Adjustable Device Research Articles

Adjustable Velcro® Compression Devices are More Effective than Inelastic Bandages in Reducing Venous Edema in the Initial Treatment Phase: A Randomized Controlled Trial

The objective of this study was to compare the efficacy and comfort of inelastic bandages (IBs) and adjustable Velcro compression devices (AVCDs) in reducing venous leg edema in the initial treatment phase. Forty legs from 36 patients with untreated venous edema (C3EpsAsdPr) were randomized to two groups. Patients in the first group received IBs (n = 20) and those in the second AVCDs (n = 20). Both compression devices were left on the leg day and night, and were renewed after 1 day. Patients in the AVCD group were asked to re-adjust the device as needed when it felt loose. Leg volume was calculated using the truncated cone formula at baseline (T0), after 1 day (T1) and after 7 days (T7). The interface pressure of the two compression devices was measured by an air filled probe, and the static stiffness index calculated after applying compression at T0 and T1, and just before removal of compression on T1 and T7. Patient comfort with regard to the two compression systems was assessed by grading signs and symptoms using a visual analog scale. At T1, the median percent volume reduction was 13% for the IB group versus 19% for the AVCD group; at T7 it was 19% versus 26%, respectively (p < .001). The pressure of the IBs was significantly higher compared with the AVCDs at T0 (63 vs. 43 mmHg) but dropped by > 50% over time, while it remained unchanged with AVCDs owing to the periodic readjustment by the patient. Comfort was reported to be similar with the two compression devices. Re-adjustable AVCDs with a resting pressure of around 40 mmHg are more effective in reducing chronic venous edema than IBs with a resting pressure of around 60 mmHg. AVCDs are effective and well tolerated, not only during maintenance therapy, but also in the initial decongestive treatment phase of patients with venous leg edema.

MODES OF OPERATION OF THE SYSTEM OF TRACTION POWER AC USING REACTIVE POWER COMPENSATION DEVICES

The paper presents a systematic analysis of existing methods of reactive power compensation. The study of operating modes of the systems external and traction power supply is carried out. The methodology for selecting promising compensation schemes and energy-saving in the traction networks AC electrified railway lines is offered. The comparative evaluation of prospective controlled compensation devices shows that use of seamlessly adjustable devices with unregulated condensing the battery and with parallel translator regulated with thyristor unit and with filters to reduce harmonics bond to the large capital investments. For traction networks of domestic railways payback period is more than 10-15 years. The most promising for traction power supply today is a stepwise adjustable devices of reactive power compensation. For the efficient allocation of investments in programs and projects of modernization of system traction power supply developed by the methodology of selecting parameters and places placement devices transverse compensation in the system traction power supply, which is based on the use of software systems with imitation of interconnected instant circuits moving loads of electric rolling stock. Based on the results of multiple calculations full factor experiment when simulating work of the systems traction power supply during the day marked the most influencing factors on energy-saving in process freight on electric traction and established the extent of their influence. These include the overflows of power, the resistance of traction network, reactive power compensation, power supply circuits and the organization of trains. Innovative technologies energy-saving railways from positions of consideration their close connection with the systems external power supply are proposed .

Effect of Scar Compaction on the Therapeutic Efficacy of Anisotropic Reinforcement Following Myocardial Infarction in the Dog.

Cardiac restraint devices have been used following myocardial infarction (MI) to limit left ventricular (LV) dilation, although isotropic restraints have not been shown to improve post-MI LV function. We have previously shown that anisotropic reinforcement of acute infarcts dramatically improves LV function. This study examined the effects of chronic, anisotropic infarct restraint on LV function and remodeling. Hemodynamics, infarct scar structure, and LV volumes were measured in 28 infarcted dogs (14 reinforced, 14 control). Longitudinal restraint reduced 48-h LV volumes, but no differences in LV volume, function, or infarct scar structure were observed after 8 weeks of healing. All scars underwent substantial compaction during healing; we hypothesize that compaction negated the effects of restraint therapy by mechanically unloading the restraint device. Our results lend support to the concept of adjustable restraint devices and suggest that scar compaction may explain some of the variability in published studies of local infarct restraint.

