Device Insertion Research Articles

Moving scope technique improves technical success rate of device insertion during EUS-guided hepaticogastrostomy (with video).

Technical tips for device insertion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) have not been reported. To improve the technical success rate of device insertion without unnecessary tract dilation, the pushing force should be transmitted directly from the channel of the echoendoscope to the intrahepatic bile duct. We developed a novel technique, termed the 'moving scope technique', the feasibility of which during EUS-HGS is described. Retrospective study. The primary outcome of this study was the technical success rate of dilation device insertion without electrocautery dilation after the moving scope technique. The initial technical success rate of dilation device insertion was defined as successful insertion into the biliary tract. If dilation device insertion failed, the moving scope technique was attempted. A total of 143 patients were enrolled in this study. The initial technical success rate for device insertion was 80.4% (115/143). The moving scope technique was therefore attempted in 28 patients. The mean angle between the intrahepatic bile duct and the guidewire was improved to 141.0° and resulted in a technical success rate of 100% (28/28). The area under the ROC curve (AUC) was 0.88, and 120° predicted successful dilation device insertion with sensitivity of 88.0% and specificity of 78.8%. Bile peritonitis (n = 8) and cholangitis (n = 2) were observed as adverse events, but were not severe. In conclusion, the moving scope technique may be helpful during EUS-HGS to achieve successful insertion of the dilation device into the biliary tract. These results should be evaluated in a prospective randomized controlled trial.

Evaluation of awareness, acceptability, and clinical outcome of postpartum vaginal insertion and intra-cesarean insertion of intrauterine contraceptive device

Background: Post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD) is a lucrative family planning method which provides safe, effective reversible, inexpensive, non-hormonal, and long-acting contraception. Aims and Objectives: The objective of the study is to evaluate the postpartum insertion of intrauterine contraceptive device in terms of awareness, acceptance, safety, efficacy, continuation, and removal rate and its complications in both vaginal as well as intra-cesarean section (CS) insertion. Materials and Methods: Prospective observational study conducted in Obstetrics and Gynaecology Department GMERS sola for 6 months. Two thousand and ninety-four pregnant women from labor room who delivered vaginally or by CS during study period were asked regarding their knowledge and acceptability for PPIUCD. Results: Total 2094 women evaluated for awareness and acceptance for PPIUCD. About 68.66% were familiar with the concept with 29.99% giving verbal consent for its insertion. About 60.01% women refused for various reasons. Conclusion: This study shows that PPIUCD insertion is a safe and convenient method which requires more population awareness, counseling, and usage.

Knowledge, Acceptability and Misconceptions Regarding Menstrual Cup among College Students of Kerala: A Cross-Sectional Study

Background: Menstrual cup is a good, safe, hygienic, eco-friendly and economical option for menstrual managementthan other menstrual products. The present study aims to find knowledge, acceptability, and misconceptions ofmenstrual cup among female college students in Kerala.Materials and methods: A cross-sectional study was conducted among 187 participants studying in Engineeringor Arts College of Ernakulam district using consecutive sampling technique. A semi-structured expert validatedquestionnaire containing socio-demographic details and questions regarding awareness, acceptability andmisconceptions of menstrual cup was used. Data was analysed using SPSS software.Results: Mean age of the participants was 20.49 ± 2.07 years. 40(21.3%) were aware of hand hygiene beforeinsertion, 43(24.6%) knew average emptying time, 117(62.6%) sterilisation method, and 60(32.1%) knew regardingstorage of cup. But only 2[1.07% (95% CI= 0.00 - 2.5)] participants were using menstrual cup regularly. The mainmisconceptions regarding menstrual cup were, the insertion of device is painful [107(57.2%)], and someone withheavy menstrual flow cannot use the cup [48(25.7%)].Conclusion:Knowledge and acceptability regarding use of menstrual cup were poor. Many misconceptions were stillprevailing among the potential users. Proper awareness and health education should be implemented to increaseits acceptability and to correct the prevailing misconceptions.

Commissioning simulations for the DIAMOND-II upgrade

The Diamond-II [1] storage ring, compared to Diamond, improves the natural emittance from 2.7 nm to 160 pm and the beam energy from 3 to 3.5 GeV. The number of straight sections is also doubled from 24 to 48 thanks to the modified hybrid six-bend-achromat lattice. To reduce the impact on the existing science program, the dark time period must be minimised. To assist in this aim, storage ring commissioning simulations have been carried out to predict and resolve possible issues. These studies include beam commissioning starting from on-axis first-turn beam threading up to beam based alignment and full linear optics correction with stored beam. The linear optics corrections with insertion devices are also included. The machine characterisations at different stages are compared. Considerations on realistic chamber limitations, error definitions and some commissioning strategies are also discussed.

