Device Insertion Research Articles

Commissioning of a gas monitor detector for an undulator beamline in the VUV and EUV wavelength range

A gas detector system was implemented to monitor the absolute photon flux at the insertion device beamline of the Metrology Light Source. This system should overcome the drawbacks in the use of traceably calibrated semiconductor photodiodes, which are prone to radiation-induced degradation and not qualified for permanent real-time monitoring during the measurements at the beamline endstation. Gas monitor detectors are based on atomic photoionization. They do not suffer from radiation-induced degradation, and their transparency makes them suitable for real-time monitoring of the photon flux. We calibrated and commissioned such a monitor at the insertion device beamline in the vacuum- and extreme ultraviolet spectral range from 14 eV to 111 eV photon energy. The resulting photon flux measurement was compared to measurements made with a photodiode and shows deviations below 5 %, which agrees well with the calculated relative uncertainty of 4.7 %.

Effects of additional gonadotropin-releasing hormone and prostaglandin F2α treatment to an estradiol/progesterone-based embryo transfer protocol for recipient lactating dairy cows

This study was designed to evaluate whether the utilization of a second PGF2α treatment at the end of an estradiol/progesterone (E2/P4)-based protocol with or without GnRH at the beginning of the protocol would improve pregnancy rates of lactating Holstein cows assigned to timed embryo transfer. A total of 501 lactating Holstein cows in 5 farms were enrolled in the experiment. Within farm, cows were blocked by parity and, within block, were assigned randomly to (1) insertion of an intravaginal P4 device (controlled internal drug-releasing device; CIDR) and estradiol benzoate on d -11, PGF2α on d -4, CIDR withdrawal and an injection of estradiol cypionate on d -2, and timed embryo transfer on d 7 (1-PGF; n = 164); (2) the same treatments as 1-PGF, but with PGF2α administered on d -4 and -2 (2-PGF; n = 171); and (3) 2-PGF with the addition of a GnRH treatment on d -11 (GnRH+2-PGF; n = 166). Ovaries were scanned by transrectal ultrasonography on d -11, -4, and 7, and blood samples were collected on d -11, -4, 0, and 7 for P4 determination. Treatment comparisons were performed using contrasts. The proportion of cows with a new corpus luteum on d -4 was greater in GnRH+2-PGF cows. Cows in 1-PGF had a greater P4 concentration on d 0 but lesser P4 on d 7 compared with cows in the other groups. Cows assigned to receive 2-PGF (2-PGF and GnRH+2-PGF) had greater estrus expression, and a greater proportion of cows ovulated to estradiol cypionate. No further contrast effects were observed for follicle diameter, double ovulation rate, pregnancy per embryo transfer (P/ET) on d 32 and 60, or pregnancy loss. As P4 concentration on d -4 increased, P/ET on d 60 tended to increase. Cows with P4 ≥3.66 ng/mL on d -4 had greater P/ET on d 32 and 60 than those with P4 below that threshold. Regardless of treatment, cows with P4 concentration ≥3.66 ng/mL also had a greater pregnancy per synchronized protocol (P/SP) on d 60. Also, a P4 concentration on d -4 (low or high) × follicle diameter (continuous) interaction tendency was observed when evaluating P/ET. Although P/ET did not differ among cows with different follicles sizes with reduced P4 concentration on d -4 (<3.66 ng/mL), it increased in cows with larger follicles exposed to increased P4 concentration (≥3.66 ng/mL). When P4 on d 0 was evaluated, P/ET on d 32 and 60 was greater for cows with low (≤0.09 ng/mL) versus high (>0.21 ng/mL) P4; as P4 concentration on d 0 increased, P/ET linearly decreased. In summary, cows with increased P4 concentrations during growth of the ovulatory follicular wave had improved P/ET. Administering a second PGF2α dose reduced P4 concentration on d 0 and increased ovulatory response to the protocol, but no benefits were observed on P/ET or P/SP.

