Pneumatic Device Research Articles

Exercise inhibits neuronal apoptosis and improves cerebral function following rat traumatic brain injury

Exercise is reported to inhibit neuronal apoptotic cell death in the hippocampus and improve learning and memory. However, the effect of exercise on inhibition of neuronal apoptosis surrounding the area of damage after traumatic brain injury (TBI) and the improvement of cerebral dysfunction following TBI are unknown. Here, we investigate the effect of exercise on morphology and cerebral function following TBI in rats. Wistar rats received TBI by a pneumatic controlled injury device were randomly divided into two groups: (1) non-exercise group and (2) exercise group. The exercise group ran on a treadmill for 30min/day at 22m/min for seven consecutive days. Immunohistochemical and behavioral studies were performed following TBI. The number of single-stranded DNA (ssDNA)-positive cells around the damaged area early after TBI was significantly reduced in the exercise group compared with the non-exercise group (P<0.05). Furthermore, most ssDNA-positive cells in the non-exercise group co-localized with neuronal cells. However, in the exercise group, a few ssDNA-positive cells co-localized with neurons. In addition, there was a significant increase in neuronal cell number and improvement in cerebral dysfunction after TBI in the exercise group compared with the non-exercise group (P<0.05). These results indicate that exercise following TBI inhibits neuronal degeneration and apoptotic cell death around the damaged area, which results in improvement of cerebral dysfunction. In summary, treadmill running improved cerebral dysfunction following TBI, indicating its potential as an effective clinical therapy. Therefore, exercise therapy (rehabilitation) in the early phase following TBI is important for recuperation from cerebral dysfunction.

1552 IN-VITRO ASSESSMENT OF TIP DYNAMICS IN A NEW PORTABLE BALLISTIC LITHOTRIPTER

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111552 IN-VITRO ASSESSMENT OF TIP DYNAMICS IN A NEW PORTABLE BALLISTIC LITHOTRIPTER Agnes J. Wang, Gavin McAlister, Jamie Gabriel, W. Neal Simmons, Michael E. Lipkin, Michael N. Ferrandino, Glenn M. Preminger, and Pei Zhong Agnes J. WangAgnes J. Wang Durham, NC More articles by this author , Gavin McAlisterGavin McAlister Durham, NC More articles by this author , Jamie GabrielJamie Gabriel Durham, NC More articles by this author , W. Neal SimmonsW. Neal Simmons Durham, NC More articles by this author , Michael E. LipkinMichael E. Lipkin Durham, NC More articles by this author , Michael N. FerrandinoMichael N. Ferrandino Durham, NC More articles by this author , Glenn M. PremingerGlenn M. Preminger Durham, NC More articles by this author , and Pei ZhongPei Zhong Durham, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1560AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intracorporeal lithotriptor technology is moving towards devices that do not need a separate unit as an energy source. The benefits are in cost reduction as well as the portability and the “wireless” nature of the device. One such pneumatic device, the LMA Stonebreaker™, is powered by sterile CO2 cartridges. A new device under development is a battery-operated electrokinetic ballistic lithotripter in which probe velocity and displacement can be modified to suit clinical applications by changing the hardness of the probe guide. An in vitro model was designed to compare the tip speed and displacement characteristics of this new electrokinetic ballistic device. METHODS To determine tip velocity and displacement, the probe tip was aligned to partially occlude an expanded laser beam that was aimed at a high bandwidth photo detector. Displacement and velocity were measured for 1mm (ureteroscopic) and 2mm (percutaneous) probes with both hard and soft probe guides. The probe position was correlated with the voltage measurement from the photo detector. A digital oscilloscope was used to capture the time/displacement characteristics of the probe tip. Twenty-five displacement profiles were measured for each probe and support combination. Means and standard deviations were computed for all groups. RESULTS The tip displacement was significantly increased when a soft probe guide was used. The mean probe tip displacement increased 37% (0.31 ± 0.04mm increase) and 52% (0.42 ± 0.10mm increase) for ureteroscopic and percutaneous probes, respectively. Soft probes guides also increased the mean tip velocity by 15% (0.9 ± 0.2 m/s increase) and 14% (0.5 ± 0.2 m/s increase) for ureteroscopic and percutaneous probes, respectively. CONCLUSIONS The elasticity of the probe guide has a large impact on tip velocity and displacement characteristics of electrokinetic ballistic lithotrites. The ability to change tip dynamics may provide optimum performance over a wide range of stone types. High velocity and smaller displacement tip characteristics are suited for hard stones such as calcium oxalate monohydrate while lower velocity and larger tip displacement may be more useful on softer stones. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e623 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Agnes J. Wang Durham, NC More articles by this author Gavin McAlister Durham, NC More articles by this author Jamie Gabriel Durham, NC More articles by this author W. Neal Simmons Durham, NC More articles by this author Michael E. Lipkin Durham, NC More articles by this author Michael N. Ferrandino Durham, NC More articles by this author Glenn M. Preminger Durham, NC More articles by this author Pei Zhong Durham, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Évaluation de la laxité antérieure du genou en IRM : la laxi-IRM

