Accessory Devices Research Articles

Endoscopic Management of Foreign Bodies in the Upper Gastrointestinal Tract: Single-Centre Experience

Introduction: Foreign body ingestion is a relatively common clinical problem. We report our clinical experiences in endoscopic management of upper gastrointestinal foreign bodies by endoscopy in a centre of northern Bangladesh. Methods: This retrospective study was conducted at Shaheed Ziaur Rahman College and Hospital, Bogura, Bangladesh, over a 2-year period. Patient characteristics, endoscopic findings, type of foreign body and its anatomical location, treatments and outcomes were analyzed. Results: We included 51 patients with foreign bodies in upper gastrointestinal tract. Most of them were found in esophagus (94.12%) predominately in lower esophagus (47.92%). Dysphagia (35.29%) and foreign body sensation (27.45%) were the most common complaints of foreign bodies impaction. Meat bolus (47.06%) and coins (29.41%) were the most common type of foreign bodies in adults and children, respectively. Patients were mostly affected (21.56%) during period of Eid -al - Adha (Islamic festival of sacrifice). Endoscopic foreign body removal was successful in 98.04% of cases, whereas surgery was required in only 1 patient. The most frequently used endoscopic accessory devices were retrieval forceps (38%) and Dormia basket (38%). Associated pathology were reported in 12 (24.53%) patients. Conclusion: Our experiences with foreign bodies impaction emphasize the importance of endoscopic approach and removal is simple and safe when performed by skilled hands. So, endoscopic interventions can increase the chance of successful removal of foreign bodies and reduction of the need of surgery.

EUS-Guided Transluminal Interventions

The role of endoscopic ultrasound (EUS) has transitioned from a diagnostic to a therapeutic one over the past 40 years. With the advent of curvilinear array echoendoscopes in the 1990s with an accessory channel, multiple tools and devices have been developed and used for a variety of transluminal interventions. EUS provides a viable option and is becoming the procedure of choice for many interventions, including bile and pancreatic duct drainage, guiding angiotherapy, pancreatic fluid collection management, gallbladder drainage, and creating a gastrojejunostomy. Although reports demonstrate the technical success of these interventions, there is tremendous study heterogeneity and a relative lack of controlled randomized trials, which may limit our understanding of their role and utility. Furthermore, adverse events are relatively common and occasionally severe. Despite the limitations, available data strongly indicate the efficacy of EUS interventions when performed by well-trained endosonographers in carefully selected patients and managed in a multidisciplinary setting.

Formal Modeling and Analysis of Collaborative Humanoid Robotics

A humanoid robot is inherently complex due to the heterogeneity of accessory devices and to the interactions of various interfaces, which will be exponentially increased in multiple robotics collaboration. Therefore, the design and implementation of multiple humanoid robotics (MHRs) remains a very challenging issue. It is known that formal methods provide a rigorous analysis of the complexity in both design of control and implementation of systems. This article presents an agent-based framework of formal modeling on the design of communication and control strategies of a team of autonomous robotics, to attain the specified tasks in a coordinated manner. To ensure a successful collaboration of multiple robotics, this formal agent-based framework captures behaviors in Petri Net models and specifies collaboration operations in four defined operations. To validate the framework, a non-trivial soccer bot set was implemented and simulation results were discussed.

Design and analysis for manipulator fixture applications

The manipulators arms are the most important components in automatic machinery and equipment. These arms must conform to product requirements and match important accessory devices such as clamping jaw so that the entire process operates properly. Therefore the most important issue is that the manipulator arm has only one clamping jaw, followed by other issues such as welding and related features. In this research the manipulator arm of automated machinery with attached equipment was optimized, and the design serves as an object of study for multifunctional applications. This research emphasizes on customized manipulator design to create products with distinguished styles and characteristics, and serve as a basis for an improvement on innovative design. Manipulator arms from different manufacturers with various head-disc size and screw-hole locations were investigated, and concept of human palm was incorporated in the design to create a mechanical fixture that can be fitted into the arm. Overall design including main body of the manipulator, pneumatic cylinder set, gear and connecting rod combination, planet gear set, and linkage rods and fixture. These components were combined to offer the functions of the manipulator. Commercial software package, SolidWorks, was used to construct the model for the manipulator arm, and CAE analysis was implemented to identify the stress on the structure and possible interferences of the mobile components. Stress analysis was also performed on the gear set under pneumatic loading to ensure that the gear mechanism has a sufficient strength. The results of this study showed that an arc shaped manipulator body is the most easily handled during installation and most effectively controlled during operation. The simple profiles of the manipulator also lower the space required for storage. The design of the gear set and integrated application of the shaft helps prevent loosening of gear and shaft during operation. In this study, a manipulator was designed with three different functions, each fixture is powered by an isolated pneumatic cylinder, and this mechanism can be manipulated to form o0to o180clamping action in accordance with requirements of the task. The methods and results of this study serve as a reference for machinery industry to achieve high quality product, and also as a basis for innovative design.

