Large Balloon Research Articles

Efficacy of Single-Operator Cholangioscopy-Guided Lithotripsy Compared With Large Balloon Sphincteroplasty in Management of Difficult Bile Duct Stones in a Randomized Trial

Although single-operator cholangioscopy (SOC)-guided lithotripsy and large balloon sphincteroplasty (LBS)-based techniques are effective rescue measures, the ideal approach to management of difficult bile duct stones is unclear. We conducted a randomized trial to compare the effectiveness of SOC-guided lithotripsy and LBS-based approaches for endoscopic management of difficult bile duct stones. Patients with difficult bile duct stones who failed retrieval using balloon or basket were randomly assigned to groups that received SOC-guided laser lithotripsy (SOC-LL, n= 33) or LBS (n= 33), from June 2016 through August 2018. When assigned treatment was unsuccessful, patients underwent mechanical lithotripsy before crossing over to the other group. The main outcome was treatment success, defined as ability to clear the duct in 1 session. Secondary outcomes were adverse events and treatment costs. A higher proportion of patients in the SOC-LL group had treatment success (93.9%) than in the LBS group (72.7%; P= .021). On multiple logistic regression analysis, treatment success was significantly associated with use of SOC-LL (odds ratio [OR], 8.7; 95% CI, 1.3-59.3; P= .026), stone to extrahepatic bile duct ratio of 1 or less (OR, 28.8; 95% CI, 1.2-687.6; P= .038), and lack of a tapered bile duct (OR, 26.9; 95% CI, 1.3-558.2; P= .034). There was no significant difference between groups in adverse events (9.1% in the SOC-LL group vs 3.0% in the LBS group, P= .61) or overall treatment cost ($16,684 in the SOC-LL group vs $10,626 in the LBS group; P= .097). In a randomized trial of patients with difficult bile stones that cannot be cleared by standard maneuvers, SOC-guided lithotripsy leads to duct clearance in a significantly higher proportion of patients than LBS-particularly when stone size exceeds the diameter of the extrahepatic bile duct. Adjunct lithotripsy might be required in patients with tapered distal bile duct, because LBS alone is less likely to be successful. ClinicalTrials.gov no: NCT00852072.

Is Endoscopic Balloon Dilation Still Associated With Higher Rates of Pancreatitis?: A Systematic Review and Meta-Analysis.

The objective of this study was to compare the efficacy and safety of endoscopic papillary balloon dilation (EPBD), endoscopic sphincterotomy (ES), and the combination of large balloon dilation and ES (ES + EPLBD) in the treatment of common bile duct stones, with a special focus on postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Individualized search strategies were developed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) which evaluated at least one of the following outcomes: PEP, complete stone removal in the first ERCP, need for mechanical lithotripsy, recurrence of common bile duct stones, bleeding, and cholangitis. Twenty-five RCTs were selected for analysis. Pancreatitis rates were higher for EPBD than for ES (P = 0.003), as were severe pancreatitis rates (P = 0.04). However, in the 10-mm or greater balloon subgroup analysis, this difference was not shown (P = 0.82). Rates of PEP were higher in the subgroup of non-Asian subjects (P = 0.02), and the results were not robust when RCTs that used endoscopic nasobiliary drainage were omitted. The incidence of pancreatitis was comparable between EPLBD and ES + EPLBD. All 3 approaches were equally efficacious. Nevertheless, the results should be interpreted with caution, because pancreatitis is a multifactorial pathology, and RCTs can have limited generalizability.

The mechanism of balloon Eustachian tuboplasty: a biomechanical study

Obstructive Eustachian tube dysfunction (OETD) is a common condition resulting from inadequate opening of the Eustachian tube (ET). A new surgical treatment involves high-pressure inflation of a balloon within the ET, with the aim of dilating the soft tissue structure. However, the mechanical effects of this intervention have not been established, nor the impact of changing device size or other technical parameters. A novel experimental technique allowed quantification of plastic and elastic tissue deformation in model materials and then human cadaver ETs during balloon dilation, based on the measured balloon inflation pressure-volume relationship. Plastic tissue deformation was found to be greater using larger balloons and deeper device insertion, but increasing the inflation pressure had a more limited effect, with most deformation occurring well below the clinically used pressures. Histological assessment of ET tissue suggested that mucosal tearing and cartilage cracking were in part responsible for the mechanical changes. Balloon dilation of the ET has huge potential if found to be clinically effective, but currently there is a need to understand and develop the technique further. The novel methods employed in this study will be valuable in future laboratory and in vivo studies of ET balloon dilation. Pressures are reported in Bar as this unit is used for medical balloon dilation procedures in clinical practice. 1 Bar = 100,000 Pa.Graphical abstract captionDilation of the Eustachian tube for obstructive dysfunction is performed clinically with 3- and 6-mm-diameter balloons of approximately the same overall length. Our data suggest that dilation with a 6-mm balloon causes greater deformation of the soft tissue structure than dilation with a 3-mm balloon. This difference has yet to be demonstrated clinically. Plastic deformation was measured in terms of energy (J) dissipated during balloon inflation.

