Outer Catheter Research Articles

#3109 Sarcopenia in peritoneal dialysis patients

Abstract Background and Aims Sarcopenia is considered a frequent cause of morbidity and mortality among patients with chronic kidney disease (CKD). In clinical practice, tools such as handgrip strength and bioelectrical impedance analysis (BIA) can help us diagnose sarcopenia and possibly predict clinical outcomes. However, the outcomes associated with this diagnosis in the population of patients under peritoneal dialysis (PD) and the consequent importance of the implementation of these tools is not clear. Method Single-centre retrospective study with patients who started peritoneal dialysis (PD) between January 1st 2017 and December 31st 2023, with a follow-up of 18 months or until technique dropout. Demographic, clinical data and outcomes were collected. Muscle strength (measured by handgrip strength with a dynamometer) and muscle mass (estimated through BIA-derived lean tissue index (LTI)) were also evaluated. Sarcopenia was considered when low strength (handgrip strength values <27 kg and <16 kg for men and women, respectively) and loss of muscle mass (LTI <10th percentile, relative to an age and gender-matched healthy population) were present. Results Fifty-three patients were included, with 66% male and a mean age of 58 ± 15 years. Comorbidities included hypertension in 88.7%, diabetes mellitus (DM) in 26.4% and coronary artery disease (CAD) in 17.0%. PD vintage was 23 months (IQR 21) and most were on continuous ambulatory peritoneal dialysis (75.5%). Median Clinical Frailty Score (CFS) was 2 (IQR 1). Mean LTI was 13.2 ± 2.7 kg/m2 and average handgrip strength was 28.4 ± 8.8 kg in the right arm and 26 kg (IQR 13) in the left. Reported outcomes of number of peritonitis, outer peritoneal catheter infection, hospitalizations and MACE (Major Adverse Cardiovascular Events) episodes were low. There were 3 reported deaths during follow-up. Six patients were considered sarcopenic, with 66% male and a mean age of 58.1 ± 14.9 years, with DM in 50%, hypertension in 100% and CAD in 33.3%. Median LTI was 9.4 (IQR 1.2), with left and right median hand grip of 24 (IQR 10) and 26 (13), respectfully. Outcomes were also low, with no statistically significant difference between sarcopenic and non-sarcopenic patients. Conclusion Despite being considered an indication of higher morbidity and mortality, the diagnosis of sarcopenia was not associated with worse outcomes in patients under peritoneal dialysis.

Temperature fluctuations during embryo transfer can be mitigated by optimizing transfer protocol

Research QuestionWhat impact do variations in embryo transfer catheter loading and movement procedures have on temperature and pH fluctuations during embryo transfer? DesignMock embryo transfers were conducted to test the impact of airflow/movement, use of catheter coverings and the type of workstation used for catheter loading on catheter temperature. A thermocouple probe inserted into the tip of the outer catheter or taped to the exterior of the inner catheter recorded temperature within the catheter every 5 sec from time of mock embryo loading (TL) up to 60 sec (TL +60s). Fluctuations in culture medium pH in embryo transfer dishes were monitored. ResultsCatheter temperature was lower at TL+15s (26.8 ±0.61°C) than TL (30.5 ±0.81°C, P <0.05). The rate of cooling during transit was slower when catheters were covered to reduce the cooling effect of air movement (P<0.05). Temperature was better maintained when catheters were loaded in a crib compared to a heated stage, until initiation of transit, when the rate of temperature decrease was similar. Culture medium pH increased faster when embryo transfer dishes remained on a heated stage during the procedure compared to within an open crib. ConclusionsTemperature loss during the ET procedure can be mitigated by reducing transit time and using catheter coverings. Use of a crib for catheter loading only improved temperature stability while the catheter remained in the crib, not during transit, and it reduced pH fluctuations during the procedure.