Purpose Evaluation of the ACL and anterior knee laxity on MR during anterior tibial translation. Patients and methods Three groups were identified based on clinical and arthrometric (KT-1000) data: normal ACL ( n = 12), complete tear ( n = 10) and partial tear ( n = 20). MRI was performed without and with anterior tibial translation (pneumatic device) with morphological and laximetric analysis: drawer tests and dynamic evaluation of ligamentous tension. Results Intra- and inter-observer reproducibility was excellent, correlated to arthrometric data and clinical tests (Lachman, pivot shift). The difference between the drawer signs of normal subjects and patients with ACL tear was significant for a threshold value of 1,1 mm for the anterior drawer (sensitivity: 93,33%, specificity: 91,7%) and 2,8 mm for the posterior drawer (sensitivity: 86,7%, specificity: 100%). Dynamic evaluation of ligamentous tension was also reproducible, statistically correlated to the MR drawer tests and reliable for the diagnosis of ACL lesions. In this preliminary study, the distinction between complete and partial ACL tears could not be detected. Conclusion Anterior cruciate ligament function can be demonstrated on MR. The predictive value of this morphological and functional association should be determined in the management of patients with partial tears.

Fast DNA hybridization on a microfluidic mixing device based on pneumatic driving

A novel fluid mixing strategy was developed which significantly enhanced the efficiency of DNA hybridization. A pneumatic micro-mixing device consisting of two pneumatic chambers and an underneath DNA microarray chamber was built up. The fluid in the array chamber was pneumatically pumped alternately by the two pneumatic chambers. The chaotic oscillatory flow caused by the pumping greatly intensified the fluidic mixing. A homogeneous distribution of the tracer dye solution in the microarray chamber was observed after 2s mixing with a pumping frequency of 24Hz. Microarray DNA hybridization was substantially accelerated using this device, and the fluorescence intensity showed a plateau after oscillating 30s at room temperature. The corresponding signal level of the dynamic hybridization was 12.5-fold higher than that of the static hybridization performed at 42°C. A signal-to-noise ratio of 117 was achieved and the nonspecific adsorption of the targets to the sample array was minimized, which might be attributed to the strong shearing force generated during the pneumatic mixing process.

415 MRIコンパチブルな空気圧駆動式生体関節圧縮試験装置の開発(GS-2 バイオエンジニアリング(5))

415 MRIコンパチブルな空気圧駆動式生体関節圧縮試験装置の開発(GS-2 バイオエンジニアリング(5))

FMRI investigation of unexpected somatosensory feedback perturbation during speech