Dimensional assessment of continuous loop cortical suspension devices and clinical implications for intraoperative button flipping and intratunnel graft length.

Continuous loop cortical suspension devices have been demonstrated to be more consistent and biomechanically superior compared to adjustable loop devices; however, continuous loop devices present unique challenges compared to adjustable loop devices, especially in short tunnel reconstruction applications. Specifically, adjustable loop devices have the advantage of a "one size fits all" approach, and the ability to tension these devices following button flipping allows for the intratunnel graft length to be maximized. Nevertheless, the reliability of continuous loop devices has sustained their widespread use. We hypothesized that continuous loop cortical suspension devices from different manufacturers would exhibit equivalent 15 mm loop lengths, as advertised. Loop length was measured using a tensile testing machine. Contrary to our hypothesis, continuous loop cortical suspension devices with equivalent advertised lengths exhibited different loop lengths (up to 27% discrepancy). Inconsistencies with regards to manufacturers' reported loop lengths for continuous loop devices could have serious clinical implications and additionally complicate technique transferal among devices. Consequently, the manufacturers' accurate and complete disclosure of the dimensions and specifications associated with each continuous loop device is critical. Furthermore, surgeon awareness of true loop length dimensions and inconsistencies among devices is needed to ensure optimal implantation and resultant clinical outcomes.

Computer science: Nanoscale connections for brain-like circuits.

Tiny circuit elements called memristors have been used as connections in an artificial neural network – enabling the system to learn to recognize letters of the alphabet from imperfect images. See Letter p.61 Building neuromorphic networks matching the cognitive complexity of their biological prototypes but with higher performance is one of the great challenges in computing. One promising approach to such devices — potentially simpler than those based on complex silicon circuits — combines complementary metal-oxide-semiconductors (CMOSs) with adjustable two-terminal resistive devices (memristors). Here Dmitri Strukov and colleagues demonstrate a transistor-free metal-oxide memristor network with low device variability that works as a single-layer perceptron. That is, it can learn to recognize imperfect 3 × 3 pixel black-and-white patterns as one of three letters of the alphabet. The strength of this approach is its scalability so that larger neuromorphic networks capable of more challenging tasks should be possible.

Engineered Dry Powder Budesonide Particles for Improved Pediatric Inhalation Therapy

Corticosteroids have been the cornerstone treatment for asthma; however, several challenges exist with current inhaled steroids for pediatric patients. Dry powder corticosteroids are now being prescribed to pediatric patients 蠅 6 years of age with some success; however, many younger patients lack the inhalation energy required to properly fluidize and deagglomerate the drug particles, which leads to improper drug delivery, increases oral steroid exposure, and reduces long term compliance. We tested the hypothesis that engineered budesonide NanoClusters, drug particles with decreased density per surface area, would improve fluidization and deagglomeration efficiency compared to commercially available micronized budesonide and Pulmicort™ powders at flow rates seen in pediatric patients. Micronized budesonide powder was wet milled into micron sized NanoClusters using a Netzsch MiniCer Media Mill and then lyophilized. Budesonide powders were tested at various flow rates in a custom fabricated electronically controlled flow rate adjustable pneumatic device coupled to an Anderson Cascade Impactor. NanoCluster budesonide achieved EFmax (~85%) at a flow rate of 2.5 L/minute, whereas EF of micronized budesonide and Pulmicort™ were only minimally emitted (~2‐3%) at this flow rate. Importantly, fine particle fraction (FPF) of NanoClusters was significantly elevated compared to micronized budesonide and Pulmicort™ formulations. The data suggests that NanoCluster formulation improves budesonide dispersion properties at low flow rates, potentially allowing a lower unit dose formulation of budesonide for children without altering the effective therapeutic dose; increasing overall therapeutic index.

