Marker Pen Research Articles

Staining intraoperative topical solutions with fluorescein: enhancing the safety of sinus surgery.

Oxymetazoline HCl 0.05%, 1:100,000 lidocaine with epinephrine (lido+epi), and 1:1000 epinephrine are all colorless solutions employed in sinus surgery. Because lido+epi is injected whereas others are not, care must be taken to label all solutions to avoid inadvertent injection of oxymetazoline or concentrated epinephrine because of life-threatening complications. Dyes have been used to color solutions for visual identification, but efficacy and cost have never been compared. We sought to determine the effectiveness of surgical marking pen (gentian violet) and fluorescein strips as coloring agents in mediums commonly used in sinus surgery. In this specialty techniques study, 4 liquid mediums (normal saline [NS], 0.05% oxymetazoline, 1:1,000 epinephrine, and lido+epi) and 2 coloring agents (fluorescein strip and surgical marking pen) were combined separately. Photos and absorbance of each solution were obtained at 15-minute intervals over 2 hours using a spectrophotometer. Peak absorbance remained stable for all solutions with fluorescein. Absorbance also remained constant for NS (0.37 absorbance units [AU] → 0.37 AU) and oxymetazoline (2.8 AU → 2.8 AU) mixed with marking pen. Absorbance decreased over 2 hours when marking pen was mixed with 1:1000 epinephrine (0.82 AU → 0.32 AU) and lido+epi (1.19 AU → 0.33 AU). Furthermore, the majority of color visibility and absorbance decreased in the first 15 minutes for concentrated epinephrine (0.82 → 0.33) and lido+epi (1.19 → 0.51). Cost of fluorescein strips ($0.14 to $0.20/strip) was less than marking pens ($13 to 46/pen). Compared to marking pen dye, solutions dyed with fluorescein retained their color and did not decay over time. We recommend fluorescein strips to label colorless materials in the operating room because of their lack of color decay and cost advantages.

V2-10 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT – A NOVEL “ROLLING PEN” TECHNIQUE

You have accessJournal of UrologyFemale Voiding Dysfunction1 Apr 2015V2-10 IDENTIFICATION OF THE S3 FORAMEN DURING TRANSFORAMINAL SACRAL NEUROMODULATION LEAD PLACEMENT – A NOVEL “ROLLING PEN” TECHNIQUE Amanda Saltzman, Kristi Hebert, Howard Woo, and Ryan Krlin Amanda SaltzmanAmanda Saltzman More articles by this author , Kristi HebertKristi Hebert More articles by this author , Howard WooHoward Woo More articles by this author , and Ryan KrlinRyan Krlin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.335AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Sacral neuromodulation (SNM) is FDA approved for urinary urgency, urinary frequency, urgency urinary incontinence, non-obstructive urinary retention and fecal incontinence. SNM modulates electrical input to the bladder preventing and decreasing over stimulation, thus improving symptoms. The S3 foramen must be localized for lead implantation and the efficacy of implantation depends on the ability to localize S3 reliably and correctly. Localization is accomplished using various strategies, most commonly using a combination of palpation of bony landmarks and fluoroscopy. This paper will serve to introduce a novel “rolling pen” technique that eliminates the use of fluoroscopy for S3 identification. This technique is currently used in clinical practice by the two highest volume implanters in Louisiana. METHODS The patients were positioned prone and prepped in the usual manner. Instead of using fluoroscopy or palpation to identify bony landmarks to localize the S3 foramen, we balanced a marking pen longitudinally in the midline of the sacrum. The pen was allowed to roll until horizontal equilibrium was established. The fulcrum of the balanced “rolling pen” identified the level of S3. A mark 2 cm proximal and 2 cm lateral to this landmark was made for entry of the finder needle at the level of the skin. We then proceeded with our implantation in the usual manner. The rolling pen technique was used for all patients as our initial strategy to identify the S3 foramen. RESULTS 228 implantations were performed between 7/2012 and 10/2014 at our 2 tertiary centers. All cases used the rolling pen technique as our initial S3 foramen identification strategy. Adhering to the ALARA principle, fluoroscopy was limited to confirming and adjusting needle and lead placement in the operating room. All office procedures were performed without fluoroscopy. CONCLUSIONS We conclude that the novel rolling pen technique can be used as yet another method for S3 localization during transforaminal lead placement during SNM implantation. This decreases radiation exposure and likely cost. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e100 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Saltzman More articles by this author Kristi Hebert More articles by this author Howard Woo More articles by this author Ryan Krlin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Fabrication of a Paper-Based Microfluidic Device To Readily Determine Nitrite Ion Concentration by Simple Colorimetric Assay