Endoscopic management of foreign bodies in the upper gastrointestinal tract: An analysis of 846 cases in China.

Foreign body ingestion is a relatively common occurrence, which may lead to morbidity and mortality. The aim of the present study was to report the experience of management of upper gastrointestinal foreign bodies by endoscopy in a large center. All patients who presented at the Department of Gastroenterology at Nanfang Hospital (Guangzhou, China) with complaints regarding upper gastrointestinal (GI) foreign body ingestion from December 1987 to December 2013. Hospital medical charts and endoscopic records were examined to evaluate etiology, treatment, and outcomes for these patients. A total of 846 patients were enrolled in the present study, from which foreign bodies were detected in 737 (87.1%) patients via X-ray or endoscopy. The objects most frequently ingested were bones (n=395, 53.6%). The detected foreign bodies were predominantly located in the cervical esophagus (n=325, 44.1%). Endoscopic foreign body extraction was successful in 92.5% of cases, whereas surgery was required in 6 patients. The most frequently used endoscopic accessory devices were retrieval forceps (n=480, 65.1%). The complication rate was 6.9%, including mucosal laceration (n=10) and others, all of which were managed conservatively. Associated GI diseases were reported in 74 (10.0%) patients, including postesophagectomy (n=34) and others. In conclusion, the endoscopic procedure was safe and effective for the removal of foreign bodies from the upper gastrointestinal tract, with a high success rate and low complication rate.

Water based fluidic radio frequency metamaterials

Electromagnetic metamaterials offer great flexibility for wave manipulation and enable exceptional functionality design, ranging from negative refraction, anomalous reflection, super-resolution imaging, transformation optics to cloaking, etc. However, demonstration of metamaterials with unprecedented functionalities is still challenging and costly due to the structural complexity or special material properties. Here, we demonstrate for the first time the versatile fluidic radio frequency metamaterials with negative refraction using a water-embedded and metal-coated 3D architecture. Effective medium analysis confirms that metallic frames create an evanescent environment while simultaneously water cylinders produce negative permeability under Mie resonance. The water-metal coupled 3D architectures and the accessory devices for measurement are fabricated by 3D printing with post electroless deposition. Our study also reveals the great potential of fluidic metamaterials and versatility of the 3D printing process in rapid prototyping of customized metamaterials.

Global bromine market estimated to reach $2.7 bn by 2025

Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves >80% of strictures after 12 months but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating healthcare costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP. We compared the traditional IDSE protocol with a sequential stent addition (SSA) protocol, in which additional stents are placed across the stricture during sequential ERCPs, without stent removal/exchange or stricture dilation.Patients undergoing ERCP for OLT-related anastomotic strictures from 2010 to 2016 were identified from a prospectively maintained endoscopy database. Procedure duration, fluoroscopy time, stricture resolution rates, adverse events, materials fees, and facility fees were analyzed for IDSE and SSA procedures.Seventy-seven patients underwent 277 IDSE and 132 SSA procedures. Mean fluoroscopy time was 64.5% shorter (P < .0001) and mean procedure duration 41.5% lower (P < .0001) with SSA compared with IDSE. SSA procedures required fewer accessory devices, resulting in significantly lower material (63.8%, P < .0001) and facility costs (42.8%, P < .0001) compared with IDSE. Stricture resolution was >95%, and low adverse event rates did not significantly differ.SSA results in shorter, cost-effective procedures requiring fewer accessory devices and exposing patients to less radiation. Stricture resolution rates are equivalent to IDSE, and adverse events do not differ significantly, even in this immunocompromised population.