Somatosensory feedback plays a critical role in the coordination of articulator movements for speech production. In response to unexpected resistance to lip or jaw movements during speech, fluent speakers can use the difference between the somatosensory expectations of a speech sound and the actual somatosensory feedback to adjust the trajectories of functionally relevant but unimpeded articulators. In an effort to investigate the neural substrates underlying the somatosensory feedback control of speech, we used an event-related sparse sampling functional magnetic resonance imaging paradigm and a novel pneumatic device that unpredictably blocked subjects' jaw movements. In comparison to speech, perturbed speech, in which jaw perturbation prompted the generation of compensatory speech motor commands, demonstrated increased effects in bilateral ventral motor cortex, right-lateralized anterior supramarginal gyrus, inferior frontal gyrus pars triangularis and ventral premotor cortex, and bilateral inferior posterior cerebellum (lobule VIII). Structural equation modeling revealed a significant increased influence from left anterior supramarginal gyrus to right anterior supramarginal gyrus and from left anterior supramarginal gyrus to right ventral premotor cortex as well as a significant increased reciprocal influence between right ventral premotor cortex and right ventral motor cortex and right anterior supramarginal gyrus and right inferior frontal gyrus pars triangularis for perturbed speech relative to speech. These results suggest that bilateral anterior supramarginal gyrus, right inferior frontal gyrus pars triangularis, right ventral premotor and motor cortices are functionally coupled and influence speech motor output when somatosensory feedback is unexpectedly perturbed during speech production.

Compression Therapy in Mixed Ulcers: Search for a Safe Pressure Range not Affecting Arterial Inflow

About 15% to 20% of patients with venous leg ulcers have a reduced ankle brachial pressure index (ABPI) causing retarded healing. Compression is able to improve venous hemodynamics in mixed ulcers but needs to be applied with caution in order not to reduce arterial inflow. This study aimed to define a safe range of compression pressure that does not impede arterial flow. In 25 patients with mixed ulcers (ten males, 15 females aged 76.4 ± 10 years), presenting with a mean ABPI of 0.57 ± 0.09 mm Hg and a systolic ankle pressure of 91.8 ± 18.3 mm Hg, skin flow was assessed in the peri-wound area and in the plantar surface of the first toe by means of laser Doppler flowmetry, and toe pressure was measured simultaneously. The measurements were carried out in baseline conditions and after inelastic bandage from the base of the toes to the popliteal area, applied with different pressure ranges of 20 to 30, 30 to 40 and 40 to 50 mm Hg. The pressure exerted by the bandage was continuously measured by a pneumatic device with its flat probe placed next to the laser Doppler probe. The flat, peri-wound laser Doppler probe remained under the bandage, whereas the toe probes were placed distally to the bandage. Compared with baseline conditions, skin perfusion increases significantly with a bandage pressure of 20 to 30 and 30 to 40 mm Hg, and returns to the baseline level with 40 to 50 mm Hg (Fig 1A). Toe perfusion shows a minor, not significant, decrease with 20 to 30 and 30 to 40 mm Hg, but a significant reduction with 40 to 50 mm Hg (Fig 1B). Toe pressure increases with every pressure step, showing significant differences compared with baseline with 30 to 40 and 40 to 50 mm Hg (Fig 1C). External compression of 20 to 30 or 30 to 40 mm Hg increases the arterial flow, even in patients with very low ABPI and does not affect the toe pressure as long the individual systolic ankle pressure is not exceeded. Absolute ankle pressure values are more reliable than ABPI to assess the individual risk concerning compression pressure.

Green Manufacturing: A Lever-Wedge Self-Locking Force Amplifying Clamping Device Driven by Linear Motor

Here introduces a kind of clamping device which is driven by linear motor and makes use of lever-wedge serial mechanism to amplify input force and to realize self-locking. We analyze its working principle and structure feature, give the calculation formulas of force amplification coefficient and output force. Compared with hydraulic clamping device or pneumatic clamping device, this kind of clamping device has the advantages: few conversion segments, no energy consumed during machining and no environment pollution.

