotherapy technique for 8 weeks, providing the treatment with the use of 0.5 cc syringes and 13 mm long, 30 G diameter needles. The solution was inoculated into the deep layer of the dermis of the face with a suitable amount of at least 0.2/0.3 mL in the cutaneous points four times every 15 days. Each subject had to be followed for 168 days after the last mesotherapy session. Only enrolled subjects received the HA and choline via mesotherapy. The primary efficacy endpoint was the absolute change in the Scientific Assessment Scale of Skin Quality from Baseline (Day 0) to Day 168. A reduction of at least one point in the SASSQ was considered to reach the endpoint goal. Results: The results of the present investigation show Scientific Assessment Scale of Skin Quality (SASSQ) mean at baseline was 2463 with a standard deviation of 0.36, while at day 168, the mean was 1303 with a standard deviation of 0.36. The difference was statistically significant (p < 0.0001). Also, the GAIS was improved after treatment with Skin Colin^®. The assessment of “satisfaction with treatment” was very high by the majority of subjects. Conclusions: In conclusion, our results suggest that a course of treatment with choline via mesotherapy results in an improvement of the Scientific Assessment Scale of Skin Quality. This data is very important for possible fields of application in the treatment of skin and muscle aging. However, the present study has limitations due to the small sample size and the lack of a control group. Full article

Date palm tree (DPT) and pine tree (PT) needles in forests form a combustible mat, posing fire risks during summer in Pakistan that damage vegetation, wildlife habitats, and biodiversity and impact local livelihoods. In this article, sintered ceramic specimens were prepared at different weight concentrations (DPT5, DPT10, DPT20, and DPT 30 and PT5, PT10, PT20, and PT30) of date palm tree leaf ash and pine tree needle ash as secondary additives in ceramic manufacturing along with primary material kaolinite (China clay). Raw materials composition was analyzed using X-ray diffraction (XRD), taking loss on ignition, water absorption, bulk density, saturated surface dry density (SSD), weight per unit area, and thermal cycling as measurement indexes. The result indicates that loss on ignition increases while increasing the quantity of secondary additives and the maximum increase for DPT30 was 19.6% and for PT30, it was 22.1%. As the secondary additives increase, the water absorption rate also increases and the maximum increase for DPT30 and PT30 is 4.5%. Meanwhile, with the increase in secondary additives, the density decreased; for DPT 30, it was 1457.7 kg/m³ and for PT30, it was 1829.8 kg/m³. Thermal performance was investigated by heating and cooling cycles. It was observed that thermal performances increase with the increase in secondary additives. The results reveal this novel approach has the potential to form a ceramic and good properties can be achieved. The prepared specimens have the potential to be used in the fields of electronics, aerospace, construction, and building engineering, alleviating environmental strain, curbing the exhaustion of China clay reserves, and most importantly, lowering the risk of forest fires in Pakistan. Full article

Cold acclimation before winter has been shown to enhance the cold tolerance of evergreen conifers, including Pinus massoniana Lamb., a characteristic heteroblastic foliage tree in the conifer. In the initial growing season of P. massoniana, both primary needle seedlings (PNSs) and secondary needle seedlings (SNSs) are generated. While previous research has highlighted differences in the morphological structure and photosynthetic physiological functions of primary and secondary needles, their response to cold acclimation remains poorly understood. This study aimed to investigate the changes in morpho-anatomical structure, starch grain accumulation, and lignin deposition in the roots, stems, and leaves of PNSs and SNSs during cold acclimation using solid potassium iodide and hydrochloric acid phloroglucinol double-staining techniques. The results revealed that, during cold acclimation, the leaves and stems of PNSs exhibited sensitivity to low-temperature stress, resulting in noticeable shrinkage and fracture of mesophyll and cortical parenchyma cells. Furthermore, the early stages of cold acclimation promoted the accumulation of starch grains and lignin in the seedling tissues. In contrast to PNSs, the leaves and stems of SNSs exhibited a shorter cold acclimation period, attributed to the hydrolysis of starch grains in the epidermal cell walls and the transformation of xylem lignin, which supports cell structure stability and enhances cold resistance. In conclusion, these findings suggest that SNSs displayed a superior cold resistance potential compared to PNSs following cold acclimation, providing a significant theoretical basis for the further screening of cold-tolerant germplasm resources of P. massoniana and the analysis of cold resistance traits in heteroblastic foliage. Full article

