Ultrasound-guided percutaneous transhepatic one-step biliary fistulation combined with rigid choledochoscopy for recurrent hepatolithiasis.

PURPOSE: Percutaneous transhepatic one-step biliary fistulation (PTOBF) is used to treat choledocholithiasis and biliary stricture. This study aimed to evaluate the safety and efficacy of ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of recurrent hepatolithiasis. MATERIALS AND METHODS: The clinical data of 37 consecutive patients who underwent PTOBF combined with rigid choledochoscopy for RHL from March 2020 to March 2022 at our hospital were retrospectively analyzed. RESULTS: A total of 68 percutaneous transhepatic punctures were performed in 37 patients, with a puncture success rate of 85.29% (58/68) and a dilatation success rate of 100.00% (58/58). The mean blood loss of operation was 9.84 ± 18.10 mL, the mean operation time was 82.05 ± 31.92 min, and the mean length of postoperative hospital stay was 5.59 ± 3.26 days. The initial stone clearance rate was 40.54% (15/37) and the final stone clearance rate was 100% (37/37). The incidence of postoperative complications was 10.81% (4/37), including 2 cases of pleural effusion, 1 case of hemorrhage, and 1 case of cholangitis, which recovered after treatment. During a mean follow-up period of 23 months (range 12 to 36 months), only 1 patient experienced stone recurrence. CONCLUSION: Ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of RHL based on skilful manipulation seems to be a safe, effective and minimally invasive method with clinical application value. Further comparative studies with large sample sizes are needed in the future to confirm the reliability of its therapeutic results.

Ceramide synthase 6 antisense RNA 1 contributes to the progression of breast cancer by sponging miR-16-5p to upregulate ubiquitin-conjugating enzyme E2C.

Breast cancer (BC) is the most dangerous female mortality all over the world, described by unavoidable spread and metastaticity of BC cells. Increasing evidences verified that lncRNA play a major role in the tumorgenesis and development of BC cell. The purpose of this study is to investigate the roles of lncRNA ceramide synthase 6 antisense RNA 1 (CERS6-AS1) and ubiquitin-conjugating enzyme E2C (UBE2C) in BC and explore the regulatory association among miR-16-5p, CERS6-AS1, and UBE2C in BC. The CERS6-AS1 and UBE2C expression levels were determined by real time quantitative PCR in cell lines and tissues of BC. The function of CERS6-AS1 and UBE2C in the apoptosis, proliferation, and migration was confirmed by cell counting kit-8, Transwell, and flowcytometry tests. We performed tumor xenograft assay to validate the roles of CERS6-AS1 in vivo. The expression of UBE2C proteins was evaluated by Western Blot analysis. Moreover, the relationship among UBE2C, CERS6-AS1, and miR-16-5p was verified by luciferase report assay. It was found that CERS6-AS1 and UBE2C were meaningfully upregulated in BC, and knockdown of both CERS6-AS1 and UBE2C inhibited the BC cell proliferation and migration, whereas induced apoptosis. Mechanistically, CERS6-AS1 could facilitate BC progression by sponging miR-16-5p for upregulation of the UBE2C expression. The CERS6-AS1/miR-16-5p/UBE2C axis might be a prospective therapeutic target in the BC treatment by sponging miR-16-5p to upregulate UBE2C, which might contribute to the development of BC.

Terahertz spectroscopic detection of antifatigue illegal additives in health care product matrices.

Tadalafil is an illegal additive in antifatigue supplements. It is often misused in various plant dietary supplements (BDS), resulting in serious health risks. In this paper, terahertz spectroscopy combined with chemometrics is used to quantitatively analyze the content of tadalafil in nutritional and health products. The absorption coefficient spectrum of tadalafil in the range of 0.1-2.5 THz was obtained, and an obvious characteristic absorption peak appeared at 1.7 THz. To verify the accuracy of this characteristic absorption peak theoretically, tadalafil was simulated by density functional theory, and the calculated terahertz vibration spectrum matched well with the experimental spectrum. Then, the pure fatigue-based nutraceutical matrix and pure tadalafil were mixed in different proportions, and the terahertz absorption coefficient spectra of the mixtures were obtained. Finally, a quantitative analysis model of the tadalafil mixture was developed based on the support vector regression (SVR) algorithm, and the SVR model was optimized using particle swarm optimization (PSO) and genetic algorithm (GA), respectively. Compared with the SVR model, both PSO-SVR and GA-SVR enabled some improvement in their prediction accuracy, but the PSO-SVR model ran faster at 4.85 s, whereas the GA-SVR model had a higher prediction accuracy with a prediction set correlation coefficient (R P) of 0.9996 and a root mean square error (RMSEP) of 0.011. In summary, this study used terahertz time-domain spectroscopy for the identification and quantification of tadalafil in health product matrices. This study provides a new solution for the nondestructive detection of illegally added tadalafil in antifatigue health products, which is pivotal to the quality control of the health product industry.

