Type Of Cannula Research Articles

Ultra-Low-Field Portable MRI and Extracorporeal Membrane Oxygenation: Preclinical Safety Testing.

Conventional MRI is incompatible with extracorporeal membrane oxygenation (ECMO) cannulas and pumps. Ultra-low-field portable MRI (ULF-pMRI) with 0.064 Tesla may provide a solution, but its safety and compatibility is unknown. ULF-pMRI does not cause significant displacement and heating of ECMO cannulas and does not affect ECMO pump function. ECMO cannulas in various sizes were tested ex vivo using phantom models to assess displacement force and heating according to the American Society for Testing and Materials criteria. ECMO pump function was assessed by pump flow and power consumption. In vivo studies involved five female domestic pigs (20-42 kg) undergoing different ECMO configurations (peripheral and central cannulation) and types of cannulas with an imaging protocol consisting of T2-weighted, T1-weighted, FLuid-Attenuated Inversion Recovery, and diffusion-weighted imaging sequences. Phantom models demonstrated that ECMO cannulas, both single lumen with various sizes (15-24-Fr) and double lumen cannula, had average displacement force less than gravitational force within 5 gauss safety line of ULF-pMRI and temperature changes less than 1°C over 15 minutes of scanning and ECMO pump maintained stable flow and power consumption immediately outside of the 5 gauss line. All pig models showed no visible motion due to displacement force or heating of the cannulas. ECMO flow and the animals' hemodynamic status maintained stability, with no changes greater than 10%, respectively. ULF-pMRI is safe and feasible for use with standard ECMO configurations, supporting its clinical application as a neuroimaging modality in ECMO patients.

Reverse cannulation method as a strategy for aortic aneurysm surgery: A computational fluid dynamics study on minimizing neurological risks

ObjectivesTo evaluate the blood flow velocity and wall shear stress in total arch replacement with a “shaggy” aorta, using computational fluid dynamics, and determine the optimal cannulation method. MethodsA patient-specific aortic arch aneurysm model was constructed by using computed tomography scans. Three cannulas were assessed, as follows: dispersive with a steep angle, dispersive with a gentle angle, and the endo-hole type. The cannula tips were oriented toward the aortic arch (standard direction) and aortic root (reversed direction), with an ideal angle (base orientation: 0°), tip orientations rotated 20° clockwise and counterclockwise from the base orientation. The variables of interest included the blood flow velocity, streamlines, wall shear stress, and flow distribution. ResultsThe standard direction resulted in variable accelerated flow and wall shear stress locations based on cannula tip orientation, leading to unstable cerebral branch flow. Minor deviation in the cannula tip angle and cannula type led to significant alterations in flow distribution. Conversely, in the reverse direction for all cannulas, no accelerated blood flow was observed in the proximal aortic arch or cerebral vessel ostia even with angular adjustments, helping maintain a stable cerebral branch flow. Minimal variation in blood flow distribution was observed across all cannula types and angles. ConclusionsOur simulations indicate that, irrespective of the cannula type or orientation, directing the cannula tip toward the aortic root (reversed direction) prevents accelerated blood flow in critical areas, suggesting its potential as an optimal approach for aortic arch surgery in “shaggy” aorta cases.

Comparing Voice Related Quality of Life scores between fenestrated and speaking valve cannula users