Paper-based microfluidic devices (μPAD) are a burgeoning platform of microfluidic analysis technology. The method described herein is for use in undergraduate and high school chemistry laboratories. A simple and convenient μPAD was fabricated by easy patterning of filter paper using a permanent marker pen. The usefulness of the device was demonstrated by determination of nitrite ion concentration employing a colorimetric assay. The results for real sample detection using this μPAD were satisfactory and show promise for use in other applications.

Thin crack observation in a reinforced concrete bridge pier test using image processing and analysis

In reinforced concrete (RC) structural experiments, the development of concrete surface cracks is an important factor of concern to experts. One conventional crack observation method is to suspend a test at a few selected testing steps and send inspectors to mark pen strokes on visible cracks, but this method is dangerous and labor intensive. Many image analysis methods have been proposed to detect and measure the dark shadow lines of cracks, reducing the need for manual pen marking. However, these methods are not applicable for thin cracks, which do not present clear dark lines in images.This paper presents an image analysis method to capture thin cracks and minimize the requirement for pen marking in reinforced concrete structural tests. The paper presents the mathematical models, procedures, and limitations of our image analysis method, as well as the analysis flowchart, the adopted image processing and analysis methods, and the software implementation. Finally, the results of applying the proposed method in full-scale reinforced concrete bridge experiments are presented to demonstrate its performance. Results demonstrate that this method can capture concrete surface cracks even before dark crack lines visible to the naked eye appear.

SIGNS AND SYMPTOMS OF TEMPOROMANDIBULAR DISORDERS AND THEIR

Objectives: This study was done with the objective of determining the distance of movement between the maxillary and mandibular midline (DMM) and its relationship with the signs and symptoms of temporomandibular disorders (TMD) in canine-guided occlusion and to compare the obtained values between the right and left sides. Materials and Methods: One hundred females showing canine-guided occlusion and Angle's class I canine and molar relation were chosen for the study. The maxillary midline’s corresponding line was marked on the mandible with a marker pen in the patient's mouth, both during maximum intercuspation and at the edges of maxillary and mandibular canine contact. DMM was considered as the distance between the two lines (measured using a digital caliper). The percentages of signs and symptoms were compared using the chi-square test to determine the differences among the groups for the rates of TMD symp- toms, bruxism, joint sounds and unilateral chewing. Results: The mean value of the DMM for all subjects was found to be 3.61 mm on the right side and 3.64 mm on the left side. The values were subjected to a paired t -test, and the P value was statistically insignificant (P>0.05). Reported TMJ(temporo mandibular joints) clicking at the start was the only significant predictor (P<0.01) for TMD symptoms (pain in jaw), and bruxism was a marginally significant predictor for pain in the jaw (P=0.055). Other predictors from the baseline examinations (unilateral chewing, missing teeth) were insignificant. Conclusion: It can be concluded from this study that these values of DMM cannot be used for predicting the manifestation of TMD. Keywords : Canine-guided occlusion, midline moving, tmj disorders

