The relative efficacy of multiple syringe tip disinfection techniques against virulent staphylococcus contamination

BACKGROUND

A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration.

AIM

We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance.

METHODS

Syringe tips (N=40) contaminated with S. aureus ST5 were randomized to 70% isopropyl pads with 10 or 60 s of drying time, scrubbing alcohol disinfection caps with 10 or 60 s of dwell time, or to non-scrubbing alcohol disinfection caps with 60 s of dwell time. The primary outcome was residual 24-h colony forming units (cfu) >10.

RESULTS

Scrubbing disinfection caps were more effective than alcohol pads (25% (12/48) <10 cfu for scrubbing caps (10- or 60-s dwell times) vs 0% (0/48) <10 cfu for alcohol pads (10 or 60 s of drying time), Holm-Sidak adjusted P=0.0016). Scrubbing disinfection caps were more effective than non-scrubbing alcohol disinfection caps (25% (12/48) <10 cfu for scrubbing alcohol caps (10- or 60-s dwell times) vs 2% (1/48) for non-scrubbing alcohol caps (60-s dwell time), adjusted P=0.0087).

CONCLUSIONS

Scrubbing alcohol caps are more effective than alcohol pads or non-scrubbing disinfecting caps for microbial reduction of syringe tips contaminated with the more pathogenic S. aureus ST5.

Atomic Force Microscopy of Viruses: Stability, Disassembly, and Genome Release

In atomic force microscopy (AFM), the probe is a nanometric tip located at the end of a microcantilever which palpates the specimen under study as a blind person manages a walking stick. In this way, AFM allows obtaining nanometric resolution images of individual protein shells, such as viruses, in liquid milieu. Beyond imaging, AFM also enables not only the manipulation of single protein cages but also the evaluation of each physicochemical property which is able of inducing any measurable mechanical perturbation to the microcantilever that holds the tip. In this chapter, we start revising some recipes for adsorbing protein shells on surfaces and how the geometrical dilation of tips can affect to the AFM topographies. This work also deals with the abilities of AFM to monitor TGEV coronavirus under changing conditions of the liquid environment. Subsequently, we describe several AFM approaches to study cargo release, aging, and multilayered viruses with single indentation and fatigue assays. Finally, we comment on a combined AFM/fluorescence application to study the influence of crowding on GFP packed within individual P22 bacteriophage capsids.

Estimation and comparative evaluation of tip and torque values of Saudis for bracket prescription

Objectives

The present study aimed at determining the tip and torque values of the teeth of Saudi adults with normal occlusion to develop orthodontic bracket prescription. In addition, we proposed to compare the results with published data of varied geographical distribution.

Materials and Methods

The study sample consisted of 60 upper and lower study models of Saudi adults (30 males and 30 females) with normal occlusion and a balanced facial profile. Evaluated by experts, the torque and tip of teeth were measured using a torque angulation device. The collected data was analyzed using SPSS (IBM SPSS Inc., version 20, Chicago, IL, USA). The mean, and standard deviation were obtained for each measurement. Paired t-test, Independent t-test and student t-test were used for the comparison at a significant level of (p ≤ 0.05).

Result

The results of torque and tip of teeth for the Saudi adult population showed no significant differences between the right and the left quadrants of the analyzed study sample. In general, there was no significant observed difference between male and female samples, accordingly, the Saudi tip and torque data were combined. However, the comparisons of the combined Saudi data to the published data showed significant differences (p ≤ 0.05).

Conclusion

Statistically Significant differences were found between the combined Saudi data when compared to North American, Italian, African, Japanese, and Indian data. We inferred, that racial differences should be considered when presenting bracket prescriptions.

Scrubbing needles: a simple and costless technique to improve needle tip visibility during US-guided liver interventions

AIMS

To evaluate the echogenicity of a commercially available needle, modified on the tip, by comparing two groups of patients undergoing to percutaneous biliary drainage.

METHODS

In this retrospective analysis 16 percutaneous transhepatic biliary drainage (PTBD) procedures performed on 16 oncologic patients were evaluated. Patients were randomly divided into two groups of eight subjects each; in the first group, a standard needle was adopted (group A); in the second group, the needle was manually modified to create a rough surface (group B), by scrubbing the tip with an 11 scalpel blade for 150 s all around its surface. To objectively quantify US needle tip visibility, the contrast-to-noise ratio (CNR) was calculated analyzing B-mode images by positioning region of interests in correspondence of needle tip and liver parenchyma.

RESULTS

Needle tip echogenicity was significantly higher in group B where the needle tip was modified compared to control group A (p value = 0.014). CNR, considered to objectively evaluate differences among needle tip echogenicity, was significantly higher in group B with respect to control group A (p value = 0.018).