Liver transplant–related anastomotic biliary strictures: a novel, rapid, safe, radiation-sparing, and cost-effective management approach

Biliary strictures after orthotopic liver transplantation (OLT) are typically managed by sequential ERCP procedures, with incremental dilation of the stricture and stent exchange (IDSE) and placement of new stents. This approach resolves >80% of strictures after 12 months but requires costly, lengthy ERCPs with significant patient radiation exposure. Increasing awareness of the harmful effects of radiation, escalating healthcare costs, and decreasing reimbursement for procedures mandate maximal efficiency in performing ERCP. We compared the traditional IDSE protocol with a sequential stent addition (SSA) protocol, in which additional stents are placed across the stricture during sequential ERCPs, without stent removal/exchange or stricture dilation. Patients undergoing ERCP for OLT-related anastomotic strictures from 2010 to 2016 were identified from a prospectively maintained endoscopy database. Procedure duration, fluoroscopy time, stricture resolution rates, adverse events, materials fees, and facility fees were analyzed for IDSE and SSA procedures. Seventy-seven patients underwent 277 IDSE and 132 SSA procedures. Mean fluoroscopy time was 64.5% shorter (P< .0001) and mean procedure duration 41.5% lower (P< .0001) with SSA compared with IDSE. SSA procedures required fewer accessory devices, resulting in significantly lower material (63.8%, P< .0001) and facility costs (42.8%, P< .0001) compared with IDSE. Stricture resolution was >95%, and low adverse event rates did not significantly differ. SSA results in shorter, cost-effective procedures requiring fewer accessory devices and exposing patients to less radiation. Stricture resolution rates are equivalent to IDSE, and adverse events do not differ significantly, even in this immunocompromised population.

Accessory Devices Frequently Used for Endoscopic Submucosal Dissection.

Endoscopic submucosal dissection (ESD) is increasingly being considered an essential component of treatment for early gastrointestinal cancers and subepithelial tumors. The ESD technique owes its popularity to the development of sophisticated instruments used for ESD. With an increase in the number of ESD procedures performed, there is rapid development in the number and types of endoscopic accessory devices used for such procedures. Despite the large numbers of new devices developed and marketed, the use of ESD instruments and accessory devices is largely determined by individual preferences and experiences. Accessory devices frequently used during ESD are important tools for ESD techniques. Each instrument possesses characteristic advantages and disadvantages associated with its use, and no one instrument is superior in all respects to others. In this article, we review the characteristics of endoscopic electrical knives, cap and hood, and hemostatic devices commonly used in ESD.

Advanced endoscopic imaging: Polyps and dysplasia detection

Colonoscopy is the gold standard for colorectal cancer screening and diagnosis. Colonoscopy is a minimally invasive procedure that provides visual inspection of colonic mucosa. The goal of imaging is to detect adenomatous changes that are the primary risk factor for colonic adenocarcinoma. Adenomatous polyps represent structurally visible low-grade dysplasia. Their detection is the key to screening for and preventing colorectal cancer. Many technological advances have been designed to improve the detection of colonic dysplasia. Some advances improve subtle changes in mucosal architecture, while others improved the field of view. Adjuncts such as chromoendoscopy were developed to improve visualization of colonic mucosal pattern. Other accessory devices improve the field of view.

Attaching Accessory Devices to the Replisome

Evidence mounts, via two studies published in Molecular Cell (Villa etal. 2016; Samora etal. 2016), that Ctf4 recruits to the replisome various factors that play diverse roles in chromosome duplication, by acting as an interaction hub.

A method for measuring rotation of a thermal carbon nanomotor using centrifugal effect.

A thermal nanomotor is relatively easy to fabricate and regulate as it contains just a few or even no accessory devices. Since the double-wall carbon nanotube (CNT)-based rotary nanomotor was established in a thermostat, assessment of the rotation of the rotor (inner tube) in the stator (outer tube) of the nanomotor has been critical, but remains challenging due to two factors: the small size of the rotor (only a few nanometers) and the high rotational frequency (»1 GHz). To measure the rotation of the nanomotor, in the present study, a probe test method is proposed. Briefly, the rotor is connected to an end-tube (CNT) through a graphene (GN) nanoribbon. As the CNT-probe is on the trajectory of the end-tube which rotates with the rotor, it will collide with the end-tube. The sharp fluctuation indicating the probe tip deflection can be observed and recorded. As a curly GN by hydrogenation is adopted for connecting the rotor and the end-tube, collision between the end-tube and the probe tip occurs only when the centrifugal force is higher than a threshold which can be considered as the rotational frequency of the rotor being measured by the present method.

New Developments in Standards for MRI Safety Testing of Medical Devices

The magnetic resonance (MR) environment presents unique safety hazards for implanted and accessory medical devices including unwanted device movement, tissue heating, device malfunction, and imaging artifacts. Ever increasing numbers of patients with implants and accessory devices undergo MRI exams, making MRI safety an important goal for all. This paper provides an overview of the current status of standards related to the testing and labeling of medical devices in the MR environment. These standards represent the efforts and ongoing collaborations between regulatory bodies, device manufacturers, scientists, and the medical community to assure the safety of patients and medical personnel in the MR environment. This paper discusses current and emerging challenges to MRI safety evaluation that present opportunities for future standards development.