Surgical airway education among anesthesia trainees: a cohort study

Purpose: Emergency invasive airway access is necessary when a provider encounters a “can’t intubate, can’t ventilate” situation where non-invasive techniques fail. Regardless of advanced airway training, a cricothyrotomy is easier, faster, and associated with less bleeding when compared to a tracheotomy. The knowledge, confidence, and procedural ability of anesthesia residents in performing a cricothyrotomy were assessed. Methods: A 2014 IRB approval was obtained. After successful intubation, anesthesia residents were provided a brief clinical vignette where the only viable option was emergency invasive airway access. They were given a marking pen and asked to perform a mock cricothyrotomy. A multimedia educational program illustrating anatomy, procedural details, and alternate procedures was subsequently provided. At least 4 weeks later, the residents were again presented with the opportunity to participate. Results: Nine residents consented to participate before and 18 after the educational component. There was no difference between the patients used in each group. When adjusted for number of years in training and size of the patient, there was no difference in accuracy between the pre- and post- intervention groups. The educational program produced a statistically significant procedural time improvement for all participants. There was improvement in time for normal and overweight patients, with a more significant improvement for overweight patients. Both junior and senior level residents were faster without statistical difference between the two. Conclusions: A knowledge and confidence deficit in emergency invasive airway management exists; directed education results in improved procedural timing, especially with overweight patients.

Revealing clinicians' experiences towards healthcare software usability using human-centred design approach

Clinicians often report a loss of productivity and frustration while using healthcare software. There is a pressing need to understand the clinicians' experiences about healthcare software. This study was a small pilot study intended to reveal clinicians' experiences towards healthcare software usability. Four participants and two facilitators from India participated in this study. This study used the human–centred design approach that included three phases - observation, pattern identification, and ideation and delivery. Each phase involved: 1) techniques - brainstorming, voting, discussion, and mutual consensus among participants; 2) tools - pen, papers, flip charts, sticky notes, and marker pen. This study revealed 29 insights, six themes, a conceptual framework with an immediately available opportunity, and 32 potential solutions for the identified immediate opportunity. The study results suggest that clinicians' experiences towards healthcare software usability are highly affected by the interface design of the healthcare software. Therefore, intuitive interface design is an immediately available opportunity. We received 32 recommendations for designing intuitive interfaces of the healthcare software. Interface designers may keep these 32 recommendations in their mind, as a broad wish list of clinicians, in the early stages of design.

A calibration test for latent fingerprint development on thermal paper.

A calibration test is described for monitoring the operation of equipment used to develop latent fingerprints on thermal paper by the application of either controlled or uncontrolled heat. A working solution of a water/glycerol emulsion and butylene glycol is applied to thermal paper by means of either a vinyl stamp and pad, or a marker pen. Varying the amount of butylene glycol enables the thermal paper to change color at different temperatures between approximately 40 and 60°C, which is below the normal color change temperature of the paper. The described test may be used to verify the correct operation, at different temperatures, of a controlled heat source during and after fingerprint development (such as the Hot Print System) or to monitor the paper temperature with an uncontrolled heat source (such as a warm air blower), thereby avoiding unintentional coloring of the entire paper surface.

A rare case of postoperative traumatic optic neuropathy in orbital floor fracture.

A rare case of postoperative traumatic optic neuropathy in orbital floor fracture.

Standing up for science: The antivivisection movement and how to stand up to it.

Animal research has been and remains crucial to the development of modern medicine. The reasons for ongoing research are manifold from finding ways to treat cancer to understanding the mechanisms behind neurodegeneration to developing new vaccines against HIV/AIDS, malaria and other diseases. Nearly all of us benefit from medical treatments made possible through animal research, and with so much at stake, it is important that scientists make the case for the importance of using animals in research. With animal rights extremism at an all‐time low, there has never been a better time for scientists to overcome their reluctance to talk about the benefits of their work. Sadly, polls show that opposition to animal research among young people, for example in the UK and USA, is significantly higher than among those aged over 65 [1], [2]. In my view, this is in part because of the large amount of misinformation propagated across the Internet by opponents of animal research—the “antivivisection” (AV) movement. Moreover, the past decades have seen bouts of intense activism—including harassment, threats and violence directed towards scientists—aimed at shutting down animal research. During the same period, the scientific community have worked diligently to replace, refine and reduce the use of animals in research (http://www.nc3rs.org.uk), making much progress; however, these efforts have not been sufficient to satisfy the passions of some activists. Part of the problem is that scientists rarely engage with those who are opposed to animal research, which can leave them detached from the need to justify or explain their work. This lack of communication also creates an information vacuum in the public sphere about the need to use animals. In a recent poll in the UK, only 31% of respondents felt “fairly well informed […] about science and scientific research/development” [2]. …