P-315 To study the efficacy of Transvaginal ultrasound-guided Embryo Transfer over Transabdominal ultrasound-guided Embryo Transfer in transfers with poor visibility due to obesity or marked retroversion

Abstract Study question Why is Transvaginal guided embryo transfer,understudied and underutilised in difficult cases of embryo transfers with compromised visibility of uterine canal in Transabdominal ultrasound ? Summary answer In patients with poor visibility of uterine canal using TAUS due Obesity, retroveted uterus,PID,pelvic adhesions, endometriosis, TVUS-ET gives significantly higher clinical Pregnancy rates. What is known already TAUS-ET is most popular method of Embryo transfer worldwide. Despite the benefits , this procedure also presents some important drawbacks. Firstly, TAUS-guided ET requires an assistant to operate the transducer while physician performs ET procedure. Moreover, patient needs to fill her urinary bladder to enable visualization of uterine canal, which causes discomfort and sometimes uterine cramping during ET, which in turn can negatively impact implantation rates.TVUS is the main technique used in all other gynecological investigations. Because of high frequency and close proximity to target area, TVUS transducers provide better resolution of the uterocervical angle and improved overall image quality. Study design, size, duration This retrospective study was conducted to compare efficacy of TVUS-guided ET to conventional TAUS-guided ET in difficult transfers, who underwent treatment at Triveni IVF, Darbhanga, India between November 2020 to December 2022. It was based on data extracted from records of all women who underwent difficult TAUS-ET procedure between Nov 2020 to Nov 2021.Data from records of matching number of women who underwent TVUS-ET procedure between Dec 2021 to Dec 2022 were used for comparison. Participants/materials, setting, methods All were ICSI and FET transfers. Inclusion criteria: (1) All included between 25–35 years of age with difficult visualisation of uterine canal during TAUS-Mock ET in previous cycle (2) BMI ≥ 30; (3) Retroverted uterus due to any underlying pathology 4)All pts included had good ovarian reserve; (4) unexplained infertility &amp;gt;3 years. Exclusion criteria: (1) severe male factor infertility, (2) any intrauterine factor of infertility (3) ovarian endometrioma or PCOS and (5) multiple ICSI failure (&amp;gt;3 trials). Main results and the role of chance Total of 123 cycles,61 guided by TVUS (Group 1) and 62 TAUS (Group 2) were included. Our results showed significantly higher Clinical Pregnancy rate in TVUS group as compared to TAUS group, in difficult transfers (43.3% vs. 36.1 % p = 0.0045). VAS (visual analog scale) of the pain during ET was significantly less in TVUS group in comparison to TAUS group (17% vs 64% p = 0.0001), also the abdominal discomfort was significantly less in TVUS group in comparison to TAUS group (11% vs. 69 % p = 0.0001). TVUS-ET group showed significantly higher CPR as it has better resolution due to proximity to target organs allowing proper visualization of catheter tip especially in cases with obesity and marked uterine retroversion.TVUS has superior role in cases with difficult transfer because it can easily analyze the cause of difficult transfers as endocervical crypts, marked anteverted uterus, cervical canal tortuosity. Another advantage of TVUS is requiring emptied urinary bladder in contrast to TAUS. Full bladder is both time consuming and causes abdominal discomfort and uterine cramps leading to increased patient anxiety.As regards to abdominal discomfort and uterine cramps, there was extremely high statistical significance between the two groups in our study. Limitations, reasons for caution Despite the wide benefits,TVUS-ET has not been widely adopted, on account of difficulty in manipulating ET catheter and vaginal transducer simultaneously in very constricted area.Other comfortable approaches that may assist physicians such as inner catheter can be pushed by embryologist while physician holds TVS-probe and outer catheter in place. Wider implications of the findings The results suggested that TVUS-guided ET was better in difficult transfers with poor visibility of uterine canal in studied sample. This technique presented deserves consideration for wider use since it can offer better visualization, excellent comfort to patients during the procedure, and requires only one operator. Trial registration number Not applicable

Inadvertent accident during balloon-occluded glue injection for facial AVM: rescue procedure using intentional glue injection

BackgroundGlue embolization during balloon inflation is a novel technique with many advantages. However, the procedure’s major complication is the adhesion of the balloon catheter by glue. Several studies have reported strategies to prevent this. However, no reports have described a rescue method after accidental adhesion occurs.Case presentationA 26-year-old male was referred to the department of interventional radiology for sclerotherapy of an aggravating large facial arteriovenous malformation (AVM). We planned a transvenous approach to decrease the velocity of AVM and increase the efficacy of the sclerotherapy treatment. We performed glue embolization of a major draining vein during microballoon inflation. Upon injection of the glue, inadvertent glue reflux occurred, and the microballoon was stuck to the vessel wall. While removing the microballoon catheter, its shaft broke in the guiding catheter. We filled the inner lumen of the guiding catheter with glue and waited for polymerization to fixate the broken microballoon catheter inside the guiding catheter. Fortunately, the stuck microballoon was separated, and two broken pieces of microballoon catheter were removed through femoral vein short sheath.ConclusionIntentional glue casting in the outer catheter is very useful when removing anything that is inside the catheter or stuck due to the glue reflux. It can be applied to various similar emergency situations.

