Push-pull Technique Research Articles

Treatment of the Buried Bumper Syndrome​​​​​: A Retrospective Multicenter Study With Inclusion of 160 Cases.

The therapy of buried bumper syndrome (BBS) is difficult. The aim of this retrospective multicenter study was to analyze the treatment methods with focus on effectiveness and safety of endoscopic techniques. The analysis of all therapies and a comparison of the papillotome technique (PT) and needle knife-based nonpapillotome technique (NPT) were performed. Primary endpoint was technical success in one session, secondary endpoints overall technical success, number and duration of treatment sessions, SAE, and mortality. The primary treatment of 160 BBS cases, diagnosed between 2003 and 2021, was NPT in 60 (37.5%), PT in 43 (26.9%), push/pull technique (PPT) in 40 (25.0%), no removal in 9 (5.6%), laparotomy in 7 (4.4%) cases, and external incision in 1 (0.6%) case. For PT and NPT rates of technical success in one session were 95.5% and 45.0% (P<0.01), rates of overall technical success 100% and 88.3% (P=0.02), and mean number and duration of treatment sessions 1.05 (±0.21) versus 1.70 (±0.91) (P<0.01) and 32.17 (±21.73) versus 98,00 (±62.28) minutes (P<0.01), respectively. No significant differences between PT and NPT were found for SAE (15.9% vs. 25.0%) and mortality (2.3% vs. 1.7%). For PPT, laparotomy and external incision rates of technical success in one session and overall technical success were 100%, rates of SAE 2.5%, 50.0%, and 0% and mortality 0%, 10.0%, and 0%. Endoscopic therapy of BBS is treatment of choice in most cases with removal of incomplete BB by PPT. In case of complete BB PT appears more effective than NPT.

Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.

Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction. Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired t tests. At maximum load, we found statistically significant differences in displacement (P=.003) and energy absorbed (P=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site. When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [Orthopedics. 2024;47(5):308-312.].

A quality control procedure for central venous blood sampling based on potassium concentrations

Abstract Objectives To evaluate the extent of agreement between two blood collection methods for electrolytes, central venous blood sampling by the push-pull technique versus venipuncture, and to mitigate errors in blood sampling by a potassium-based quality control procedure. Methods A comparative within-subject study was carried out for adult patients in the intensive care unit. Intraclass correlation coefficients (ICCs) were used to estimate concordance, and Bland–Altman analysis and clinically acceptable limits were used to compare the equivalence of the two methods. An in-house checklist was designed to identify errors made by nurses throughout central venous blood sampling by the push-pull technique, the corrective training and quality control procedure were conducted, and the rate of errors, incidence of hemolysis and distribution of potassium concentrations were comparatively analyzed for the quality of central venous blood sampling before and after the quality control procedure. Results All the ICCs of 220 paired blood samples displayed excellent reliability, except for potassium. Most of the electrolyte variables were within the clinically acceptable limits, and the results showed that the potassium concentrations did not seem to sufficiently affect clinical decision-making. A total of 30 nurses accepted 90 observations before and after the quality control procedure, and the results showed that blood exposure and repeated disconnections of the line in the push-pull technique were always the main problems throughout the process of central venous blood sampling. In addition, after improvement, the number of patients with hypokalemia or hyperkalemia tended to decrease, but the difference was not statistically significant. For all of the blood samples, only three push-pull paired samples received hemolysis notice. Conclusions Central venous blood sampling by the push-pull technique could be an acceptable substitute for most electrolytes via venipuncture, but caution should be exercised for potassium-based quality control procedures.

Chemical ecology in conservation biocontrol: new perspectives for plant protection.

