Device Insertion Research Articles

Development of NbTi planar superconducting undulators at the IHEP

Superconducting undulators (SCUs) have the advantages of generating stronger magnetic field and the radiation hardness compared to permanent magnet undulators. Therefore, SCUs are valuable to be applied in the free-electron lasers (FELs) driven by high-repetition-rate linear accelerators. The Insertion Device Group at the Institute of High Energy Physics (IHEP) in China started an R&D project to produce NbTi planar SCU prototypes with 15 mm period length. Several SCU prototypes, including short mock-ups, a 0.5-m-long SCU, and a 1.5-m-long SCU, have been successfully produced and cryogenic tested. The short mock-up coils were cooled by a liquid helium free cryostat to be quench trained at 4 K. The maximum current in the coils reached 500 A and the magnetic peak field exceed 1 T with 7 mm gap. The 0.5-m-long SCU was tested by using a vertical test system. The correction coils were confirmed with the ability in both correcting the magnetic field integrals and the phase error. The 1.5-m-long SCU was not only vertically tested, but also installed in a cryostat to be operated with high current over a long time. We applied the gap adjustment method to reduce the phase error within 9 degrees. The development of SCUs at the IHEP is introduced in this paper in detail.

Development and validation of a performance assessment checklist for insertion of an intra-uterine device (IUD).

The World Health Organization (WHO) supports increasing the availability and acceptability of long-acting reversible contraception including intra-uterine device (IUD), but its insertion includes certain risks (uterine perforation). The objective was to develop and validate an IUD insertion performance assessment checklist. This prospective study took place in hospitals and simulation center of the Poitou-Charentes region, France. The checklist content reached consensus among 10 experts solicited by a Delphi method. A modified gynecologic mannequin Zoe (Gaumard®) was used for simulations. Psychometric testing included 30 multi-professional participants for internal consistency and reliability between two independent observers, and 27 residents for assessment of score evolution over time and reliability. Cronbach alpha (CA) and intraclass coefficient (ICC) were used. Progression of performance was carried out using ANOVA for repeated measures. The data collected were used to plot receiver operating characteristic (ROC) curves for the score values and the area under the curve (AUC) was determined. The checklist included 27 items (2 sections, total score = 27). Psychometric testing showed CA = 0.79, ICC = 0.99, and good clinical relevance. The checklist is discriminative, showing a significant increase in performance scores when the simulations were repeated (F = 77.6, p < 0.0001). ROC curve [AUC: 0.792 (95% CI: 0.71-0.89); p < 0.0001] revealed the best score cutoff predictive of 100% sensitivity, i.e., true positive rate or success rate. Performance score was highly correlated to success rate. The cut-off score guaranteeing successful IUD insertion was 22/27. This coherent and reproducible checklist for IUD insertion provide an objective assessment of the procedure during SBT, with the aim of obtaining a score ≥ 22/27.