Beam orbit shift due to BPM thermal deformation using machine learning

Stabilizing beam orbit is critical for advanced synchrotron radiation light sources. The beam orbit can be affected by many sources. To maintain a good orbit stability, global orbit feedback systems (OFB) has been widely used. However, the BPM thermal deformation would lead to BPM misreading, which can not be handled by OFB. Usually, extra diagnostics, such as position transducers, is needed to measure the deformation dependency of BPM readings. Here, an alternative approach by using the machine operation historic data, including BPM temperature, insertion device (ID) gaps and corrector currents, is presented. It is demonstrated at Hefei Light Source (HLS). The average orbit shift due to BPM thermal deformation is about 34.5 μm/°C (horizontal) and 20.0 μm/°C (vertical).

LMA Protector ve Baska Maskın Retrograd Üreteroskopik Cerrahide Karşılaştırılması: Prospektif Randomize Klinik Çalışma

Objective: The Baska and the Protector Laryngeal masks are single-use second-generation supraglottic airway devices with a dual gastric channel. Material and Methods: 64 American Society of Anesthesiologists physical status 1-2 patients between the ages of 18-70 undergoing retrograde ureteroscopic surgery enrolled in this prospective randomized study. Results: Demographic airway variables and airway characteristics were similar between the groups. Insertion time was shorter in the Baska mask group [14 (11-20) versus 20 (13-27) seconds, p=0.035]. The need for optimization maneuvers during insertion was higher for the Baska mask group (p=0.009). The laryngeal mask airway (LMA) insertion was easier in the LMA Protector group (p=0.023). The first insertion success rate was 75% for the LMA Protector and 84% in the Baska mask. The total success rate of both devices was 91%. Nasogastric tube insertion was faster in the Baska mask group [14 (12-15) versus 17 (13-25) seconds; p=0.003]. Fiberoptic views were similar between the groups. Minute volume after insertion of the device was higher in the LMA Protector group [8 (6.5-10) L/min versus 6 (5-7) L/min; p<0.001]. Expiratory tidal volume was higher in the LMA Protector group after insertion of the device, 15 minutes, 30 minutes, and 45 minutes after insertion (p<0.001, p=0.032, p=0.001, p=0.027 respectively). The end-tidal sevoflurane concentration (ETsevo) 30 minutes after device insertion was higher in the Baska mask group (1.49±0.38 vs 1.75±0.36; p=0.014). Conclusion: The LMA Protector is superior to the Baska mask in providing higher tidal volumes and decreased need for optimization maneuvers in retrograde ureteroscopic surgery.

Outcomes of Intrauterine Device Insertion by Certified Midwives and Obstetric Nurse Practitioners.

to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center. a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews. no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction. the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.

Implementation of modified Seldinger technology for percutaneous catheterization in critically ill newborns.

To describe the implementation of Modified Seldinger Technology for percutaneous catheterization in critically ill newborns. A quasi-experimental before- and-after study, carried out with neonatologist nurses in a Neonatal Intensive Care Unit. Seven nurses participated in the research. Catheter pre-insertion, insertion and maintenance were assessed using the conventional and modified Seldinger technique. Reliability was satisfactory in pre-test, 5.40 (Md = 6.00), and post-test, 5.94 (Md = 7.00), and perfect in the items about device insertion and maintenance. There was low assertiveness in the items on indication, microintroduction procedure via ultrasound, limb repositioning and disinfection of connections/connectors. Despite the Modified Seldinger Technique expanding some stages of execution over the traditional method of percutaneous catheterization, nurses were more assertive after theoretical-practical training. The technology was implemented and is in the process of being implemented in the health service.

