Accurate Insertion Research Articles

Chula Formula is recommended in Estimating the Length of Tracheal Tube Insertion in Patients Receiving Mechanical Ventilation in Intensive Care Units in the Absence of Chest X-Ray

Background: Chest X-Ray (CXR) is one of the most effective ways of confirming the length of the tracheal tube (TT) insertion. However, some intensive care unit in developing countries has no sufficient facilities. This study aims to evaluate the accuracy of TT length insertion using the Chula formula and Colombian formula in patients receiving mechanical ventilation in intensive care units. Methods: This study is a comparative observational study of 50 adults in the Intensive care unit, divided into two groups. Group A used the Chula formula for TT length insertion (n= 25) and Group B used the Colombian formula (n= 25). The TT length insertion accuracy was evaluated using radiological parameters. Statistical analysis used: Data were analyzed statistically using the T-test and Chi-square test. Result: The Chula formula is significantly more precise than the Colombian formula in estimating the length of TT insertion based on the radiographic parameters of the TT length insertion right midway between the medial tip of the clavicle and TT located in the T3 or T4 vertebrae (p <0.05), but not significantly different in the two other parameters. Conclusion: Both the Chula formula and the Colombian formula can estimate the length of TT insertion in adult patients. However, the Chula formula is more recommended in the length of TT insertion and benefit in the ICU with insufficient CXR.

Data mining for signal detection of adverse events for taxanes based on the food and drug administration adverse drug events reporting system database

ABSTRACT Background This study aimed to mine and compare the positive signals of adverse drug events (ADE) in paclitaxel, docetaxel, and nab-paclitaxel to evaluate the accuracy of current drug package information inserts and enable clinicians to select the appropriate treatment. Research design and methods ADE data reported from January 2006 to December 2020 were extracted from the Food and Drug Adverse Drug Events Reporting System (FAERS) database, and the reporting odds ratio (ROR) was used to detect the risk signals of the 3 taxanes. The definition relied on system organ class (SOCs) and preferred terms (PTs) by the Medical Dictionary for Regulatory Activities (MedDRA). Results A total of 39,163 case reports on paclitaxel, docetaxel and nab-paclitaxel involving 25 different system organ classes (SOCs) were retrieved from the database. The ADE paclitaxel and nab-paclitaxel reports mainly focused on ‘general disorders and administration site conditions’ and the docetaxel ADE reports focused on ‘skin and subcutaneous tissue diseases.’ Among the three taxanes, nab-paclitaxel had the highest positive signal for serious adverse events. Conclusions Overall, the most common ADE signals and ADE mapping systems obtained in this study were consistent with the package inserts. However, some inconsistencies were noted. Further research is recommended to confirm some of the strong risk signals for ADEs for taxanes before updating the drug package information inserts.

In Situ Flexible Needle Adjustment Towards MRI-Guided Spinal Injections Based on Finite Element Simulation.

This paper investigates the possibility of robotically performing in situ needle manipulations to correct the needle tip position in the setting of robot-assisted, MRI-guided spinal injections, where real time MRI images cannot be effectively used to guide the needle. Open-loop control of the needle tip is derived from finite element simulation, and the proposed method is tested with ex vivo animal muscle tissues and validated by cone beam computed tomography. Preliminary results have shown promise of performing needle tip correction in situ to improve needle insertion accuracy when real-time feedback is not readily available.

Analysis of accuracy of pedicle screw placement in dysplastic pedicles in adolescent idiopathic scoliosis using the pedicle expansion technique with CT-based navigation