HighAltitude ballooning

Every person would have thought of this idea of launching aballoon high up in the sky in their youth, and that is exactlywhat we did. We filled a large elastic balloon filled withhelium and flew it high up into the sky until it popped andlanded on the ground. The main purpose of this high altitudeballooning is to collect and measure various kinds of datafrom the balloon flights. Addition to that, we add severalother new kinds of interesting experiments such as addingsolar flux or bacteria cells to the payload boxes attached tothe balloon. While experimenting on multiples of flights, weoften ran into problems and failed to succeed in variouskinds of experimentations, but we learned from thosemistakes and collected significant amount of data related tothe balloon flight such as speed, and altitude.

Endoscopic papillary large balloon dilation alone or combined with small or complete sphincterotomy for the removal of large common bile duct stones

Endoscopic papillary large balloon dilation alone or combined with small or complete sphincterotomy for the removal of large common bile duct stones

Research and analysis of stiffness-enhanced soft gripper

In view of the problems of low stiffness, small driving force and large balloon effect existing in the current soft actuator, this paper proposes an optimization method to enhance the overall stiffness of the soft gripper by using rigid components based on the multi-cavity soft pneumatic actuator. This paper introduces the main components of the actuator: the soft part poured by liquid silica gel, and the open rectangular rigid structures by 3D printed. The kinematics model of the finger is established based on the Piecewise Constant Curvature model(PCC). The bending performance of the enhanced stiffness gripper is verified by finite element analysis(FEA): the tip force of actuator increased with the increase of the number of rigid structures when the bending angle is constant. According to the and experimental data, the overall stiffness of soft gripper is increased by the rigid structure without affecting the flexibility of operation. And the maximum weight which can grasp is 3.4 times that of the traditional soft gripper, improved the grasping range of the soft gripper effectively.

Role of ERCP in Diagnosis and Treatment of Type I Mirizzi Syndrome: A Case Series with Review of Literature

Background/aim: Mirizzi syndrome is a rare condition complicating long-standing gallstones disease. The aim of this study is to define, through a 17 year-experience, the role of Endoscopic Retrograde Cholangiopancreatography in the diagnosis and the treatment of Mirizzi syndrome type I according to Csendes classification. Materials and Methods: A retrospective study including patients diagnosed with Mirizzi syndrome type I, between 2002 and 2019 was conducted in the department of digestive endoscopy of our university hospital. Data collected included demographic, clinical, biological and imaging findings. Endoscopic characteristics and procedures used for treatment were collected. Statistical analysis was performed using SPSS 20.0. Results: Type I Mirizzi syndrome was diagnosed during ERCP in 0,48% of patients with gallstone disease, the median age was 55.5 (46-69.5) without gender difference. 50% of our cases were diagnosed before surgery. Endoscopic therapeutic procedures included biliary decompression techniques using nasal bile drainage or plastic stents, balloon sweeping after selective catheterization of cystic duct and large balloon papillary dilation with double cannulation. The success rate of endoscopic management was 66,6%. Surgical treatment was performed at the same time as laparoscopic cholecystectomy in patients with lithiasic gall bladder. Conclusions: Mirizzi syndrome remains a fascinating and rare condition complicating gallstone disease with no uniform guidelines to date. Our study emphasizes the role of ERCP as a diagnostic and therapeutic procedure in the management of type I Mirizzi syndrome.

Endoscopic papillary large balloon dilation for pancreatic duct stone: a first report.

Endoscopic papillary large balloon dilation for pancreatic duct stone: a first report.