Clinical outcomes of intrauterine device insertions by newly trained providers: The ECHO trial experience

ObjectivesTo assess the rates of failed insertion, expulsion, and perforation when intrauterine device (IUD) insertions were done by newly trained clinicians, and to examine factors that may affect these outcomes. Study designWe evaluated skill-based outcomes following IUD insertion at 12 African sites in a secondary analysis of the Evidence for Contraceptive Options and HIV Outcomes (ECHO) randomized trial. Before trial initiation, we provided competency-based IUD training to clinicians and offered ongoing clinical support. We used Cox proportional hazards regression to examine factors associated with expulsion. ResultsAmong 2582 IUD acceptors who underwent first attempted IUD insertion, 141 experienced insertion failure (5.46%) and seven had uterine perforation (0.27%). Perforation was more common among breastfeeding women within three months postpartum (0.65%) compared with non-breastfeeding women (0.22%). We recorded 493 expulsions (15.5 per 100 person-years, 95% confidence interval [CI] 14.1─16.9): 383 partial and 110 complete. The risk of IUD expulsion was lower among women older than 24 years (aHR 0.63, 95% CI 0.50─0.78) and may be higher among nulliparous women. (aHR 1.65, 95% CI 0.97─2.82). Breastfeeding (aHR 0.94, 95% CI 0.72─1.22) had no significant effect on expulsion. IUD expulsion rate was highest during the first three months of the trial. ConclusionsIUD insertion failure and uterine perforation rates in our study were comparable to those reported in the literature. These results suggest that training, ongoing support, and opportunities to apply new skills were effective in ensuring good clinical outcomes for women receiving IUD insertion by newly trained providers. ImplicationsData from this study support recommendations to program managers, policymakers, and clinicians that IUDs can be inserted safely in resource-constrained settings when providers receive appropriate training and support.

Standard Technique versus Rotational Technique of Insertion of Baska Mask®

Background and Aims: Baska Mask® is a new third-generation supraglottic airway device (SGAD). The placement of Baska Mask® using the standard technique causes posterior displacement of the tongue, leading to incorrect positioning and insertion failure. The rotation technique may alleviate this obstacle during insertion by decreasing resistance between the airway and tongue. The primary objective of this study was to compare the insertion time between the standard versus rotational technique of Baska Mask®, and the secondary outcome measures were ease of insertion, number of attempts and postoperative airway morbidity with both techniques. Methods: One hundred consenting adults of the American Society of Anaesthesiologists I-II, aged 20–65 years of either gender scheduled for a variety of surgical procedures under general anaesthesia in a tertiary care hospital (May 2019 to November 2020), were included in the study. The patients were randomly allocated to Group S and Group R using the standard and rotation techniques, respectively. All statistical analyses were done using the SPSS (Statistical Package for the Social Sciences) software. The comparison of quantitative variables between the study groups was done using the Student's t-test and Mann–Whitney test. For comparing categorical data, the Chi-square χ 2 test was performed. Results: The mean insertion time was significantly higher with the standard compared to the rotation technique of Baska Mask (20.90 ± 3.13 vs. 14.84 ± 1.11 s, P = 0.000). Device insertion was easy in rotation compared to the standard technique (P = 0.031). The number of attempts required for insertion was more with the standard technique than with the rotation technique (P = 0.011). Conclusion: Although the standard technique of Baska Mask® remains the first choice, the rotational technique of Baska Mask® has a higher success of insertion with fewer complications than the standard technique; hence, it can be accepted as an alternative.

Sublingual misoprostol before insertion of levonorgestrel-releasing intrauterine contraceptive device in lactating women following cesarean section

Sublingual misoprostol before insertion of levonorgestrel-releasing intrauterine contraceptive device in lactating women following cesarean section

Immediate Postpartum Insertion of Copper Intrauterine Device in a Brazilian University Hospital: Expulsion and Continuation Rates.

To evaluate the expulsion and continuation rates of the copper intrauterine device (IUD) inserted in the immediate postpartum period in a Brazilian public university hospital. In the present cohort study, we included women who received immediate postpartum IUD at vaginal delivery or cesarean s March 2018 to December 2019. Clinical data and the findings of transvaginal ultrasound (US) scans performed 6-weeks postpartum were collected. The expulsion and continuation rates were assessed 6-months postpartum using data from the electronic medical records or by telephone contact. The primary outcome was the proportion of IUDs expelled at 6 months. For the statistical analysis, we used the Student t-test, the Poisson distribution, and the Chi-squared test. There were 3,728 births in the period, and 352 IUD insertions were performed, totaling a rate of 9.4%. At 6 weeks postpartum, the IUD was properly positioned in 65.1% of the cases, in 10.8% there was partial expulsion, and in 8.5% it had been completely expelled. At 6 months postpartum, information was obtained from 234 women, 74.4% of whom used IUD, with an overall expulsion rate of 25.6%. The expulsion rate was higher after vaginal delivery when compared with cesarean section (68.4% versus 31.6% respectively; p = 0.031). There were no differences in terms of age, parity, gestational age, final body mass index, and newborn weight. Despite the low insertion rate of copper IUDs in the postpartum period and a higher expulsion rate, the rate of long-term continuation of intrauterine contraception was high, indicating that it is a useful intervention to prevent unwanted pregnancies and to reduce short-interval birth.