Pneumatic Pulsatile Ventricular Assist Device as a Bridge to Heart Transplantation in Pediatric Patients

Despite the remarkable advances with the use of ventricular assist devices (VAD) in adults, pneumatic pulsatile support in children is still limited. We report on our experience in the pediatric population. A retrospective review of 17 consecutive children offered mechanical support with Berlin Heart as a bridge to heart transplant from February 2002 to April 2010 was conducted. The median patient age was 3.9 years (75 days to 13.3 years). The median patient weight was 14.1 kg (2.9-43kg). Before VAD implantation, all children were managed by multiple intravenous inotropes and mechanical ventilation (14) or extracorporeal membrane oxygenation (3). All patients had right ventricular dysfunction. Nine patients required biventricular mechanical support (BVAD), but in all other cases a single left ventricular assist device proved sufficient (47%). The median duration of VAD support was 47 days (1-168 days). The median pre-VAD pulmonary vascular resistance index (Rpi) was 5.7 WU/m(2) (3.5 to 14.4WU/m(2) ). Eleven patients (65%) were successfully bridged to heart transplantation after a median duration of mechanical support of 68 days (6-168 days). Six deaths occurred (35%), three for neurological complications, one for sepsis, and two others for device malfunctioning. Since 2007, the survival rate of our patients has increased from 43% to 80%, and the need for BVAD has decreased from 86% to 30%. In two patients with Rpi >10WU/m(2) , unresponsive to pulmonary vasodilatator therapy, Rpi dropped to 2.2 and 2WU/m(2) after 40 and 23 days of BVAD support, respectively. Seven patients (41%) required at least one pump change. Of 11 patients undergoing heart transplant, four developed an extremely elevated (>60%) panel reactive antibody by enzyme-linked immunosorbent assay, confirmed by Luminex. All of them experienced at least one acute episode of rejection in the first month after heart transplant, needing plasmapheresis. The survival rate after heart transplantation was 100% with a median follow-up of 25.4 months (6 days to 7.7 years). Mechanical support in children with end-stage heart failure is an effective strategy as a bridge to heart transplantation with a reasonable morbidity and mortality. BVAD support may offer an additional means to reverse extremely elevated pulmonary vascular resistance.

A suction-type, pneumatic microfluidic device for liquid transport and mixing

This study presents a new suction-type, pneumatically driven microfluidic device for liquid delivery and mixing. The three major components, including two symmetrical, normally closed micro-valves and a sample transport/mixing unit, are integrated in this device. Liquid samples can be transported by the suction-type sample transport/mixing unit, which comprised a circular air chamber and a fluidic reservoir. Experimental results show that volume flow rates ranging from 50 to 300 μl/min can be precisely controlled during the sample transportation processes. Moreover, the transport/mixing unit can also be used as a micro-mixer to generate efficient mixing between two reaction chambers by regulating the time-phased deformation of the polydimethylsiloxane (PDMS) membranes. A mixing efficiency as high as 98.4% can be achieved within 5 s utilizing this prototype pneumatic microfluidic device. Consequently, the development of this new suction-type, pneumatic microfluidic device can be a promising tool for further biological applications and for chemical analysis when integrated into a micro-total analysis system (μ-TAS) device.

The propagation of induced tendon lesions in the equine superficial digital flexor tendon: An ex vivo study

Clinical tendon lesions usually enlarge during the first days to weeks after sustaining the injury due to enzymatic and biomechanical influences. Limiting this enlargement would positively influence prognosis related to lesion size. To investigate the effect of cyclic loading on the propagation of enzymatically and physically induced tendon lesions and to assess the effect of immobilisation thereon in an ex vivo model. Equine cadaver limbs with either physically or collagenase-induced SDFT lesions were placed in a pneumatic loading device. Groups consisted of unloaded limbs, cyclically loaded limbs and cyclically loaded limbs with fibreglass cast immobilisation. Lesion size was evaluated ultrasonographically and macroscopically and load at failure was determined for groups where lesions enlarged. Physically induced lesions did not propagate after cyclical loading and were not further investigated. Collagenase-induced lesions propagated significantly more after cyclical loading compared to unloaded limbs. This propagation could effectively be reduced by immobilisation through a lower limb cast. Immobilisation did not influence load at failure. The combination of enzymatic and mechanical stimulation caused the lesions to propagate most. Casting appeared effectively to reduce the enlargement of the original tendon lesions in this ex vivo model, while it did not affect ultimate tendon strength. As prognosis of tendon injuries is related to lesion size, the outcome of this study warrants further investigations in vivo.