A fine tuning of embryo loading technique by eliminating the air bubble in the outer sheath of embryo catheter among women undergoing IVF treatment.

The role of air bubbles in bracketing the embryo-containing medium in inner catheter during embryo transfer (ET) has already been established. However, the role of air bubbles in outer catheter (OC) during implantation is yet to be determined. This study aimed to compare the implantation rates between women who have undergone ET with or without ASP (Vitrolife®; Sweden), a medium use for oocyte retrieval and rinsing in OC embryo catheter. The purpose of introducing the ASP medium to the OC was to eliminate air bubbles in that space during implantation. A total of 312 women were randomly divided into two groups with 156 participants each group. In Group A, ASP medium was used during ET, whereas in Group B, no ASP medium was utilized. Positive implantation was defined as serum beta-hCG level >5 mIU/mL taken on the 7th day following ET. The average age of the majority of the participants was 30-39 years and had at least 4-5 years of subfertility. The unexplained subfertility was the prominent cause of ET failure in both groups. In most of the participants in both groups, ET was done using fresh embryo cycles with good to excellent embryo grades. After the ASP medium was manipulated in the OC in both groups, the positive implantation rate was not different in both groups (p>0.05). The elimination of air bubbles in OC by using the ASP medium during ET did not confer an additional benefit nor exert a negative impact on implantation rate.

Left ventricular lead placement using inner guiding catheter alone in cardiac resynchronization therapy device implantation.

Subselection inner catheters (Inner-Cath) are used adjunctively with outer guiding catheters (Outer-Cath) during cardiac resynchronization therapy (CRT) device implantation. This study aims to investigate the feasibility and efficacy of left ventricular lead placement (LV-LP) guided by Inner-Cath alone. A total of 74 patients undergoing de novo CRT implantation were investigated. LV-LP was initially guided by Inner-Cath in 42 patients (Inner-Cath group) and Outer-Cath in 32 patients (Outer-Cath group). In the Inner-Cath group, a 7Fr Inner-Cath was advanced to the coronary sinus through a 7 Fr sheath inserted in a subclavian vein. In the Outer-Cath group, 9Fr or 10Fr Outer-Caths were used. Success rate of LV-LP, additional use of inner or outer catheters and procedure-related complications were compared between groups. LV-LP was successful in all patients in the Inner-Cath group, while LV-LP had to be abandoned in two patients (6.3%) of the Outer-Cath group due to CS perforation caused by Outer-Cath manipulation. Procedure time was significantly shorter in the Inner-Cath group (148 vs. 168min; p=.024). Deployment of both an inner and outer cath became necessary less frequently for the Inner-Cath group (4.8% vs. 56.3%; p<.001). Mechanical CS injuries due to guiding catheter manipulation were only observed in the Outer-Cath group (0% vs. 15.6%, p=.013). LV-LP guided by Inner-Cath alone was feasible in over 95% of the patients without severe complications. This methodology for LV-LP may be preferable in CRT candidates with severe LV dysfunction in terms of shorter procedure time, smaller guiding sheath, and less procedure-related complications.