Air pressure in mini hovercraft

calculate the pressure on the mini hovercraft experiments by using the formula by knowing the mass of large balloon is 20,49 gr with a force of 0,2045 N was counted after balloon filled by air. The surface area was 0.011304 m2 so the obtained pressure was 18.09 Pa. Calculation of a small balloon pressure with a mass of 20.3 g calculated after the balloon is filled with air by the force of surface area 0.203 the N of the surface area 0,011304 m2 then the pressure of Pa is 17.95. A simple mini hovercraft that used for physics learning media on the pressure principal explains the utilization of air pressure on the mini hovercraft. The making of this mini hovercraft as a learning media is aimed to show the concept of pressure. From the results of observation and analysis of the data, it was proved that air pressure generated can produce bigger lift than the mini hovercraft weight. The air flowing out from the balloon in the bottom caused the mini hovercraft to be pushed upward.

Endoscopic Papillary Balloon Dilation/Endoscopic Papillary Large Balloon Dilation

ë‚´ì‹œê²½ìœ ë‘í’ì„ í™•ìž¥ìˆ (EPBD)ê³¼ ë‚´ì‹œê²½ìœ ë‘í°í’ì„ í™•ìž¥ìˆ (EPLBD)은 총담관결석의 치료를 위하여 지난 수십 ë „ê°„ ì „ì„¸ê³„ì ìœ¼ë¡œ 시행되어왔다. 직경이 작은 확장용 í’ì„ ë„ê´€ì„ 이용한 EPBD는 ë‚´ì‹œê²½ê´„ì•½ê·¼ì ˆê°œìˆ (EST)에 비하여 ìœ ë‘ê´„ì•½ê·¼ì˜ 기능을 보존하며 담관결석의 ìž¬ë°œë¥ ì„ 감소시킬 수 있다. 또한 이들 ì‹œìˆ ì€ 출혈 발생 위험성이 낮아서 ì‘ê³ ë³‘ì¦ì´ë‚˜ 간경변, ë§ê¸°ì‹ ì§ˆí™˜ 및 Billroth ìœ„ì ˆì œìˆ ê³¼ 같은 ì™¸ê³¼ì ìœ¼ë¡œ 변화된 해부구조를 가지거나 ë°©ìœ ë‘ê²Œì‹¤ì´ 있는 환자에 ì í•©í•˜ë‹¤. 그러나 ì‹œìˆ í›„ 췌장염 발생의 위험은 더 크다. 12 mm 이상 직경의 큰 í’ì„ ë„ê´€ì„ 이용한 EPLBD는 총담관결석이 10 mm 이상으로 큰 경우에 ì í•©í•˜ë‹¤. EPLBD의 ìž¥ì ìœ¼ë¡œ EST ì„ í–‰ 여부와 관계 없이 ê¸°ê³„ì  ì‡„ì„ìˆ ì˜ 필요성을 줄여 ì‹œìˆ ì‹œê°„ì„ ë‹¨ì¶•í•˜ê³ , ë°©ì‚¬ì„ ë ¸ì¶œì‹œê°„ì„ 줄일 수 있다는 것이다. ê·¸ë¦¬ê³ ì™„ì „ ê²°ì„ì œê±°ì— 필요한 ERCP 횟수도 줄여서 보다 비용-íš¨ê³¼ì ì´ë‹¤. EPLBD에서의 ì‹œìˆ í›„ 췌장염의 ë°œìƒë¥ ì€ EST에 비하여 낮다. EPBD와 EPLBD는 ì•ˆì „í•œ ì‹œìˆ ê°€ì´ë“œë¼ì¸ì„ 준수하여 시행한다면, 총담관결석증 치료에 있어서 ì•ˆì „í•˜ê³ íš¨ê³¼ì ì´ë©° EST의 대안이 ë ìˆ˜ 있을 것이다. Keywords: 총담관결석증, ë‚´ì‹œê²½ìœ ë‘í’ì„ í™•ìž¥ìˆ , ë‚´ì‹œê²½ìœ ë‘í°í’ì„ í™•ìž¥ìˆ , ë‚´ì‹œê²½ê´„ì•½ê·¼ì ˆê°œìˆ

