Simple Clip Research Articles

Clip-assisted endoloop ligation of the mucosal defect after resection of colorectal polyps decreased postprocedural delayed bleeding.

Postprocedural delayed bleeding (PDB) remains the most common major complication of colorectal polypectomy. Incomplete clip closure of mucosal defect and unclosed injured blood vessels in gaps between clips may be the risk factors for PDB. To observe whether completely no-gap closure of mucosal defect after polypectomy can reduce PDB occurrence. Single-center, retrospective case-control study. In this study based on historical comparisons of patients in 2 time periods, only the patients with polyps sized between 6 and 15 mm were included. A new clip-assisted endoloop ligation (CAEL, treatment group) method was used between January 2019 and December 2020, and a traditional simple clip closure (SCC, control) was used Between January 2017 and December 2018 to prevent PDB after polypectomy. The rate of PDB of two groups and risk factors for PDB were evaluated. Totally 4560 patients were included in the study; 2418 patients belong to CAEL group, and 2142 patients belong to SCC group. The overall rate of PDB was significantly lower in CAEL group compared to SCC group (0.6% versus 1.5%, p < 0.00). On multivariate logistic analysis, CAEL was a significant independent preventive factor for PDB (odds ratio (OR), 0.092; 95% confidence interval (CI), 0.029-0.3335; p = 0.000). Polyps located at rectum (colon versus rectum) represented a significant independent risk factor for PDB (OR, 11.888; 95% CI, 3.343-42.269; p = 0.001). Completely no-gap closure of mucosal defect after polypectomy further reduced the rate of PDB for polyps sized between 6 and 15 mm. CAEL may be a significant independent preventive factor for PDB. Polyps located at the rectum may be a significant independent risk factor for PDB.

Additively Manufactured Parametric Universal Clip-System: An Open Source Approach for Aiding Personal Exposure Measurement in the Breathing Zone

Design for additive manufacturing is adopted to help solve problems inherent to attaching active personal sampler systems to workers for monitoring their breathing zone. A novel and parametric 3D printable clip system was designed with an open source Computer-aided design (CAD) system and was additively manufactured. The concept was first tested with a simple clip design, and when it was found to be functional, the ability of the innovative and open source design to be extended to other applications was demonstrated by designing another tooling system. The clip system was tested for mechanical stress test to establish a minimum lifetime of 5000 openings, a cleaning test, and a supply chain test. The designs were also tested three times in field conditions. The design cost and functionalities of the clip system were compared to commercial systems. This study presents an innovative custom-designed clip system that can aid in attaching different tools for personal exposure measurement to a worker’s harness without hindering the operation of the worker. The customizable clip system opens new possibilities for occupational health professionals since the basic design can be altered to hold different kinds of samplers and tools. The solution is shared using an open source methodology.

The using of endoscopic technology in transcranial neurosurgery of tumors chiasmosellar region and arterial anterior ring aneurysm