White tail spots and tail-flicking behavior enhance foraging performance in the Hooded Warbler

Many species of insectivorous birds have contrasting plumage patches that are often displayed during foraging. Although such displays are widely hypothesized to flush potential prey and enhance foraging performance, experimental evidence that they function in this way was previously available only from redstarts (Myioborus spp.). I provide additional evidence from an experimental study of the Hooded Warbler (Setophaga citrina) in northwestern Pennsylvania, USA. Hooded Warblers regularly flick their tails while foraging, revealing large white spots on the outer tail feathers. I tested the function of the white tail spots with plumage manipulation experiments. At nests containing 5-day-old nestlings, the attending adults were captured and assigned to one of two treatment groups. For experimental birds, I temporarily darkened the white tail spots with a brown marking pen; for sham-darkened controls, I applied a comparable amount of ink to the dark inner rectrices. Experimental birds with darkened tails showed significantly reduced foraging performance compared with controls, and the decline in foraging performance was driven almost entirely by a decreased frequency of aerial prey attack. High-definition video recording at nests showed that plumage manipulation also altered the types of prey females delivered to nestlings; females with darkened tails delivered significantly fewer winged insects, and proportionally more insect larvae, than controls. However, the types of prey delivered by males were unaffected by plumage manipulation. Tail-flicking behavior codevelops with independent foraging in juveniles and is a significant positive predictor of juvenile foraging performance, even when the effects of juvenile age and activity are controlled statistically. Collectively, these results provide strong support for the hypothesis that white tail spots and tail-flicking behavior of Hooded Warblers function to flush visually oriented winged prey and enhance foraging performance. They also raise questions about sexual dimorphism in the tail pattern and its relationship to possible sex differences in foraging strategies.

Age and Growth of the Ark ShellScapharca broughtonii(Bivalvia, Arcidae) in Japanese Waters

ABSTRACT Age and growth of the ark shell Scapharca broughtonii in 3 bays in Japan (Mutsu, where ark shells are cultured, and Nanao and Sendai, where they occur naturally) were examined using a shell sectioning and staining method. When a water-based marking pen was used to stain the opaque zones only in shell cross-sections, unstained translucent zones (i.e., growth rings) were clearly observed. Based on seasonal changes in marginal structures of shell cross-sections and marginal growth indices (MGIs), growth rings were estimated to be formed annually in summer when shell growth ceased. The estimated maximum ages for ark shells from Nanao and Sendai bays were 6 y and 20 y, respectively, whereas for Mutsu Bay the maximum age was not calculated because we had only young, cultured specimens, von Bertalanffy growth models were estimated as Lt = 80.1(1 -e -0.365(t+ 0-160) for Mutsu Bay, Lt = 115.3(1-e -0.478t-0162) for Nanao Bay, and Lt = 84.8(1 -e -0.473(t + 0.222) for Sendai Bay. There was no significant dif...

Lateral antebrachial cutaneous nerve compression after traumatic rupture of the long head of the biceps: a case series