Threats to food security require novel sustainable agriculture practices to manage insect pests. One strategy is conservation biological control (CBC), which relies on pest control services provided by local populations of arthropod natural enemies. Research has explored manipulative use of chemical information from plants and insects that act as attractant cues for natural enemies (predators and parasitoids) and repellents of pests. In this review, we reflect on past strategies using chemical ecology in CBC, such as herbivore-induced plant volatiles and the push-pull technique, and propose future directions, including leveraging induced plant defenses in crop plants, repellent insect-based signaling, and genetically engineered crops. Further, we discuss how climate change may disrupt CBC and stress the importance of context dependency and yield outcomes.

A push-pull strategy to control the western flower thrips, Frankliniella occidentalis, using alarm and aggregation pheromones.

Since the first report in 1993 in Korea, the western flower thrips, Frankliniella occidentalis, has been found in various crops throughout the country. Although more than 20 different chemical insecticides are registered to control this insect pest, its outbreaks seriously damage crop yields, especially in greenhouses. This study developed a non-chemical technique to control F. occidentalis infesting hot peppers cultivated in greenhouses. The method was based on behavioral control using an alarm pheromone ("Push") to prevent the entry of the thrips into greenhouses and an aggregation pheromone ("Pull") for mass trapping inside the greenhouses. The greenhouse fences were treated with a wax formulation of the alarm pheromone and a yellow CAN trap covered with sticky material containing the aggregation pheromone was constructed and deployed inside the greenhouses. Field assay demonstrated the efficacy of the push-pull tactics by reducing thrips density in flowers of the hot peppers as well as in the monitoring traps. Especially, the enhanced mass trapping to the CAN trap compared to the conventional yellow sticky trap led to significant reduction in the thrips population. This novel push-pull technique would be applicable to effectively control F. occidentalis in field conditions.

Preventing Iatrogenic Fibula Fractures using the Push-Pull Technique: A Biomechanical Comparison of Unicortical vs Bicortical Post Screws

Category: Ankle; Basic Sciences/Biologics; Sports; Trauma Introduction/Purpose: In displaced diaphyseal fractures fixed with a plate, reduction is often achieved using the direct reduction method known as the Push-Pull Technique. In this method, the plate is attached to the distal fragment of the fracture while a post screw is placed on the proximal fragment. A bone spreader is then placed between the plate and the post screw to achieve length by distracting the fracture for reduction. After fixation, the post screw is removed. This screw is placed either bicortically or unicortically based upon surgeon preference. Anecdotally, the force imparted onto the unicortical screw may cause iatrogenic fracture of the bone. This study evaluates the relative risk of causing iatrogenic fibula fracture with either a unicortical or bicortical post screw during the push-pull technique. Methods: Four matched pairs of fresh-frozen human cadaveric lower limbs were used. A 2 cm oblique osteotomy was performed on the distal diaphysis of the fibula to simulate a displaced, oblique fracture. A 6-hole tubular locking plate was attached distally. For the post screw, a 12 mm unicortical screw or 20 mm bicortical screw was placed 1 cm proximal to the proximal end of the plate. For all constructs, the only difference was the type of post screw used. Each leg was secured to a wooden jig in the neutral position, and the jig was mounted to the platform of an MTS 858 Mini-Bionix testing system which provided compressive load as well as data measurements. The tip of the spreader was wedged between the plate and post screw to simulate the 'push' phase of the 'push-pull' distraction technique. Force applied, displacement, and number of ratchet clicks were recorded for each specimen. Results: All unicortical screws failed at under 15 clicks of the lamina spreader. There was no significant difference between applied load, energy absorbed, or stiffness at the greatest common displacement prior to any failure (22.64 mm, or 10 'clicks') between unicortical and bicortical post screw placement. At maximum applied spreader load, there were statistically significant differences in displacement (p=0.002) and energy absorbed (p=0.023). Post-hoc power analysis shows 99% power achieved for displacement and 90% power achieved for energy. The failure mode for all unicortical screws was through screw toggle and bone cut-out, while all bicortical screws failed through bending of the screws with no visible damage to the bone at the screw site. Conclusion: Clinically speaking, if a distal fibula fracture requires minimal distraction to achieve proper reduction (less than approximately 10 spreader 'clicks'), then it may be appropriate to use a unicortical post screw in order to minimize residual cortical bone damage post-surgery at the post screw location. When performing extensive reductions that require longer distractions, a bicortical post screw should be used to prevent screw toggle and potential bone chipping or fracture at the expense of residual diaphyseal bicortical screw holes.