BackgroundThis study aimed to study the accuracy of pedicle screw (PS) insertion into dysplastic pedicles in adolescent idiopathic scoliosis (AIS) comparing cannulated screw using the pedicle expansion technique (PET) versus conventional technique. MethodsForty-two AIS patients with 766 PSs were evaluated. In total, 236 screws were inserted into dysplastic pedicles: 138 and 98 screws were inserted using the PET (PET group) and standard technique (conventional group), respectively. Both methods used CT-based navigation to determine the insertion point. In the PET, a rigid ball tip feeler was tapped with a mallet to create an insertion route, a guide wire was passed through the tap, the pedicle was enlarged, and then a cannulated PS with a diameter of 4.35 mm was inserted. Postoperative CT was used to compare the accuracy of PS insertion. ResultsIn total, 23/236 (9.7%) perforations occurred. Regarding overall perforation, there were six (4.3%) and 17 (17.3%) cases in the PET and conventional group, respectively (P = 0.008). In terms of medial perforation, the PET group (n = 2, 1.4%) was significantly better than the conventional group (n = 7, 7.1%) (P = 0.021). In terms of lateral perforation, the PET group (n = 4, 2.9%) was significantly better than conventional group (n = 10, 10.2%) (P = 0.030). Only grade 1 perforation had occurred in the PET group, whereas grades 2 and 3 perforation occurred in the conventional group. ConclusionUse of the PET with CT-based navigation significantly increased the accuracy and safety of PS insertion in dysplastic pedicles in AIS.

Magnetic Resonance-Guided Stereotaxy for Infusions to the Pig Brain.

The overall goal of this procedure is to perform stereotaxy in the pig brain with real-time magnetic resonance (MR) visualization guidance to provide precise infusions. The subject was positioned prone in the MR bore for optimal access to the top of the skull with the torso raised, the neck flexed, and the head inclined downward. Two anchor pins anchored on the bilateral zygoma held the head steady using the head holder. A magnetic resonance imaging (MRI) flex-coil was placed rostrally across the head holder so that the skull was accessible for the intervention procedure. A planning grid placed on the scalp was used to determine the appropriate entry point of the cannula. The stereotactic frame was secured and aligned iteratively through software projection until the projected radial error was less than 0.5 mm. A hand drill was used to create a burr hole for insertion of the cannula. A gadolinium-enhanced co-infusion was used to visualize the infusion of a cell suspension. Repeated T1-weighted MRI scans were registered in real time during the agent delivery process to visualize the volume of gadolinium distribution. MRI-guided stereotaxy allows for precise and controlled infusion into the pig brain, with concurrent monitoring of cannula insertion accuracy and determination of the agent volume of distribution.

Accuracy and Safety of Fluoroscopy-Assisted Transpedicular Screw Insertion in Thoracolumbar Spine Surgery: Evaluation of 122 Screws.

The objective of this study is to determine the accuracy and safety of trans-pedicular screws' insertion in the thoracolumbar spine using a fluoroscopy-assisted surgical technique. We retrospectively evaluated all patients who underwent a postoperative computed tomography scan to assess the location of the pedicular screws following thoracolumbar spinal surgery, at the Mohammed Vth Military Training Hospital-Rabat, from January 2020 to April 2022. We used Gertzbein's classification to grade pedicular cortex breaches. A screw penetration greater than 4 mm (grades D-E) was considered critical and one less than 4 mm was classified as noncritical (grades A-C). A total of 122 screws inserted in the T1 to L5 vertebrae were included from 25 patients. The average age was 46 years old. Pathologies included degenerative disorders (5 patients), tumors (8 patients), and trauma (12 patients). All screws were inserted using lateral and anteroposterior fluoroscopic guidance. A total of 11 transpedicular screws breaches were identified. The breaches incidence was significantly higher in thoracic pedicles (8 screws) than in lumbar pedicles (3 screws). Of these, three critical cases occurred in two patients and one of them required reintervention. The remaining eight exceedances were not critical and were closely monitored and followed up. Transpedicular screws fluoroscopy-assisted surgical fixation can be performed for the stabilization of the thoracolumbar spine with satisfactory safety and precision.

Digital workflow for periodontal splinting with a guided device.

To detail a technique for bonding periodontal splint precisely in a digital workflow. Periodontal splinting can be considered to stabilize the mobile teeth, especially for mandibular anterior teeth. Reliable bonding of periodontal splints is a prerequisite for successful clinical performance. However, when bonding the indirect splint to place or making direct splint intraorally, there is a significant risk of mobile teeth drifting away from the splint. To guide accurate insertion of periodontal splint with no risk of displacement of mobile teeth, a guide device fabricated by digital workflow is introduced in this article. Periodontal compromised teeth can be provisionally fixed during splinting, with the help of the guided device, and precise bonding of the splint is readily accomplished by using such digital workflow. This technique is not only applicable to the lingual splints, but also suitable for the labial ones. The use of a guided device, after being digitally designed and fabricated, enables to stabilize the mobile teeth, in case of any displacement during splinting. It is straightforward, and beneficial to reduce the risk of complications, such as debonding of the splint, and secondary occlusal trauma.