Some Properties of Multiple-Antenna-Port and Multiple-User-Port Antenna Tuners

A user port impedance range and a user port tuning range characterize an antenna tuner at a given frequency. These sets and their local dimensions are defined and studied for an antenna tuner having any number n of antenna ports and any number m of user ports. A reciprocal antenna tuner is said to have a full tuning capability if it can provide or compensate all relevant small impedance variations, under the assumption that its adjustable impedance devices can provide suitable reactance values. For reciprocal antennas and a reciprocal antenna tuner, it is proven that the local dimension of the user port impedance range is equal to m(m+1) if and only if the antenna tuner has a full tuning capability. We use this result to study an antenna tuner made of several uncoupled single-antenna-port and single-user-port antenna tuners. We also use this result to show that a new multiple-antenna-port and multiple-user-port antenna tuner has a full tuning capability.

Arthroscopic assisted femoral tunnel drilling for the intra-articular anatomic cranial cruciate ligament reconstruction in dogs.

To develop and test an arthroscopic aiming device for extra- to intra-articular femoral tunnel drilling emerging at the center of the femoral insertion of the cranial cruciate ligament (CrCL) in medium to large breed dogs. Hindlimbs (n=12) of six cadaveric dogs (≥20kg bodyweight). One hindlimb from each cadaver was randomly chosen. On a standard medio-lateral stifle radiograph the caudo-cranial position of the CrCL center was measured and transferred onto an adjustable aiming device. After arthroscopic debridement of the CrCL the aiming device was hooked behind the lateral condyle and a 2.4mm guide pin was placed from extra- to intra-articular. The intra-articular position of the resulting bone tunnel was evaluated radiographically as well as compared to the anatomic CrCl center of the contralateral hindlimb using 3D renderings. According to the postoperative radiographs all six drill tunnels were located at or near the CrCL center. The median absolute 3D error from the anatomical center of the CrCL was 0.6mm (range: 0.2-0.9mm). Precise anatomic placement of the femoral tunnel for intra-articular repair of the CrCL was achieved using an adjustable aiming device. The proposed technique will reduce femoral tunnel misplacement when performing intra-articular CrCL repair in dogs. In combination with the published technique for arthroscopic tibial tunnel drilling using a similar aiming device, the technical requirements for arthroscopic assisted tunnel positioning for anatomical graft replacement are available.

Current interventional management of male stress urinary incontinence following urological procedures.

IntroductionDespite improvements in surgical techniques and implementation of minimally invasive procedures, male stress urinary incontinence affects a substantial number of patients after prostatic surgery. In response to increasing demand of optimal treatment modality, new alternatives to artificial urinary sphincter have recently been introduced. This review summarises the therapeutic surgical options with their outcomes in management of postprostatectomy stress incontinence.Material and methodsWe performed a literature review by searching the PubMed, Web of Science and Embase databases for articles published from January 2000 until April 2015 based on clinical relevance.ResultsArtificial urinary sphincter is currently considered the “gold standard” treatment of male stress urinary incontinence. Although the new devices in this group have recently been investigated, the AMS 800 remains the only widely used implant. Male slings and adjustable continence devices, achieve the social continence rates up to 60%. Periurethral injections of bulking agents, have limited efficacy of male stress incontinence. Argus sling and ProACT are both associated with substantial explantation rates. Stem cell therapy is a promising option but still requires additional testing.ConclusionsThe development of new alternatives to artificial urinary sphincter is constantly progressing. Although recently introduced minimally invasive treatment options have not yet surpassed the outcomes of the artificial urinary sphincter they should continue to be evaluated and compared against the gold standard.

Training and operation of an integrated neuromorphic network based on metal-oxide memristors.