Novel curved tongue depressor for the easier insertion of supraglottic airway devices

Novel curved tongue depressor for the easier insertion of supraglottic airway devices

Intraventricular Hemorrhage and Related Hydrocephalus Patients Demographics in a University Hospital NICU: Single-Center Data.

To analyze the demographic and clinical data of preterm or low birth weight newborns with periventricular hemorrhage. This retrospective study analyzed patients admitted to the neonatal intensive care unit of a Bahcesehir University School of Medicine-Affiliated Hospital due to preterm birth or low birth weight between June 1, 2012, and April 30, 2021. Categorical values were evaluated by Pearson chi-square or Fisher's exact test. The Mann-Whitney U test compared continuous values between the groups. Logistic regression was used to evaluate the factors that affected permanent cerebrospinal fluid (CSF) diversion. The study finally evaluated 180 newborns. Ninety-one newborns (50.5%) had grade I, 18 (10%) had grade II, 22 (12.2%) had grade III, and 49 (27.2%) had grade IV hemorrhage. One hundred and forty-nine patients (82.8%) were delivered by cesarean section, and 31 (17.2%) were delivered vaginally. All patients with low-grade hemorrhage who needed temporary CSF diversion eventually required permanent CSF diversion. For high-grade hemorrhage, 15 (grade III, 1; grade IV, 14) of 51 (29.4%) patients with ventricular access device (VAD) insertion required permanent CSF diversion. Fifteen (grade III, 6; grade IV, 9) of these 51 (29.4%) patients did not need permanent CSF diversion; thus, their VADs were removed. The permanent CSF diversion rate was significantly higher in the high-grade hemorrhage group, which had significantly lower weight and gestational age at birth. Moreover, only weight at VAD insertion had minimal effect on the need for permanent CSF diversion.

Факторы риска плохой подготовки к колоноскопии и сравнение способов очищения кишечника в педиатрии

Objective. To study the influence of constipation in the anamnesis, diet as risk factors for inadequate bowel preparation for colonoscopy in children, after bowel preparation with sodium picosulfate with magnesium citrate , cleansing enemas or with combination of both. Patients and methods. Children (1 year – 17 years 11 months) were referred for routine colonoscopy to two children's hospitals in Moscow and were randomly assigned three types of preparation for the research. Exclusion criteria were the need for an emergency colonoscopy, kidney disease, or colectomy. All patients were prescribed low-fiber diet during three days before the procedure. Endoscopists did not know about the method of preparation and evaluated the effectiveness of preparation according to the Boston Bowel Preparation Scale (BBPS ), noting the maximum depth of insertion of device (intubation of the cecum, ileum, etc.). Tolerability of methods and adherence of diet were assessed using the questionnaire for patients, as well as by the incidence of undesirable effects. The BBPS of ≥2 in 3 segments of the colon (left, transverse, right) was considered satisfactory, while BBPS &lt;2 in more than 1 segment was considered unsatisfactory. Results. 440 children (mean age 12 years) were randomly assigned to bowel preparation with sodium picosulfate with magnesium citrate (n = 135), cleansing enemas (n = 79) or combination (n = 226) . The satisfactory result of preparation was achieved in 127 (94.1%) patients in the bowel preparation with sodium picosulfate group, in 71 (90%) in the group with cleansing enemas and in 201 (89%) using the combined method (BBPC value for bowel preparation with sodium picosulfate 7.0 (6.0–8.0), Cleansing enemas 7.0 (5.0–8.0), Combination 6.5 (6.0–8.0), p = 0.009). Analysis of logistic regression showed that age, body mass index and the presence of a diagnosis of constipation in the anamnesis did not affect (p &gt; 0.05)to success of achieving the satisfactory result of bowel preparation in all groups (p &gt; 0.05). However, constipation was associated with depth of insertion and intubation of the cecum and/or terminal ileum, which was 6.8 times less likely in patients with constipation (OR = 0.146; 95% CI: 0.036–0.602, p = 0.014). In patients who followed the diet, inadequate bowel preparation was observed with a probability of 7.4 times less (OR = 0.135; 95% CI: 0.053–0.345, p &lt; 0.001). In children who followed the dosage, the probability of inadequate bowel preparation was also 7.393 times lower, regardless of the method of preparation (OR = 0.135; 95% CI: 0.053–0.345, p &lt; 0.001). Frequency of undesirable effects between the groups was almost the same, there was no statistically significant difference (sodium picosulfate 29%, cleansing enemas 27%, combination 39%, p = 0.03). Conclusion. The results of our study show that in children without constipation on diet and adequate doses of medicines makes it easier to tolerate preparation, qualitatively prepare the intestines and conduct full colonoscopy. We consider that these criteria are the most important for bowel cleansing and the quality of the colonoscopy performed in children, regardless of the methods of colon preparation. Key words: colonoscopy, children, pediatrics, preparation