Menstrual Management Choices in Transgender and Gender Diverse Adolescents

PurposeTransgender and gender diverse patients who are assigned female at birth may request menstrual management to alleviate an increased dysphoria due to menses. The objective of this study is to describe the initiation and use over time of menstrual management methods (MMMs) in transgender and gender diverse adolescents. MethodsA retrospective chart review was conducted of patients in a multidisciplinary pediatric gender program from March 2015 to December 2020 who were assigned female at birth, identified as transgender or gender diverse, and had achieved menarche. A descriptive statistical analysis was performed. ResultsOf 133 patients, 119 (90%) identified as transgender male, 11 (8%) as gender nonbinary, and 3 (2%) as another gender identity. Mean age was 15 (standard deviation 1.6) years. Only 12 (9%) patients had ever been sexually active. During the study period, 48 (36%) used gender-affirming testosterone. At the initial visit, 114 (86%) patients were not using an MMM. Of 80 patients who initiated a new MMM, 3 (4%) chose continuous oral contraceptive pills, 65 (83%) used norethindrone acetate (NETA), and 9 (11%) planned levonorgestrel intrauterine device (IUD) insertion. At 1 year, 56 patients were using NETA and 20 had an IUD in place. DiscussionThis study provides data on MMM choice in transgender and gender diverse adolescents using these methods almost exclusively for menstrual management and not contraception. Although few patients were using an MMM at baseline, most opted to start a method when given the opportunity. The most common methods were NETA or an levonorgestrel IUD.

Impact of choice of nostril on nasotracheal intubation when using video rigid stylet: a randomized clinical trial

BackgroundPatients undergoing oral and maxillofacial surgeries under general anesthesia usually require nasotracheal intubation. When presented with patients with equally patent nostrils, selection of the nostril to use for intubation is an important decision for facilitating intubation. The objective of this trial is to determine whether choice of nostril impacts nasotracheal intubation when using a video rigid stylet in patients undergoing oral and maxillofacial surgery.MethodsFifty patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly allocated into two groups to undergo nasotracheal intubation through the left nostril (Group L, n = 25) or the right nostril (Group R, n = 25). Intubation was performed by experienced anesthesiologists using a video rigid stylet. The primary endpoint was time to successful intubation, which was defined as the duration from when the tip of the stylet-tube assembly entered the selected nostril to when the tube entered the trachea. Secondary outcomes included: length of time for device insertion; length of time for tube insertion; total success rate; first-attempt success rate; number of intubation attempts; requirement of airway assisted maneuvers; incidence and severity of epistaxis. Intubation-related adverse events were monitored for up to postoperative 24 h.ResultsMedian time (interquartile range) to tracheal intubation was 25.3 seconds (20.7 to 27.6) in Group L and 26.8 seconds (22.5 to 30.0) in Group R (median difference (MD) = 1.9; 95% confidence interval (CI) –1.8 to 5.7, P = 0.248). Nasotracheal intubation was successful in all patients in both groups and the first-attempt success rates in both groups were similar (Group L: 96% (24/25); Group R: 96% (24/25); relative risk (RR) 1.0; 95% CI 0.9 to 1.1; P > 0.999). No significant difference of requirement of assisted maneuvers was noted between the two groups (Group L: 36% (9/25); Group R: 28% (7/25); RR 0.8; 95% CI 0.3–1.8; P = 0.544). Furthermore, all patients showed a high quality of visualization of the glottis (Cormack and Lehane Grade I). For safety outcomes, the incidence and severity of epistaxis during intubation was comparable between the two groups. There were no significant differences between the selection of nostrils and intubation-related adverse events up to 24 h after surgery.ConclusionsWhen considering which nostril to use for intubation with video rigid stylet, either nostril can be used similarly.Trial registrationClinicaltrials.gov. Identifier: NCT05218590.

Airway management with novel intubating laryngeal tubes has no influence on cerebral oxygenation in cardiac surgery patients: A prospective observational study