The effect of mining development in karst areas on water acidification and fluorine enrichment in surface watersheds.

High fluoride water is a crucial driving factor for endemic fluorosis. As an important research content of hydrogeochemistry, the enrichment of fluorine in alkaline water has received a fair amount of scholarly attention, but the understanding of the migration and enrichment of fluorine in acid mine drainage (AMD) in karst area remains very limited. An analysis of 13 consecutive periods of hydrochemical samples (312 samples in total) revealed that the weathering of carbonates and sulfide-rich coal measures induced a pH as low as 2.29 in the Chetian River in Jinsha, Southwest China. The highest content of fluorine in AMD was 23.8 mg/L, and the average content in the basin was 1.4 mg/L. In terms of the seasonal variation in the whole basin, the fluorine content were higher in the rainy season than in the dry season. The mineral saturation index shows that the dissolution of fluorapatite and fluorite is an important source of fluorine. The chloro-alkaline indices displayed a strong ion exchange process in the basin, promoting the release of fluorine in silicate minerals. In comparison, the contribution of external inputs, such as atmospheric deposition, was less. Additionally, evaporation was shown to have a limited influence on fluorine enrichment. Meanwhile, pH was an essential factor driving the dynamic transformation of the mode of occurrence of fluorine in water. In the upstream alkaline water, the main occurrence form of fluorine was free F-, while the F/Al ratio for most of the acidic samples was ≤ 1.0, indicating the main occurrence form of fluorine was likely AlF2+. The conclusion of this study provides a new understanding for deepening the geochemical characteristics of fluorine in karst surface water.

Design of a terahertz dual-channel modulator based on metamaterials.

In this paper, we propose a terahertz dual-channel modulator by combining a high electron mobility transistor (HEMT) with a metamaterials structure, in which the HEMT is embedded in the opening of the structure metamaterial. The modulator consists of a metamaterial structure, silicon carbide (SiC), HEMT active device, and feeder. The concentration of the two-dimensional electron gas (2DEG) in the HEMT can be controlled by gate voltages, and the change of the concentration can realize the modulation of the intensity and phase of the terahertz wave. The simulation results indicate that when a single channel works, the modulation depth is 90.7% at 0.22 THz and 94.0% at 0.34 THz. When both channels work, the modulation depth is 88.9% at 0.22 THz and 93.3% at 0.34 THz. The terahertz modulator designed in this paper can work in two frequency bands and can be controlled independently, which efficiently uses the spectrum resources and has broad application prospects in the field of terahertz communication.

Dual-band and polarization-independent metamaterial terahertz narrowband absorber.

A dual-band terahertz metamaterial narrowband absorber is investigated based on a single simple windmill-shaped structure. The proposed metamaterial absorber achieves near-perfect absorption at 0.371 THz and 0.464 THz. The full width at half-maximum is 0.76% and 0.31% relative to absorption frequency. The multireflection interference theory is used for analyzing the absorption mechanism at low absorption frequency. The theoretical predictions of the decoupled model have excellent agreement with simulation results. By investigating the absorber's distribution of electric field and surface current density at high absorption frequency, the absorber's near-perfect absorption at the high absorption frequency originating from the magnetic resonance formed between the top metal structure and the bottom metal plane is explained. Besides, the absorber proposed is independent of the polarization angle. It is significant to various applications such as narrowband thermal radiation, photoelectric detection, biological sensing, and other fields.

A Potential Tool for the Study of Venous Ulcers: Blood Flow Responses to Load.