Objective – to study the experience and technical possibilities of the optimal using of the endoscopic assistance during different stages of intracranial surgical procedures in patients with chiasmal–sellar tumors (CST) and arterial aneurysms (AA) of the anterior circulation (AC).Materials and methods. The results of initial series of 59 patients with CST and 14 patients with AA of the AC who were operated at Romodanov Neurosurgery Institute NAMS of Ukraine between 2012 to August 2017, with the using of endoscopic assistance at the different stages of procedure were analyzed. There were used following methods: clinical and neurological exams, laboratory measurements, instrumental evaluation, neuroimaging (brain Computer Tomography (CT), CT Angiography, brain Magnetic Resonance Imaging (MRA), Magnetic Resonance Angiography (MRA), Digital Subtraction Angiography (DSA) of cerebral vessels), functional (Doppler Ultrasound (DU) of the head and neck vessels), morphological evaluation, electroencephalography, statistical analysis.Results. The choice of surgical tactics and approach for CST was performed considering the localization and expansion of CST on the seller region (ante, retro, para, endosellar) and three-dimensional virtual and material modeling. According to the histological type, distribution of CST was follow: tuberculum and diaphragm sellar meningioma – 22 (37.2%) cases, craniopharyngioma – 15 (25.5%), pituitary adenomas – 14 (23.8%), epidermoid and dermoid cysts – 5 (8.5%), optic nerve gliomas – 3 (5.1%). Craniotomy approaches was follow: supraorbital – in 25 (42.4%) patients, pterional – in 18 (30.5%), modified orbitozygomatic- in 16 (27.1%). In 48 (81.3%) cases, initial removal was done, and in 11 (18.7 %) – repeated surgical interventions (regrowth and residual growth of the pituitary adenoma – 7 (63.6%) cases, craniopharyngioma – 4 (36.4%). Microscopic tumor removal were considered as radical in 46 among 56 patients (82.1%). Postoperative mortality was 2.49% (1 patient). The new onset of diabetes insipidus occurred in 3 (5.1%) observations, transient functional disorders, including cosmetic – in 38 (64.4%). Thirty-two (54.3%) patients showed an improvement of visual function (expansion of vision fields, regression of scotomas and / or increased of visual acuity according to Kadasheva scale assessment). Patients with AA of the AC underwent microsurgical procedure under endoscopic assistance and measuring the depth of the wound and the angles of the surgical field during pterional approach – in 9 (64.3%), orbitozygomatic – in 1 (7.1%), pterional with anterior clinoidectomy – in 2 (14.3%), infratemporal – in 2 (14.3%) cases.The evaluation of results included an assessment of AA clipping: Simple clip – 6 (42.9%), Multiple clips – 8 (57.1%). Following intraoperative complication was seen – AA rupture in 1 (7.1%) case, and secondary postoperative ischemic complication in 1 (7.1%) case. The grade of AA exclusion from the blood flow after clipping was done according to Raymond scale: class I – 13 (92.9%) cases, class II – 1 (7.1%). The quality of life of the surgical treated patients was evaluated using Extended Glasgow Outcome Scale. Full and good recovery was observed in 6 (42.9%) patients, mild dependence in 4 (28.6%), moderate dependence in 4 (28.6%).Conclusions. Endoscopic assistant should be used during tumor inspection, its dissection and for control of radical removal considering the size of the bone window, parameters of surgical approach and quality of microscopic visualization. Extreme importance has the utilization of endoscopic assistance for controlling of tumor removal, since its remaining may be inaccessible for microscopic examination, which is situated in «blind» spots. Endoscopic assistance during different stages of clipping of AA of the AC is accessory technique that improves intraoperative visualization during separation of the affected aneurysmal arterial segment of the AC, determining the anatomical location of the perforating arteries, AA neck regions, assessment of the clip / clips position on the AA neck or AA body without additional traction on the wound margins, and for inaccessible regions for microscope examination.

A3-A3 Bypass Surgery for Aneurysm: Technical Nuances.

Cerebral bypass remains important for the treatment of complex cerebral aneurysms including dissecting, giant, and fusiform aneurysms not amenable to endovascular treatment or simple clip ligation. For such aneurysms involving the anterior communicating artery complex or its branches, distal anterior cerebral artery (ACA) A3-A3 side-to-side bypass represents a valuable treatment option. Distal ACA in situ anastomosis is recognized to be technically demanding mainly due to the relative depth and narrowness of the interhemispheric surgical corridor and type of anastomosis. To demonstrate technical nuances of A3-A3 side-to-side in situ bypass surgery through case illustrations and operative videos. Elements of the procedure relating to positioning, approach, and anastomosis which have evolved in the operative technique of the senior author were collated based on review of clinical case material, imaging and video recordings of ACA aneurysms treated with side-to-side in situ A3-A3 bypass procedure. Technical elements were contrasted with relevant literature. Nuances relative to patient positioning, selection of craniotomy variants, adjunctive intraoperative tools and microsurgical nuances of the side-to-side bypass procedure are reviewed. Three illustrative operative video cases, along with illustrations, are provided to complement the description of the nuances. In the light of the inherent technical difficulty, as well as the rather limited case volumes, the technical tips provided may contribute to bringing additional refinement and simplicity to the A3-A3 bypass procedure.

IClaire: A Fast and General Layout Pattern Classification Algorithm With Clip Shifting and Centroid Recreation

Layout pattern classification, which groups similar layout clips into clusters, underlies a variety of design for manufacturability (DFM) applications, such as hotspot library generation, hierarchical data storage, and yield optimization speedup. The key challenges of layout pattern classification are clip representation and clip clustering. In this paper, we present a fast and general layout pattern classification algorithm considering clip shifting and centroid recreation. Our simple but general clip representation captures both topology and density; we can handle not only rigid area match or edge displacement constraints but also variant edge tolerances and don’t care regions. For achieving a small cluster count, our clip clustering is guided by the natural grouping structure of layout clips. The clustering results are further improved by centroid recreation. Our experiments are conducted on 2016 CAD contest at ICCAD benchmark suite. Our results show that our algorithm outperforms the reference solution and all contest winning teams, delivering the smallest cluster count, fastest runtime, and 100% validity. Moreover, our algorithm with clip shifting and centroid recreation further reduces the cluster count effectively and efficiently. In addition to the good solution quality, the interplay between adopted data structures and our algorithm makes it fast and viable to be incorporated into practical DFM flows.