Pneumatic impulsion device for microfluidic systems

Design, fabrication and characterization of a highly integrable fluid impulsion microdevice developed for microfluidic systems are presented in this paper. The device is composed by a chamber and a single-use microvalve that connects its output port to an external microfluidic circuit. Due to the in-plane structure, a high integration with microfluidic and electronic components can be achieved. The activation is based in the combination of mechanical to thermal phenomena. The thermal effect is producing by making an electrical current flow through a resistor, and the mechanical one by applying a differential pressure. The combination of these phenomena at the time of activation produces a reduction of the required electrical energy with respect to other devices, and also enables fluid movement. It is based on the simultaneous application of a temperature ramp that weakens the membrane and a pressure difference that provokes its collapse, bringing on also the impulsion of the fluid. The in-plane structure allows the embedding of a thermal actuator, maximizing the heat transfer to the membrane. Another significant advantage of this structure is manufacturing a series of microdevices in an array, which has been reported. As a result of the integration of SU-8 and PCB-MEMS technologies in the fabrication of the device, fully integrated microfluidic circuits can be implemented within a PCB substrate without the need of complex interfaces to external impulsion actuation. The integration also incorporates outstanding advantages as the possibility of integration with sensing and auxiliary electronics and the drastic decrement of the fabrication cost. A series of microvalves has been characterized varying their parameters of fabrication, leading to a device that requires 0.35 J of electrical energy and supports a range of differential pressures from 50 to 400 kPa.

Flow Visualization of A Monoleaflet and Bileaflet Mechanical Heart Valve in A Pneumatic Ventricular Assist Device Using A PIV System

Our group is developing a new type of pulsatile pneumatic ventricular assist device (PVAD) that uses the Medtronic Hall tilting disc valve (M-H valve). Although tilting disc valves have good washout effect inside the blood pump, they are no longer in common clinical use and may be difficult to obtain in the future. To investigate the stability of the Sorin Bicarbon valve (S-B valve) in our PVAD, we constructed a model pump made of an acrylic resin with the same configuration as our PVAD and attempted to compare the flow visualization upstream and downstream of the outlet position valve between the M-H valve and the S-B valve using a particle image velocimetry (PIV) method. The outlet S-B valve had faster closure than the M-H valve. The maximum flow velocity was greater than with the M-H valve. The maximum Reynolds shear stress (RSS) of the M-H valve reached 150 N/m(2) and that of the S-B valve reached 300 N/m(2) upstream during the end-systolic and early-diastolic phases. In both valves, the maximum RSS upstream of the valve was higher than downstream of the valve because of the regurgitation flow during valve closure. In addition, the maximum viscous shear stress reached above 2 N/m(2), which occupied only about 1%-1.5% of the maximum RSS.

Research on the Fault Diagnosis of Trenchless Drilling Pneumatic Impact Device Based on Grey Relational Theory

Recently the technology of the trenchless drilling of road construction is developing fast as a new technology. However the problem of fault diagnosis in the trenchless drilling pneumatic impact device which works under ground puzzles users frequently. Combined the traditional vibration diagnosis technology with the grey relational theory, a novel grey fault diagnosis approach is presented. With the grey relational degree used to make cluster analysis, the on-line monitoring and diagnosis is realized. The experiment results show that this method is highly reliable and the stucture is very simple.

Numerical study of a swirled turbulent flow in the separation zone of a centrifugal air separator

A mathematical model of a swirled turbulent flow in the separation zone of a pneumatic centrifugal device is presented. The model is based on the known k-? model of turbulence proposed by Wilcox. The influence of rotation of the separation-zone walls, input swirl of the gas flow, and other characteristic parameters on the mean velocity field is demonstrated. A comparison of parameters is performed, which reveals good agreement between the numerical and experimental results for a turbulent fluid flow between parallel disks.