Venous ulcers are deep wounds that are located predominantly on the lower leg. They are prone to infection and once healed have a high probability of recurrence. Currently, there are no effective measures to predict and prevent venous ulcers from formation. Hence, the goal of this work was to develop a Windkessel-based model that can be used to identify hemodynamic parameters that change between healthy individuals and those with wounds. Once identified, these parameters have the potential to be used as indicators of when internal conditions change, putting the patient at higher risk for wound formation. In order to achieve this goal, blood flow responses in lower legs were measured experimentally by a laser Doppler perfusion monitor (LDPM) and simulated with a modeling approach. A circuit model was developed on the basis of the Windkessel theory. The hemodynamic parameters were extracted for three groups: legs with ulcers ("wounded"), legs without ulcers but from ulcer patients ("nonwounded"), and legs without vascular disease ("healthy"). The model was executed by two independent operators, and both operators reported significant differences between wounded and healthy legs in localized vascular resistance and compliance. The model successfully replicated the experimental blood flow profile. The global and local vascular resistances and compliance parameters rendered quantifiable differences between a population with venous ulcers and healthy individuals. This work supports that the Windkessel modeling approach has the potential to determine patient specific parameters that can be used to identify when conditions change making venous ulcer formation more likely.

Far-field characteristics of the square grooved-dielectric lens antenna for the terahertz band.

In order to improve the gain and directionality of a terahertz antenna, a square grooved-dielectric lens antenna based on a Fresnel zone plate is proposed. First, a diagonal horn, which is adopted as the primary feed antenna, is designed. Then, the far-field characteristics of the lens antenna are studied by using Fresnel-Kirchhoff diffraction theory and the paraxial approximation. The effects of the full-wave period, the focus diameter ratio, the subregion, and the dielectric substrate thickness on radiation characteristics are studied. The experimental results show that the proposed lens antenna has axisymmetric radiation patterns. The gain is over 26.1 dB, and the 3 dB main lobe beam width is lower than 5.6° across the operation band. The proposed lens antenna is qualified for applications in terahertz wireless communication systems.

Comparing triple scope-combined bile duct exploration lithotripsy with laparoscopic hepatectomy for hepatolithiasis (with video).

BACKGROUND: To compare the efficacy of Three-scope combined (laparoscopic, rigid choledochoscopy and electronic choledochoscopy, TS) with laparoscopic hepatectomy (LH) for patients with hepatolithiasis (HL). METHODS: Between January 2019 and January 2020, 118 consecutive patients with HL treated with TS (TS group, n = 57) or LH (LH group, n = 61) were analyzed in this study. Perioperative and long-term outcomes, including operative time, intraoperative blood loss, blood transfusion, postoperative bowel function recovery time, postoperative hospital stay, complication rate, stone removal rate, and stone recurrence rate, were compared and analyzed between the two groups. RESULTS: Compared with the LH group, the TS group had significantly lower intraoperative blood loss and transfusions, significantly shorter operative time and hospital stay, and fewer complications (P < 0.05 for all). There was no significant difference in the final stone removal rate, stone recurrence rate and postoperative bowel function recovery time (P > 0.05 for all). CONCLUSION: TS is a safe and effective treatment for HL and is superior to LH in terms of overall treatment outcome and complications.

Console video games, postural activity, and motion sickness during passive restraint.

We examined the influence of passive restraint on postural activity and motion sickness in individuals who actively controlled a potentially nauseogenic visual motion stimulus (a driving video game). Twenty-four adults (20.09 ± 1.56 years; 167.80 ± 7.94 cm; 59.02 ± 9.18 kg) were recruited as participants. Using elastic bands, standing participants were passively restrained at the head, shoulders, hips, and knees. During restraint, participants played (i.e., controlled) a driving video game (a motorcycle race), for 50 min. During game play, we recorded the movement of the head and torso, using a magnetic tracking system. Following game play, participants answered a forced choice, yes/no question about whether they were motion sick, and were assigned to sick and well groups on this basis. In addition, before and after game play, participants completed the Simulator Sickness Questionnaire, which provided numerical ratings of the severity of individual symptoms. Five of 24 participants (20.83 %) reported motion sickness. Participants moved despite being passively restrained. Both the magnitude and the temporal dynamics of movement differed between the sick and well groups. The results show that passive restraint of the body can reduce motion sickness when the nauseogenic visual stimulus is under participants' active control and confirm that motion sickness is preceded by distinct patterns of postural activity even during passive restraint.

Postural activity and motion sickness during video game play in children and adults.