Background: Tracheostomy is a procedure that aims to maintain the airway so that air can enter the lungs and bypass the upper airway. Tracheostomy causes physiological changes, especially in terms of communication, which leads to reduced voice-related quality of life. Fenestrated tracheal cannula and speaking valve can assist patients in generating voice.
 Objective: To compare the V-RQOL scores of the fenestrated tracheal cannula and speaking valve users.
 Methods: Analytic observational study using a cross-sectional design. Data collection was done through interviews with the V-RQOL questionnaire guide. The study was conducted in September-December 2022 at the THTBKL Polyclinic of Dr. Mohammad Hoesin Hospital Palembang. Data were analyzed with IBM SPSS 26.
 Results: 42 patients were using tracheal cannula, with 21 patients each with a fenestrated and speaking valve tracheal cannula. Patients with fenestrated tracheal cannula had lower quality of life in the physical, social, and total domains than those in the speaking valve group (poor QoL in the physical domain: 66.67% vs. 9.52%; social domain: 85.71% vs. 57.14%; total domain: 76.19% vs. 4.76%; p<0.001). From the multivariate analysis, the tracheal cannula type influenced the patient's quality of life was (p<0.001). The probability of someone with a fenestrated tracheal cannula will experience a poor QoL is 76.2%, while speaking valve is 4.7%.
 Conclusion: The quality of life of patients with a fenestrated type of tracheal cannula is significantly lower than that of speaking valve tracheal cannula users in both the physical, social, and total domains as measured by the V-RQOL.

A Novel Educational Approach for Safe Endodontic Syringe Irrigation: A Randomized Controlled In Vitro Study.

Syringe irrigation, commonly used for delivering sodium hypochlorite (NaOCl) during root canal treatment, requires careful handling to prevent NaOCl extrusion into periapical tissues. This randomized controlled in vitro study aimed to quantify syringe plunger forces exerted by dental undergraduates and to assess the impact of an educational intervention on adherence to safe irrigant delivery parameters. Fifty-two undergraduates performed syringe irrigation at three intervals: baseline (T1), after two weeks (T2), and after 12 weeks (T3). At T1, irrigation was conducted without prior educational intervention, while at T2, it was preceded by an intervention. The educational intervention involved a short video highlighting safe irrigation practices, including plunger force and time recommendations for syringe irrigation. At T3, the undergraduates were randomly allocated to two groups: One received a repeated intervention, while the other did not. Syringe irrigation was performed on a 3D-printed tooth using two side-vented cannulas: one of 25 Gauge (G) and another of 30 G. A syringe equipped with a force sensor recorded the plunger forces. Based on earlier research, plunger forces exceeding 10 Newtons (N) for the 25 G cannula and 40 N for the 30 G cannula were deemed critical. The data were subjected to descriptive statistical analyses. Overall, the mean of maximum values of plunger forces remained under 10 N for the 25 G and below 20 N for the 30 G cannulas, with only few measurements exceeding 40 N. Instances of surpassing the critical plunger force threshold were more common with the 25 G side-vented cannula than with the 30 G variant. At T3, the group that received the repeated educational intervention exhibited lower average maximum plunger forces for both types of cannulas compared with the group that did not receive the intervention. Integrating plunger force measurements with targeted educational interventions presents an effective approach for instructing undergraduates in the proper techniques of syringe irrigation. The findings suggest that, generally, undergraduates do not apply excessive plunger forces that could risk apical irrigant extrusion. The implementation of repeated educational interventions has been shown to decrease the plunger forces exerted by undergraduates, underscoring its effectiveness in fostering safe endodontic irrigation.

A Computational Fluid Dynamics Study to Compare Two Types of Arterial Cannulae for Cardiopulmonary Bypass

Thanks to recent technological and IT advances, there have been rapid developments in biomedical and health research applications of computational fluid dynamics. This is a methodology of computer-based simulation that uses numerical solutions of the governing equations to simulate real fluid flows. The aim of this study is to investigate, using a patient-specific computational fluid dynamics analysis, the hemodynamic behavior of two arterial cannulae, with two different geometries, used in clinical practice during cardiopulmonary bypass. A realistic 3D model of the aorta is extracted from a subject’s CT images using segmentation and reverse engineering techniques. The two cannulae, with similar geometry except for the distal end (straight or curved tip), are modeled and inserted at the specific position in the ascending aorta. The assumption of equal boundary conditions is adopted for the two simulations in order to analyze only the effects of a cannula’s geometry on hemodynamic behavior. Simulation results showed a greater percentage of the total output directed towards the supra-aortic vessels with the curved tip cannula (66% vs. 54%), demonstrating that the different cannula tips geometry produces specific advantages during cardiopulmonary bypass. Indeed, the straight one seems to generate a steadier flow pattern with good recirculation in the ascending aorta.