The ability of people with intellectual disability to use inhalers – an exploratory mixed methods study

Objective: This aim of this study was to assess inhaler technique of people with intellectual disability (ID), and evaluate the effectiveness of teaching with respect to their individual ability to adopt correct technique. Methods: Seventeen people with ID were recruited through existing networks of general practitioners and disability support organisations. Inhaler technique was assessed using validated checklists and placebo devices, followed by provision of individualised training. The educational interaction between participant and researcher was captured via video recording and analysed qualitatively. Results: Seventeen people with ID participated; females comprised 65%. At baseline, no participants correctly used any device. Pressurised metered dose inhalers, with or without accessory devices, were the most poorly used devices. Inhalation steps were poorly performed across all devices. Following training, the proportions of assessed participants that were able to master inhaler technique were 100% of Accuhaler users, 40% of Turbuhaler users, 25% of pressurised metered dose inhaler users and 0% of Handihaler users. Barriers identified included poor comprehension of breathing processes, the lack of attentiveness and poor dexterity. Facilitators for educator delivery of inhaler technique education included the use of analogies and being patient. Conclusions: This is the first study to examine inhaler technique mastery in people with ID. Results show that with education that addresses the unique patient barriers inherent in this group, some individuals can be trained to mastery. Structured modules of inhaler technique training tailored for people with ID, but which can be individualised, are recommended.

A feasible ambulatory mini-incision microsurgical vasovasostomy under local anaesthesia using a specially designed double-ringed clamp that simplifies surgery.

In line with the effort to evaluate feasible surgical options for vasectomy reversal and to increase patients' willingness to undergo the procedure, this study reported on a technique for ambulatory mini-incision microsurgical vasovasostomy using a double-ringed clamp (i.e. Moon's clamp). This technique does not require the use of dilators, approximators and other accessory devices. Ambulatory mini-incision microsurgical vasovasostomy was conducted on 263 patients who satisfied the surgical eligibility requirements for vasovasostomy and the safety criteria for local anaesthesia. The operation time, details on postoperative recovery and results of the postoperative semen analysis were recorded and retrospectively analysed. The mean time used to isolate the bilateral vas deferens was 25.5 minutes. All patients were discharged on the day of surgery and all patients returned to their normal activities within 24-48 hours after surgery. No haematoma or infection occurred except in one patient. Postoperative semen analysis showed that the surgery was successful in 182 (96.8%) of the 188 patients who complied with the postoperative patient instructions. Ambulatory mini-incision microsurgical vasectomy reversal using Moon's clamp and under local anaesthesia is a surgically feasible option that offers the advantages of a low-risk operation. It also achieves successful vasovasostomy without other accessory devices and allows patients to return to their daily activities quickly with minimal complications.

MP74-05 PRACTICE PATTERNS IN SURGICAL STERILIZATION: AN ANALYSIS OF US UROLOGIST SURGICAL LOGS

INTRODUCTION AND OBJECTIVES: To consider the feasible surgical options and increase patients’ willingness to seek vasectomy reversal. We report on the techniques for simple and ambulatory miniincision supermicrosurgical vasovasostomy(3-4 layer anastomosis by 9-0 or/and 10-0 nylon with >10x magnification) using a double-ringed clamp (Moon’s clamp), which makes use of dilators, approximators, and background material unnecessary. We also report the results METHODS: Ambulatory mini-incision supermicrosurgical vasovasostomy was conducted on 263 patients who satisfied surgical eligibility requirements for vasovasostomy and safety criteria for local anesthesia. We recorded and retrospectively analysed the operation time, postoperative recovery, and the results of postoperative semen analysis. RESULTS: A mean time of 25.5 min was spent isolating the bilateral vas deferens. All patients were discharged on the day of surgery and returned to their ordinary activities 24e48 h after surgery. No hematoma or infection occurred, except in one patient. Postoperative semen analysis showed that the surgery was successful in 182 patients (96.8%). CONCLUSIONS: Simple ambulatory mini-incision microsurgical vasectomy reversal using Moon’s clamp under local anaesthesia could be a surgically feasible option, with the advantages of a low-risk operation and the achievement of successful vasovasostomy without other accessory devices, for patients who wish to return to their daily activities quickly with minimal complications. Source of Funding: none