BackgroundA laryngeal tube is often used as an alternative to intubation with direct laryngoscopy during cardiopulmonary resuscitation. However, in a study with piglets undergoing simulated cardiac arrest, reduced carotid artery blood flow was associated with the insertion of different supraglottic airway devices, such as a laryngeal tube. Limited by its construction, secondary tracheal intubation through a laryngeal tube was difficult or impossible in contrast to a second generation laryngeal mask. The new disposable intubating laryngeal tube with suction (iLTS-D®) seems to facilitate tracheal intubation. We hypothesized that iLTS-D, when inflated to the recommended air volume, does not reduce cerebral oxygenation in patients with cardiovascular diseases undergoing elective cardiac surgery.MethodsThis single-center prospective, controlled observational study was approved by the local ethics committee (Ethical Committee No. 2018-13716). Forty adult patients undergoing elective cardiac surgery requiring tracheal intubation were included in this study. The exclusion criteria were age &amp;lt;18 years and a high risk of aspiration, inability to consent, height &amp;lt;155 cm, or pregnancy. Prior to insufflation and deflation of the cuffs, we performed cerebral oximetry via near-infrared spectroscopy. The primary outcome was a significant reduction in NIRS in the context of the preinduction baseline value after inflation of the cuffs with the recommended air volume, defined as a ≥25% decrease from baseline or an absolute value ≤ 50%. The secondary endpoints were differences in time points, insertion success rates, and complications.ResultsThere was no significant reduction in cerebral oximetry after inflation with the recommended cuff volume and an initially measured cuff pressure of &amp;gt;120 cmH2O. Overall, tracheal intubation was achieved in a median of 20 s [interquartile range 15-23 s] and enabled sufficient ventilation and tracheal intubation through the iLTS-D in all patients. Traces of blood on the cuffs (after removing the iLTS-D) and a sore throat (evaluated 2 h after removing the tracheal tube) were observed in one patient.ConclusionOur results showed no association between the insertion of the iLTS-D and reduced cerebral oxygenation in patients undergoing elective cardiac surgery.Trial registrationClinicalTrials.gov, NCT03942809.

Socio-technical context for insertable devices.

In this article, we show that voluntarily inserting devices inside the body is contested and seek to understand why. This article discusses insertables as a source of contestation. To describe and understand the social acceptability, reactions toward, and rhetoric surrounding insertable devices, we examine (i) the technical capabilities of insertable devices (the technical context), (ii) human reactions toward insertables (the social context), and (iii) the regulatory environment. The paper offers explanations to the misperceptions about insertables.

P065Long acting reversible contraceptive (larc) insertions in 2019 in the states with most restrictive and trigger abortion policies

<h3>Objectives</h3> As of May 2022, 26 states have been identified as certain or almost certain to ban abortion should the 1973 Roe decision recognizing women's constitutional right to choose to terminate be overturned. The purpose of this analysis was to describe the rate of insertions of long-acting reversible contraceptives (LARCs), the most effective forms of contraception, in those 26 states. <h3>Methods</h3> Data was from a HealthVerity Marketplace claims data source representing 130 million patients, representing 58% of the US census population. Women aged 15–44 were included in the analysis. For each healthcare encounter, the following data were gathered: three-digit zip code, age, implant insertion (y/n), intrauterine device (IUD) insertion (y/n), provider specialty, and payer type (Medicaid or commercial). LARC insertion rates by three-digit zip code geographic areas in the 26 states with pending abortion bans were described. <h3>Results</h3> In four states with pending abortion bans, LARC insertion rates were consistently low: <2.6% in either all or nearly all three-digit zip code areas. Four states had consistently top quartile LARC insertion rates (>4.1%). The remaining states had wide variation in LARC insertion rates; some three-digit zip code areas fell in the lowest quartile of insertions (<2.6%) and other areas showing highest percentiles of LARC insertions (>4.1%) <h3>Conclusions</h3> Use of LARCs vary among the geographic areas within the states with certain or near-certain abortion trigger bans. These variations in LARC insertion rates may indicate significant additional reproductive health burdens for women who may already be facing significant restrictions on their reproductive health choices.

Iodination of PEGylated Polymers Counteracts the Inhibition of Fibrinogen Adsorption by PEG.

Poly(ethylene glycol), PEG, known to inhibit protein adsorption, is widely used on the surfaces of biomedical devices when biofilm formation is undesirable. Poly(desaminotyrosyl-tyrosine ethyl ester carbonate), PDTEC, PC for short, has been a promising coating polymer for insertion devices, and it has been anticipated that PEG plays a similar role if it is copolymerized with PC. Earlier studies show that no fibrinogen (Fg) is adsorbed onto PC polymers with PEG beyond the threshold weight percentage. This is attributed to the phase separation of PEG. Further, iodination of the PC units in the PC polymer, (I2PC), has been found to counteract this Fg-repulsive effect by PEG. In this study, we employ surface-sensitive X-ray techniques to demonstrate the surface affinity of Fg toward the air-water interface, particularly in the presence of self-assembled PC-based film, in which its constituent polymer units are assumed to be much more mobile as a free-standing film. Fg is found to form a Gibbs monolayer with its long axis parallel to the aqueous surface, thus maximizing its interactions with hydrophobic interfaces. It influences the amount of insoluble, surface-bound I2PC likely due to the desorption of the formed Fg-I2PC complex and/or the penetration of Fg onto the I2PC film. The results show that the phase behavior at the liquid-polymer interface shall be taken into account for the surface behavior of bulk polymers surrounded by tissue. The ability of PEG units rearranging into a protein-blocking layer, rather than its mere presence in the polymer, is the key to antifouling characteristics desired for polymeric coating on insertion devices.