Air bubbles removal technique from intravenous tubing

Background: The air bubbles in the intravenous tubing can be fatal if it enters the body. It can result in an air embolism. Air embolism is a condition in which air bubbles enter the blood vessels. Several methods can be used to remove air bubbles in the intravenous tubing. One is replacing it with new intravenous tubing, but this method is considered less efficient. This article describes effective and efficient ways to remove air bubbles from intravenous tubing and tests them for effectiveness.Technique: Four techniques can be applied when the intravenous tubing is filled with air, namely the roll-up technique, flick technique, combination roll-up and flick technique, and push-pull technique.Conclusion: From the test, the push-pull technique is the most effective and efficient in removing air from intravenous tubing compared to the others.

Exploration of Pull-Push Effect for Novel Photovoltaic Dyes with A-π-D Design: A DFT/TD-DFT Investigation.

The π-rich versus π-poor units in 4,6-di(thiophen-2-yl)pyrimidine (DTB) alternating the π-backbone of solar cells dyes have been extended with a push-pull technique to lower their HOMO-LUMO energy gap and to increase Intramolecular Charge Transfer (ICT). Density functional theory was used to optimize the ground state moleculargeometries of newly designed dyes (DTB1-DTB6). Time Dependent DFT (TD-DFT) was used to simulate the Uv-vis spectral values at the maximum absorbance values ranging between 481-535nm. These values were red shifted from DTB value of experimental (333nm) and theoretical (346nm). however, their computed absorbance and fluorescence spectra revealed a bathochromic shift of them upon an increasing the solvent polarity. Different DFT functionals such as (B3LYP, CAM-B3LYP, B97XD, and APFD) were employed to choose their proper use Uv-visible analysis to revealan unexpected coherence at the B3LYP level withexperimentalvalues. As a result, the B3LYP with most diffused basis sets of 6-31G + (d,p) were used for further calculations. The parameters of Global Chemical reactivities revealed that all the dyes had a softer nature with their softness value range of 0.27-0.41. their Ionization Potentials (IP) ranged between 6.21-8.10eV to comply that the new dyes had good electron donating potentials. With a good electron injection potential of -1.47-1.74eV, aluminumcan be the best electrode, while Au is excellent towards a hole injection operation which had the potential range of 1.79-3.68eV. For Natural Bond Orbital (NBO) assessment, (N14)LP → (F16-F28)π* with stabilization energy of 42.55kcal/mol was noted for DTB4. Their Second order hyperpolarizability [Formula: see text] values as their Nonlinear Optical (NLO) response ranged between 59.16-232.11 debye-angstrom-1 which were almost 6 times higher than the reference DTB (8.47D). The NLO attributes has also shown that a dyes with its small bandgap was related with higher hyperpolarizability values. Because of the decreased reorganization frequencies, newly discovered derivatives withelectron transfer qualities might be comparable to or equivalent to those of commonly used electron transmission materials.

A Power-Efficient 1–2-MHz Hysteretic Buck Converter With High DVS Rate Enabled by Isosceles-Triangular Shunt Current Push–Pull Technique

This letter presents a DC-DC buck converter featuring rapid dynamic voltage scaling (DVS) speed without sacrificing efficiency. The proposed isosceles-triangular shunt current (ITSC) push-pull technique allows an arithmetically-simplified turningpoint voltage for optimal DVS to be independent of passive components while supplying a sufficient current of 35 A/μs. Currenttailing handover (CTH), also presented in this work, can realize no voltage droop after DVS even under resistive loads. Combining ITSC and CTH aids in enhancing load-transient response. The chip fabricated in a 180-nm CMOS operates at the slow switching frequency of 1–2 MHz, offering a peak efficiency of 97.6%. A high DVS rate of 7 V/μs, enabled by the proposed ITSC, is measured.