The effectiveness and predictive factors of Sacroiliac Joint Radiofrequency Neurotomy success – A retrospective cohort study

BackgroundThe Sacroiliac Joint (SIJ) accounts for 10–27% of lower back pain. Radiofrequency neurotomy (RFN) is commonly utilized for refractory pain. Outcomes are variable and may be related to patient selection and procedural technique differences. ObjectiveTo assess the effectiveness and outcome success predictors of SIJ RFN at three months. Design/MethodsData of patients undergoing SIJ RFN were extracted from the electronic medical record of one physiatrist's interventional pain practice between 2016 and 2021. The extracted data included the following outcome variables: ≥2 decrease in Numerical Rating Scale (NRS) [minimal clinically important difference MCID-2], ≥50% NRS reduction, and ≥17 points decrease in the Pain Disability and Quality of Life Questionnaire – Spine (PDQQ-S) [MCID]. Predictor variables included block type [>79% LBB/LBB, >79% IA/LBB, 50–79% LBB/LBB, 50–79% IA/LBB, >79% LBB, and 50–79% LBB] and cannula type/configuration [16 g/longitudinal, Trident bipolar/perpendicular, and 18 g quadripolar/perpendicular]. Data analysis included descriptive statistics and logistic regression with an odds ratio (OR). Covariates included in the logistic regression models were age, gender, and laterality (right, left, and bilateral). ResultsOf the 128 patients analyzed for this study (20.8% males; 60.4 ± 14.4 years of age), 66.9% achieved MCID-2 in NRS, 53.9% experienced ≥50% NRS reduction, and 50% experienced ≥17 points decrease in PDQQ-S. Achieving MCID-2 in NRS for the 18 g quadripolar/perpendicular technique was approximately four times higher than the odds for 16 g/longitudinal technique (OR = 3.91; 95% CI = 1.34–11.43; p = 0.013). Block type was not significantly associated with any outcome variable after adjusting for cannula type and other covariates (p > 0.05). Younger age was significantly associated with achieving MCID-2 in NRS, ≥50% NRS reduction, and ≥17 points decrease in PDQQ (p = 0.034, 0.020, and 0.002, respectively). ConclusionSIJ RFN effectively reduces pain and improves function in most patients at three months. Quadripolar/perpendicular technique and younger age predict SIJ RFN treatment success, whereas block type does not.