Despite much progress in semiconductor integrated circuit technology, the extreme complexity of the human cerebral cortex, with its approximately 10(14) synapses, makes the hardware implementation of neuromorphic networks with a comparable number of devices exceptionally challenging. To provide comparable complexity while operating much faster and with manageable power dissipation, networks based on circuits combining complementary metal-oxide-semiconductors (CMOSs) and adjustable two-terminal resistive devices (memristors) have been developed. In such circuits, the usual CMOS stack is augmented with one or several crossbar layers, with memristors at each crosspoint. There have recently been notable improvements in the fabrication of such memristive crossbars and their integration with CMOS circuits, including first demonstrations of their vertical integration. Separately, discrete memristors have been used as artificial synapses in neuromorphic networks. Very recently, such experiments have been extended to crossbar arrays of phase-change memristive devices. The adjustment of such devices, however, requires an additional transistor at each crosspoint, and hence these devices are much harder to scale than metal-oxide memristors, whose nonlinear current-voltage curves enable transistor-free operation. Here we report the experimental implementation of transistor-free metal-oxide memristor crossbars, with device variability sufficiently low to allow operation of integrated neural networks, in a simple network: a single-layer perceptron (an algorithm for linear classification). The network can be taught in situ using a coarse-grain variety of the delta rule algorithm to perform the perfect classification of 3 × 3-pixel black/white images into three classes (representing letters). This demonstration is an important step towards much larger and more complex memristive neuromorphic networks.

Clinical outcomes using translateral all-inside ACL reconstruction

Introduction Current practices in anterior cruciate ligament (ACL) reconstruction fail to restore normal knee kinematics. In vitro studies demonstrate biomechanical advantages of anatomic positioning in single bundle reconstructions over traditional techniques. We present the clinical outcomes in a series of 237 patients, mean age 32.2 years (range 10–74) who underwent anatomic all-inside ACL reconstruction, using the translateral surgical technique. Methods The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory cortical fixation devices. Anatomic placement on the femur is achieved using the validated direct measurement technique. Femoral and tibial sockets are created with a retrograde drill. Patients were evaluated preoperatively and at 6, 12 and 24 months postoperatively using the KOOS, Tegner and Lysholm scoring indices. Knee laxity was assessed using KT-1000 along with goniometric measurement of range or motion. Results Overall complication rate 8.4% (20 cases). There were 9 graft failures (3.8%) – 6 due to significant postoperative trauma. Other complications include 5 superficial wound infections treated with oral antibiotics, 2 haemarthroses, 3 knees with postoperative stiffness requiring manipulation and 1 patient who developed chronic regional pain syndrome. Mean increase at 1 year in KOOS, 26.3 points; Tegner, 1.4 levels; and Lysholm, 30.4 points. Mean range of movement at 12 months, 1o hyperextension to 137o flexion. KT-1000 improved to 3.1 mm side-to-side difference.

In vivo testing of a novel adjustable glaucoma drainage device.

We report on the in vivo testing of a novel noninvasively adjustable glaucoma drainage device (AGDD), which features an adjustable outflow resistance, and assess the safety and efficiency of this implant. Under general anesthesia, the AGDD was implanted on seven white New Zealand rabbits for a duration of 4 months under a scleral flap in a way analogous to the Ex-PRESS device and set in an operationally closed position. The IOP was measured on a regular basis on the operated and control eyes using a rebound tonometer. Once a month the AGDD was adjusted noninvasively from its fully closed to its fully open position and the resulting pressure drop was measured. The contralateral eye was not operated and served as control. After euthanization, the eyes were collected for histology evaluation. The mean preoperative IOP was 11.1 ± 2.4 mm Hg. The IOP was significantly lower for the operated eye (6.8 ± 2 mm Hg) compared to the nonoperated eye (13.1 ± 1.6 mm Hg) during the first 8 days after surgery. When opening the AGDD from its fully closed to fully open position, the IOP dropped significantly from 11.2 ± 2.9 to 4.8 ± 0.9 mm Hg (P < 0.05). Implanting the AGDD is a safe and uncomplicated surgical procedure. The fluidic resistance was noninvasively adjustable during the postoperative period with the AGDD between its fully closed and fully open positions.

Accuracy of an adjustable patient-specific guide for acetabular alignment in hip replacement surgery (Optihip).