374 User Characteristics of Six Intraosseous Devices in a High Bone Density Humerus and Sternum Cadaveric Swine (Sus Scrofa) Model

Intraosseous (IO) infusion, the pressurized injection of fluids into bone through a catheter, is a life-preserving resuscitative technique for treating critical care patients and trauma patients with severe hemorrhage. To be effective as a bridge to central venous access, IO infusion flow rates must be sufficient to sustain life but at pressures low enough to avoid complications. However, little is known regarding end user characteristics of available battery-powered and manual IO devices. User characteristics are important, because to be efficient and effective, an IO device should optimally have a minimal set-up (placement) time and be perceived as easy and comfortable to use, resistant to bending and displacement, effective and trustworthy in meeting the demands of rapid resuscitation, and cause minimal hand fatigue. The present study was specifically designed to fill this important gap in the literature. Three experienced emergency medicine residents each inserted a variety of commercially available 15-gauge IO catheters in cadaveric swine (Sus scrofa) proximal humeri and sternums with bone density similar to adult humans (1.0-1.1 gm/cm2) in a randomized prospective experimental design, and then infused 500 cc of isotonic crystalloid using push-pull technique with a 60cc syringe. Devices included the battery-powered EZ-IO Rapid Infuser and the manual Jamshidi IO, Persys NIO, SAM Manual IO, Tactical Advanced Lifesaving IO Needle (TALON), and PYNG FASTR devices (30 trials per device, 10 per user). Pressures were measured using an in-line manometer. Subjective user characteristics were assessed across eight Likert-type items, which were analyzed individually and as a composite score. Objective and user ratings data were analyzed using ANOVA and nonparametric statistics at p<.05. Infusion flow rates, mean pressures, and peak pressures were generally similar across devices and locations, save that the TALON in the sternum conferred roughly 50% higher flow rates at 30% lower mean pressures and 15% lower peak pressures than other devices in sternum or humerus (each p<.0001). The EZ-IO demonstrated the fastest set-up times and the highest composite user ratings (Figure 1), including highest ratings for each of the eight survey items (p<.0001). The TALON conferred intermediate set-up times and next-highest user ratings overall. The Jamshidi had the longest set-up times, the slowest infusion rates, and relatively low user ratings. IO access devices differ in construction, method of application, effectiveness, and user characteristics. The commonly used battery-powered EZ-IO had the fastest set-up times and the highest user ratings. While the present study was limited by the utilization of a cadaveric swine model rather than an in vivo model, findings suggest the possibility that the TALON, which performed well in objective assessments and user ratings, may be worth considering as a manual backup to the battery-operated EZ-IO Rapid Infuser. Combined, these results highlight the importance of studying the end user characteristics of IO infusion devices towards preserving the lives of critically ill or injured patients requiring rapid fluid or blood product resuscitation.

The humeral head push-pull plate technique significantly diminishes secondary complications in the Treatment of Osteoporotic Varus Displaced Proximal Humeral Fractures

The humeral head push-pull plate technique significantly diminishes secondary complications in the Treatment of Osteoporotic Varus Displaced Proximal Humeral Fractures

Neurotransmitters and nitric oxide are released in various brain areas according to ultradian and infradian rhythms

The push-pull superfusion technique was used to investigate release of endogenous neurotransmitters and nitric oxide in various brain regions. The transmitters catecholamines, histamine, GABA, glutamate, as well and nitric oxide are released according to ultradian rhythms which generate fluctuations of vegetative functions such as blood pressure and arousal. More frequent infradian oscillations of neurotransmitter and nitric oxide release fates are implicated in mutual interneural control.