BIO11: Ambulatory Rabbit ECLS Model for Long-term Biocompatibility Testing

Background: Thrombosis causes rapid failure of oxygenators within extracorporeal life support (ECLS) circuits. To combat this problem, various groups are developing new surface coatings and anticoagulants, but their testing typically relies on either (a) inexpensive, but overly-brief (< 8 hour) in vitro or small animal in vivo testing or (b) expensive, long-term (days to weeks) testing in large animals. A more inexpensive model is thus needed to assess the long-term biocompatibility of new anticoagulant technologies. In this study, the feasibility of a long-term, ambulatory rabbit ECLS model was assessed. Methods: A miniaturized ECLS circuit was attached to rabbits (2.5-4 kg) under anesthesia using a pumpless arteriovenous (AV) configuration. The circuit contained a miniature artificial lung (surface area of 400 cm2) using the same materials as full-scale artificial lungs. The circuit was tunneled behind the animal’s back and secured just below the scruff of the neck. IV heparin was provided via a battery-powered infusion pump (SAI 3D Mini Infusion Pump) within a small jacket. Twelve non-recovery experiments were used to optimize the model, and two subsequent recovery experiments were run until oxygenator failure (blood flow rate below 5 mL/min for over 2 hours and/or resistance > 5x baseline). Non-recovery experiments were used to optimize the cannulation strategy. This included cannula type and circuit placement on the rabbit. Once optimized, two survival studies were performed. The average circuit blood flow during the first experiment was 50-60 mL/min. The circuit blood flow was then limited to 35-45 mL/min with a Hoffman clamp for the second experiment. Blood flow resistance was measured to assess anticoagulation effectiveness, and physiology was monitored through hepatic and renal panels. Results: Bilateral cannulation was ideal for circuit placement. A flexible 16G single-lumen central line was chosen because of its low blood flow resistance and resistance to kinking. The circuit was tunneled 40 cm, emerging just below the scruff. This enabled safe handling of the animal without impacting its mobility and ability to eat. The recovery experiments lasted 47 and 21 hours prior to oxygenator failure. Animals were completely ambulatory with free access to food and water. Heparin delivery could be controlled simply using the infusion pump, and coagulation could be assessed by drawing blood samples and measuring oxygenator resistance. The first survival rabbit developed hyperlipidemia on Day 1. The cause is unclear at this time but could be attributed to high blood flow through AV circuit. Conclusion: This study demonstrates the feasibility of using a lower-cost rabbit model for long-term anticoagulation testing that requires less staffing. Future studies will use this model to compare the anticoagulation effectiveness of heparin, a selective Factor XIIa inhibitor, and surface coatings for a period of five days.

Respiratory Syncytial Virus-Load Kinetics and Clinical Course of Acute Bronchiolitis in Hospitalized Infants: Interim Results and Review of the Literature.

Respiratory Syncytial Virus (RSV) bronchiolitis is the leading cause of hospitalization in infants. The role of RSV load in disease severity is still debated. We present the interim results of a prospective monocentric study enrolling previously healthy infants hospitalized for RSV bronchiolitis, collecting nasopharyngeal aspirates every 48 h from admission to discharge, and evaluating RSV load dynamics in relation to clinical outcome measures of bronchiolitis severity, including: need, type and duration of oxygen therapy, length of hospitalization, and the bronchiolitis clinical score calculated at admission. The results showed that the highest viral replication occurs within the first 48 hours after admission, with a significant decrease at subsequent time points (p < 0.0001). Moreover, higher RSV-RNA values were associated with the need for oxygen therapy (p = 0.03), particularly high-flow nasal cannula type (p = 0.04), and longer duration of respiratory support (p = 0.04). Finally, higher RSV load values were correlated with lower white blood cells, especially lymphocyte counts and C-reactive protein levels (p = 0.03, p = 0.04, and p = 0.01, respectively), as well as with patients of a younger age (p = 0.02). These data suggest that RSV may actively contribute to the clinical severity of bronchiolitis, together with other potential non-viral factors.

Confirmation of Dual Lumen Cannula Position Before Extracorporeal Membrane Oxygenation Initiation Using a Microbubbles Contrast Technique.

Dual lumen cannulas (DLCs) for venovenous extracorporeal membrane oxygenation (ECMO) therapy are introduced in the right internal jugular vein, passing through the superior vena cava and the right atrium (RA) down to the inferior vena cava. The correct placement is challenging and needs careful positioning to limit mechanical complications. The outflow port needs to be located in the RA and directed toward the tricuspid valve (TV) to optimize therapy and reduce recirculation rate. Transesophageal echocardiography (TEE) is considered the standard to monitor insertion and optimal placement of this type of cannula. In addition to TEE 2D imaging, confirmation of optimal positioning is possible after ECMO initiation using color Doppler in a bicaval view to visualize the reinfusion jet located in the RA and pointing toward the TV. We present an example of DLC implantation where correct positioning was confirmed before ECMO initiation using a microbubbles contrast technique. Using TEE 2D imaging, in a bicaval (Figure 1, A and B) and modified bicaval view (Figure 1, C and D), we depict the contrast obtained while flushing the reinjection port of the DLC with saline, simulating the reinfusion jet adequately directed toward the TV (arrows in Figure 1, B and D). We use a 50 cc catheter tip syringe (conical tip) with 0.9% saline to rapidly flush the DLC. The turbulences and bubbles created provide sufficient contrast.Figure 1.: A: Bicaval view and (C) modified bicaval view without contrast; (B) bicaval and (C) modified bicaval view with contrast. DLC, dual lumen cannula; IVC, inferior vena cava; RA, right atrium; SVC, superior vena cava; TV, tricuspid valve.The authors believe that this technique helps to ensure immediate optimal efficiency of venovenous ECMO and avoid further correction of cannula position after ECMO initiation (See Video, Supplemental Digital Content 1, https://links.lww.com/ASAIO/A878).