Lateral antebrachial cutaneous (LABC) nerve compression is a rare but debilitating injury. There are limited data on the association of LABC nerve compression and proximal biceps rupture. We theorized that because of distal migration, the biceps muscle and tendon cause compression on the nerve. We present 2 cases in which patients had proximal biceps ruptures with tendon retraction and developed neurologic symptoms associated with the LABC nerve. To demonstrate our theory, we performed a cadaveric experiment. After making an incision to expose the entire biceps muscle and the musculocutaneous nerve and its branch into the LABC nerve, we marked each structure in 2-cm increments with a marking pen. The long head of the biceps was then cut to simulate a proximal biceps rupture. The relationship between the 3 structures was then studied, showing no change in position of the musculocutaneous nerve or LABC nerve. The biceps muscle and tendon had migrated distally toward the LABC nerve, demonstrating compression of the nerve. Proximal biceps tears commonly occur from trauma as well as iatrogenically after a biceps tenotomy for treatment of biceps tendinopathy. However, it is unusual for neuropathy of the LABC nerve to occur. Patients who develop neuropathy associated with the LABC nerve after a proximal biceps rupture can be effectively treated with LABC nerve decompression and biceps plasty. We found that this was an effective surgical treatment of LABC neuropathy without the need for proximal biceps tenodesis.

Ultrasound for Routine Lumbar Puncture

The objective was to determine if use of ultrasound (US) by emergency physicians (EPs) to localize spinal landmarks improves the performance of lumbar puncture (LP). This was a prospective, randomized, controlled study conducted in a county teaching hospital. Subjects, adults 18years of age or older who were to receive LPs for routine clinical care in the emergency department (ED), were randomized either to undergo US localization of the puncture site or to have the puncture site determined by palpation of spinal landmarks. Primary outcomes were the number of needle insertion attempts and success of the procedure. Secondary outcomes were pain associated with the procedure, time to perform the procedure, number of traumatic taps, and patient satisfaction with the procedure. One-hundred patients were enrolled in the study, with 50 in each study group. There were no significant differences between the two groups in terms of age, sex, body mass index (BMI), indication for LP, or ease of palpation of landmarks. For both primary outcomes and secondary outcomes there were no significant differences between those undergoing US localization and those with palpation alone. These data do not suggest any advantage to the routine use of US localization for LP insertion, although further study may be warranted to look for benefit in the difficult to palpate or obese patient subgroups.

Monitoring presence, abundance and survival probability of the stag beetle, Lucanus cervus, using visual and odour-based capture methods: implications for conservation

A capture-mark-recapture study on the threatened saproxylic beetle Lucanus cervus was carried out in a chestnut (Castanea sativa) woodland located in northern Italy, using visual encounter surveys (VES) as well as aerial flight interception traps and pitfall traps (PT), both of which were baited with different odour lures. In total, 111 males and 25 females were captured, and VES was by far the most efficient method, accounting for 93 % of first captures, and 95 % of all captures. Stag beetles were not significantly attracted to any tested odour, and many PT were damaged by wild boars (Sus scrofa). Flying males were the most frequent adults observed during the season. The use of a net is necessary to capture the stag beetles, in order to evaluate the population parameters and to assess the local status of threat for the species. Capture data revealed that body size (i.e. body weight and elytron length) influences the survival probability of stag beetles, showing a lower survival probability for larger males. Felt-tip pen marking on the ventral sclerites of head and pronotum is a reliable and long lasting method for marking beetles, as proved by the use of an independent marking procedure with a small drill. Assessing the presence and threat status of L. cervus across Europe is urgently needed, and with no efficient odour-based strategy available, collection of adult beetles, dead or alive, by VES is the most reliable way to monitor this emblematic species.