CONCLUSIONS

The proposed method, scrubbing a 22 gauge commercially available needle tip with a scalpel blade, represents an effective technique to improve needle visibility during US-guided punctures of the liver.

Comparative clinical study with a novel technique for stabilization of the nasal tip projection and rotation: fixation of the septum and the strut graft through the septal cartilage autoextension

PURPOSE

It is important to reinforce nasal tip support for long-term satisfactory results. Two workhorses of tip support are strut grafting and the tongue-in-groove technique. Tongue-in-groove causes retraction and stiffness; the strut causes loss of rotation and projection of tip. We introduced a novel technique that avoids these consequences.

METHODS

Between February 2018-February 2019, 40 female underwent primary rhinoplasty. Mean age: 27 years (18-41 years).

FOLLOW-UP

1-2 years. In first group (20 patients), caudal septum was resected and strut was not fixated to caudal septum. In second group (20 patients), tongue-like extension (septal autoextension) was preserved at caudal septum and sutured to strut. Preoperative, peroperative, and postoperative images were compared.

RESULTS

Tip projection ratio calculations, nasolabial angle measurements were evaluated by statistical analyses. The change in projection ratios between peroperative period and 1-year postoperative period of strut-only group was higher than septal autoextension group (p = 0.001). This result indicates that nasal tip projection loss in strut-only group was higher compared to septal autoextension group. The change in nasolabial angle measurements from peroperative period to 1-year postoperative period differed significantly between two groups (p = 0.001). Significant difference was observed between 1-year postoperative nasolabial angle measurements of two groups (p = 0.006); septal autoextension group measurements were higher than strut-only group. These results showed that fixation of strut graft to the septal autoextension provides better preservation of the nasolabial angle and stabilization of nasal tip projection. CONCLUSıON: Fixation of septum and strut graft through septal autoextension provides satisfactory stabilization of tip projection and rotation without stiffness or rigidity.

The "TIP algorithm" for the accurate diagnosis of pediatric otitis media

OBJECTIVES

The authors studied the correlation between the grading TIP which evaluates three otoendoscopic characteristics of the tympanic membrane (TM) (transparency, integrity and position) with the gold standard represented by the impedenzometry.

METHODS AND MATERIALS

Cross-sectional studies with independent and blind comparison with the gold standard diagnostic. The setting was primary care and ambulatory. 115 TMs were examined (57 right and 58 left) of 60 children (36 males and 24 females) and classified according to the TIP grading (transparency, integrity, position). Each patient underwent otoendoscopy to obtain TIP grading and subsequently to tympanometry, which was considered the gold standard for diagnosis. The Transparency is the condition in which at least one or more structures behind the TM are visible: promontory, incudo-malleolar and incudo-stapedial articulations. The Integrity is such when no holes in the TM are visible. The TM must be displayed up to the anulus. The position of the TM is evaluated according to the handle and the short apophysis of the malleus. The correlation between TIP grade and tympanometry was measured by the "Chi Square" test.

RESULTS

The method showed an average sensitivity and specificity of the three TIP parameters (TIP1 TIP2, TIP 4) versus tympanometry of 95.6% (I.C. 90.1-98.5); PPV and PPN 95.6 (I.C 90.3%-98.1%) Positive Likelihood Ratio 22,000 (I.C. 9.327 to 51.894) Negative Likelihood Ratio 0.045 0.019 to 0.107.

CONCLUSION

Grading TIP is a valid method for accurate diagnosis of pediatric otitis media and can predict the tympanometry result with high statistical significance.

The application of atomic force microscopy for viruses and protein shells: Imaging and spectroscopy

Atomic force microscopy (AFM) probes surface-adsorbed samples at the nanoscale by using a sharp stylus of nanometric size located at the end of a micro-cantilever. This technique can also work in a liquid environment and offers unique possibilities to study individual protein assemblies, such as viruses, under conditions that resemble their natural liquid milieu. Here, I show how AFM can be used to explore the topography of viruses and protein cages, including that of structures lacking a well-defined symmetry. AFM is not limited for imaging and allows the manipulation of individual viruses with force spectroscopy approaches, such as single indentation and mechanical fatigue assays. These pushing experiments deform the protein cages to obtain their mechanical information and can be used to monitor the structural changes induced by maturation or the exposure to different biochemical environments, such as pH variation. We discuss how studying capsid rupture and self-healing events offers insight into virus uncoating pathways. On the other hand, pulling tests can provide information about the virus-host interaction established between the viral fibers and the cell membrane.

Caudal Septal Extension Graft Sutured with Absorbable Material and Not Fixed to the Nasal Spine Region Compared with the Conventional Fixation Method: A Retrospective Study

BACKGROUND

The caudal septal extension graft (CSEG) is a predictable method for positioning the tip and columella during rhinoplasty, and it is commonly performed using permanent sutures and in some cases fixating the graft to the nasal spine region (NSR) (conventional method). Whether this predictability is preserved when using absorbable sutures has yet to be determined.