V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP

You have accessJournal of UrologyCME1 Apr 2023V11-03 PENILE RECONSTRUCTION FOR CONGENITAL MICROPENIS WITH THE ANTEROLATERAL THIGH PEDICLED FLAP Aurélie Schirmann, Nim Christopher, David Ralph, and Wai Gin Lee Aurélie SchirmannAurélie Schirmann More articles by this author , Nim ChristopherNim Christopher More articles by this author , David RalphDavid Ralph More articles by this author , and Wai Gin LeeWai Gin Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003337.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Congenital micropenis is defined as a normally formed penis with a stretched penile length less than 2.5 standard deviations below the mean for that man’s age and ethnicity. Micropenis may present as an isolated condition or with other genital or multi-system abnormalities. Penile reconstruction or phalloplasty may be required where topical and systemic hormonal treatment have failed. The most common flap used for phalloplasty is the radial artery forearm free flap phalloplasty. Other alternatives include the anterolateral thigh (ALT), musculocutaneous latissimus dorsi and abdominal flaps.The aim of this video is to illustrate the technique for penile reconstruction using a pedicled ALT flap without integrated urethra. METHODS: A 21-year-old man with micropenis and hypospadias from a disorder of sexual differentiation (46XY) presents for penile reconstruction following multiple failed attempts at hypospadias repair. He requested an ALT flap without integrated urethra because he is dependent on a long-term suprapubic catheter due to a hypocontractile bladder.Intraoperative vascular doppler identified 3 perforators from the descending branch of the lateral circumflex iliac artery of the left leg. The flap was designed centred on the perforators with dimensions of 14cm (length), 13cm (width at base) and 12cm (width at tip). The flap was raised carefully and transferred to the recipient groin. The neophallus was constructed and microsurgical anastomosis of the lateral cutaneous of the thigh to one of the dorsal penile nerves with 8/0 nylon was completed. The partially divided left vastus lateralis muscle was re-approximated and the skin edges drawn in and flattened. The left thigh was then resurfaced with a 14/1000 of an inch split-thickness skin graft from the contralateral thigh. All wounds were dressed. RESULTS: The man had an uneventful post-operative course with careful vascular monitoring, and he was discharged on day 10. He is currently awaiting glans-sculpting and will eventually proceed with insertion of an inflatable erectile device. CONCLUSIONS: Penile reconstruction using an ALT flap can be offered to a well-informed and motivated man with a micropenis following appropriate assessment. As shown, the technique requires careful dissection of the perforator vessels and can usually be transferred as a pedicled flap. Pedicled flaps do not require microvascular anastomosis and therefore have a lower risk of vascular compromise. Further aesthetic and functional refinements like the insertion of an erectile device are possible in later stages, if desired. Source of Funding: None declared © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e999 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aurélie Schirmann More articles by this author Nim Christopher More articles by this author David Ralph More articles by this author Wai Gin Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Recurrent Transient Ischemic Attacks in a Patient with Multiple Pacemaker Leads

Venous complications-specifically, stenosis and thrombosis-are both well-known complications of transvenous implantation of pacemakers and defibrillators. Although they are a well-recognized phenomenon, these complications are rarely of clinical significance. One of the most concerning complications is the development of superior vena cava (SVC) syndrome. Studies have found that the incidence of SVC syndrome varies from 1 in 3,100 to 1 in 650 patients. The azygos-hemiazygos venous system is the most commonly observed collateral. We report a case of a 71-year-old female patient who presented with stroke-like symptoms during the injection of agitated saline bubbles while performing an echo and was found to have an unusual venous collateral circulation formed as a result of brachiocephalic and SVC obstruction from multiple pacemaker leads. Our patient's clinical presentation was extremely unique, and we did not find any cases during our literature search reporting a similar presentation. Multiple collaterals formed between the brachiocephalic and subclavian veins, and bilateral pulmonary veins in our patient allowed the injected air bubbles from the venous system to reach the left side of the heart and eventually the cerebrovascular system, resulting in these transient ischemic attacks. These attacks eventually resolved as the air bubbles were dissolved and washed away by the continuous blood flow. It is advisable to monitor the patient for possible venous stenosis and SVC syndrome after any device insertion during regular device follow-up appointments.

Evaluation of Immediate Post-placental Insertion of the Copper Intrauterine Contraceptive Device during Caesarean Delivery

Evaluation of Immediate Post-placental Insertion of the Copper Intrauterine Contraceptive Device during Caesarean Delivery

Characteristics of shunt failure in 38,095 adult shunt insertion surgeries: a systematic review and meta-analysis.