Repair of an Anastomotic Pseudoaneurysm with a Novel Hybrid Technique

Anastomotic false aneurysms are a late complication of aortic grafting. Treatment usually consists of débridement of the degenerated tissue and placement of a short interposition graft. In infectious situations, graft excision is required. An 80-year-old frail man with numerous comorbidities presented to clinic with an anastomotic pseudoaneurysm (PSA) between the left limb of an aortobifemoral Dacron graft and the common femoral artery (FA). The superficial FA (SFA) and deep FA (PFA) were exposed and controlled from an anterior thigh approach. Sheaths were inserted in each artery. An Amplatzer II vascular plug (Abbott, Abbott Park, IL) was deployed in the PFA. A Viabahn (Gore, Flagstaff, AZ) was first deployed in the left limb of the Dacron graft and into the proximal SFA. A Viabahn VBX stent (Gore, Flagstaff, AZ) was then deployed from inside the Viabahn and going proximally further into the limb of the bifurcated Dacron graft. The proximal end of the Viabahn VBX was flared with a larger balloon. The arteriotomies in the SFA and PFA were then used to create a side-to-side anastomosis. There were no immediate complications. On 6 months follow-up, the PSA sac was noted to have decreased in size, and the stents to be patent with no endoleak. Elective surgical repair of anastomotic PSAs is preferred since emergent repair has significantly higher morbidity and mortality. Still, open elective repair has its own mortality and limb loss risks in addition to postoperative wound infection, seroma, hematoma, and recurrence, along with myocardial infarction and stroke. The novel procedure we performed eliminated the risk factors of redo groin incision and added easier-to-control vessels in a clean field. With this procedure being performed more often in the future, these changes will hopefully prove to reduce complications while preserving flow in both the SFA and PFA.

Management of Difficult Bile Duct Stones by Large Balloon, Cholangioscopy, Enteroscopy and Endosonography.

Endoscopic management of bile duct stones is now the standard of care, but challenges remain with difficult bile duct stones. There are some known factors associated with technically difficult bile duct stones, such as large size and surgically altered anatomy. Endoscopic mechanical lithotripsy is now the standard technique used to remove large bile duct stones, but the efficacy of endoscopic papil-lary large balloon dilatation (EPLBD) and cholangioscopy with intraductal lithotripsy has been increas-ingly reported. In patients with surgically altered anatomy, biliary access before stone removal can be technically difficult. Endotherapy using two new endoscopes is now utilized in clinical practice: enter-oscopy-assisted endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided antegrade treatment. These new approaches can be combined with EPLBD and/or cholangioscopy to remove large bile duct stones from patients with surgically altered anatomy. Since various endoscopic procedures are now available, endoscopists should learn the indications, advantages and disad-vantages of each technique for better management of bile duct stones.

1361 Facilitating Direct Cholangioscopy and Lithotripsy in a Roux-en-Y Bypass With a Stuck Dilation Balloon

INTRODUCTION: A 66-year-old woman with a history of Roux-en-Y gastric bypass, thromboembolic CVA on dual antiplatelet therapy, and known common bile duct (CBD) stones presented an outside facility 2 months prior complaining of chronic intermittent abdominal pain and jaundice. She was in sepsis due to cholangitis and MRCP showed a 2.1 cm CBD stone. ERCP was unsuccessful due to her altered anatomy; therefore, she was treated medically and referred for repeat attempt at ERCP, lithotripsy and bile duct clearance. CASE DESCRIPTION/METHODS: ERCP was performed using a double balloon enteroscope (DBE). Ampulla was seen next to a periampullary diverticulum. Retrograde cannulation and cholangiogram showed 2 large stones (Figure 1). Sphincterotomy and balloon dilation was done to 10 mm and stone extraction attempted but failed due to their large size. The procedure was repeated with plans to perform cholangioscopy and electrohydraulic lithotripsy (EHL). The ampulla was further dilated using a 14 mm balloon to allow direct cholangioscopy using the DBE. Unfortunately, attempt at removing the dilating balloon afterwards failed due to the small lumen size of the scope. Therefore, the scope was removed while keeping the overtube in place. The balloon at the tip of the DBE was removed to facilitate direct cholangioscopy and the scope was readvanced through the overtube to the ampulla. The DBE without the scope balloon passed easily into the CBD. Two stones, a black pigmented and a brown pigmented, were seen (Figure 2) and fragmented using EHL. Stone fragments were cleared in the usual fashion and direct cholangioscopy confirmed bile duct clearance (Figure 3). DISCUSSION: ERCP is difficult in patients with prior Roux-en-Y gastric bypass. The newest approach is to place a lumen apposing metal stent (LAMS) from the gastric pouch to the remnant stomach then perform antegrade ERCP in the usual fashion. If this is not possible (e.g., unfavorable anatomy, patient, or surgeon refusal) then the only approach is retrograde using a DBE; our patient underwent ERCP prior to the introduction of LAMS. DBE ERCP is cumbersome at best due to the small channel size and limited maneuverability of the scope as well as lack of an elevator. For these reasons, the only way to perform lithotripsy is by direct cholangioscopy after large balloon dilation.