空気圧ゴム人工筋を用いた上肢動作支援ウェアラブルマスタスレーブ装置の開発

In this study, a bilateral type pneumatic wearable master-slave device has been developed in order to feed back a force information to the trainer. Developed device is constructed with a master and a slave device using pneumatic rubber muscles. By feeding back the reaction torque to a torque control system of the master device, a master device user can feel the reaction torque from the slave. In this paper, the structure of the developed device, the fundamental characteristics of device are discussed, and then the validity of the developed device is evaluated from the fundamental experiments.

Application of an optical clearing agent during noninvasive laser coagulation of the canine vas deferens.

Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26+/-3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291+/-31 mmHg) to 7.0 W with OCA (BP=292+/-19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82+/-28 mmHg) significantly below typical ejaculation pressures (136+/-29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure.

Mechanical Spring Replacement With Pneumatic Return Device in a Valve Train: Effects on Dynamics and Preload Tuning

The paper presents a comparison of performance for a cam transmission of an engine valve train operating with a mechanical spring and with a return spring device that uses a pneumatic spring. Dynamic analysis of the cam mechanism is performed in the frequency and time domains employing a combined lumped-distributed parameter model capable of predicting the effects of the higher harmonics of the cam lift profile on system performance, in particular of the return spring device. Dynamic stiffness of the transmission in the frequency domain and time history of the contact force between cam and follower are evaluated. The limits of the traditional mechanical spring-closing system at high-speed camshaft operations are investigated, highlighting that they are mainly imposed by the internal resonances of the spring. The pneumatic spring is an improved replacement of the steel spring because of better dynamic behavior. Furthermore, the pneumatic return device allows preload tuning of the spring, which may increase transmission efficiency through proper control of the fluid pressure. Study of the pressure control circuit is also presented.

Development of an Algorithm to Regulate Pump Output for a Closed Air‐Loop Type Pneumatic Biventricular Assist Device

The closed air space-type of extracorporeal pneumatic ventricular assist device (VAD) developed by the Korea Artificial Organ Center utilizes a bellows-transforming mechanism to generate the air pressure required to pump blood. This operating mechanism can reduce the size and weight of the driving unit; however, the output of the blood pump can be affected by the pressure loading conditions of the blood sac. Therefore, to guarantee a proper pump output level, regardless of the pressure loading conditions that vary over time, automatic pump output regulation of the blood pump is required. We describe herein a pump output regulation algorithm that was developed to maintain pump output around a reference level against various afterload pressures, and verified the pump performance in vitro. Based on actual operating conditions in animal experiments, the pumping rate was limited to 40-84 beats per minute, and the afterload pressure was limited to 80-150 mm Hg. The tested reference pump output was 4.0 L/min. During experiments, the pump output was successfully and automatically regulated within the preset area regardless of the varying afterload conditions. The results of this preliminary experiment can be used as the basis for an automatic control algorithm that can enhance the stability and reliability of the applied VAD.

Development of a framework for pneumatic device selection for lymphedema treatment

The results of three patients with difficult to manage leg and trunk lymphedema are reported. Patients were treated with the current standard of care: combined decongestive therapy. All three patients met obstacles in achieving independent self-care, which impeded their discharge to home care. The use of two currently available programmable pneumatic compression devices (PCDs) was investigated to determine if these devices could enable these difficult-to-manage patients to meet their discharge goals. Results indicate that programmable PCDs can be effective in managing complicated cases of leg and trunk lymphedema, and that differences may exist between devices. In this trial, the device with lower applied pressures and smaller pneumatic chambers provided better tolerated treatment and overall better patient outcomes. These three case reports show that in-home use of an appropriate PCD can help patients with stage 3 and advanced stage 2 lymphedema achieve stable limb volumes with no exacerbation of lymphedema-related symptoms. Results also demonstrate the ability of patients to consistently use programmable PCDs in a home environment. The results are presented in a structured decision-making framework to aid the therapist and physician in selecting appropriate patients for home PCD lymphedema therapy, and in the selection of an appropriate PCD.