Enabling faster subcutaneous delivery of larger volume, high viscosity fluids

ABSTRACT Objectives Many current subcutaneous (SC) biologic therapies may require >1 mL volume or have increased viscosity, necessitating new delivery system approaches. This study evaluated 2-mL large-volume autoinjector (LVAI) delivery performance across varying solution viscosities and design inputs to assess the design space and identify configurations that produce practical injection times. Methods Investigational LVAI delivery duration and volume, depot location, and tissue effects were examined in both air and in vivo models across various pre-filled syringe (PFS) cannula types (27 G Ultra-thin wall [UTW], 27 G special thin wall [STW], or 29 G thin-wall [TW]), drive spring forces (SFLOW or SFHIGH), and Newtonian solutions (2.3–50 centipoise [cP]). Results Within each design configuration, increasing PFS internal diameters and spring forces reduced delivery times, while increasing viscosity increased times. The 27 G UTW PFS/SFHIGH combination achieved shorter delivery times across all injection conditions, with 2 mL in vivo durations <15 seconds at ≤31 cP and routinely <20 seconds at 39 and 51 cP, with nominal and transitory tissue effects. Conclusion PFS cannula and spring force combinations can be tailored to achieve various injection durations across viscosities, while UTW PFS enables faster rates to potentially better accommodate human factors during LVAI injection, especially at high viscosity.

Surgical Exposure and Competence in Performing Open Tracheostomy

Background: Advancements in airway procedures and intensive care medicine have resulted in a reduction in open tracheostomy (OT) performed annually which could affect the training of residents. The aim of this study is to highlight the otolaryngology-head-and-neck surgery (OHNS) trainees' perception of their surgical exposure and competency in performing OT. Methodology: A cross-sectional questionnaire-based study (using a 22-item previously validated, peer-reviewed, and published questionnaire) conducted from June 2019 to February 2020 of OHNS residents training in multiple hospitals in the two metropolitan cities. Results: The response rate was 54% (which represents n = 67 out of 125 in both cities). There were 35 juniors (52.2%) and 32 seniors (47.8%). Thirty (44.8%) residents estimated that there are ≤50 tracheostomies/year in their hospital. Only 6% of the residents reported scheduled teaching regarding OT, and only one-third (34.3%) were actually aware of the different types of cannulas and postoperative care. Conclusion: The reason behind the lower confidence of trainees is likely multifactorial, and requires restructuring of the training program to improve the confidence of graduating trainees.

Factors Related to the Incidence of Dysphagia in Patients Using Tracheal Cannula at Dr. Mohammad Hoesin General Hospital Palembang