METHODS

We performed a retrospective assessment of 1146 patients who underwent rhinoplasty performed by the same surgeon using the CSEG method from 2008 through 2017 in an academic setting. We utilized a computer-based patient record system for automatic data collection comparing outcomes of two groups: a group of patients who were operated on using the conventional fixation method (2008-2011) (group 1) with a second group in which absorbable sutures were used without fixation to the NSR (2011-2017) (group 2). The average follow-up period was 33.2 months. Patients operated on using a combination of methods and patients with less than 6 months of follow-up were excluded. All cases had the same septum-to-extension graft suturing technique with either permanent or absorbable suture material. This technique was side-to-side fixation with simple interrupted stitches.

RESULTS

Outcomes were measured in terms of reoperation rates and complication rates grouped in 10 categories. There were no statistical differences in complication or reoperation rates between group 1 and group 2 except for suture extrusion and/or foreign body reaction (3.9% and 0.2%, respectively, P < 0.0001). Tip deprojection was of rare and similar occurrence in both groups (0.9% and 0.8%, respectively, P 0.88).

CONCLUSION

Suturing CSEG with absorbable material and not fixing it to the NSR is a reliable variation in the conventional technique.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Structural and Mechanical Characterization of Viruses with AFM

Microscopes are used to characterize small objects with the help of probes that interact with the specimen, such as photons and electrons in optical and electron microscopies, respectively. In atomic force microscopy (AFM) the probe is a nanometric tip located at the end of a micro cantilever which palpates the specimen under study as a blind person manages a walking stick. In this way AFM allows obtaining nanometric resolution images of individual protein shells, such as viruses, in liquid milieu. Beyond imaging, AFM also enables not only the manipulation of single protein cages, but also the characterization of every physicochemical property able of inducing any measurable mechanical perturbation to the microcantilever that holds the tip. In this chapter we start revising some recipes for adsorbing protein shells on surfaces. Then we describe several AFM approaches to study individual protein cages, ranging from imaging to spectroscopic methodologies devoted for extracting physical information, such as mechanical and electrostatic properties. We also explain how a convenient combination of AFM and fluorescence methodologies entails monitoring genome release from individual viral shells during mechanical unpacking.

Atomic Force Microscopy of Viruses

Atomic force microscopy employs a nanometric tip located at the end of a micro-cantilever to probe surface-mounted samples at nanometer resolution. Because the technique can also work in a liquid environment it offers unique possibilities to study individual viruses under conditions that mimic their natural milieu. Here, we review how AFM imaging can be used to study the surface structure of viruses including that of viruses lacking a well-defined symmetry. Beyond imaging, AFM enables the manipulation of single viruses by force spectroscopy experiments. Pulling experiments can provide information about the early events of virus-host interaction between the viral fibers and the cell membrane receptors. Pushing experiments measure the mechanical response of the viral capsid and its contents and can be used to show how virus maturation and exposure to different pH values change the mechanical response of the viruses and the interaction between the capsid and genome. Finally, we discuss how studying capsid rupture and self-healing events offers insight in virus uncoating pathways.

Cutting the Holy Dome: The Evolution of Vertical Alar Resection

INTRODUCTION

Dome division or vertical dome division (VDD) is a tip plasty technique that is effective when applied appropriately to suitable patients. For 15 years, we have used VDD and made modifications as needed. In classical VDD, the dome area is cut and left to heal, but experience shows that additional components are needed to complement dome division, such as sutures or grafts. In this study, we retrospectively analysed our rhinoplasty patients in whom we used vertical alar resection (VAR) to assess the advantages and disadvantages of this technique. To our knowledge, this is one of the most exhaustive studies of VDD, including over 3000 patients.

MATERIALS AND METHODS

This retrospective case series reviewed the charts of 3965 patients who underwent VAR between 2000 and 2015. All patients were operated on by the senior surgeon. Dome division was used for various reasons, including a deformed tip area in revision rhinoplasties, droopy nose, wide tip, pinched nose, tip asymmetry, and overprojected nasal tip. Patients were excluded if they had septal deviation that enabled tip rotation, or a dorsum problem that caused tip asymmetry.

RESULTS

The study included 3965 patients (3172 women and 793 men) who underwent open rhinoplasty from 2000 to 2015. The mean patient age was 28.3 years (range 18-50 years). The mean clinical follow-up duration was 11.2 years.

CONCLUSION

In conclusion, this technique is capable of modifying all parameters of the nasal tip (projection, rotation, and volume), as required, at the same time, addressing many tip problems.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Peening the tip of a notch using ultrasonic cavitation

A peening technique using ultrasonic cavitation was proposed to peen the tip of deep notches. The working theory of the present peening technique for the notch tip was described and numerically demonstrated. An experiment using a deep notch shape and an ultrasonic loading with a frequency of 20kHz achieved noticeable compressive residual stresses at the notch tip.