Optimal Placement of a Brachioplasty Scar

Brachioplasty has become a popular procedure to rejuvenate the upper arm, with its frequency increasing proportionately to the popularity of surgical weight loss procedures. The major complication of the procedure is undesirable, visible scarring. An ongoing, unresolved debate in the brachioplasty literature is the optimal placement of the brachioplasty scar. Some authors advocate a medially based incision along the bicipital groove, whereas others prefer to leave the scar posteriorly in the brachial sulcus. In addition, some advocate a sinusoidal scar over a straight-line closure. This study attempts to resolve the question of where and how to place the scar based on population surveys. Photographs were taken of a model with her arm progressively abducted at the shoulder to a level of 90 degrees, with the elbow progressively flexed to 90 degrees and the arm externally rotated. Anterior and posterior views were included. Using Photoshop, a brachioplasty scar was digitally created and placed on the arm first medially in the bicipital groove, then posteriorly in the brachial sulcus. Straight-line scars and sinusoidal scars were also compared in each position. Before creating a computer-generated image of the scars, the scar lines were marked with a marking pen to ensure they could be followed with movement of the model's arm. An online survey was then created and distributed and included multiple variables: position of the scar, length of scar vs residual deformity, and acceptability based on phase of scar in time (early vs late result). The scale was numerical from 1 to 5, with 1 being a very objectionable scar and 5 being a very acceptable scar. The survey was disseminated among the general public, plastic surgeons, and patients in the Yale Cosmetic Surgery Resident Clinic who were either seen in consultation for brachioplasty or who underwent the procedure. Electronic surveys were distributed to and completed by the general public (n = 117), local plastic surgery residents and attendings (n = 10), and patients who had undergone or were seen in consultation for brachioplasty (n = 9). Among all participants, in the chronic phase, a medial straight scar received an average rating of 4.00, a posterior straight scar received an average rating of 3.14, a posterior sinusoidal scar received an average rating of 2.61, and a medial sinusoidal scar received an average rating of 2.03. Across age groups, gender, plastic surgeons, and patients, the medially based straight brachioplasty scar is more acceptable than the posteriorly based straight scar (4.00 vs 3.14, P < 0.001). If the scar shape is made sinusoidal, a posteriorly based scar is favored over a medial one (2.61 vs 2.03, P < 0.001), yet this is still not as aesthetically pleasing as a medial straight scar (4.00 vs 2.61, P < 0.001). Furthermore, survey participants accepted a longer scar over a residual deformity (58.8% vs 41.2%). Based on the preferences of the populations surveyed, we conclude that the medially based straight scar is the most aesthetically acceptable option when performing a brachioplasty.

The Cosmetic Circumcision

Figure 1A penile injection of 10–20mcg prostaglandin E1 is given with a 31-gauge 8-mm needle at the beginning of the case to provide the patient with an erection. This helps the surgeon determine how much skin needs to be removed. While the penis remains erect, the foreskin is pulled over the glans penis, and released. The skin at the base of the penile shaft is marked with a marking pen in a circumferential manner at the junction of the penis with the pubis on the dorsum and at the junction of the scrotal skin on the sides and the ventral aspect of the penile shaft.

Fructose–Maltodextrin Ratio Governs Exogenous and Other CHO Oxidation and Performance

Fructose coingested with glucose in carbohydrate (CHO) drinks increases exogenous-CHO oxidation, gut comfort, and physical performance. This study aimed to determine the effect of different fructose-maltodextrin-glucose ratios on CHO oxidation and fluid absorption while controlling for osmolality and caloricity. In a crossover design, 12 male cyclists rode 2 h at 57% peak power then performed 10 sprints while ingesting artificially sweetened water or three equiosmotic 11.25% CHO-salt drinks at 200 mL·15 min, comprising weighed fructose and maltodextrin-glucose in ratios of 0.5:1 (0.5 ratio), 0.8:1 (0.8 ratio), and 1.25:1 (1.25 ratio). Fluid absorption was traced with D2O, whereas C-fructose and C-maltodextrin-glucose permitted fructose and glucose oxidation rate evaluation. The mean exogenous-fructose and exogenous-glucose oxidation rates were 0.27, 0.39, and 0.46 g·min and 0.65, 0.71, and 0.58 g·min in 0.5, 0.8, and 1.25 ratio drinks, representing mean oxidation efficiencies of 54%, 59%, and 55% and 65%, 85%, and 86% for fructose and glucose, respectively. With the 0.8 ratio drink, total exogenous-CHO oxidation rate was 18% (90% confidence interval, ±5%) and 5.2% (±4.6%) higher relative to 0.5 and 1.25 ratios, respectively, whereas respective differences in total exogenous-CHO oxidation efficiency were 17% (±5%) and 5.3% (±4.8%), associated with 8.6% and 7.8% (±4.2%) higher fructose oxidation efficiency. The effects of CHO ratio on water absorption were inconclusive. Mean sprint power with the 0.8 ratio drink was moderately higher than that with the 0.5 ratio (2.9%; 99% confidence interval, ±2.8%) and 1.25 ratio (3.1%; ±2.7%) drinks, with total- and endogenous-CHO oxidation rate, abdominal cramps, and drink sweetness qualifying as explanatory mechanisms. Enhanced high-intensity endurance performance with a 0.8 ratio fructose-maltodextrin-glucose drink is characterized by higher exogenous-CHO oxidation efficiency and reduced endogenous-CHO oxidation. The gut-hepatic or other physiological site responsible requires further research.