On the Significance of Salt Modelling—Example from Modelling of Salt Tectonics, Temperature and Maturity Around Salt Structures in Southern North Sea

Salt structures are attractive targets for hydrocarbon exploration. Salt can flow as a viscous fluid, act as hydrocarbon seal, and salt-related deformation may create reservoir traps. The high conductivity of salt can be crucial for hydrocarbon maturation in a basin. Here, we present results from the study of salt structures on the Eastern flank of Central Graben, on the Norwegian sector of the North Sea. By using our in-house basin modeling software (BMTTM), we modelled the salt structure evolution and the effects of salt on temperature and maturation. Our results show up to 85 °C cooling due to the salt heat pipe effect. An integrated impact of cooling is the depression of vitrinite Ro by up to 1.0% at the base of a large salt balloon. Our work shows that it is of critical importance to correctly identify salt volumes and to have a good geological model, and to understand the timing and geometrical evolution of salt structures. This study is, to our knowledge, the most specific analysis of the impact of salt on basin temperature and maturation published so far, and is an example of how basin modeling in the future should be an integrated part of exploration.

Predictive factors for extraction of common bile duct stones during endoscopic retrograde cholangiopancreatography in Billroth II anatomy patients.

Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in Billroth II anatomy patients is still a technical challenge and factors affecting stone extraction have not yet been clarified. This study aimed to analyze our experience and evaluate potential factors affecting CBD stone extraction. A retrospective analysis of CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from August 1999 to December 2017, was conducted. The outcomes of ERCP and potential factors affecting stone extraction were examined. A total of 227 patients were enrolled, and 176 patients (77.5%) achieved technical success. The success rate of duodenal ampullary access and selective biliary cannulation was 84.1% (191/227) and 92.1% (176/191), respectively. The mean CBD diameter was 15mm (range 6-35mm), and the largest stone size was 13mm (range 4-36mm). CBD stones were ultimately removed in 137 patients (77.8%), and 105 patients (59.7%) for the first session. Mechanical lithotripsy was used in 17 patients (9.7%). The overall ERCP-related complication rate was 6.3% (11/176), including bleeding in 3 patients (1.7%) and mild pancreatitis in 6 patients (3.4%). The multivariate analysis indicated that CBD stone number ≥ 2 (OR 2.171; 95% CI 1.095-4.306; p = 0.027), and the largest CBD stone size ≥ 12mm (OR 3.646; 95% CI 1.833-7.251; p < 0.001) were patient-related risk factors for failed stone removal; while the use of endoscopic papillary (large) balloon dilation (EPBD/EPLBD) (OR 0.291; 95% CI 0.147-0.576; p < 0.001) was a procedure-related protective factor for successful stone extraction. ERCP is safe and effective for extraction of CBD stones in Billroth II anatomy patients. The number and the largest size of CBD stones, and the use of EPBD/EPLBD are predictive factors for CBD stone extraction.

Large balloon expansion method for re-intervention after endoscopic ultrasound-guided hepaticogastrostomy for stent obstruction.

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Curative effects and prognosis of endoscopic papillary large balloon dilatation on the treatment of choledocholithiasis