The management of excess CSF in patients with hydrocephalus typically requires using a shunt to divert CSF. Unfortunately, there is a high rate of shunt failure despite improvements in device components and insertion techniques. Reoperation is frequently necessary, which contributes to patient harm and increased healthcare costs. While factors affecting shunt failure are well defined in the pediatric population, information regarding adults is lacking. The authors undertook a systematic review and meta-analysis to determine how shunt failure in the adult population is reported and investigated the etiologies of shunt failure. This review is reported according to PRIMSA and utilized the MEDLINE, Embase, and Google Scholar databases. Abstracts were screened by two independent reviewers, and data were extracted in duplicate by two independent reviewers. Statistical analyses were performed using SPSS and Stata. The pooled rates of shunt failure were 10% (95% CI 5%-15%) in studies with a mean follow-up time of less than 1 year, 12% (95% CI 8%-14%) with a follow-up time between 1 and 2 years, and 32% in studies with a follow-up time of 2 years or greater (95% CI 19%-43%). The pooled rate of failure was 17% across all studies. The most common cause of shunt failure was obstruction at 3.0% (95% CI 2%-4%), accounting for 23.2% of shunt failures. Infection was the second most common at 2.8% (95% CI 2%-3%), accounting for 22.5% of shunt failures. The most common location of shunt failure was the distal catheter, with a failure rate of 4.0% (95% CI 3%-5%), accounting for 33.4% of shunt failures. The definition of shunt failure was heterogeneous and varied depending on institutional practices. The combination of symptoms with either CT or MRI was the most frequently reported method for assessing shunt failure. Important variation regarding how to define, investigate, and report shunt failure was identified. The overall shunt failure rate in adults is at least 32% after 2 years, which, while lower than that typically reported in the pediatric population, is significant. The most common causes of shunt failure in adults are infection and obstruction. The most common site of failure occurred at the distal catheter, highlighting the need to develop strategies to both report and mitigate distal shunt failure in adult shunt patients.

Different Routes for Misoprostol Usage Before Intra Uterine Contraceptive Device Insertion in Women with Previous Cesarean Section

Different Routes for Misoprostol Usage Before Intra Uterine Contraceptive Device Insertion in Women with Previous Cesarean Section

(289) Does Lateral Approach Preserve Better Right Ventricular Function after Left Ventricular Assist Device Insertion?

(289) Does Lateral Approach Preserve Better Right Ventricular Function after Left Ventricular Assist Device Insertion?

Lidocaine Spray 10% versus Oral Ibuprofen Tablets in Pain Control during Copper Intrauterine Device Insertion (A Randomized Controlled Trial)

Lidocaine Spray 10% versus Oral Ibuprofen Tablets in Pain Control during Copper Intrauterine Device Insertion (A Randomized Controlled Trial)

Autologous fat grafting: current state of clinical practice in the Australian setting

**Objective**: This study aimed to gather and present systemic data about current fat grafting practice in Australia. We knew prior to the study that data for Australian fat grafting is limited, so we sought information from distinct sources. Part 1 aimed to present fat grafting data available from the Australian Breast Device Registry (ABDR). Part 2 aimed to present the details of current fat grafting practice by Australian plastic and reconstructive surgeons. **Methods**: In part 1, fat grafting data from the ABDR from its inception in 2012 to 2020 was collected and summarised. In part 2, a comprehensive survey about all aspects of fat grafting practice was distributed to surgeon members of the Australian Society of Plastic Surgeons (ASPS). **Results**: Part 1. The ABDR recorded an 8.4 per cent and 6.0 per cent increase in fat grafting at the time of breast device insertion surgery from 2012 to 2020 for reconstructive and aesthetic procedures respectively. Fat grafting with breast device insertion, in previously irradiated breast tissue, increased from 0 per cent to 17.4 per cent in the same period. Part 2. One in five of all surgeons of the Australian Society of Plastic Surgeons completed the survey. Our survey demonstrated that fat grafting is highly heterogeneous with respect to donor site selection, harvest technique, processing technique, number of sessions required and volumetric follow-up. **Conclusion**: Our study is the first attempt to present national data on fat grafting. It demonstrates clearly that uptake of autologous fat grafting for breast reconstruction and aesthetic procedures is rapidly increasing Australia-wide. It demonstrates that procedural variables of fat grafting are not standardised among Australian plastic surgeons. This indicates that further clinical data relating to patient demographics, procedural variables and outcomes are vital to ensure patient safety, health resource management and to inform best practice guidelines.

Characteristics and Outcomes of ICU Patients Without COVID-19 Infection-Pandemic Versus Nonpandemic Times: A Population-Based Cohort Study.