Routine Fixation of Weber B Fibula Fractures with a Lateral Locking Plate and No Lag Screw

Category:AnkleIntroduction/Purpose:The current standard of care for management of an unstable ankle fracture that includes an oblique Weber B fibula fracture is open reduction and internal fixation (ORIF) using a plate and screws to anatomically reduce and compress the fractured fibula. The most popular first-line techniques include either a lag screw with neutralization plate or an anti- glide plate with or without a lag screw through the plate. However, these techniques can be technically challenging in osteoporotic bone or within fibulas of smaller diameter, and in some cases can result in fragmentation at the fracture site. The purpose of this study is to examine an alternative first-line method for routine treatment of Weber B fibula fractures.Methods:Fifty-two patients undergoing ORIF of a Weber B fibula fracture by a single surgeon were included in this retrospective study. In every case, reduction and clamping of the fracture was attempted. If successful, a lateral locking plate was slid underneath the clamp(s) and applied with cortical screws proximally and locking screws distally. If clamping was unsuccessful, length/alignment/rotation was achieved by alternative methods (i.e. push-pull technique, use of plate to reduce fracture, etc.), and a lateral locking plate was ultimately applied in a similar manner. No screw crossed the fracture in any case. Per published precedent, nonunion was defined as either a gap of >3mm between fracture surfaces >6 months postoperatively or a fracture line >2-3 mm wide and sclerosing of the fracture surfaces >6 months postoperatively. Similarly, malunion was defined as >=1 of the following: talar tilt >2 degrees, talar subluxation >2 mm, or tibiofibular clear space >=5 mm.Results:The mean (+- standard deviation) age of the 52 included patients was 44.2 +- 16.2 years, the mean body mass index was 27.7 +- 6.6 kg/m2, and 63.5% of patients identified themselves as female. The mean follow-up was 6.2 +- 4.4 months. In addition to undergoing fixation of the lateral malleolus, 21 patients also underwent fixation of the posterior malleolus, 27 underwent fixation of the medial malleolus, 29 underwent fixation across the syndesmosis, and seven underwent repair of the deltoid. In all patients, bony anatomic union of the fibula and congruence of the mortise were achieved, with no cases of malunion or nonunion.Conclusion:Routine fixation of Weber B fibula fractures with a lateral locking plate and no lag screw is an alternative method to treat Weber B fibula fractures with excellent radiographic results.

Venous blood gas parameters, electrolytes, glucose and lactate concentration in sick neonatal foals: Direct venipuncture versus push-pull technique.

Blood collection by indwelling intravenous catheter (IVC) avoids repeated venipuncture, which could cause thrombophlebitis risk, anxiety and pain in patients. To compare blood gas parameters, electrolytes, glucose, lactate and haematocrit concentration obtained from venous blood samples collected via a jugular IVC by push-pull (PP) technique to those obtained by venipuncture in hospitalised foals, at the time of catheter placement (T0) and 24hours after the beginning of intravenous therapy (T24). Prospective observational study. Paired blood samples were drawn from hospitalised foals at T0 and T24. In each foal, one venous blood sample was collected via IVC by the following PP technique: 2.4mL of blood was aspirated and immediately reinfused through the catheter three times consecutively, then 1mL of blood was collected using a 1mL heparinised syringe. Thereafter, another sample was collected by direct venipuncture of the contralateral jugular vein, with an identical 1mL heparinised syringe, with a 1-inch, 20-G needle. All samples were analysed with an automated blood gas analyser within 10minutes of collection. The agreement between the two techniques was assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). The level of agreement of blood gas values obtained by the two different techniques was high with very small bias and clinically acceptable ICC (>0.907 at T0; >0.794 at T24) for all variables, except for haematocrit (bias -3.52 at T0; -2.44 at T24) and PvO2 at T0 and T24 (ICC 0.669 and 0.733, respectively). Potential sub-clinical catheter-related complications were not investigated by ultrasound or bacterial culture of the catheter; short duration of the study. PP technique appears to be acceptable for collection of blood samples for venous blood gas parameters, as well as electrolytes, glucose and lactate in sick neonatal foals.