PLF Design for DC-DC Converters Based on Accurate IL Estimations

Even though today’s electromagnetic compatibility (EMC) standards and measurement techniques set specific limitations and a clear methodology to measure the conducted emissions (CE) of equipment under tests (EUTs), the design methodology of a suitable power-line filter (PLF) to solve non-compliance is, in general, neither accurate nor efficient. This is due to different reasons, such as unknown actual load and line impedances, unknown dominant mode in the CE, and/or inappropriate instrumentation for the appropriate measurements. The objective of this paper is to investigate if different topologies of switching mode power supplies (SMPSs) lead to different PLF structures. For the sake of exemplification, the analysis is focused on switched-mode DC-DC converters. From an EMC point of view, these devices can be completely modeled by means of Scattering (S)–parameter and CE measurements. Additionally, an analysis of their circuit models has been performed to allow a better comprehension of their characterization. In this paper, the circuit models of three different types of DC-DC converters are presented, and their component values (including nonlinearities and parasitic effects introduced by the actual behavior of the circuit elements) are estimated using the S-parameter characterization. Then, a new methodology for PLF design, based on accurate insertion loss (IL) estimations, is applied to obtain the optimal PLF for one of the converters. This methodology is experimentally tested and validated.

Freehand Ventriculoperitoneal Shunt for Idiopathic Intracranial Hypertension: Technical Note for Slit-Like Ventricle Puncture.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure, headache, and papilledema. It is frequently associated with obese women and can result in irreversible vision loss. The ventriculoperitoneal (VP) shunt has been proven to be superior to the lumboperitoneal (LP) shunt in IIH patients, with better clinical outcomes. It has been reported that the accurate placement of the ventricular catheter is highly important for shunt survival. However, a slit-like ventricle pattern, typically seen in the disease, has been considered a great concern and challenge for ventricular catheter placement, primarily for freehand technique. Frameless stereotaxy, ultrasound, and endoscopy have been described to improve the accuracy of catheter insertion. However, intraoperative image guidance is not widely accessible, especially in lower-resource countries, due to the high costs associated with its use. Techniques to improve the accuracy of the freehand VP shunt in IIH are scarce in the literature, and any effort to contribute to its development is valuable and helpful.

Low Radiation Protocol for Intraoperative Robotic C-Arm Can Enhance Adolescent Idiopathic Scoliosis Deformity Correction Accuracy and Safety.

Retrospective case-series study. To assess (1) low cone beam CT (CBCT) mediated intraoperative navigation to limit radiation exposure without compromising surgical accuracy, and (2) the potential of intraoperative C-arm CBCT navigation to augment pedicle screw (PS) placement accuracy in AIS surgery compared to pre-surgery CT-based planning. The first part involved a prospective phantom study, comparing radiation doses for conventional CT, and standard (6sDCT) and a low dose (5sDCT) Artis Zeego®-imaging. Next, 5sDCT- and 6sDCT-navigation were compared on PS accuracy and radiation exposure during AIS correction. The final part compared surgical AIS deformity correction through intraoperative 5sDCT navigation to a matched cohort treated using conventional pre-surgery CT-scans for navigation. Outcome parameters included operation time, skin dose (SD), dose area product (DAP), intraoperative blood loss, postoperative complications, and PS deviation rates. The phantom study demonstrated a reduction in radiation for the 5sDCT protocol. Moreover, 5sDCT-imaged patients (n = 15) showed a significantly lower SD (-27.41%) and DAP (-30.92%), without compromising PS accuracy compared with 6sDCT-settings (n = 15). Finally, AIS correction through intraoperative CBCT C-arm navigation (n = 27) significantly reduced screw deviation rates (6.83% versus 10.75%, P = .016) without increasing operation times, compared with conventional CT (n = 37). Intraoperative navigation using a CBCT C-arm system improved the accuracy of PS insertion and reduced surgery time. Moreover, it reduced radiation exposure compared with conventional CT, which was further curtailed by adapting the low-dose 5sDCT protocol. In short, our study highlights the benefits of intraoperative CBCT navigation for PS placement in AIS surgery.