To demonstrate the characteristics and outcomes of non-COVID patients admitted to an ICU during the pandemic, compared with the previous year. A population-based study conducted using linked health administrative data comparing a cohort from March 1, 2020, to June 30, 2020 (pandemic) to a cohort from March 1, 2019, to June 30, 2019 (nonpandemic). Adult patients (18 yr old) admitted to an ICU in Ontario, Canada, without a diagnosis of COVID-19 during the pandemic and nonpandemic periods. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included hospital and ICU length of stay, discharge disposition, and receipt of resource intensive procedures (e.g., extracorporeal membrane oxygenation, mechanical ventilation, renal replacement therapy, bronchoscopy, feeding tube insertion, and cardiac device insertion). We identified 32,486 patients in the pandemic cohort and 41,128 in the nonpandemic cohort. Age, sex, and markers of disease severity were similar. Fewer patients in the pandemic cohort were from long-term care facilities and had fewer cardiovascular comorbidities. There was an increase in all-cause in-hospital mortality among the pandemic cohort (13.5% vs 12.5%; p < 0.001) representing a relative increase of 7.9% (adjusted odds ratio, 1.10; 95% CI, 1.05-1.56). Patients in the pandemic cohort admitted with chronic obstructive pulmonary disease exacerbation had an increase in all-cause mortality (17.0% vs 13.2%; p = 0.013), a relative increase of 29%. Mortality among recent immigrants was higher in the pandemic cohort compared with the nonpandemic cohort (13.0% vs 11.4%; p = 0.038), a relative increase of 14%. Length of stay and receipt of intensive procedures were similar. We found a modest increase in mortality among non-COVID ICU patients during the pandemic compared with a nonpandemic cohort. Future pandemic responses should consider the impact of the pandemic on all patients to preserve quality of care.

Comparison of Frequency of Menorrhagia after Immediate Versus Delayed Intrauterine Contraception Device Insertion

Objective: To compare the incidence of menorrhagia after immediate post-partum versus delayed intrauterine contraception device insertion in local population. Place and Duration of Study: Department of Obstetrics &amp; Gynecology, Bahawal Victoria Hospital, Bahawalpur from 1st January 2022 to 31st December 2022. Methodology: One hundred and ten women willing for intrauterine contraceptive device insertion of age 18-40 years were included. Females in which emergency hysterectomy was done, sepsis, premature rupture of membranes and fibroid uterus were excluded. Group A included the women in which intrauterine contraceptive device was inserted within 24 hours of delivery and Group B included the women in which intrauterine contraceptive device (IUCD) was inserted after 6 weeks of delivery. All patients were followed for 3 months for presence or absence of menorrhagia. Results: The mean age of women in group A was 28.67±5.72 years and in group B was 29.02±5.63 years. The mean parity in group A was 3.02±1.11 and in group B was 3.16±0.96. Menorrhagia in group A (immediate IUCD) was seen in 04 (7.27%) and in group B (delayed IUCD) was seen in 24 (25.45%) females with p-value of 0.010. Conclusion: There is less frequency of menorrhagia after immediate IUCD compared to delayed intrauterine contraception device insertion. Keywords: Intrauterine devices, Post-placental, Menorrhagia

Impact of oestrus synchronization devices on ewes vaginal microbiota and artificial insemination outcome.

The low pregnancy rate by artificial insemination in sheep represents a fundamental challenge for breeding programs. In this species, oestrus synchronization is carried out by manipulating hormonal regimens through the insertion of progestogen intravaginal devices. This reproductive strategy may alter the vaginal microbiota affecting the artificial insemination outcome. In this study, we analyzed the vaginal microbiome of 94 vaginal swabs collected from 47 ewes with alternative treatments applied to the progesterone-releasing intravaginal devices (probiotic, maltodextrin, antibiotic and control), in two sample periods (before placing and after removing the devices). To our knowledge, this is the first study using nanopore-based metagenome sequencing for vaginal microbiome characterization in livestock. Our results revealed a significant lower abundance of the genera Oenococcus (Firmicutes) and Neisseria (Proteobacteria) in pregnant compared to non-pregnant ewes. We also detected a significant lower abundance of Campylobacter in the group of samples treated with the probiotic. Although the use of probiotics represents a promising practice to improve insemination results, the election of the suitable species and concentration requires further investigation. In addition, the use of progestogen in the synchronization devices seemed to increase the alpha-diversity and decrease the abundance of harmful microorganisms belonging to Gammaproteobacteria and Fusobacteriia classes, suggesting a beneficial effect of their use.