Background: The need for tracheostomy increases during the coronavirus diseases 2019 (COVID-19) pandemic. However, some studies suggest that tracheostomy causes dysphagia which can lead to other health problems such as pneumonia, choking, weight loss, malnutrition, and dehydration with serious side effects. This study aims to determine the factors associated with the incidence of dysphagia in patients using a tracheal cannula.&#x0D; Methods: This study is an observational study using a cross-sectional design. Data collection was carried out using medical record data on 58 patients who used a tracheal cannula recorded in the medical record data for the FEES examination at Dr. Mohammad Hoesin General Hospital Palembang from January 2019 to September 2021. The data were analyzed by descriptive statistics, chi-square, and multiple logistic regression.&#x0D; Results: Of 58 patients who used a tracheal cannula, it was found that 75.9% had dysphagia. The results of the comparison test showed that the factors associated with the incidence of dysphagia were gender (p=0.001), nutritional status (p=0.013), incision location (p=0.043), and primary disease (p=0.021). Factors that were not associated with the incidence of dysphagia were age (p=0.933), tracheostomy indication (p=0.741), and the type of tracheal cannula (p=1,000). Patients are male, with low and high tracheal cannula incision locations, and have a primary neurological disease. The probability or chance of dysphagia is 79.8%.&#x0D; Conclusion: Tracheostomy can cause dysphagia which is influenced by gender, location of tracheal cannula incision, and primary disease.

Direct Axillary Artery Cannulation for Aortic Surgery: Lessons From Contemporary Experiences

BackgroundThis study seeks to assess the outcomes of direct axillary artery (AX) cannulation for thoracic aortic surgery. MethodsFrom October 2009 to November 2021 direct AX cannulation was planned in 515 patients for thoracic aortic pathology. An important aspect of our technique is that the cannula is not inserted deeper than 3 cm. AX cannulation–related events included shift of cannulation site from the initial site, vascular injury, and iatrogenic dissection. ResultsHalf of the patients had acute type A dissection (ATAD). An angled cannula was used in 442 patients and a straight cannula in 73 patients (14.2%) after August 2020. A previously cannulated AX was reused in 36 patients (7.0%). Mortality and stroke rates were 5.4% (ATAD vs non-ATAD: 8.0% vs 2.8%, P = .008) and 2.7% (ATAD vs non-ATAD: 4.6% vs 0.8%, P = .034), respectively. AX cannulation–related events were observed in 2.7% of patients. There was no difference in the vascular injury rate between ATAD and non-ATAD cases (1.6% vs 0.4%, respectively; P = .385), between different cannula types (angled vs straight: 0.9% vs 1.4%, P = 1.00), or between primary and redo AX cannulation cases (0.8% vs 2.8%, respectively; P = .791). On multidetector computed tomography analysis using automated 3-dimensional images, the mean distance from the thoracoacromial artery to the vertebral artery on the right and left sides was 8.70 cm and 8.69 cm, respectively. ConclusionsDirect AX cannulation for thoracic aortic repair is safe and carries a low rate of vascular injury, especially in elective cases. Our direct cannulation technique, which includes not inserting a cannula deeper than 3 cm, seems to be safe in not occluding the vertebral artery.

Thrombus formation at the inflow cannula of continuous-flow left ventricular assist devices-A systematic analysis.

Despite numerous design iterations, thrombus formation at the inflow cannula of continuous-flow left ventricular assist devices remains an unsolved problem. We systematically investigated the impact of cannula surface on thrombus formation. Thrombus appearance was photographically documented in 177 explanted hearts with the polished (N=46) or sintered (N=131) inflow cannula of the Medtronic HeartWare™ HVAD™ System. Thrombus load was compared for both inflow cannula types. Mean thrombus length was correlated with protruding cannula length. Support duration and the extent of thrombus growth were examined. The prevalence of thrombi at the left ventricular entry site and at the sintered-to-polished transition zone was correlated with left ventricular geometry and hemodynamic parameters. Polished inflow cannulas showed a greater percentage and also a greater mean length of thrombus formation at the entry site than sintered cannulas (91.3% [Pol] vs. 36.7% [sTi]; p<0.0001; mean 7.6mm vs. 1.9mm; p<0.0001). A comparison of the early postoperative period (POD1-90) with long-term support (POD>90) showed an increase in thrombus length originating from the transition zone (1.96±3.41mm vs. 3.03±2.91mm; p=0.013). A sintered titanium surface at the entry site is crucial to enable anchoring of myocardial tissue to the cannula. As thrombus growth progresses on polished surfaces, a greater sintered length seems to be beneficial. After an initial three-month healing period, thrombus load appears to decline during prolonged support duration at the sintered entry site but not at the transition zone.