Do 3D printed templates aid in exposure, improve the accuracy and safety of pedicle screw insertion in complex spinal kypho-scoliotic deformities? A comparative cohort study

Do 3D printed templates aid in exposure, improve the accuracy and safety of pedicle screw insertion in complex spinal kypho-scoliotic deformities? A comparative cohort study

Comparative Effectiveness, Efficiency, and ED Nurse Preference Between Two Methods of Visualization for Midline Catheter Insertion: A Pilot Study.

Rapid and reliable peripheral IV access is essential for many patients admitted to the emergency department (ED) to ensure administration of life-saving medications, and successful intravenous cannulation can significantly affect patient care. The objective of this study was to assess the impact of a continuous needle tracking system on the accuracy, speed, and quality of ultrasound-guided peripheral venous catheter insertions. A convenient sample study based on the study setting using simulated tissue was conducted with 49 US-based ED nurses to compare the insertion of a midline catheter using traditional ultrasound guidance versus an advanced needle-tracking technology along with ultrasound guidance. The purpose of this evaluation was to assess the impact of continuous needle tracking system. Informed consent was obtained from all individual participants involved in this study. All participants were made aware that the results may be published. There was no IRB approval for this study. All sources were properly disclosed within the text. The addition of the advanced needle-tracking technology significantly reduced total insertion attempts, insertion time, backwall penetrations, and redirects (probes to hit the target vein), while improving image clarity and confidence for participants. The innovative needle-tracking system evaluated in this pilot study has the potential to improve emergent difficult vascular access. EDs should assess the value of this technology to potentially improve the management of difficult intravenous access patients in their settings.

Analysis of dimensional accuracy of RP pattern and RTV mould inserts using DOE technique

Analysis of dimensional accuracy of RP pattern and RTV mould inserts using DOE technique

Analysis of dimensional accuracy of RP pattern and RTV mould inserts using DOE technique

Analysis of dimensional accuracy of RP pattern and RTV mould inserts using DOE technique

Computed Tomography-Based Occipital Condyle Morphometric Analysis in the Turkish Population: A Trajectory Analysis for Optimal Screw Selection.

To provide a comprehensive analysis for accurate screw size selection and insertion angle during surgical procedures. In this retrospective study, a total of 120 patients participated, resulting in the analysis of 240 occipital condyles using coronal, sagittal, and axial planes on CT scans. Statistical evaluation was performed using the Wilcoxon rank-sum test, with p < 0.05 considered statistically significant. The mean sagittal length and height were measured at 17.2 ± 1.7 mm and 9.1 ± 1.5 mm, respectively. The average condyle angle, a crucial factor for screw insertion, was assessed at 38.0 ± 5.5 mm in length, 19.6 ± 2.6 mm in width, and 9.5 ± 1.0 mm in height. Condyle height in the anterior and posterior hypoglossal canals was measured at 10.8 ± 1.4 mm and 9.0 ± 1.4 mm, respectively. Screw angle and condyle width were statistically smaller in females compared to the male population. The OC is a significant anatomical structure in the craniovertebral junction, playing a crucial role in stability. The obtained morphological values are applicable to the Turkish population and offer statistically significant findings for preoperative planning involving occipital condyle screw instrumentation.