Decision-making regarding immediate vs. interval postpartum levonorgestrel intrauterine device insertion timing

BackgroundUnderstanding decision-making for contraception initiation timing postpartum may help guide patients in selecting a contraceptive method most aligned with their reproductive goals. The objective of this study was to explore the decision-making process in patients who chose immediate postplacental (IPP) levonorgestrel intrauterine device (LNG IUD) insertion versus interval insertion at the postpartum follow-up visit.MethodsWe recruited English-speaking, reproductive-aged adult postpartum participants who received either an IPP or interval postpartum LNG IUD from September to December 2017 at MetroHealth Medical Center. We conducted interviews over the phone utilizing a pilot-tested, semi-structured interview guide. Interview topics included past experiences with contraception, provider counseling, intrapartum factors, and current experiences after IUD insertion.ResultsWe interviewed 20 participants (12 IPP and eight interval IUD recipients). Participants receiving an IPP IUD described convenience, desire for immediate contraception, pain control and availability of alternative contraception options as influential for their decision. Patients who received an interval IUD performed outside research, focused on the events surrounding delivery, and generally favored additional recovery time before obtaining an IUD. Patients who received interval IUDs were often not aware that IPP IUDs were available. Early, frequent, and comprehensive counseling was viewed favorably when compared to counseling upon arrival to the laboring unit. While overall there was congruence of participant expectations and experiences, unexpected expulsion affected desire for future IUD use in some participants.ConclusionProviders should be mindful that prior experience and knowledge as well as delivery room considerations affect insertion timing decision-making.Trial registrationN/A

An automated system for cattle reproductive management under the IoT framework. Part I: the e-Synch system and cow responses

The objective of this manuscript was to present the e-Synch system, integrating an intravaginal electronically controlled hormone delivery and sensing device with an IoT platform for remote programming and monitoring. Secondary objectives were to demonstrate system functionality and cow responses to e-Synch. External components of e-Synch include a 3D-printed case with retention wings, a flexible wideband antenna, and silicone membrane for pressure balancing. Internal components include a central control board, battery, wireless charging coil, and two silicone hormone reservoirs connected to individual peristaltic pumps. An accelerometer and a high-accuracy temperature sensor are integrated in the custom printed circuit board (PCB). The IoT platform includes a gateway consisting of Raspberry PI 3 and a CC1352 radiofrequency module that collects sensor data at 915 mHz. Data is transferred to the Google Cloud utilizing the IoT Core service through TCP/IP, and then is pulled by the Pub/Sub service. After routing to a BigQuery table by the Dataflow service, data visualization is provided by Data Studio. Drug delivery protocols are selected using an IOS device app that connects to e-Synch through Bluetooth. Experiments with lactating Holsteins cows were conducted to demonstrate proof-of-concept system functionality and evaluate cow responses. Despite unstable communication and signal discontinuity because of signal strength attenuation by body tissue, devices (n=6) communicated with the IoT platform in 89% (24/27) of use instances. Temperature and accelerometer data were received for at least one 15 min period during an 8 h insertion period from all devices that communicated with the IoT platform. Variation in accelerometer data (± 8.565 m/s2) was consistent with cow activity during experimentation and mean vaginal temperature of 39.1 °C (range 38.6 to 39.5 °C) demonstrated sensor functionality. Hormone release was confirmed in all instances of device use except for one. Cow behavior evaluated through signs of discomfort and pain, and tail raising scores was mostly unaltered by e-Synch. Vaginal integrity and mucus scores also remained unaltered during and after device insertion. In conclusion, the e-Synch device integrated with a controlling app and IoT platform might be used to automate intravaginal hormone delivery and sensing for controlling the estrous cycle of cattle.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures(PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Safety and efficacy of a suction cervical stabilizer for intrauterine contraceptive device insertion: Results from a randomized, controlled study