The Effect of Embryo Transfer Process Duration on Implantation Success

OBJECTIVE: To evaluate the effect of the embryo transfer duration of standard and simple embryo transfer method. STUDY DESIGN: This study was a retrospective cohort study conducted at a tertiary ART Centre, between June 2018- September 2018. Day 5 fresh embryo transferred patients aged between 18 - 40, BMI &lt;35 kg/m2 without uterine pathology were enrolled in the study. Patients were divided into two groups. Group-1 consisted of patients who had successful implantation and Group-2 consisted of patients who did not have implantation. Groups were compared according to their embryo transfer durations. Ninety-two patients were enrolled in the study. Also, sub-steps of as; cleaning of the cervical mucus and placing the outer catheter in the cervix, loading the embryo to the catheter, the period between embryo loading and embryo transfer, and following that, time spent for retracting the outer catheter evaluated. RESULTS: Between Group-1 and Group-2, there was no significant difference for the period of cervical cleaning and placing the outer catheter into the cervix (Respectively; 63 sec vs. 76 sec; p=0.18), the period of embryo loading (Respectively; 69sec vs. 71sec; p=0.46), the period between embryo loading and embryo transfer (Respectively; 10 sec vs. 10 sec; p=0.74, retracing the outer catheter (Respectively; 25.5sec vs. 24sec; p=0.42 and the total period of embryo transfer (182sec vs. 182.5 sec; p=0.55). CONCLUSION: The embryo transfer duration is not related to implantation rates. The duration of the embryo transfer process steps is not a distinguishing factor if a good-quality embryo transfer is done.

The Influence of Ultrasound-Guided Technique Using a Catheter-Over-Needle on the Incidence of Accidental Intravascular Injection during Caudal Block-A Retrospective Case Series Study.

Background and Objectives: This study was conducted to investigate the influence of an ultrasound-guided technique using a catheter-over-needle when an intravascular injection occurs in patients undergoing a caudal block. Material and Methods: We retrospectively investigated 41 cases of an ultrasound-guided technique using an angiocatheter for caudal block. These had been performed between November 2019 through August 2020 to manage pain of lumbosacral origin. Under ultrasound guidance, after advancing the introducer needle through the sacrococcygeal ligament and then slowly withdrawing it, the outer catheter was continuously advanced into the sacral hiatus. We confirmed proper needle placement under fluoroscopic imaging, using 5 mL of contrast media. We assessed the contrast spread pattern with fluoroscopic imaging and checked it for the presence of intravascular injection. Results: In all recruited cases, the catheter-over-needle was guided successfully to the sacral hiatus and into the caudal epidural space. There was 100% accuracy under ultrasound guidance, without intravascular uptake, as confirmed by contrast media fluoroscopy. The incidence of ventral spread was 84.2% above the S1 with 5 mL of contrast. Conclusions: The technique of using a catheter-over-needle under ultrasound induced successful block without intravascular injection. Thus, this technique is a reliable option for conventional caudal block.

Impact of DMPEI on Biofilm Adhesion on Latex Urinary Catheter.

Microorganisms can migrate from the external environment to the patient's organism through the insertion of catheters. Despite being indispensable medical device, the catheter surface can be colonized by microorganisms and become a starting point for biofilm formation. Therefore, new technologies are being developed in order to modify surfaces to prevent the adhesion and survival of microorganisms. Patents with the use of DMPEI have been filed. In the present work, we coated latex catheter surfaces with 2 mg mL-1 DMPEI in different solvents, evaluated the wettability of the surface and the anti- biofilm activity of the coated catheter against Escherichia coli, Staphylococcus aureus, and Candida albicans. We coated the inner and outer catheter surfaces with 2 mg mL-1 of DMPEI solubilized in butanol, dimethylformamide, and cyclohexanone and the surfaces were analyzed visually. Contact angle measurement allowed the analysis of the wettability of the surfaces. The CFU mL-1 count evaluated E. coli, S. aureus, and C. albicans adhesion onto the control and treated surfaces. The contact angle decreased from 50.48º to 46.93º on the inner surface and from 55.83º to 50.91º on the outer surface of latex catheters coated with DMPEI. The catheter coated with DMPEI showed anti-biofilm activity of 83%, 88%, and 93% on the inner surface and 100%, 92%, and 86% on the outer surface for E. coli, S. aureus, and C. albicans, respectively. Latex catheter coated with DMPEI efficiently impaired the biofilm formation both on the outer and inner surfaces, showing a potential antimicrobial activity along with a high anti-biofilm activity for medical devices.