Atomic force microscopy of virus shells

Microscopes are used to characterize small specimens with the help of probes, such as photons and electrons in optical and electron microscopies, respectively. In atomic force microscopy (AFM) the probe is a nanometric tip located at the end of a microcantilever which palpates the specimen under study as a blind person manages a white cane to explore the surrounding. In this way, AFM allows obtaining nanometric resolution images of individual protein shells, such as viruses, in liquid milieu. Beyond imaging, AFM also enables the manipulation of single protein cages, and the characterization of every physico-chemical property able of inducing any measurable mechanical perturbation to the microcantilever that holds the tip. Here we describe several AFM approaches to study individual protein cages, including imaging and spectroscopic methodologies for extracting mechanical and electrostatic properties. In addition, AFM allows discovering and testing the self-healing capabilities of protein cages because occasionally they may recover fractures induced by the AFM tip. Beyond the protein shells, AFM also is able of exploring the genome inside, obtaining, for instance, the condensation state of dsDNA and measuring its diffusion when the protein cage breaks.

A prospective, randomised, cross-over trial comparing two standard polyvinyl chloride tracheal tubes. Are all the tubes the same?

BACKGROUND

A randomised study was conducted on the number of attempts made during the conventional endotracheal intubation of a mannequin using two polyvinyl (PVC) tracheal tubes, apparently similar but from different manufactures: INTERSURGICAL (IS; Intersurgical S.L., Madrid, Spain) and Mallinckrodt (ML; Mallinkrodt Medical S.A., Madrid, Spain).

METHODS

A total of 26 anaesthesiologists, in randomly established order (generated by Epidat 3.1) intubated a mannequin twice using a different tube each time. The tubes were masked by painting them to prevent recognition. The main outcome of the study was to compare the number of attempts needed to complete the manoeuvre for each tube. Data on intubation time and failed intubations were also collected.

RESULTS

The number of attempts with the ML tube was significantly lower than with the IS tube. Intubation was completed on the first attempt with the ML tube in 93.3% of cases, while using the IS tube the percentage fell to 30.8% (Fisher exact test, P<.001). The time required to complete the manoeuvre was greater with the IS tube (median 10.8seconds, interquartile range 6-22) than with the ML tube (median 4.4seconds, interquartile range 3.5 to 6.3).

CONCLUSIONS

The PVC tube from the ML manufacturer was superior when compared with the IS, the latter was also associated with a larger number of attempts to complete intubation using a conventional Macintosh blade.

Reconstruction of lateral defects of the tip and supratip less than 1.5 cm in diameter

The authors describe the surgical technique as well as the indications and limitations of the East-West flap for repair of lateral defects of the tip/supratip of the nose less than 1.5 cm in diameter. This easy and reliable technique is based on the use of skin from the lower third of the nose to repair the defect. This tissue presents the same thickness and colour characteristics, which limits excessive thickness, distortion and dyschromia phenomena.

Tip-enhanced Raman spectroscopy: tip-related issues

After over 15 years of development, tip-enhanced Raman spectroscopy (TERS) is now facing a very important stage in its history. TERS offers high detection sensitivity down to single molecules and a high spatial resolution down to sub-nanometers, which make it an unprecedented nanoscale analytical technique offering molecular fingerprint information. The tip is the core element in TERS, as it is the only source through which to support the enhancement effect and provide the high spatial resolution. However, TERS suffers and will continue to suffer from the limited availability of TERS tips with a high enhancement, good stability, and high reproducibility. This review focuses on the tip-related issues in TERS. We first discuss the parameters that influence the enhancement and spatial resolution of TERS and the possibility to optimize the performance of a TERS system via an in-depth understanding of the enhancement mechanism. We then analyze the methods that have been developed for producing TERS tips, including vacuum-based deposition, electrochemical etching, electrodeposition, electroless deposition, and microfabrication, with discussion on the advantages and weaknesses of some important methods. We also tackle the issue of lifetime and protection protocols of TERS tips which are very important for the stability of a tip. Last, some fundamental problems and challenges are proposed, which should be addressed before this promising nanoscale characterization tool can exert its full potential. Graphical Abstract ᅟ.

'Universal retraction suture' for the overprojecting nasal tip

Achieving a proper nasal tip projection is a crucial element of a successful rhinoplasty. A large number of correction methods and manoeuvres have been proposed in the medical literature as solutions for the prominent nasal tip, thus complicating the surgeon's strife to choose the ideal plan of action. In the present article, a single straight-forward technique, christened the 'universal retraction suture', is suggested to tackle the overprojecting tip in a simplified, controlled and efficient fashion.