MP74-04 A SIMPLE AMBULATORY MINI-INCISION SUPERMICROSURGICAL VASOVASOSTOMY UNDER LOCAL ANESTHESIA : USING A SPECIALLY DESIGNED DOUBLE-RINGED CLAMP WITHOUT ANY ACCESSORY DEVICES

INTRODUCTION AND OBJECTIVES: To consider the feasible surgical options and increase patients’ willingness to seek vasectomy reversal. We report on the techniques for simple and ambulatory miniincision supermicrosurgical vasovasostomy(3-4 layer anastomosis by 9-0 or/and 10-0 nylon with >10x magnification) using a double-ringed clamp (Moon’s clamp), which makes use of dilators, approximators, and background material unnecessary. We also report the results METHODS: Ambulatory mini-incision supermicrosurgical vasovasostomy was conducted on 263 patients who satisfied surgical eligibility requirements for vasovasostomy and safety criteria for local anesthesia. We recorded and retrospectively analysed the operation time, postoperative recovery, and the results of postoperative semen analysis. RESULTS: A mean time of 25.5 min was spent isolating the bilateral vas deferens. All patients were discharged on the day of surgery and returned to their ordinary activities 24e48 h after surgery. No hematoma or infection occurred, except in one patient. Postoperative semen analysis showed that the surgery was successful in 182 patients (96.8%). CONCLUSIONS: Simple ambulatory mini-incision microsurgical vasectomy reversal using Moon’s clamp under local anaesthesia could be a surgically feasible option, with the advantages of a low-risk operation and the achievement of successful vasovasostomy without other accessory devices, for patients who wish to return to their daily activities quickly with minimal complications. Source of Funding: none

Tips and tricks of double-balloon endoscopic retrograde cholangiopancreatography (with video).

Although endoscopic retrograde cholangiopancreatography (ERCP) is technically difficult in patients with altered gastrointestinal tract, double-balloon endoscopy (DBE) allows endoscopic access to pancreato-biliary system in such patients. Balloon dilation of biliary stricture and extraction of bile duct stones, placement of biliary stent in patients with Roux-en-Y or Billroth-II reconstruction, using DBE have been reported. However, two major technical parts are required for double-balloon ERCP (DB-ERCP). One is insertion of DBE and the other is an ERCP-related procedure. The important point of DBE insertion is a sure approach to the afferent limb with Roux-en-Y reconstruction or Braun anastomosis. Short type DBE with working length 152 cm is beneficial for DB-ERCP because it is short enough for most biliary accessory devices. In this paper, we introduce our tips and tricks for successful DB-ERCP.

Accumulative Secure Group Association in an Ad-hoc and Ubiquitous Network (Version 3.0)

The increased popularity of mobile devices, such as laptops, mobile phones, tablets, accessory devices, and more, brings new challenges in the area of network security in the ubiquitous environment, where ad-hoc networks may be formed using mobile devices. There has been little discussion of setting up secure connections among a group of devices. A number of group security protocols has been proposed; however, these have tended to focus on a scenario whereby all devices must be located in one place at one time. In this paper, we describe a new secure group associa- tion method that associates mobile devices in an accumulative manner, so it does not require all group members to be physically present. It utilizes digital certification and extends the concept of out-of-band channels, through which the authentication data can be transferred using human user involvement. We have implemented a prototype system and conducted a comparative user experiment to demonstrate viability of the accumulative association.

Ergonomic Investigation of Interventional Radiology

Interventional radiology (IVR) refers to a variety of minimally invasive procedures using small-caliber catheters under fluoroscopic or ultrasound guidance for the treatment of vascular and digestive diseases. Common IVR applications include dilatation, occlusion, and selective cannulation of vessels and the digestive canal without open surgery. Indications for IVR are rapidly increasing. However, ergonomic problems of IVR for physicians have not been considered. Such ergonomic problems and countermeasures were investigated in this study. Ergonomic problems during hepatic arterial catheterization and placement of a stent in the digestive canal, two frequent IVR procedures, were investigated. Ergonomic problems of IVR, problems induced by X-ray protectors, inadequate working postures and asthenopia induced by the apparatus, impaired maneuverability and neuro-muscular fatigue forced by small caliber catheter for intra-vascular catheterization, lacks of intuitive usability and standardization the devices and instruction documents are revealed in this study. For the continued safe development of IVR, outstanding ergonomic and technological problems must be resolved. Potential solutions include the development of adequate holding and accessory devices for small-caliber devices, improved educational software, and head-mounted displays. Further analyses of the workflow and ergonomic medical device design with input from end users are also critical.