30 Uterine flushing as a non-invasive method to access inflammatory cytokines in sows reproductive tract after parturition

Abstract Inflammatory mediators, such as cytokines, can reduce feed intake and drastically modify the partitioning of nutrients. Thus, it may increase the animal’s maintenance requirements, reduce milk production and piglet growth, impact reproductive performance, and reduce sow lifetime productivity. The objective of this experiment was to evaluate a non-invasive method, not tested before in swine, to assess cytokine profiles from post-partum uterine lavage. The uteri of second and third parity sows (n=14) were flushed with sterile saline solution (0.9%) on days 2, 4, and 14 post-parturition. An artificial insemination (AI) catheter, in its plastic covering, to avoid vaginal contents, was inserted through the vagina into the cervix. A flexible inner catheter was passed through the outer AI catheter and into the uterine horn. Sterile saline (30-40 mL) was flushed through the inner catheter into one uterine horn. After inner catheter removal, a tube was attached to the end of the outer AI catheter to allow collection of the natural back-flow of uterine lavage fluid (avg 24.7% recovery). Uterine fluid collected was immediately centrifuged and the supernatant stored at -20°C. Samples were freeze-dried, re-suspended in sterile saline (2 mL), and stored at -80°C. Cytokine profiles of the uterine fluid were evaluated using a multiplex ELISA panel including interleukin (IL)-1β, IL-6, IL-8, IL-4, IL-10, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ). Cytokine concentrations were calculated relative to protein content (pg/mg of protein). IFN-γ and TNF-α were lower than the limit of detection in most samples (5/38 and 1/38, respectively). IL-4 and IL-10 concentrations did not differ among days of collection (P &amp;gt;0.14). IL-8 was greater on day 4 than on days 2 or 14 (P&amp;lt; 0.05). IL-1β and IL-6 were greater on days 2 and 4 than on day 14 (P&amp;lt; 0.05). Uterine flushing is a novel non-invasive method to access uterine inflammatory cytokines in sows.

Tube-Based DBD Plasma Treatment for Improving the Performance of the Slippery Coating Layers on Medical Catheters

This work develops a tube-based dielectric barrier discharge (DBD) plasma treatment for improving the performance of the slippery coating layers on medical catheters. The raw materials of the polymer catheters usually exhibit hydrophobic surface property and need a hydrophilic slippery coating layer for reducing the friction during catheter insertion. However, the high friction force may cause an uncomfortable feeling or even the infective or thrombosis injuries on the epithelium. This study develops an atmospheric tube-based DBD plasma for treating the surface of the plastic catheter for enhancing the coating performance of the slippery layer coating on medical catheters. The tube-based DBD plasma system is a semiclose and co-axial concentric circles system composed of a glass tube as the DBD layer and the inner supporting hook for catheter production as the center electrode for DBD discharges. The treatment for the inner and outer catheter tube can be achieved simultaneously with a small carrier flow rate of 30–100 sccm. Results show that the contact angles of these catheter tubes are significantly reduced after plasma treatment and the hydrophilicity of the treated surface maintains 57% for more than 30 min after the treatments. The catheters with different plasma treatments are coated with the commercial slippery layer and tested the kinetic friction under the ASTM D1894 standard. The kinetic friction test indicates that the catheters with plasma treatment exhibit lower kinetic friction force, indicating that lower friction during catheter medical insertion operations. The experimental results have shown that the medical catheter treated by the developed tube-based DBD plasma can be effectively modified and facilitated in the subsequent coating process.

Analysis of risk factors for implantable venous access port catheter fracture with internal jugular vein

To investigate the risk factors of the in vivo implantable venous access port (IVAP) catheter fracture. We retrospectively analyzed 3,102 cases of patients with vascular access devices from November 2013 to March 2016 in the hospital by PACS. The clinical and radiographic features (age, occupation, living habit, IVAP duration, intravascular outer catheter angle, location of catheter tip and IVAP implantation site) were summarized to analyze the related risk factors of fracture in the 3,102 patients. There were 15 cases of fracture in 3,102 patients, and the fracture site were located at the entrance of the internal jugular vein (IJV) (n=12), the outlet of the vascular access devices (n=1), the distal portion of the catheter (n=2). Fracture was closely related to the factors of port time, age and occupation, but not related to the location of the port, the position of the catheter tip and the angle of the inner and the outer catheter. Age and IVAP duration were an independent risk factor for IVAP catheter fracture. Implantable vascular access devices are approved by its advantages of being safe, effective and less invasive. It is important to clarify the related factors and early prevention of fracture.