A study of BlockBuster laryngeal mask airway versus Fastrach/Intubating laryngeal mask airway as a conduit for blind oro-tracheal intubation: A prospective randomized controlled study

A Laryngeal Mask Airway (LMA) has two parts, a simple breathing tube and a mask. The mask at the laryngeal end of the tube aligns against the glottis and provides better channel of ventilation than the face mask. There have been modifications in the basic design of the LMA to incorporate gastric drainage channel and some devices are also equipped with a channel for intubation to secure airway by guiding endotracheal tube (ETT) through it. In this study we evaluated the performance of two LMA devices that can aid in rescue ventilation and are also equipped with a channel for intubation namely the BlockBuster LMA(2012) and the Fastrach/ Intubating LMA(1997) for blind oro-tracheal intubation in terms of First attempt success rate and Over-all success rate of intubation. A hundred consenting patients of age group 18-60 years and ASA status I or II, were randomly allocated into two groups Group BB (BlockBuster LMA) and Group FT (Fastrach LMA) with 50 patients each. Standard anesthesia technique was used for both groups. After insertion of airway device, cuff was inflated and ventilation was attempted (maximum 2 attempts). Once ventilation was achieved, ETT of appropriate size was inserted through LMA (maximum 2 attempts). The correct placement of ETT was confirmed by capnography. Data was collected for number of attempts of tracheal intubation, time taken for intubation and complications. First attempt success rate of intubation was more in Blockbuster LMA than Fastrach LMA. Over-all success rate of Intubation was 100% for both devices. Time taken for intubation and incidence of post-operative sore throat was less in BlockBuster LMA than Fastrach LMA(p-value&amp;#60;0.05). Blockbuster LMA is better conduit for oro-tracheal intubation than Fastrach LMA in terms of higher first attempt success rate, lesser time taken for intubation and lesser post-operative complications.

Comparison of Estradiol Cypionate, Estradiol Benzoate and Gonadotropin-Releasing Hormone in Fixed-Time Artificial Insemination in Multiparous Murrah Buffaloes

The present study was aimed to evaluate the efficiency of estradiol cypionate, estradiol benzoate and gonadotropin-releasing hormone during fixed-time artificial insemination (FTAI) protocols in multiparous Murrah buffaloes. A total of 35 buffaloes were used between September and November 2021 and subjected to a synchronization protocol. On day 0, insertion of an intravaginal progesterone device (CIDR, 1.38 g) was made with intramuscular (i/m) injection of estradiol benzoate (EB, 2 mg); On day 9: CIDR removed with i/m injections of Dinoprost (12.5 mg) and eCG (400 IU), and then buffaloes were randomized into three treatment group: 1) EB 1 mg on day 10 (n=13). 2) estradiol cypionate (EC) 1 mg on day 9 (n=12), and 3) Buserelin acetate (GnRH) 0.0105 mg on day 10 (n=10). The estrus signs observed during the FTAI (56 h after CIDR withdrawal) and conception rate at 90 days after FTAI were recorded. The conception rates were 61.5, 58.3 and 60.0% for EB, EC and GnRH treatment groups, respectively. There was no significant difference between the treatment groups for conception rate and signs of estrus. Therefore, it was concluded that all three treatments can be efficiently used during estrus synchronization protocol with FTAI in multiparous Murrah buffaloes.

Medical Devices, Invisible Women, Harmful Consequences.

In this commentary, we explore the disproportionate risk women experience with the insertion of various medical devices. Although pre-market device testing and complication tracking could be improved for all, a failure to consider sex differences in hormones, anatomy, inflammatory responses, and physical function puts women at particular risk. This invisibility of women is an example of gender bias in medical science and practice, a bias that could be corrected in the ways we suggest.