Implant malalignment in hip arthroplasty increases the risk of revision surgery due to problems such as hip instability, wear, and impingement. Traditional instrumentation lacks accuracy and does not individualize the goal. Computer-assisted surgery (CAS) and patient-specific solutions improve accuracy but add considerably to the cost, amongst other drawbacks. We developed an adjustable mechanical device, called Optihip, which is set to a patient-specific goal preoperatively and is independent of pelvis position intraoperatively. The purpose of the present study was to evaluate Optihip's accuracy ex vivo. Acetabular components were implanted into six cadaveric specimens, 12 hips, by two surgeons, with the device individually adjusted according to preoperative templating on computed tomography (CT) images relative to defined acetabular rim landmarks; options also exist for templating on single or biplanar X-rays. Intraoperatively, the device was positioned on the corresponding anatomical landmarks allowing the insertion of a guide pin, which then defined the desired orientation of the acetabular cup during impaction. Mean absolute difference between the preoperatively planned cup alignment and final acetabular cup orientation, measured from postoperative CT images, was 2.5±1.2° for inclination and 2.5±2.2° for version with maximum values of 4.7° and 6.8°, respectively. Compared with previous in vivo reports, Optihip guided the acetabular cup orientation more accurately than conventional hip arthroplasty, and comparably to CAS or patient-specific systems, while fitting into the normal surgical workflow. Although clinical testing is required to confirm these experimental results, the positive ex vivo accuracy suggests good potential for improving revision rates and patient functional outcome.

One year adjustable intragastric balloon: safety and efficacy of the Spatz3 adjustable balloons

Background: The Spatz3 Adjustable balloon system is approved for 1 year implantation and allows multiple changes in the balloon volume during the course of implantation.Other intragastric balloons are currently approved for 6 months and their balloon volumes cannot be adjusted after implantation.Aim: To determine the efficacy and safety of the Spatz3 adjustable balloon system.Methods: Seventy seven consecutive patients (66 females and 11 males) in two medical centers were implanted with the Spatz3 adjustable balloon device and were followed prospectively. The patients’ mean BMI was 37.2; the mean weight was 108.7 kg; the mean age was 41 (16-68); the mean balloon volume was 469 ml (450-500 ml). Adjustments were made for intolerance or weight loss plateau.Results: The mean weight loss at 1 year was 17.2 kg with 15.9 % weight loss and 42.9 % Excess Weight Loss (%EWL). Eighteen patients underwent balloon volume adjustments: three downward adjustments of 100 -150 cc which alleviated early intolerance; 15 upward adjustments (mean 320 ml; range 200-500) at a mean 4.1 months (range 2-5 months) yielded additional mean wt loss of 8.2 kg (range 0-25 kg) after the adjustment. Three balloons were removed before the 1 year completion date due to intolerance and three others were removed for other reasons (pregnancy, gall bladder surgery, and alcoholism). There was one episode of gastric ulceration which required endoscopic therapy and balloon removal. There were no deflations or perforations. Conclusions: The Spatz3 adjustable balloon is a safe and effective treatment for weight loss. The adjustability function can yield greater weight loss for those who show weight loss plateau and can mitigate intolerance.

Development of an Adjustable Sinus Tarsi Device for Flatfoot Correction: A Pilot Study in a Sawbones Model1

Development of an Adjustable Sinus Tarsi Device for Flatfoot Correction: A Pilot Study in a Sawbones Model1