A validation study on the insertion depth ranges of the five phase points by using musculoskeletal ultrasound: A pilot study

We conducted preliminary research to validate the insertion depth ranges of the five phase points by using ultrasonography. The insertion depth ranges of the five phase points were investigated by reviewing acupuncture and moxibustion literature. The following lengths were measured in centimetres in order to substitute B-cun values with centimetre values: the distance from the cubital crease to the palmar crease, from the inferior border of the medial tibia condyle to the medial malleolus, and from the popliteal crease to the prominence of the lateral malleolus. The five phase points were represented by pen marks on the skin, per the World Health Organization acupuncture point specifications. The anatomical structures of the five phase points within the insertion depth ranges were observed using colour Doppler ultrasound. The five phase points for which the insertion depth ranges needed to be modified were LU11, HT9, PC9, LI1, LI2, SI1, SI2, TE1, ST45, BL66, GB44, SP1, SP2, LR1, and BL67. The five phase points that required careful insertion of acupuncture needles were LU8, LU9, LU10, LI5, ST36, ST41, SP3, HT4, HT7, HT8, SI3, SI8, BL40, KI2, KI3, KI10, KI27, GB34, GB38, LR3, and LR4. This preliminary study provided evidence on the insertion depths in acupuncture treatment. To generate more concrete evidence regarding insertion depths, further research should be conducted in a participant group with more diverse body mass index (BMI) values by using acupoint-specific ultrasonography transducers that can measure the acupoints properly.

Safe and Simple Gastric Conduit Pull-through Procedure Through the Posterior Mediastinal Route Using Echo Probe Cover in Thoracoscopic Subtotal Esophagectomy

A gastric conduit is commonly used to reconstruct the alimentary tract after esophagectomy. When the posterior mediastinum is applied to a reconstruction route, the gastric conduit created has been protected by an echo probe cover and, then blindly elevated to the neck. However, using this elevation method, the gastric conduit has the potential to catch on the vessels and nerves, posing a risk of major bleeding. We report a safe method of gastric conduit pull-through procedure to avoid unexpected technical complications. Two approximately 60-cm-long polyester tapes are prepared and ligated at both ends forming a loop. A 50-cm-long echo probe cover of 10 cm in diameter is prepared, and the closed end of the echo probe cover is cut to make an open-ended echo probe cover. A line parallel to the long axis of the echo probe cover is drawn across the echo probe cover with a sterile surgical marking pen. The looped polyester tape is inserted into the echo probe cover. The looped polyester tape and echo probe cover are ligated with 2-0 silk, approximately 5 cm in front of the knots on both sides. After dissection is carried out according to practice, the previously crafted polyester tape is inserted into the chest cavity. The echo probe cover is placed to connect the distal and proximal ends of the esophagus, and its torsion is corrected using the line marked with the pen and a crease, both of which are parallel to the long axis of the echo probe cover. One end of polyester tape is fixed to the distal esophageal stump by using the clips, with the opposite end fixed to the proximal esophageal stump. Either one of the 2 lengths of polyester tape is connected to the gastric conduit. By pulling up this length of polyester tape from the neck, the gastric conduit can pass through the echo probe cover and be elevated to the neck.