Monopole directional antenna bioinspired in elliptical leaf with golden ratio for WLAN and 4G applications

In this work, it is proposed the development a new monopole directional antenna, bioinspired in elliptical leaf, with cut by golden ratio, for 4G band application, by the use of the technique of the cut of the radiating element for the increasing of the antenna perimeter, being the first work to use this technique in a bioinspired antenna, promotes resonance frequency turned, and reconfiguring of the antenna parameters as bandwidth, radiation pattern and gain, with the use of the reflector near to the group plane, without the insertion of active devices as the pin diode or change in radiating element. The shape antenna is generated by Gielis formula, built in FR4 substrate, with cuts calculated by golden ratio. To compare the results of the bioinspired monopole on the elliptical sheet, a square-shaped monopole antenna was designed, simulated and measured, the structures were designed in the MATLAB software version 2015(b) and the simulations were performed in the Ansys software version 2016. In the results compared between the square monopole and the bioinspired antenna in the elliptical sheet, it can be seen that the measured bioinspired antenna, compared to the square monopole, presented a bandwidth reduction of 77.27%, a more compact structure, with a reduction of 98%, covering the wireless local area network, and long-time evolution 4G at 2.5 GHz. The proposed technique uses a reflector on the ground plane, to change the parameters of the monopole planar antenna, of omnidirectional radiation pattern to a directional, maintaining the characteristics of the broadband, half-power beamwidth great than 100°, with high current density, and similar gain of a directional antenna. From the results, it has been observed that the elliptical leaf monopole antenna shows broadband characteristics, with a half-power beamwidth of 128°, wideband, the bandwidth of 500 MHz, a gain of 6.28 dBi, a current density of 13.01 A/m2, and circular polarization.

The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes.

Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50-0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82-0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24-1.27) had a significant relationship with outcomes. Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.

Real-world Characterization and Use of Insertable Cardiac Monitor Remote Programming.

Remote device programming may enable workflow efficiencies and reduce resource strains on clinics as well as patients. Although the remote patient management ecosystem has evolved, several challenges remain, and the role of remote device programming for an insertable cardiac monitor (ICM) has yet to be described in a real-world setting. The purpose of this study was to characterize the initial real-world use of remote programming of an ICM. The cohort included 8,238 patients with the LUX-Dx™ ICM (Boston Scientific, Marlborough, MA, USA) during the first year of commercial use, which is also the first year that remote programming was available for an ICM. A descriptive review of reprogramming events revealed that 24% of devices were reprogrammed and that 82% of all reprogramming events occurred remotely. Over 74% of first reprogramming events occurred within the first 30 days following device insertion, and nearly 80% of devices only had 1 reprogramming event. These early data support the hypothesis that remote programming of an ICM is a clinically useful tool that may improve the clinical experience of device programming optimization, especially within the first month following device insertion.

Hysteroscopic Resection of Uterine Septum: An Updated Approach

<h3>Study Objective</h3> Demonstrate an updated technique for hysteroscopic resection of uterine septum. <h3>Design</h3> Case Study–Surgical Technique. <h3>Setting</h3> Major academic medical center. <h3>Patients or Participants</h3> Patient with known uterine septum undergoing hysteroscopic resection of septum with concomitant indicated laparoscopy. <h3>Interventions</h3> Operative hysteroscopy with resection of septum, with laparoscopic assistance. <h3>Measurements and Main Results</h3> The purpose of this video is to demonstrate the combined technique of traditional hysteroscopic scissors with an advanced hysteroscopic tissue removal system to optimally remove the avascular septal tissue and restore normal uterine cavity architecture. The patient later underwent a successful intrauterine device insertion with sonographic guidance, demonstrating a normal uterine cavity and fully resected septum. <h3>Conclusion</h3> Use of an advanced hysteroscopic tissue removal system in combination with traditional incision of the uterine septum results in optimal anatomic cavity restoration. This technique can be used alone or in combination with indicated laparoscopy, which provides additional visual confirmation of adequate resection using a "jack-o-lantern" technique. Further prospective studies should be conducted to evaluate the impact of this updated technique on gynecologic (i.e., bleeding) and obstetric outcomes.

Home care: home venous access device insertion during covid-19 pandemic in not autonomous patients. From an emergency activity to a daily work practice.