A New Adjustable Glaucoma Drainage Device

This work is focused on the testing of a new experimental noninvasively adjustable glaucoma drainage device (AGDD) that allows for the control of its outflow resistance to modulate intraocular pressure (IOP) in a customized fashion. Six AGDDs were directly connected to a pressure transducer and a perfusion system continuously delivering saline solution at rate of 2 μL/min. The steady-state pressure was measured and reported as a function of the angular position of the AGDD disk. Ex vivo experiments were conducted on six freshly enucleated rabbit eyes. The IOP was measured, and the flow rate was increased with a syringe pump to simulate elevated IOP associated with glaucoma. After insertion of the implant in the anterior chamber, the position of the disk was sequentially adjusted. The relation between the pressure drop and the angular position of the AGDD disk is nonlinear. The functional range lies between 80° and 130°, which allows for four or five different reproducible adjustment positions. Above 130° the implant is considered to be closed (no outflow), and below 80° it is considered to be open (minimum resistance to flow). The resistance to outflow of the experimental AGDD can be adjusted to keep IOP in the desired physiological range. This feature could be useful for addressing the risk of hypotony in the early postoperative stages and could provide a means to achieve optimal IOP under a wide range of postoperative conditions.

An Adjustable Gas-Mixing Device to Increase Feasibility of In Vitro Culture of Plasmodium falciparum Parasites in the Field

A challenge to conducting high-impact and reproducible studies of the mechanisms of P. falciparum drug resistance, invasion, virulence, and immunity is the lack of robust and sustainable in vitro culture in the field. While the technology exists and is routinely utilized in developed countries, various factors–from cost, to supply, to quality–make it hard to implement in malaria endemic countries. Here, we design and rigorously evaluate an adjustable gas-mixing device for the in vitro culture of P. falciparum parasites in the field to circumvent this challenge. The device accurately replicates the gas concentrations needed to culture laboratory isolates, short-term adapted field isolates, cryopreserved previously non-adapted isolates, as well as to adapt ex vivo isolates to in vitro culture in the field. We also show an advantage over existing alternatives both in cost and in supply. Furthermore, the adjustable nature of the device makes it an ideal tool for many applications in which varied gas concentrations could be critical to culture success. This adjustable gas-mixing device will dramatically improve the feasibility of in vitro culture of Plasmodium falciparum parasites in malaria endemic countries given its numerous advantages.

Simple circumcision device: proof of concept for a single-visit, adjustable device to facilitate safe adult male circumcision

To conduct a proof-of-concept study to determine the potential utility of a novel, adjustable single-visit, disposable device to facilitate rapid adult circumcision. Prospective pilot trial of a novel surgical device. Tertiary care Veterans Administration medical center. Five adult males. Circumcisions performed by junior trainees using an adjustable, single-size surgical-assist device constructed by the University of Washington Applied Physics Laboratory. The attending surgeon and trainees completed standardized forms after each procedure to assess technical problems and ease of use. Follow-up visits were scheduled to evaluate adverse events, postoperative pain, cosmetic outcomes, and participant satisfaction at 3, 8, 30, and 90 days postoperatively. The average operative time was 16.4 minutes. All cases were performed with local anesthesia, and no case required electrocautery or conversion to standard surgery. At the postoperative day 3 visit, all subjects were happy with their results and would recommend the procedure to another patient. One participant had a minor wound separation noted at the 30-day visit that resolved during follow-up. There were no wound infections, hematomas, or other adverse events. This proof-of-study suggests that the Simple Circumcision Device may facilitate delivery of safe adult male circumcision services.

Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability

To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT-MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. Prospective, nonrandomized, before-after study. Sixty-four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. Mean apnea-hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment (P < .001). Thirty-nine patients (60.9%) achieved post-treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 (P < .05), along with most FOSQ subscale scores. Thirty-four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. This is the first study in Asians demonstrating that an AT-MAD, if done properly, is a practical short-term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready-to-use nature. However, further randomized controlled trials are required.

Height Adjustable Machine with Parallel Jaw

Machine with a parallel jaw as a fixture of a widely used, it is an indispensable tool in the machining of the existing. But the actual processing according to the workpiece size, pad iron with different specifications in the clamping to adjust the height of the processed parts. The height adjustable machine with a parallel jaw improves caused problems and the use of existing in the actual processing is organic with parallel jaw of inconvenience, in order to solve this problem to design a highly available parallel jaw adjustable machine of the utility model patent, can improve the productivity and reliability, so that the operation all great satisfaction. height adjustable device of the machine with parallel jaw are discussed.