Determining On‐Target, Off‐Target, and Copy Number Status of Transgenic Events After CRISPR/Cas9 Targeted AAVS1 Safe‐Harbor Modification of iPSCs Using Double‐Control Quantitative Copy Number PCR

Double-control quantitative copy number PCR (dc-qcnPCR) is a recently described tool that can be used to quantify donor DNA insertions in genetically modified monoclonal cell lines. In conjunction with an insert-confirmation PCR, the technique can quickly and easily identify clones containing on-target heterozygous or homozygous donor DNA integrations and exclude off-target insertions. The genetic manipulation of immortal cell lines is a versatile tool to elucidate cellular signaling pathways and protein functions. Despite recent advances in the precision of genetic engineering tools such as CRISPR/Cas9, transcription-activator-like effector nucleases (TALENs), and zinc-finger nucleases (ZFNs), it is still essential to verify the accurate insertion of the sequence of interest (donor DNA) into the targeted genomic DNA (gDNA) locus. This precise integration into a genetic safe harbor, and exclusion of the donor DNA from functionally relevant genes, can ensure normal cellular functionality. Current methods to analyze the specificity of donor DNA insertions either are cost-prohibitive or create dependency on manufacturers for assay design and production. The dc-qcnPCR method is a simple, yet powerful, approach that can be prepared and carried out in any laboratory equipped with standard molecular biology supplies. Here we provide step-by-step instructions to prepare and perform the dc-qcnPCR, and its companion insert-confirmation PCR, to determine donor DNA insertion numbers in monoclonal cell lines genetically modified through CRISPR/Cas9. © 2023 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Genetic modification at AAVS1 safe harbor in induced pluripotent stem cells (IMR90-4) using CRISPR/Cas9: from plasmid design to monoclonal expansion Support Protocol 1: Measurement of Gaussia luciferase activity to verify reporter protein functionality Support Protocol 2: Verification of monoclonal expansion using immunofluorescence. Basic Protocol 2: Insert-confirmation PCR Basic Protocol 3: Design and preparation of double-control quantitative copy number PCR reagents and quantification of donor DNA integrations in genetically modified monoclonal cells.

Development of an Electric Pegboard (e-Peg) for Hand Dexterity Improvement and Cognitive Rehabilitation: A Preliminary Study

Fine motor dysfunction and cognitive impairments commonly develop after stroke, which greatly impact the daily lives of patients. In current occupational therapy, hand dexterity and cognitive functions are evaluated individually (e.g., by manipulation of small objects with fingers, or a paper-and-pencil test), which is insufficient for therapists to grasp the total ability of combined dexterity and cognition in everyday situations. Additionally, the traditional methods require a tester to measure the completion time manually and tend to be monotonous for patients. These problems would be solved using technology. This study aimed to develop a new electric pegboard (e-Peg) prototype and to investigate preliminary utility in healthy adults. The system judges the peg insertion accuracy based on magnetism and records the time course and scores, which are linked to human object manipulation ability. The e-Peg executes three types of tasks: a basic color matching task (BT), a color comparison task using a pattern sheet (CT), and a visual memory task (MT), with one/two-color sample patterns. Six older and nine younger healthy adults performed the e-Peg tasks, functional tests, and responded to questionnaires. As a result, the number of correct answers in a bicolor symmetrical MT were significantly greater in the younger group than in the older group. The older group required a significantly longer completion time for BT and CT than the younger group. Significant correlations were found between one-color BT/CT and dexterity tests, between bicolor BT/CT and dexterity/cognitive tests, and between a bicolor MT and a cognitive test. Questionnaire results revealed that participants regarded BT/CT as easy/interesting tasks, whereas MT was considered a difficult/challenging task. In conclusion, our e-Peg is potentially a useful rehabilitation device that facilitates many tasks related to hand manipulation and attention/executive functions, and a valuable tool for personalized therapy.

Miniature CRISPR-Cas12f1-Mediated Single-Nucleotide Microbial Genome Editing Using 3'-Truncated sgRNA.

The CRISPR-Cas system has been used as a convenient tool for genome editing because the nuclease that cuts the target DNA and the guide RNA that recognizes the target are separated into modules. Cas12f1, which has a smaller size than that of other Cas nucleases, is easily loaded into vectors and is emerging as a new genome editing tool. In this study, AsCas12f1 was used to negatively select only Escherichia coli cells obtained by oligonucleotide-directed genome editing. Although double-, triple-, and quadruple-base substitutions were accurately and efficiently performed in the genome, the performance of single-base editing was poor. To resolve this limitation, we serially truncated the 3'-end of sgRNAs and determined the maximal truncation required to maintain the target DNA cleavage activity of Cas12f1. Negative selection of single-nucleotide-edited cells was efficiently performed with the maximally 3'-truncated sgRNA-Cas12f1 complex in vivo. Moreover, Sanger sequencing showed that the accuracy of single-nucleotide substitution, insertion, and deletion in the microbial genome was improved. These results demonstrated that a truncated sgRNA approach could be widely used for accurate CRISPR-mediated genome editing.