Superhydrophobic Coatings for Urinary Catheters To Delay Bacterial Biofilm Formation and Catheter-Associated Urinary Tract Infection.

In this research, a multilayered superhydrophobic coating for urinary catheters was synthesized by a layer-by-layer deposition technique. A mussel-inspired polydopamine coating was utilized as a platform for the in situ anchoring of silver nanoparticles followed by hydrophobic modification with 1H,1H,2H,2H-perfluorodecanethiol. Benefiting from the synergistic effect of hierarchical micro/nanostructures and antibacterial silver nanoparticles, the prepared catheters exhibited excellent superhydrophobicity and prolonged antibacterial activity against Escherichia coli WT F1693 and Proteus mirabilis WT F1697. Compared with commercial all-silicone and silver-alloy-hydrogel catheters, the superhydrophobic catheter exhibited significant antibiofilm activities in both static and dynamic models. In an in vitro bladder model, bacterial migration along the outer catheter was effectively delayed, reducing biomass accumulation by up to 55 and 90% compared with all-silicone and silver-alloy-hydrogel catheters. Encrustations in the catheter lumen were also retarded, extending the lifetime of silicone catheters from ∼40 to ∼100 h. The superhydrophobic catheter also exhibited good biocompatibility to the L929 mouse fibroblasts, therefore providing a promising direction for the future design of urinary catheters.

378 Resting Upper Esophageal Sphincter Pressure Is Elevated in Proton Pump Inhibitor-Refractory Chronic Cough Patients and May Be a Marker for Laryngeal Hypersensitivity

INTRODUCTION: Chronic cough is difficult to treat when unresponsive to proton-pump inhibitor (PPI) and sinus therapy. In this setting it is presumed to be neurogenic in etiology. Despite the role of the upper esophageal sphincter (UES) as a barrier to laryngopharyngeal reflux disease, it has not been well characterized in chronic cough patients. We aim to assess UES tonicity in patients with PPI-refractory chronic cough and otherwise intact esophageal motor function. METHODS: Patients with a Chicago Classification diagnosis of normal esophageal motility on high-resolution esophageal manometry (HRM) on studies performed for the indication of chronic cough were retrospectively studied. All studies were performed at a GI motility lab at a tertiary care center from January 2013 to August 2018. Patients with prior cervical spinal surgery, foregut surgery, gastroparesis, severe pulmonary disease or manometric hiatal hernia were excluded. All HRM were performed with a solid-state assembly with a 4.2 mm outer diameter catheter. Upper esophageal resting pressure and residual pressure (mmHg) were recorded from HRM studies and compared to a control group of patients with normal esophageal motility on studies performed for an indication of non-cardiac chest pain. Available pH-metry tests in chronic cough patients were also reviewed for acid exposure time. RESULTS: Fourteen patients with chronic cough (mean age 63 ± 25, 71% female) and twenty patients with non-cardiac chest pain (mean age 55 ± 14, 60% female) were included. Median resting UES pressure (mmHg) was higher in the chronic cough group (80) vs the chest pain group (50.8) with a p value of 0.004 (Figure 1). There was no difference in residual UES pressure (3.5 in chronic cough vs 3.15 in chest pain). A total of 12 pH studies were performed in chronic cough patients; 9 of these were on PPI. Median distal acid exposure time % was 1.35 [IQR 0.5-6]. CONCLUSION: UES hypertonicity found in PPI-refractory chronic cough patients may be a marker of laryngeal hypersensitivity. A second possibility is that primary UES dysfunction is the cause of cough in this subgroup.

EUS-specific stents: Available designs and probable lacunae.