Objective To evaluate the curative effect and prognosis of endoscopic papillary large balloon dilatation (EPLBD) in the treatment of choledocholithiasis. Methods A total of 153 patients with choledocholithiasis (>1.0 cm in stone diameter) admitted and treated in Shanxi People′s Hospital from August 2016 to November 2017 were randomly divided into two groups according to the random number table: the EPLBD group (n=83) and the small endoscopic sphincterotomy plus large balloon dilatation (ESLBD) group (n=70) . The success rate of stone removal, the rate of lithotripsy, and the incidence of short-term and long-term complications were compared between the two groups. Results There were no statistical differences between the EPLBD group and the ESLBD group in total stone removal rate [95.2% (79/83) VS 97.1% (68/70) , χ2=0.388, P=0.533] and one-time stone removal rate [92.8% (77/83) VS 90.0% (63/70) , χ2=0.375, P=0.540]. The lithotripsy rate between the two groups had no statistical difference [25.3% (21/83) VS 35.7% (25/70) , χ2=1.958, P=0.162]. There was no statistical difference in the incidence of recent complications between the two groups [43.4% (36/83) VS 40.0% (28/70) , χ2=0.178, P=0.673]. No postoperative perforation was found in either group. The follow-up time was 22.7±4.3 months in the EPLBD group, and 20.8±6.3 months in the ESLBD group.The cumulative recurrent rate of choledocholithiasis in the two groups were 2.4% (2/83) and 15.7% (11/70) , respectively, and the difference was significant (P=0.003) . Conclusion Simple EPLBD in the treatment of choledocholithiasis is equivalent to ESLBD in the success rate of stone removal, utilization rate of lithotripsy, and incidence of recent complications, but the long-term stone recurrence rate of EPLBD is lower than that of ESLBD. EPLBD is effective and safe on the treatment of choledocholithiasis. Key words: Choledocholithiasis; Cholangiopancreatography, endoscopic retrograde; Endoscopic papillary large balloon dilatation; Small endoscopic sphincterotomy plus large balloon dilatation

The efficacy of limited endoscopic sphincterotomy plus endoscopic papillary large balloon dilation for removal of large bile duct stones

BackgroundThe removal of large bile duct stones (> 15 mm) by conventional endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) can be challenging, requiring mechanical lithotripsy (ML) in addition to EST or EPBD. The primary complication of ML is basket and stone impaction, which can lead to complications such as pancreatitis and cholangitis. The present study aims to investigate the efficacy of limited EST plus endoscopic papillary large balloon dilation (EST-EPLBD) for large bile duct stone extraction with an extent of cutting < 1/2 the length of the papillary mound.MethodsWe enrolled 185 patients with ≥15 mm bile duct stones who received EST, EPLBD and limited EST-EPLBD treatment from January 1, 2010 to February 28, 2018, at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan). All patients were categorized into three groups: EST group (n = 31), EPLBD group (n = 96), and limited EST-EPLBD group (n = 58). The primary outcome variables were the success rate of complete stone removal and complications.ResultsThe limited EST-EPLBD group exhibited a higher success rate of the first-session treatment compared with the EST and EPLBD groups (98.3% vs. 83.9% vs. 86.5%; P = 0.032) but required a longer procedure time (32 (12–61) min vs. 23.5 (17–68) min vs. 25.0 (14–60) min; P = 0.001). The need for ML during the procedure was 4 (12.9%) in the EST group, 10 (10.4%) in the EPLBD group and 2 (3.4%) in the limited EST-EPLBD group. Post-procedure bleeding in the EST group was more common than that in the limited EST-EPLBD group (9.7% vs. 0%; P = 0.038). Furthermore, dilated bile duct was the only risk factor for bile duct stone recurrence in the limited EST-EPLBD group.ConclusionsLimited EST-EPLBD exhibits a higher success rate but requires marginally longer procedure time for the first-session treatment. Furthermore, dilated bile duct is the only risk factor for bile duct stone recurrence in patients undergoing limited EST-EPLBD.

Error Compensation for 3D Digital Laser Scanning Data Based on the Surface of Aluminum Coated F-12 Aramid Plain Weave Fabric and a Test of Configuration for Large Balloon

The measurement of the configuration parameters for the large balloon is an important content, including volume, surface area and specific size under a certain internal pressure. Non-contact measurement techniques using laser scanning have the advantage of fast acquiring large numbers of points. However, compared to their contact-based counterparts, these techniques are known to be less accurate. Furthermore, this accuracy depends on different parameters such as materials properties, surface texture, product color, etc. The large balloon is made by aluminum coated F-12 aramid plain weave fabric pieces. The digitizing errors for high-speed 3D digital laser scanning data based on the surface of F12 fabric material are analyzed and characterized in this paper. With error characterisation, an empirical model is obtained relating the errors to the influencing factor. Establishing a reasonable test scheme and using the technology of laser scanning, the spatial information of the surface for large balloon can be obtained quickly. The empirical formula is used to compensate for 3D laser scanning data of large balloon. The problem of compensation for 3D laser scanning data for improved test accuracy is addressed. The more accurate parameters of the configuration for large balloon are quickly obtained. This provides a method for the rapid, high-efficiency and high-precision test of configuration for large balloon.

Re-expansion of Osteoporotic Compression Fractures Using Bilateral SpineJack Implants: Early Clinical Experience and Biomechanical Considerations.

Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJackR (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.