Artificial chordae: A simple clip and tie technique

1. Ilbawi AM, Spicer DE, Bharati S, Cook A, Anderson RH. Morphologic study of the ascending aorta and aortic arch in hypoplastic left hearts: surgical implications. J Thorac Cardiovasc Surg. 2007;134:99-105. 2. Mahle WT, Rychik J, Weinberg PM, Cohen MS. Growth characteristics of the aortic arch after the Norwood operation. J Am Coll Cardiol. 1998;32:1951-4. 3. Forbess JM, Cook N, Roth SJ, Serraf A, Mayer JE Jr, Jonas RA. Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome. Risk factors related to stage I mortality. Circulation. 1995; 92(9 Suppl):II262-6. FIGURE 1. A, Intraoperative image showing diminutive aorta. B, Angiogram revealing narrowed ostium to native ascending aorta.

Revascularization for complex intracranial aneurysms

The modern management of intracranial aneurysms includes both constructive and deconstructive strategies to eliminate the aneurysm from the circulation. Both microsurgical and endovascular techniques are used to achieve this goal. Although most aneurysms can be eliminated from the circulation with simple clip reconstruction and/or coil insertion, some require revascularization techniques to enhance tolerance of temporary arterial occlusion during clipping of the aneurysm neck or to enable proximal occlusion or trapping. In fact, the importance of revascularization techniques has grown because of the need for complex reconstructions when endovascular therapies fail. Moreover, the safety and feasibility of bypass have progressed due to advances in neuroanesthesia, technological innovations, and ~ 5 decades of accumulating wisdom by bypass practitioners. Cerebral revascularization strategies become necessary in select patients who possess challenging vascular aneurysms due to size, shape, location, intramural thrombus, atherosclerotic plaques, aneurysm type (for example, dissecting aneurysms), vessels arising from the dome, or poor collateral vascularization when parent artery or branch occlusion is required. These techniques are used to prevent cerebral ischemia and subsequent clinical sequelae. Bypass techniques should be considered in cases in which balloon test occlusion demonstrates inadequate cerebral blood flow and in which there is a need for Hunterian ligation, trapping, or prolonged temporary occlusion. This review article will focus on decision making in bypass surgery for complex aneurysms. Specifically, the authors will review graft options, the utility of balloon test occlusion in decision making, and bypass strategies for various aneurysm types.

Alternative Methods to Measure the Adhesive Shear Displacement in the Thick Adherend Shear Test

There are standard tests to determine the adhesive properties, one of the most used being the Thick Adherend Shear Test (TAST). This test assumes that the adhesive deforms only in shear. The standard method recommends the use of a special extensometer attached to the specimen. The use of this extensometer needs a very experienced technician, in addition to requiring high costs of production. In this work, the adhesive shear deformation is measured with a conventional clip gauge used for tensile tests. The steel deformation correction is made using a non-contact method (optical) that gives only the adhesive deformation and a numerical analysis. The objective of this study was to evaluate the applicability of a simpler method of measuring the adhesive deformation and to evaluate methods without contact for the measurement of the deformation of thin adhesive layers. The results show that a simple clip gauge can be used to measure the adhesive deformation, provided a correction factor is applied.

An audit of cystic duct closure in laparoscopic cholecystectomies

Cystic duct leak is an infrequent but potentially serious complication of laparoscopic cholecystectomy. The aims of this audit were to assess the efficacy of locking absorbable clips for closing the cystic duct and to compare the results with those for simple clips used previously. The records for all laparoscopic cholecystectomies performed in one hospital over a 5-year period were reviewed. The results were compared using Fisher's exact test. Of 518 laparoscopic cholecystectomies attempted, 24 were excluded. There was no difference in age or sex ratio between the two groups. Cystic duct leaks were identified either on endoscopic retrograde choloangio pancreatography or at laparotomy. No cystic duct leak occurred in any of the 344 locking clip cases, as compared with 3 leaks in the 146 (2%) simple clip cases (p < 0.03). Locking clips are a safe and effective method for cystic duct closure. They are associated with a reduced cystic duct leak rate, as compared with that for simple clips.

J-Integral Evaluation of Single-Edge Notched Specimens under Mixed-Mode I/II Loading

Abstract Standard test methods of mixed-mode fracture toughness still do not exist, even though a decrease of fracture toughness with increasing Mode II (shear components) has been observed for a number of steels. A J-estimation scheme for mixed-mode loaded single-edge notched specimens is therefore developed in this paper. In accordance with the ASTM Standard E 1820-99, the evaluation of the plastic part of J is based on the measurement of the dissipated plastic energy weighted by a ηpl-factor. Two different approaches for the ηpl-factor are derived. Factors from both showed good correlation with finite element calculations for the specific case of a compact-tension-shear specimen (C(TS)), Finally, a simple clip gage setup for the measurement of the crack-opening displacements needed for the evaluation of the dissipated plastic energy is presented. The problem of the qualification of the mixed-mode crack initiation data is not specifically addressed, but some general comments on this topic are given at the end of the paper.