Research has confirmed that console video games give rise to motion sickness in many adults. During exposure to console video games, there are differences in postural activity (movement of the head and torso) between participants who later experience motion sickness and those who do not, confirming a prediction of the postural instability theory of motion sickness. Previous research has not addressed relations between video games, movement and motion sickness in children. We evaluated the nauseogenic properties of a commercially available console video game in both adults and 10-year-old children. Individuals played the game for up to 50 min and were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. During game play, we monitored movement of the head and torso. Motion sickness was reported by 67% of adults and by 56% of children; these rates did not differ. As a group, children moved more than adults. Across age groups, the positional variability of the head and torso increased over time during game play. In addition, we found differences in movement between participants who later reported motion sickness and those who did not. Some of these differences were general across age groups but we also found significant differences between the movement of adults and children who later reported motion sickness. The results confirm that console video games can induce motion sickness in children and demonstrate that changes in postural activity precede the onset of subjective symptoms of motion sickness in children.

Targeted Anti-Hepatocellular Carcinoma Research of Targeted Peptides Combined with Drug-Loaded Cell-Derived Microparticles.

To conduct an anti-tumor research by using targeted drug-loaded cell-derived microparticles to target the tumor microenvironment and enhance NK cell killing function. In this experiment, we obtained HepG2 tumor cell-derived microparticles by physical extrusion, high speed centrifugation and filtration, modified the hepatocellular carcinoma targeting peptide SP94 on the surface of microparticles and encapsulated the TGF-ß inhibitor SB505124. Finally we validated and analyzed whether the new drug delivery system can target to tumor site and enhance the anti-tumor function of NK cells. This type of novel targeted cell-derived microparticles drug delivery system will provide a novel idea for tumor immunotherapy.

China Public Psychology Analysis About COVID-19 Under Considering Sina Weibo Data.

COVID-19 not only poses a huge threat to public health, but also affects people's mental health. Take scientific and effective psychological crisis intervention to prevent large-scale negative emotional contagion is an important task for epidemic prevention and control. This paper established a sentiment classification model to make sentiment annotation (positive and negative) about the 105,536 epidemic comments in 86 days on the official Weibo of People's Daily, the test results showed that the accuracy of the model reached 88%, and the AUC value was greater than 0.9. Based on the marked data set, we explored the potential law between the changes in Internet public opinion and epidemic situation in China. First of all, we found that most of the Weibo users showed positive emotions, and the negative emotions were mainly caused by the fear and concern about the epidemic itself and the doubts about the work of the government. Secondly, there is a strong correlation between the changes of epidemic situation and people's emotion. Also, we divided the epidemic into three period. The proportion of people's negative emotions showed a similar trend with the number of newly confirmed cases in the growth and decay period, and the extinction period. In addition, we also found that women have more positive emotional performance than men, and the high-impact groups is also more positive than the low-impact groups. We hope that these conclusions can help China and other countries experiencing severe epidemics to guide publics respond.

c-Jun NH2-terminal kinase suppression significantly inhibits the growth of transplanted breast tumors in mice.

OBJECTIVE: The current study investigated the effect of c-Jun NH2-terminal kinase (JNK) expression on the growth of transplanted breast cancer tumors in mice. METHODS: A breast cancer transplantation model was established in BALB/c mice, which were then treated with SP600125 (30 mg/kg) for 24 days. After sacrificing the mice, the inhibitory effects of SP600125 on breast cancer growth were calculated by weighing tumors. Moreover, vascular endothelial growth factor (VEGF) expression and the tumor microvascular density (MVD) were evaluated via immunohistochemistry. Cell apoptosis was also examined using a TUNEL kit. RESULTS: Compared with the findings in the control group, SP600125 treatment (30 mg/kg) obviously suppressed tumor growth during the 15-day observation period. SP600125 treatment markedly inhibited JNK mRNA expression. Furthermore, VEGF protein expression (50% vs. 100%) and MVD (18.27 ± 1.70 vs. 23.17 ± 4.02) were also significantly decreased by SP600125 treatment, whereas the apoptosis index was significantly higher in the treatment group (10.23 ± 1.97% vs. 4.53 ± 1.40%). CONCLUSION: Inhibition of JNK signaling can significantly suppress the growth of transplanted breast tumors in mice.

Human alpha-defensin-1 inhibits growth of human lung adenocarcinoma xenograft in nude mice.