A Fatal Arterio-Tracheal Fistula Post-Tracheostomy: A Case Report in a Sub-Saharan Setting

Fatal bleeding in patients with tracheostomy is an uncommon incident, in the order of 0.1% to 1% of cases. It is secondary in 70% of cases to the innominate artery fistula in the tracheal lumen. The fistula is generally created after the necrosis of tracheal rings. The incriminated factors are the type of cannula used, the site of tracheal opening below the 3rd tracheal ring, tracheal infections and the proximity of the innominate artery to the tracheal axis. The outcome of this incident is fatal in most cases. We report the case of a 59-year-old patient with a tracheostomy on the 11th day of his admission to intensive care for severe head trauma secondary to a road accident. On the 22nd day of his admission, the occurrence of a cataclysmic and fatal haemorrhage through the tracheostomy tube evoked an arterio-tracheal fistula of the innominate artery.

Comparison of Harvesting and Processing Technique for Adipose Tissue Graft: Evaluation of Cell Viability

Background: Clinical studies demonstrated the efficacy of therapies based on the autologous grafting of adult mesenchymal stem cells to accelerate the healing and regenerative processes of the skin and mesenchymal tissues; therefore, it is considered a valuable approach in the aesthetic rejuvenation treatment to give volumization and skin regeneration effects. Objective: The aim of the project consisted of the control of cell viability of adipose tissue (AT) harvested using the two types of cannulas having 0.8 mm and 1 mm side port holes. The results were compared with tissue harvested with a standard liposuction technique and processed with a standard procedure consisting of enzymatic digestion (collagenase). Methods: This study was performed on adipose tissues harvested from 7 patients (6 females and 1 male) with an average age of 48.5 years with 3 different techniques. We compared the cell vitality of every sample at T0 and T72. Results: Lipoaspirate tissue-derived by 0.8- and 1 mm cannula from all samples proved to be vital and possess viable cells. The average absorbance was similar immediately after plating (T0) and 72 hours after (T72) for the two cannulas, 0.8- and 1 mm cannula. The two systems proved to equally harvest vital tissue. An increase in cell viability was observed in all samples for each condition (0.8-, 1 mm and enzymatic digestion). Conclusion: This study proved that guided harvested adipose tissue with small cannulas with small side port holes yields a comparable amount of viable cells compared to adipose tissue harvested with a liposuction system and processed with enzymatic digestion (collagenase). This study confirms that the minimally invasive technique and minimal manipulation of the adipose tissue could yield a tissue with a good amount of viable cells. This micro fragmented adipose tissue is a promising source for regenerative treatments.

A design and application method of the thoracic puncture cannula

Thoracentesis is common in daily medical practice. During the operation, it is easy to cause complications such as re-expansion pulmonary edema, pulmonary hypotension, liver and spleen injury, pleural reaction, intercostal artery injury, pneumothorax, and so on. If the operator does not master procedures properly, it is easy to damage the thoracic organs. Therefore, the department of the general practice of the First Hospital of Jiaxing improved the puncture needle device based on thoracic puncture cannula, developed a new type of disposable thoracic puncture cannula, and obtained the National Utility Model Patent of China (patent number: ZL 2019 2 2112955.7). New type of disposable thoracic puncture cannula comprises a flexible puncture cannula, a steel needle, a limit structure, and a second bolt. In the process of puncture, the length of the puncture is limited by the limit structure. If the puncture force is too strong, the limit structure will prevent further penetration of the needle. The device is easy to use, flexible to operate, easy to master, and can reduce the risk of thoracentesis, which is worth of clinical promotion.

Extracorporeal membrane oxygenation and rehabilitation in patients with COVID-19: A scoping review.

