The "Barbed Roman Blinds" technique: a step forward.
Bibliographic record
Abstract
Dear Editor, The recently developed Roman Blinds technique, firstly described a few months ago in this journal 1, whose main appeals consist in lack of resection, reversibility, repeatability, low cost and minimal discomfort, appears to be effective in the treatment of snorers and patients with mild obstructive sleep apnoea 1. The technique achieves the widening and stiffening of the meso-pharyngeal inlet without any tissue sacrifice through insertion of three threads through the fibro-muscular tissues of the soft palate and the posterior tonsillar pillars, which are then tightened and eventually tied in knots around three steady holds: the posterior nasal spine and the two hamuli pterygoidei 1. In order to overcome the two drawbacks of intra-oral thread-knotting namely i) low patient acceptance requiring general anaesthesia, and ii) possibility of secondary trans-mucosal knot extrusion), in 2011 we introduced sutures (QUILL® Knotless Tissue Closure Device, Angiotech Pharmaceutical Inc., Vancouver, CA), which are conceived to distribute tension along the full length of the thread route and to create dynamic vectors inside the soft tissue without the necessity of knots and avoiding subsequent ischaemic damage. This less traumatic and faster technology has been previously used in general, gynaecologic, urologic, orthopaedic and plastic surgery 2-4; its potential to work in difficult places made it also useful in laparoscopic, endoscopic and arthroscopic procedures 2-4. A further advantage offered by this novel suturing system in the oro-pharyngeal area is the possibility to use only one thread introduced along an ergonomically conceived route, in order to obtain the desired action on velar and posterior pillars soft tissues. Our preliminary experience with this new suturing material has been effective both regarding trans-mucosal extrusion (none to date) and snoring outcome. Considering that the placement of just one barbed suture is less traumatic and faster than the traditional three stitches in the Roman Blinds technique, it is foreseeable that the new procedure could become feasible in an outpatient setting under local anaesthesia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.008 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.010 | 0.015 |
| Insufficient payload (model declined to judge) | 0.003 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".