Human alpha-defensin-1 (HNP1), a small antimicrobial peptide, shows cytotoxicity to tumor cells in vitro and inhibitory activity for pathologic neovascularization in vivo. Here, we did a gene therapy with a plasmid that expresses a secretable form of HNP1 for assaying its antitumor activity. The expression and secretion of HNP1 were determined by reverse transcription-PCR and ELISA in vitro. We found that expression of HNP1 in A549 tumor cells caused significant growth inhibition. This effect is most likely cell autonomous, as a significant amount of recombinant HNP1 protein was found to be accumulated in the cytoplasm by immunohistochemical staining using an anti-HNP1 antibody and the supernatant containing secreted HNP1 failed to produce any noticeable antitumor activity. Flow cytometry and Hoechst 33258 staining showed that the number of apoptotic cells among the A549 cells expressing recombinant HNP1 proteins was significantly greater than that of the nontransfected control cultures, suggesting that this growth-inhibitory activity was due to an apoptotic mechanism triggered by the intracellular HNP1. The antitumor activity of intracellularly expressed HNP1 was also shown in vivo. Decreased microvessel density and increased lymphocyte infiltration were observed in tumor tissue from HNP1-treated mice through histologic analysis. These results indicate that intracellularly expressed HNP1 induces tumor cell apoptosis, which inhibits tumor growth. The antiangiogenesis effect of HNP1 may contribute to its inhibitory activity in vivo, and HNP1 might involve the host immune response to tumor. These findings provide a rationale for developing HNP1-based gene therapy for cancer.

Influences of sodium and glycosaminoglycans on skin oedema and the potential for ulceration: a finite-element approach.

Venous ulcers are chronic transcutaneous wounds common in the lower legs. They are resistant to healing and have a 78% chance of recurrence within 2 years. It is commonly accepted that venous ulcers are caused by the insufficiency of the calf muscle pump, leading to blood pooling in the lower legs, resulting in inflammation, skin oedema, tissue necrosis and eventually skin ulceration. However, the detailed physiological events by which inflammation contributes to wound formation are poorly understood. We therefore sought to develop a model that simulated the inflammation, using it to determine the internal stresses and pressure on the skin that contribute to venous ulcer formation. A three-layer finite-element skin model (epidermis, dermis and hypodermis) was developed to explore the roles in wound formation of two inflammation identifiers: glycosaminoglycans (GAG) and sodium. A series of parametric studies showed that increased GAG and sodium content led to oedema and increased tissue stresses of 1.5 MPa, which was within the reported range of skin tissue ultimate tensile stress (0.1-40 MPa). These results suggested that both the oedema and increased fluid pressure could reach a threshold for tissue damage and eventual ulcer formation. The models presented here provide insights to the pathological events associated with venous insufficiency, including inflammation, oedema and skin ulceration.

Interfacial Engineering of Graphene Nanosheets at MgO Particles for Thermal Conductivity Enhancement of Polymer Composites.

An important task in facilitating the development of thermally conducting graphene/polymer nanocomposites is to suppress the intrinsically strong intersheet π-π stacking of graphene, and thereby to improve the exfoliation and dispersion of graphene in the matrix. Here, a pre-programmed intercalation approach to realize the in situ growth of graphene nanosheets at the inorganic template is demonstrated. Specifically, microsized MgO granules with controlled geometrical size were synthesized using a precipitation method, allowing the simultaneous realization of high surface activity. In the presence of a carbon and nitrogen source, the MgO granules were ready to induce the formation of graphene nanosheets (G@MgO), which allowed for the creation of tenacious linkages between graphene and template. More importantly, the incorporation of G@MgO into polymer composites largely pushed up the thermal conductivity, climbing from 0.39 W/m∙K for pristine polyethylene to 8.64 W/m∙K for polyethylene/G@MgO (60/40). This was accompanied by the simultaneous promotion of mechanical properties (tensile strength of around 30 MPa until 40 wt % addition of G@MgO), in contrast to the noteworthy decline of tensile strength for MgO-filled composites with over 20 wt.% fillers.

Novel hepatoprotective role of Leonurine hydrochloride against experimental non-alcoholic steatohepatitis mediated via AMPK/SREBP1 signaling pathway.