Interventional EUS has seen exponential growth in its indications and applications in the last decade.[1,2,3] Dedicated endoscopic devices for EUS-guided interventions are still limited. Up until recently, the tools used have been borrowed from other procedures such as ERCP. In interventional EUS, the linear-array echoendoscope allows a needle to be advanced under EUS-guidance from the upper gastrointestinal lumen to the biliary, pancreatic, or another adjacent intestinal lumen. Real-time puncture can be performed and provide the possibility of EUS-guided transluminal drainage (EUS-TLD). Plastic stents and conventional self-expandable metallic stents (SEMSs) were initially used but present several limitations due to their design.[1,4,5] They lack lumen-to-lumen anchorage and present migratory risks in the absence of stricture to hold them in place. Plastic stents are associated with potential pneumoperitoneum and bile peritonitis, whereas fully-covered SEMS (FCSEMS), despite preventing bile leak, will not maintain secure apposition between two nonadherent organs. Furthermore, their length often exceeds the anatomical requirement of a shorter transluminal anastomosis and predisposes them to obstruction as well as difficult positioning. With the rise in new EUS-guided interventional techniques, new tools, in particular, new stent designs have evolved to facilitate the various applications. A few EUS-specific stents have now become available for EUS-TLD.[4,5] We hereby review the stent designs and discuss lacunae to be addressed to improve the efficacy, safety, and ease of procedures.

Value of Broncho-Alveolar Lavage in Diagnosis of Newly Developed Lung Infiltrates in Mechanically Ventilated Patients

Background and Objectives: in a developing country, cost effectiveness is an important consideration. The aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage (mini BAL) samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients. Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-Y gel instead of the pre-packaged catheters. Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while fourteen had polymicrobial infection. Fungal infection (Candida) was the most frequent isolated pathogen (32%) followed by Gram-negative bacteria (Klebsiella) (30%). Legionella was the commonest isolated atypical bacteria. Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly developed pulmonary infiltrates.

What is a difficult transfer? Analysis of 7,714 embryo transfers: the impact of maneuvers during embryo transfers on pregnancy rate and a proposal of objective assessment

To establish the relationship between the degree of difficulty of ET and pregnancy rate (PR), with a view to proposing an algorithm for the objective assessment of ET. Retrospective, observational study. Invitro fertilization unit. Women undergoing assisted reproductive technology (ART) with ET after IVF/intracytoplasmic sperm injection, in whom fresh embryo transfer or frozen-thawed embryo transfer was performed. None. Clinical pregnancy rate (CPR). A total of 7,714 ETs were analyzed. The CPR was significantly higher in the cases of easy ET compared with difficult ET (38.2% vs. 27.1%). Each instrumentation needed to successfully deposit the embryos in the fundus involves a progressive reduction in the CPR: use of outer catheter sheath (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.79-1.01), use of Wallace stylet (OR 0.71; 95% CI 0.62-0.81), use of tenaculum (OR 0.54; 95% CI 0.36-0.79). Poor ultrasound visualization significantly diminish the CPR. The CPR decreases progressively with the use of additional maneuvers during ET. An objective classification of the instrumentation applied during ET is proposed.

AB298. SPR-25 NLRP3/IL-1β mediates denervation during bladder outlet obstruction in rats

ObjectiveBladder outlet obstruction (BOO) is a common condition resulting from benign prostatic hyperplasia, neurologic pathology, organ prolapse, etc. Long-term, obstruction is well-established to evoke denervation in the bladder which causes the detrusor to become hypocontractile, resulting in inefficient bladder emptying and consequent infections, continence issues or even renal failure. Recently, considerable attention has been paid to a role for inflammation in bladder deterioration during BOO and we have shown a central role for the NLRP3 inflammasome in triggering this inflammation. In the present study we explore a possible connection between this NLRP3-induced inflammation and bladder denervation.MethodsRats were divided into five groups: (I) control; (II) sham operated; (III) BOO + vehicle (1 mL, 40% ethanol in PBS, p.o.); (IV) BOO + glyburide (Gly, NLRP3 inhibitor; 10 mg/kg, p.o.); (V) BOO + anakinra (Ana, IL-1 receptor antagonist; 25 mg/kg, i.p.). BOO is constructed in female rats by inserting a 1 mm outer diameter transurethral catheter, tying a silk ligature around the urethra and removing the catheter. Medications were administered prior to surgery and once daily. At 12 days animals were sacrificed and the bladders processed for histological analysis. Transverse sections (5 µm) were stained for PGP9.5 expression (a pan-neuronal marker) using standard immunohistochemistry techniques. Entire sections were scanned, using a 10× objective, into TIFF files using Zen software (Zeiss Inc.). Images were imported into Elements software (Nikon Inc.) and the area of individual neurons designated as well as total bladder area (exclusive of the urothelium and lumen). The number of neurons and respective areas were used to calculate nerve density.ResultsDenervation in the bladder wall during BOO was significant, as measured by nerve density. This effect was attenuated by either preventing NLRP3 activation with Gly or blocking IL-1β’s action at its receptor by treatment with Ana, clearly indicating a role for NLRP3/IL-1β in bladder denervation during BOO. The effect was also apparent with the total number of nerves despite considerable changes in bladder wall area (increased in BOO, maintained by Gly or Ana). Interestingly, the mean area of individual nerves was increased in BOO. This effect was blocked by Gly or Ana suggesting a loss of smaller neurons and/or retraction of neuronal branching during BOO as a result of NLRP3/IL-1β.ConclusionsNLRP3/IL-1b-induced inflammation leads to bladder denervation during BOO and blocking this pathway, either by preventing NLRP3 activation or inhibiting the action of IL-1B, prevents nerve loss.Funding Source(s)NIDDK—R01DK103534 (PI-Purves)