ObjectivesTo compare patient-reported pain, bleeding, and device safety between intrauterine contraceptive device (IUD) insertion procedures employing a suction cervical stabilizer or single-tooth tenaculum. Study designThis was a randomized, prospective, single-blinded study conducted at two centers, enrolling women aged 18 years or older, eligible for IUD insertion. The primary end point measure was patient-reported pain, measured on a 100-mm Visual Analogue Scale. Safety was assessed on the amount of bleeding, adverse events, and serious adverse events. ResultsOne hundred women were randomized, 48 to the investigational device and 52 to control. There were no statistically significant differences between the groups in factors potentially associated with pain on IUD insertion. IUD insertion was successful in 94% of all subjects. Subjects in the investigational device group reported pain scores ≥14 points lower than in the control group at cervix grasping (14.9 vs 31.3; p < 0.001) and traction (17.0 vs 35.9; p < 0.001), and smaller differences in pain scores at the IUD insertion (31.5 vs 44.9; p = 0.021) and cervix-release (20.6 vs 30.9; p = 0.049) steps. Nulliparous women experienced the greatest pain differences to control. Mean blood loss was 0.336 (range 0.022–2.189) grams in the investigational device group and 1.336 (range 0.201–11.936) grams in the control group, respectively (p = 0.03 for the comparison).One adverse event (bruising and minor bleeding) in the investigational device group was considered causally related to the study device. ConclusionsThe suction cervical stabilizer had a reassuring safety profile and its use was associated with significant reductions in pain during the IUD insertion procedure compared with standard single-tooth tenaculum use, particularly among nulliparous women. ImplicationsPain can be an important barrier to greater use of IUD devices among prescribers and users, particularly nulliparous women. The suction cervical stabilizer may provide an appealing alternative to currently available tenacula, filling an important unmet need.

Comparison between the CIDR or sponge with hormone injection to induce estrus synchronization for twining and sex preselection in Naimi sheep

Abstract The management of sheep reproduction requires the induction and synchronization of the estrus cycle and ovulation for the ewe out-of-season and/or synchronized lambing. These managements are based on the insertion of an intravaginal device of controlled internal drug release (CIDR or sponge) and then the administration of a hormonal injection, such as PMSG, eCG, hCG, or GnRH. This study aimed to compare the impact of CIDR or sponges, with PMSG and GnRH injection, respectively, for inducing estrus synchronization, lambing rate, twining, and sex preselection rate in Naimi sheep. A total of 86 Naimi sheep ewes and six male rams with proven fertility were used in this study. The results showed that the first ewes or CIDR group had the highest ewe fertility rate of 26/28 (92.59%) with a 35/92 (38.04%) lamb production ratio. The offspring sex ratio was 22/35 males (62.85%) and 13/35 female lambs (37.14%). Their twin ratios were 9/22 (34.4%), producing 14 males (77.77%) and 13 females (37.14%). The second or sponge ewe group’s fertility ratio was 16/26 (61.53%). They sired the lowest offspring ratio of 20/92 total lambs (21.73%) and had sex ratios of 11/20 males (55.0%) and 9/20 (45.0%) female lambs. The twin production ratios were 4/22 (25% with two males and two males with female twins). Their twin sex ratio was six males (77.77%) and two females (22.34%). The third or control ewe group’s fertility rate was 29/33 (87.87%). They produced 37/92 (40.27%) lambs, and the total sex ratios were 22/37 male lambs (59.45%) and 15/35 (40.45%) female lambs. They produced eight twins (27.58%), and their twins’ sex was equal to six male and six female (50%) lambs. Regarding the progesterone and testosterone hormone levels, no differences during pre- or post-intravaginal insertion were observed, but the estrogen level showed some differences during pre-insertion. In conclusion, the use of CIDR with hormone injection is better for reproduction management, male lambing, and sex preselection rate. The control group produced approximately the same fertility rate with equal male and female lambing sex preselection rates.