BACKGROUND AND AIMS: Non-alcoholic steatohepatitis (NASH) is the hepatic manifestation of metabolic syndrome and is characterized by steatosis, inflammation, and fibrosis. We aim to characterize the hepatoprotective effects of Leonurine hydrochloride (LH) and the possible pathway in a cell and rodent model of diet-induced steatohepatitis (NASH). METHODS: For in vitro studies, Palmitic acid (PA) and free fatty acid (FFA) induced HepG2 and HL7702 steatosis cell models were used. For in vivo studies, NASH was induced by feeding mice MCD diet. These mice received either placebo or LH at three different doses (50、100、200 mg/kg/day) for 6 weeks. Histological staining's, and commercially available kits for ALT and AST and hepatic contents of TG, TC, MDA, SOD, and GSH were used to assess NASH. Furthermore, relative liver protein and gene expression levels were determined by Western Blot and qPCR, respectively. RESULTS: After establishing NASH models, LH treatment improved lipid accumulation, hepatic contents of TG, TC, and expression levels of ALT and AST in dose-dependent manner. Also, LH improved MDA, SOD, and GSH expression levels. The results of RT-PCR and Western blotting showed that LH upregulated the expression of AMPK phosphorylation and downregulated SREBP-1c and its target genes expression level. CONCLUSIONS: Our data reveal the promising role of Leonurine hydrochloride in the prevention and treatment of NASH, in vitro and in vivo. This effect may be partially mediated by the AMPK/SREBP1 pathway. These findings provide a novel therapeutic target for the clinical treatment of NASH.

Administration of methyl palmitate prevents non-alcoholic steatohepatitis (NASH) by induction of PPAR-α.

BACKGROUND AND AIMS: The lack of valid therapeutic approach that can ameliorate the manifestations of NASH is a barrier to therapeutic development. Therefore, we investigate the novel role of Methyl Palmitate (MP) in preventing NASH and the possible mechanism involved. METHODS: 50 Male C57BL/6 J mice were randomly divided into 5 groups (n = 10). The control group was fed control diet; model group was fed MCD diet; MP 1 group was fed MCD diet supplemented with MP (75 mg/kg/day); MP 2 group was fed MCD plus MP diet (150 mg/kg/day); and MP 3 group was fed MCD plus MP diet (300 mg/kg/day). Histological staining's, and commercially available kits for serum ALT and AST and hepatic contents of TG, TC, MDA, SOD, and GSH were used to assess NASH. Furthermore, relative liver protein and gene expression levels were determined by Western Blot and qPCR, respectively. RESULTS: Mice fed MCD diet developed NASH, which was markedly improved by MP in a dose-dependent manner. MP treatment improved hepatic content of TG, TC, MDA, SOD and GSH and serum levels of ALT and AST. In vivo studies showed that MP treatment activated PPARα expression, that in turns, promoted ß-oxidation protein and gene expressions, suppressed TNFα, MCP1, TGFß1 and Colla1 protein and gene expression levels, contributing to the prevention of NASH. CONCLUSIONS: Our results indicated that MP could successfully prevent NASH. This effect of MP was mediated through induction of PPARα pathway. This study provides a novel therapeutic target that plays pivotal role in the prevention of NASH.

Reducing levels of medical device contamination through package redesign and opening technique.

OBJECTIVES: The goal of this research was to evaluate how material curl, package structure and handling of pouches containing medical devices affect rates of contact between non-sterile surfaces and sterile devices during aseptic transfer. METHODS: One hundred and thirty-six individuals with practical experience in aseptic technique were recruited. Participants were asked to present the contents of four different pouch designs (a standard, one designed to curl in, another to curl out and one that incorporated a tab) using two transfer techniques. During the first block of trials "standard technique" was used; participants presented using their typical methods to the sterile field. Trials in the second block employed "modified technique"; participants were instructed to grab the package at the top center and present package contents using a single, fluid motion. The outside of the pouch and the backs of the participants' hands were coated using a simulated contaminant before each trial. The simulant was undetectable in the visible spectrum, but fluoresced under a black light. The dependent variable was recorded in a binary fashion and analyzed using a generalized linear mixed model. RESULTS: Participants were between 20-57 and the averaged year 5.1 years of experience in aseptic technique. The data analysis was based on generalized linear mixed effects (GLMM) model, which accommodates the repeated measurements within the same participant. The effect of the pouch design was significant (P<0.001), but the effect of aseptic technique did not suggest significance (P = 0.088). Specifically, pouches designed with the material curled outward resulted in significantly fewer contacts with non-sterile surfaces than the other styles, including the inward, tab, and standard styles; this was true regardless of the used aseptic technique, standard (P = 0.0171, P = 0.0466, P = 0.0061, respectively) or modified (P<0.0001 for all comparisons)). CONCLUSION: Results presented here contribute to a growing body of knowledge that investigates packaging as a potential route of contamination for sterile devices during aseptic presentation. Specifically, we provide insights regarding how both package design and opening technique can be informed in ways that build safety into the healthcare system.