Low-cost 3D Modeling Software for Generating Patient-specific Drill Guide Templates for Cervical Pedicle Screw Insertion: An In Vitro Study

Background. Instrumented posterior cervical spine surgery (IPCSS) can be conducted using screws inserted through the pedicles of the vertebra. A safe IPCSS method uses 3D-printing to produce templates that will serve as drill guides for screw placement.Objectives. This study describes the generation of 3D-printed drill guides using low-cost general purpose 3D modeling software and the comparison of screw insertion accuracy scores against the traditional landmark method and guides created using commercial grade software.Methods. Twenty-five (25) subaxial pedicles of five cadaveric spines were selected and scanned using computedtomography (CT). A digital reconstruction of the five cadaveric spines were created based on the CT DICOM data. A low-cost 3D modeling software, Rhinoceros 3D, was utilized for trajectory planning and generation of a patientspecific drill template using the digital reconstruction. The templates were then fabricated in ABS plastic using a fused deposition modeling (FDM) 3D printer. Insertion of cervical pedicle screws on the cadaveric spines was done by an orthopedic resident using the 3D printed guides. Postoperative CT scans were obtained, and placement accuracy of the screws were scored by two assessors utilizing a four-point rating system. Screws in correct placement were scored Grade 0 while misplaced screws with neurovascular damage were given a score of Grade 3.Results. Accuracy scores for the 3D-printed drill guides were 52% for assessor 1 and 44% for assessor 2. Forassessor 1, screw placement in C3, C6, and C7 received the highest scores. For assessor 2, the highest scores were achieved in C3 and C7. The hybrid method of Bundoc et al. achieved scores of 94% while 3D printed guides utilizing commercial software like Materialise Mimics, Geomagic Freeform, or UG Imageware achieved scores of 80-100%. The traditional landmark method had scores ranging from 12% to 94% depending on the skill of the surgeon.Conclusion. Commercial medical 3D image-based engineering software has high acquisition costs that might be beyond the reach of most institutions. A sub-$1000 general purpose 3D modeling software can be used to create drill templates. Several factors were identified in the design and fabrication of the template that can be addressed to increase accuracy. Trajectory planning can also be improved by automating the process. The researchers recommend further studies in these areas specially in the context of developing 3D printing as a support service for surgical operations in the Philippines.

Robot and ultrasound assisted needle insertion to the transverse carpal ligament

BackgroundA potential alternative treatment to surgery for carpal tunnel syndrome is to inject enzymes into the transverse carpal ligament to decrease its stiffness and alleviate pressure off the median nerve. An accurate injection is needed for delivery to achieve the effects of tissue degradation. The purposes of this study were to 1) determine injection sites using 3D reconstructed anatomy, and 2) insert the needle to the middle of the transverse carpal ligament thickness in situ. MethodsSix fresh-frozen cadaveric hands were used in this study. Five injection sites were determined in the sagittal plane along the center of the transverse carpal ligament thickness ulnar to the thenar muscle attachment using 3D ultrasonographic reconstruction. Each injection was delivered by rigidly fixing a 27-gauge needle to a six degrees of freedom robot arm programmed to insert the needle tip to the intended target. Ultrasound images were taken of the needle after insertion to measure accuracy and precision of the needle placement. FindingsThe needle tip was successfully delivered to the middle region of the transverse carpal ligament thickness and visualized using ultrasound imaging. The accuracy and precision of the needle insertion were 0.83 and 0.31 mm, respectively. InterpretationMethodology was established for robot-assisted needle insertion to the transverse carpal ligament using 3D ultrasonographic reconstructed anatomy. This methodology can be used in the future to deliver enzymatic injections to the transverse carpal ligament as a potential treatment for carpal tunnel syndrome.