Prevention of postpartum haemorrhage: Economic evaluation of the novel butterfly device in a UK setting

ObjectivesTo explore the cost-effectiveness of a novel PPH device as compared with usual care. DesignA decision analytical model was used to explore the cost-effectiveness of the PPH Butterfly device compared with usual care. This was part of a United Kingdom, UK, clinical trial ISRCTN15452399 using a matched historical cohort who had standard PPH management without the use of the PPH Butterfly device. The economic evaluation was conducted from a UK National Health Service (NHS) perspective. SettingLiverpool Women’s Hospital, UK. Participants57 women with 113 matched controls. InterventionThe PPH Butterfly is a novel device that has been invented and developed in the UK to facilitate bimanual compression of the uterus in the treatment of PPH. Main outcome measuresMain outcome measures included healthcare costs, blood loss, and maternal morbidity events. ResultsMean treatment costs in the Butterfly cohort were £3,459.66 as compared with standard care £3,223.93. Treatment with the Butterfly device resulted in decreased total blood loss in comparison with standard care. The Butterfly device had an incremental cost-effectiveness ratio of £3,795.78 per PPH progression avoided (defined as ≤ 1000 ml additional blood loss from device insertion point). If the NHS is prepared to pay £8,500 per PPH progression avoided, then the Butterfly device is cost-effective with a probability of 87 percent. In the PPH Butterfly treatment arm there were 9% fewer cases of massive obstetric haemorrhage (severe PPH of more than 2000mls or more than 4 units of blood transfusion required) recorded as compared with the standard care historical cohort. As a low-cost device, the PPH Butterfly device is cost-effective but can be cost-saving to the NHS. ConclusionThe PPH pathway can result in high-cost resource use such as blood transfusion or high dependence unit hospital stays. The Butterfly device is a relative low-cost device in a UK NHS setting with a high probability of being cost-effective. The National Institute for Health and Care Excellence (NICE) can use this evidence in considering the adoption of innovative technologies such as the Butterfly device in the NHS. Extrapolation on an international scale to lower and middle-income countries could prevent mortality associated with PPH.

Retrospective comparison of the effects of laryngeal mask and endotracheal tube on some cardio-respiratory variables in pet rabbits undergoing anaesthesia for elective gonadectomy

BackgroundEndotracheal intubation in rabbits is challenging and supraglottic airway devices, such as laryngeal masks (LMA), represent an alternative as they are easy to insert, and do not stimulate the larynx requiring therefore a lighter plane of anaesthesia for their insertion and positioning than the endotracheal tubes. We investigated whether, compared to an endotracheal tube, the LMA can reduce the negative effects of general anaesthetics on some cardiovascular and respiratory parameters routinely monitored in rabbits anaesthetized for elective gonadectomy. The records of 21 adult mixed breed pet rabbits were collected retrospectively. Rabbits were divided in two groups based on the type of airway device used. A laryngeal mask secured the airway in group LMA (n = 11), and in group ETT (n = 10) an endotracheal tube was used. The amount of propofol used before successful insertion of the airway device was recorded. A pitot-based spirometer was connected and ventilatory variables were measured immediately after insertion. Pulse rate, non-invasive arterial blood pressure, haemoglobin oxygen saturation, respiratory rate, end-tidal carbon dioxide and volatile anaesthetic consumption were also monitored during the surgical procedure; extubation time was noted as well.ResultsThe use of LMA required significantly less propofol (0.8 to 4 mg/kg) for insertion than the ETT (1.2 to 5.6 mg/kg), and the difference was statistically significant (P < 0.01). No differences were observed in ventilatory variables measured immediately after airway positioning. Intraoperatively, there were no differences between groups for respiratory and cardiovascular variables, and amount of isoflurane administered. In all rabbits mean and diastolic blood pressure progressively decreased during surgery. Mean extubation time was shorter in group LMA (6 ± 2 min) than group ETT (8 ± 3 min, P < 0.01).ConclusionThe airway device did not clinically affect the cardiovascular and respiratory variables during anaesthesia. Intraoperative hypoventilation was observed in most rabbits regardless of the device being used; therefore ventilatory support may be required. Rabbits with the laryngeal masks were extubated earlier.