Background and purposeThe coronavirus diseases 2019 (COVID‐19) pandemic posed severe difficulties in managing critically ill patients in hospital care settings. Extracorporeal membrane oxygenation (ECMO) support has been proven to be lifesaving support during the SARS‐CoV‐2 outbreak. The purpose of this review was to describe the rehabilitative treatments provided to patients undergoing ECMO support during the COVID‐19 pandemic.MethodsWe searched PubMed and Scopus for English‐language studies published from the databases’ inception until June 30, 2021. We excluded editorials, letters to the editor, and studies that did not describe rehabilitative procedures during ECMO support. We also excluded those articles not written in English.ResultsA total of 50 articles were identified. We ultimately included nine studies, seven of which were case reports. Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients and a case series of three patients. Extracorporeal support duration varied from 9 to 49 days, and the primary indication was acute respiratory distress syndrome COVID‐19‐related. Rehabilitative treatment mainly consisted of in‐bed mobilization, postural transfers (including sitting), and respiratory exercises. After hospital discharge, patients were referred to rehabilitation facilities. Physiotherapeutic interventions provided during ECMO support and after its discontinuation were feasible and safe.ConclusionThe physiotherapeutic treatment of patients undergoing ECMO support includes several components and must be provided in a multidisciplinary context. The optimal approach depends on the patient’s status, including sedation, level of consciousness, ECMO configuration, types of cannulas, and cannulation site.

Management of vascular access for extracorporeal life support: A cohort study.

Extracorporeal membrane oxygenation (ECMO) is required for patients with refractory cardiac or respiratory failure. Inadequate securement of ECMO cannulae may lead to adverse events, ranging from line kinking to catastrophic accidents, such as air entrainment into the circuit or massive bleeding. Furthermore, the micro-motion of the cannulae at the entry site might increase the risk of local infections. Since 2015, we implemented a written protocol for management of ECMO cannulae and tubing, which specifically includes the securement of each cannula with three sutureless devices. The aim of the present study was to retrospectively assess cannulae micro-motion and the rate of bleeding events at the insertion site. Secondarily we aimed to evaluate the impact of prone positioning maneuvers during ECMO on these events. We performed a single-centre retrospective analysis of prospectively collected data on nursing care of ECMO cannulae. We included adult patients treated with veno-venous (V-V) or veno-arterial (V-A) ECMO between 2015 and 2018 in our general intensive care unit. The distance between the insertion site and the end of the wire-wound part of the cannula was recorded daily. Variations of this distance (defined as "cannula micro-motion") were recorded. Forty-five ECMO consecutive adult patients (40 V-V and 5 V-A) were included. No accidental cannula dislodgement was recorded. Median daily "cannula micro-motion" was 0.0 (-0.5 to 0.2) cm, without any significant difference between ECMO configuration, cannula type, and insertion site. Twelve patients (26%) presented at least one bleeding episode at cannula insertion site, none of which required surgical intervention. In the subgroup of patients who underwent prone positioning, no difference in cannulae micro-motion was recorded. An ECMO nursing protocol for cannulae management providing sutureless devices for cannula and tubing securement allows safe line stabilization, with the potential to reduce complications related to ECMO vascular access.

Neurosurgery planning based on automated image recognition and optimal path design

Abstract Stereotactic neurosurgery requires a careful planning of cannulae paths to spare eloquent areas of the brain that, if damaged, will result in loss of essential neurological function such as sensory processing, linguistic ability, vision, or motor function. We present an approach based on modelling, simulation, and optimization to set up a computational assistant tool. Thereby, we focus on the modeling of the brain topology, where we construct ellipsoidal approximations of voxel clouds based on processed MRI data. The outcome is integrated in a path-planning problem either via constraints or by penalization terms in the objective function. The surgical planning problem with obstacle avoidance is solved for different types of stereotactic cannulae using numerical simulations. We illustrate our method with a case study using real MRI data.