Ultrasonic transducer-guided electrochemical impedance spectroscopy to assess lipid-laden plaques

Plaque rupture causes acute coronary syndromes and stroke. Intraplaque oxidized low density lipoprotein (oxLDL) is metabolically unstable and prone to induce rupture. We designed an intravascular ultrasound (IVUS)-guided electrochemical impedance spectroscopy (EIS) sensor to enhance the detection reproducibility of oxLDL-laden plaques. The flexible 2-point micro-electrode array for EIS was affixed to an inflatable balloon anchored onto a co-axial double layer catheter (outer diameter=2mm). The mechanically scanning-driven IVUS transducer (45MHz) was deployed through the inner catheter (diameter=1.3mm) to the acoustic impedance matched-imaging window. Water filled the inner catheter to match acoustic impedance and air was pumped between the inner and outer catheters to inflate the balloon. The integrated EIS and IVUS sensor was deployed into the ex vivo aortas dissected from the fat-fed New Zealand White (NZW) rabbits (n=3 for fat-fed, n=5 normal diet). IVUS imaging was able to guide the 2-point electrode to align with the plaque for EIS measurement upon balloon inflation. IVUS-guided EIS signal demonstrated reduced variability and increased reproducibility (p<0.0001 for magnitude, p<0.05 for phase at <15kHz) as compared to EIS sensor alone (p<0.07 for impedance, p<0.4 for phase at <15kHz). Thus, we enhanced topographic and EIS detection of oxLDL-laden plaques via a catheter-based integrated sensor design to enhance clinical assessment for unstable plaque.

Does embryo transfer technique influence the pregnancy outcome? A retrospective study

Background: Embryo transfer (ET) is the final and most crucial step of an in vitro fertilization (IVF) program. The majority of couples (approximately 80%) who undergo IVF reach the ET stage, yet few pregnancies occur. The pregnancy rate after ET is dependent on multiple factors including embryo quality, endometrial receptivity, and the technique of the ET. The latter might be directly responsible for a lot of unsuccessful embryo implantations. However, comparatively less attention has been paid to ET techniques than IVF technique. Recently, many investigators have identified the relationship between IVF outcome and different techniques and they have noted a pregnancy rate of 33.3% for excellent transfers, and 10.5% for poor transfers. Aim: To study the impact of ET technique on pregnancy outcome. Design and Setting: A retrospective study conducted at the Institute of Reproductive Medicine in Chennai. A total of 123 patients who had a frozen ET by a single consultant during the study period of 6 months were included in the study. The patients were divided into two groups based on final confirmation of pregnancy by ultrasound. In this study, we evaluated the effect of the depth of ET, presence of blood and mucus in the catheter, duration of the interval loading-discharging embryos (ILDE), and nature of transfer on pregnancy outcome. Statistical analysis has been done using SPSS version 21. Results: Among the four variables evaluated in this study, only the duration of the ILDE had a statistically significant effect on the pregnancy outcome ( P = 0.046). Conclusion: This study concluded that the duration of ILDE is a prognostic factor and should be shortened. The depth of ET, nature of ET, and presence of blood and mucus in outer catheter has no influence on pregnancy outcome.