Hemodynamic differences by increasing low profile visualized intraluminal support (LVIS) stent local compaction across intracranial aneurysm orifice.

The Low-profile Visualized Intraluminal Support device (LVIS) has been successfully used to treat cerebral aneurysm, and the push-pull technique has been used clinically to compact the stent across aneurysm orifice. Our aim was to exhibit the hemodynamic effect of the compacted LVIS stent. Two patient-specific aneurysm models were constructed from three-dimensional angiographic images. The uniform LVIS stent, compacted LVIS and Pipeline Embolization Device (PED) with or without coil embolization were virtually deployed into aneurysm models to perform hemodynamic analysis. Intra-aneurysmal flow parameters were calculated to assess hemodynamic differences among different models. The compacted LVIS had the highest metal coverage across the aneurysm orifice (case 1, 46.37%; case 2, 67.01%). However, the PED achieved the highest pore density (case 1, 19.56 pores/mm2; case 2, 18.07 pores/mm2). The compacted LVIS produced a much higher intra-aneurysmal flow reduction than the uniform LVIS. The PED showed a higher intra-aneurysmal flow reduction than the compacted LVIS in case 1, but the results were comparable in case 2. After stent placement, the intra-aneurysmal flow was further reduced as subsequent coil embolization. The compacted LVIS stent with coils produced a similar reduction in intra-aneurysmal flow to that of the PED. The combined characteristics of stent metal coverage and pore density should be considered when assessing the flow diversion effects of stents. More intra-aneurysmal flow reductions could be introduced by compacted LVIS stent than the uniform one. Compared with PED, compacted LVIS stent may exhibit a flow-diverting effect comparable to that of the PED.

Endoscopic extraction of large foreign bodies utilizing a novel push-pull extraction technique

Background and AimsWhile endoscopic removal of large (2-2.5 cm) objects can be accomplished utilizing a combination of endoscopic accessories, very large (>2.5 cm) foreign bodies are often referred for surgical management. We developed a novel, safe, and effective technique for the removal of very large solid foreign bodies utilizing commercially available endoscopes, dilation balloons, and accessories. MethodsThree consecutive patients who presented with acute foreign body ingestion of very large objects (>2.5 cm × >2.5 cm) underwent a novel push-pull extraction technique employing endotracheal intubation, paralysis, esophageal dilation, and extraction with a double-channel therapeutic endoscope with a combination of balloon-assisted traction (push) and snare guidance (pull). One patient presented after ingestion of a C-type battery (50 mm × 26.2 mm) retained in the gastric antrum. Two patients presented after the ingestion of bundled illicit narcotic packets (46 mm × 43 mm and 36 mm × 26 mm), impacted in the esophagus and the antrum, respectively. ResultsSuccessful endoscopic removal of the very large foreign bodies was safely achieved in all cases (3/3) without surgical assistance. Patients recovered without any reported adverse events and were discharged within 1 hour of the procedure. The procedure times and recovery times were not outside that expected for complex foreign body retrievals. There was no disruption of the plastic packages containing illicit narcotics in the 2 patients who ingested these objects. ConclusionsEndoscopic extraction of very large (>25 mm × >25 mm) foreign bodies is safe and possible utilizing a novel push-pull technique with currently available endoscopes and accessories.