Comparison of Omentum and Subcutis as Implant Sites for Device-Encapsulated Human iPSC-Derived Pancreatic Endoderm in Nude Rats

Subcutaneous implants of device-encapsulated stem cell–derived pancreatic endoderm (PE) can establish a functional beta cell mass (FBM) with metabolic control in immune-compromised mice. In a study with human-induced pluripotent stem cell-PE, this outcome was favored by a preformed pouch which allowed lesion-free insertion of devices in a pre-vascularized site. This was not reproduced in nude rats, known to exhibit a higher innate reactivity than mice and therefore relevant as preclinical model: a dense fibrotic capsule formed around subcutis (SC) implants with virtually no FBM formation. Placement in omentum (OM) of nude rats provided a less fibrous, better vascularized environment than SC. It resulted in less donor cell loss (56% recovery at post-transplant-PT week 3 versus 16% in SC) allowing FBM-formation. At PT week 30, 6/13 OM-recipients exhibited glucose-induced plasma hu-C-peptide to 0.1–0.4 ng/ml, versus 0/8 in SC-recipients. These levels are more than 10-fold lower than in a state of metabolic control. This shortcoming is not caused by inadequate glucose responsiveness of the beta cells but by their insufficient number. The size of the formed beta cell mass (0.4 ± 0.2 µl) was lower than that reported in mice receiving the same cell product subcutaneously; the difference is attributed to a lower expansion of pancreatic progenitor cells and to their lower degree of differentiation to beta cells. This study in the nude rat model demonstrates that OM provides a better environment for formation of beta cells in device-encapsulated PE-implants than SC. It also identified targets for increasing their dose-efficacy.

Parameter optimization and test of hydraulic soil insertion device of orchard gas explosion subsoiling and fertilizing machine

Parameter optimization and test of hydraulic soil insertion device of orchard gas explosion subsoiling and fertilizing machine

Parallelization of Radia magnetostatics code

Radia 3D magnetostatics code has been used for the design of insertion devices for light sources over more than two decades. The code uses the magnetization integral approach that is efficient for solving permanent magnet and hybrid magnet structures. The initial version of the Radia code was sequential, its core written in C++ and interface in the Mathematica language. This paper describes a new Python interfaced parallel version of Radia and its applications. The parallelization of the code was implemented on C++ level, where the semi-analytical calculations of interaction matrix elements and resultant magnetic fields were parallelized using the Message Passing Interface. The parallel performance results are encouraging, particularly for magnetic field calculation post relaxation where a ∼600 speedup with respect to sequential execution was obtained. The new parallel Radia version facilitates designs of insertion devices and lattice magnets for novel particle accelerators.

A concept of "materials" diffraction and imaging beamline for SKIF: Siberian circular photon source.

Over the next decade, the extremely brilliant fourth generation synchrotron radiation sources are set to become a key driving force in materials characterization and technology development. In this study, we present a conceptual design of a versatile "Materia" diffraction and imaging beamline for a low-emittance synchrotron radiation facility. The beamline was optimized for operation with three main principal delivery regimes: parallel collimated beam ∼1mm beam size, micro-focus regime with ∼10μm beam spot size on the sample, and nano-focus regime with <100nm focus. All regimes will operate in the photon energy range of 10-30keV with the key feature of the beamline being fast switching between them, as well as between the various realizations of diffraction and imaging operation modes while maintaining the target beam position at the sample, and with both spectrally narrow and spectrally broad beams up to the energy band ΔE/E of 5 × 10-2. The manuscript presents the details of the principal characteristics selected for the insertion device and beamline optics, the materials characterization techniques, including the simulations of thermal load impact on the critical beamline optics components. Significant efforts were made to design the monochromators to mitigate the very high beam power load produced by a superconducting undulator source. The manuscript will be of interest to research groups involved in the design of new synchrotron beamlines.

Cost Effective Trend in Epistaxis Management

Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.