A high-alloy (Cr-Mo-V) cold-work tool steel was manufactured by laser powder-bed fusion (PBF-LB) without preheating and by electron-beam powder-bed fusion (PBF-EB) with the build temperature set at 850 °C. The solidification rates, cooling, and thermal cycles that the material was subjected to during manufacturing were different in the laser powder-bed fusion than electron-beam powder-bed fusion, which resulted in very different microstructures and properties. During the solidification of the PBF-LB steel, a cellular–dendritic structure was formed. The primary cell size was 0.28–0.32 µm, corresponding to a solidification rate of 2.0–2.5 × 10⁶ °C/s. No coarse primary carbides were observed in the microstructure. Further rapid cooling resulted in the formation of a martensitic microstructure with high amounts of retained austenite. The high-retained austenite explained the low hardness of 597 ± 38 HV. Upon solidification of the PBF-EB tool steel, dendrites with well-developed secondary arms and a carbide network in the interdendritic space were formed. Secondary dendrite arm spacing was in the range of 1.49–3.10 µm, which corresponds to solidification rates of 0.5–3.8 × 10⁴ °C/s. Cooling after manufacturing resulted in the formation of a bainite needle-like microstructure within the dendrites with a final hardness of 701 ± 17 HV. These findings provide a background for the selection of a manufacturing method and the development of the post-treatment of a steel to obtain a desirable final microstructure, which ensures that the final tool’s performance is up to specification. Full article

Objectives: To investigate whether phakia affects the outcome of XEN-45 gel stent implantation in the treatment of pseudoexfoliative glaucoma (PXG). Methods: A retrospective, comparative cohort study of 30 phakic and 55 pseudophakic PXG patients who received the XEN-45 gel stent at a tertiary centre. The primary outcome measure was two-year success defined as a ≥20% lowering of intraocular pressure (IOP) and a target IOP of 6–21 mmHg. Success was complete without and qualified irrespective of antiglaucoma medication use. Further glaucoma surgery other than needling was regarded as a failure. The secondary outcome measures included changes in IOP, revision and complication rates. Results: The complete two-year success rates were 70% and 59% in the phakic and pseudophakic groups, respectively (p = 0.75, log-rank test), and the qualified rates were 80% and 72%, respectively (p = 0.89). The median IOP reduction from baseline was 54% in phakic, and 46% in pseudophakic eyes. While needling rates were similar, the incidence of early incisional bleb revisions was significantly higher in the phakic eyes (13% vs. 0% within 3 months; p = 0.0098, chi-square). Increasing after a year, significantly more pseudophakic eyes failed due to secondary glaucoma surgery (16% vs. 0%; p = 0.0191). Conclusions: The XEN-45 gel stent offers equally effective IOP control for both phakic and pseudophakic patients. However, the onset of bleb revisions and the necessity for secondary glaucoma surgery differed significantly between the groups. Full article

A small tumor size may impact the diagnostic performance of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for diagnosing solid pancreatic lesions (SPLs). We aimed to compare the diagnostic yield of EUS-guided fine-needle aspiration (FNA) and biopsy (FNB) in SPLs with a diameter ≤ 15 mm. Consecutive patients who underwent EUS-TA for SPLs ≤ 15 mm between January 2015 and December 2022 in a tertiary referral center were retrospectively evaluated. The primary endpoint was diagnostic accuracy. The final diagnosis was based on surgical pathology or disease evolution after a minimum follow-up of 6 months. Inadequate samples were all considered false negatives for the study. Secondary outcomes included sample adequacy, factors impacting accuracy, and safety. We included 368 patients (52.4% male; mean age: 60.2 years) who underwent FNA in 72 cases and FNB in 296. The mean size of SPLs was 11.9 ± 2.6 mm. More than three passes were performed in 5.7% and 61.5% of patients in the FNB and FNA groups, respectively (p < 0.0001). FNB outperformed FNA in terms of diagnostic accuracy (89.8% vs. 79.1%, p = 0.013) and sample adequacy (95.9% vs. 86.1%, p < 0.001). On multivariate analysis, using FNA (OR: 2.10, 95% CI: 1.07–4.48) and a final diagnosis (OR: 3.56, 95% CI: 1.82–6.94) of benign conditions negatively impacted accuracy. Overall, the adverse event rate was 0.8%, including one pancreatitis in the FNA group and one pancreatitis and one bleeding in the FNB group, all mild and conservatively managed. EUS-TA for SPLs ≤ 15 mm has a high diagnostic yield and safety. This study suggests the superiority of FNB over FNA, with better performance even with fewer passes performed. Full article