Reliable venous access is essential in providing effective care for many patients. Various vascular access devices (VAD) are available, and are placed by a specialized team using ultrasound guidance in a dedicated room of the hospital; however, during the pandemic covid-19 many not autonomous or bedridden patients were unable to reach the hospital for VAD insertion, because the unavailability of ambulance for the transport. For this reason the specialized team organized a modality for positioning the VAD at bedside at home. In 2012 a VAD-team was established by the health authority in the oncology-hematology Department at the hospital of Piacenza. This team was dedicated in positioning ultrasound-guided vascular access. During the covid-19 pandemic the VAD-team modified its organization to reach patients at home to position VAD, initially for oncologic people unable to go to the hospital; this procedure was subsequently extended to other bedridden patients with non-oncologic disease. The positioning of the VAD was performed under ultrasound guidance, according to the same modalities used in hospital. The primary endpoin was the suitability of the VAD to allow the planned treatment. The secondary endpoint was complications of the use of VADs. Between March 2020 to December 2020 and January 2021 to December 2021, VAD were positioned in 118 and 134 patients respectively. The VAD utilized were midlines for each patient. The mean age of the patients was 88 years, the majority were female (>60%). The majority of the patients had neurodegenerative disease (>60%) or advanced cancers (>25%). The VAD allowed the planned treatment in 94% of the patients. The complications were infrequent: VAD dislocation (<1%), thrombosis (<2%). No infection was registered. During covid-19 pandemic, the VAD-team demonstrated the feasibility of VADs home positioning, for patients that need to be transported by ambulance to the hospital for a venous catheter insertion. This procedure allows saving of economic and human resources both for patients and caregivers, in addiction can leave the ambulance free for other use. Due to this study, this procedure has become routine practice in our health district for patients bedridden or not autonomous.

The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis

The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.

Safety and efficacy of midline catheters versus peripheral intravenous catheters: A pilot randomized controlled trial.

Despite pervasive need for peripheral intravenous catheters, insertion is often difficult, and approximately two thirds fail prematurely. Midline catheters are an alternative long peripheral catheter, inserted in the upper arm, ideal for patients with difficult access. The aim of this study is to test feasibility of the protocol and compare the efficacy and safety of midline catheters to peripheral intravenous catheters. A parallel-group, pilot randomized controlled trial of adult medical/surgical hospitalized patients, from a single Australian referral hospital. Participants with difficult vascular access (≤2 palpable veins) and/or anticipated ≥5days of peripherally compatible intravenous therapy were recruited between May 2019 and March 2020. Participants were randomized to (1) peripheral intravenous catheter or (2) midline catheter. Primary feasibility outcome measured eligibility, recruitment, protocol adherence, retention and attrition. Primary clinical outcomes measured device insertion failure and post-insertion failure. In total, n = 143 participants (71 peripheral intravenous catheters and 72 midline catheters) were recruited; n = 139 were analysed. Most feasibility criteria were met. Peripheral intravenous catheters had shorter functional dwell time, with higher incidence of post-insertion failure compared to midline catheters. Midline catheters appear to be superior for patients with difficult vascular access or receiving prolonged intravenous therapy; a large, multi-centre trial to confirm findings is feasible.

A neural network model of a quasiperiodic elliptically polarizing undulator in universal mode.

Machine learning has recently been applied and deployed at several light source facilities in the domain of accelerator physics. Here, an approach based on machine learning to produce a fast-executing model is introduced that predicts the polarization and energy of the radiated light produced at an insertion device. This paper demonstrates how a machine learning model can be trained on simulated data and later calibrated to a smaller, limited measured data set, a technique referred to as transfer learning. This result will enable users to efficiently determine the insertion device settings for achieving arbitrary beam characteristics.

Ultrasonography in Tubo-Ovarian Abscess: A Case Study

Tubo-ovarian abscess (TOA) is one of acute complications of pelvic inflammatory disease that usually occur in woman of childbearing age. Factors associated with TOA are reproductive age, Intra-Uterine Device (IUD) insertion, multiple sexual partners, and a history of a prior episode of PID. The classic presentation of a TOA includes abdominal pain, pelvic mass on examination, fever, and leukocytosis. However, prompt diagnostic evaluation must be undertaken to specify the diagnosis. Tubo-ovarian abscess can be found on imaging with ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography as the cheaper of all could be used as first-line diagnostic modality. This study presents an example of ultrasonography examination of 42-year-old woman presenting with stomach pain and fever. Abdominal ultrasonography was performed and we found abscess formation in adnexa. Emergency surgery was performed and antibiotics were given after surgery. This study showed us how abdominal ultrasound could diagnose tubo-ovarian abscess.