Decreasing inhaled contaminant dose of a factory worker through a hybrid Emergency Ventilation System: Performance evaluation in worst-case scenario

Air pollution is detrimental to human health, causing several human illnesses. The industrial microenvironment generates high levels of indoor airborne pollutants, becoming a pervasive issue for workers. It is essential to improve the indoor air quality in this workplace by applying enhanced ventilation systems to minimize inhalation risk. Displacement ventilation is used in industrial buildings because of its stratified air distribution and low cost. However, in case of accidental pollutant release, an enhancement is needed to minimize inhalation exposure. This study proposes a hybrid emergency ventilation system using localized push-pull ventilation to improve the installed displacement ventilation system of a representative workshop. Computational fluid dynamics was applied to calculate steady-state indoor air flow and volume-averaged pollutant concentration. System performance was evaluated in terms of source position; a computer simulated person was integrated to the building to confirm effectiveness against personal inhalation. Results showed marked improvement in performance when push-pull technique was used: room-averaged concentration diminished up to 91% while ventilation rate only increased 4%. Inhaled pollutant mitigation was achieved but performance dependence against leakage source and personal position was confirmed.

The Safety and Feasibility of a New Through-the-scope Balloon-assisted Enteroscopy in Children.

Small bowel involvement in Crohn disease (CD) is clinically important for diagnosis and treatment. Single and double-balloon enteroscopy have already become important diagnostic tools in such cases. The on-demand NaviAid AB device enables deep advancement into the small bowel, using an anterograde or retrograde approach. In adults, this procedure is feasible, safe, and rapid. This work aimed to assess the safety and feasibility of NaviAid AB enteroscopy in pediatric patients. Single-center, prospective study using the through-the-scope balloon-assisted-enteroscopy (TTS-BAE) NaviAid AB device for the evaluation of the small bowel in children with suspected or known inflammatory bowel disease (IBD). The system consists of a single-use balloon catheter inserted through the instrument channel of a standard colonoscope. It consists of an inflation/deflation system (NaviAid SPARK), which is inflated to anchoring pressure. The repetitive push-pull technique enables the advancement of the colonoscope along the small intestine. Fifty analyzed endoscopic procedures (30 retrograde, 20 anterograde) were performed in 34 children (52.9% boys, mean age 13.7 years). Average maximal depth of insertion (MDI), advancement depth using the NaviAid AB and average total procedure time were 138 cm (range 100-190 cm), 81 cm (range 40-120 cm), and 12.8 minutes (range 7.3-19.0 minutes), respectively, for the anterograde approach and 143 cm (range 100-170 cm), 64 cm (range 20-95 cm), and 21.9 minutes (range 13.9-32.0 minutes), respectively, for the retrograde approach. No serious or device-related adverse events were reported. NaviAid AB enteroscopy in children is safe, feasible, and enables assessment of the small intestine in a short period of time.

Percutaneous trigger thumb release: a safe push-pull technique

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Stenosing tenosynovitis of the thumb is an inflammation of flexor tendon sheath of A1 pulley. Percutaneous release has recently gained popularity. Successful percutaneous release depends upon proper prediction of the location of the A1 pulley and circumventing injury to the neurovascular bundles. The aim of this study was to determine the safety of percutaneous release of trigger thumb.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Twenty eight patients were included in the study between 2015 and 2018. All the patients were percutaneously released using push-pull technique. Steroid injection was given following the release. Quinnell grading, patient questionnaire and visual analogue scale score was used to assess the patients at 2 weeks, 6 weeks and 6 months and 1 year.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Satisfactory results were found in 93% of patients. Two patients complained of pain and swelling till third week. No digital nerve injury occurred in any patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Percutaneous trigger thumb release using this push-pull technique is a simple and a safe technique with very minimal complications. &lt;/p&gt;

Fast-transient high-performance low dropout regulator with push-pull technique

A fast transient response low dropout (LDO) regulator based on push-pull structure is presented in this paper. The push-pull circuit sampling the output of the LDO and adjusting the gate voltage of the power MOSFET by push-pull current. The slew rate of the power MOSFET gate is accelerated and the transient response performance is improved. With a 1μF decoupling under 180 nm CMOS technology, the proposed LDO exhibits an excellent transient performance. When the workload changes steeply between 100μA and 20mA in 100ns, the overshoot is 10.176mV and undershoot is 10.795mV with the recovery time are 1.272μs and 0.888μs respectively.