Special Catheter Research Articles

ECABLE (External Catheter Flexible) innovation of catheter external products for women

The increasing age of humans leads to reduced strength and muscle mass. Increasing age can also cause a decrease in the function of other organs, such as the urinary tract so that some elderly people have difficulty moving places to urinate and need to use diapers. The types of urinary catheters on the market are intermittent catheters, suprapubic catheters, and external catheters. The purpose of this study was to design a special external catheter for women with the name Ecable. Ecable is designed according to the needs of users both the elderly themselves and people who care for the elderly. The method used in this design is design thinking. ecable consists of five major components: a urine bag, an alarm, a hose, special underwear, and a urine funnel. The advantages offered by this product are easy to install and remove, comfortable to use, minimize unpleasant odors, there is a full urine bag detection alarm, minimize the cause of irritation, and are cost-effective because they can be used repeatedly. This catheter is expected to help the elderly and caregivers to overcome existing needs.

Non-invasive estimation of left ventricular systolic peak-pressure: a prerequisite to calculate of myocardial work in hypertrophic obstructive cardiomyopathy

Abstract Introduction Myocardial work (MW) is an echocardiographic parameter to estimate global and regional myocardial performance. This method utilizes pressure strain loops derived from global longitudinal strain (GLS) and left ventricular systolic pressure (LVSP) estimated by brachial blood pressure (BP). Purpose Since LVSP cannot be equated with BP in pts with HOCM, we investigated whether the LVSP can be calculated non-invasively by combining Doppler echo parameters and the BP. This estimation is mandatory to make MW applicable for HOCM-pts. Methods We studied 20 consecutive pts (8 women, 12 men; mean age 57.0±13.9 years; NYHA class 2.1±0.8) with indication for first alcohol septal ablation. 6 pts had hypertension and 2 pts unexplained syncope. 18 (90%) pts were in sinus rhythm. NTproBNP was 1431 pg/ml (1912 IQR). Echo baseline measurements showed subaortic septal (IVS) thickness of 21.0±5.0 mm and maximal IVS thickness of 24.7±6.3 mm. Pts showed high-normal left ventricular ejection fraction (70.4±10.1%). Left atrial (LA) volume was 101.2±26 ml. All measurements of pressures and gradients were performed in the catheterization laboratory after placement of a 5F Judkins JR4 in the ascending aorta and a 5.2F special pigtail catheter in the apex of LV beyond the obstruction. Simultaneous measurements of BP at left upper arm, echo intraventricular gradients (instantaneous and mean) with CW Doppler (GE Vivid E70), and invasive pressures and gradients (peak-to-peak and mean) of the LV and ascending aorta were performed. Echo and invasive gradients were averaged over 3 cardiac cycles. Finally, we tried to identify an estimation of invasively measured LV systolic pressure by combining systolic BP and echo measured gradients. Results Systolic BP was 143±21 mmHg. Max. CW Doppler gradient was 65±29 mmHg and mean gradient was 31±14 mmHg. Invasive simultaneous measurements at rest showed peak-to-peak gradient of 55±24 mmHg and mean gradient of 34±13 mmHg between apical LV and ascending aorta. Mean LVSP was 190±40 mmHg. Systolic pressure of the ascending aorta was 134±28 mmHg. Adding systolic peripheral BP and maximal echo-gradient mean value was 208±38 mmHg. Adding systolic peripheral BP and echo-mean gradient mean value was 174±26 mmHg. Correlating these values with the invasively measured systolic LV pressure we found a slightly higher correlation of the sum of systolic BP and mean-echo gradient (Pearson correlation coefficient: 0.867 p<0.001) compared with the sum of systolic BP and maximal echo-gradient (Pearson correlation coefficient: 0.851; p<0.001). Bland–Altman plots demonstrated good levels of agreements between invasively measured LVSP and both non-invasively estimated LVSP. Conclusions Non-invasive estimation of LVSP is feasible by combining conventional BP and CW Doppler measured mean LV outflow tract gradient in HOCM. Hereby estimation of MW in pts with HOCM is applicable.

Abstract 16980: Real World Performance of a Conduction System Pacing Lead

Introduction: With the shift towards conduction system pacing (CSP), a technique that preserves ventricular synchrony unlike standard right ventricular pacing (RVP), the use of the smaller diameter fixed-helix Medtronic 3830 4Fr Select Secure lead and its’ special delivery catheter has dramatically increased. The near and long-term performance of the 3830 lead in a large real-world setting remains poorly characterized. Thus, we evaluated our experience with the 3830 lead in comparison to the Medtronic 6Fr stylet-driven active fixation CapSureFix Novus 5076 lead used for conventional RVP. Hypothesis: The performance of the 3830 CSP lead is equivalent to that of the 5076 RVP lead. Methods: Patients with 3830 CSP or 5076 RVP leads implanted at our institution between January 1st, 2018 and March 1st, 2022 were included. All patients were followed at our institution and lead complications, revisions, explants, and upgrades to present day were tracked. Groups were compared using the chi-squared and Fisher’s exact tests in R 4.2.3. Results: The outcomes for 2,077 patients receiving either a 3830 CSP lead (n=1,018) or a 5076 RVP lead (n=1,059) are shown in the table. Initially, 13 (1.3%) 3830 leads could not be implanted vs. 3 (0.3%) 5076 leads (p=0.011). Subsequently, however, total revisions were similar between groups (p=0.20), and there were no significant differences in dislodgement, infection, or need for upgrade. One 3830 lead fractured and was replaced; otherwise, there were no lead failures in either group. The distribution of time from implant to event was also similar (p=.376). Conclusion: The long-term performances of the 3830 and 5076 leads are similarly satisfactory. A small proportion of 3830 leads could not be implanted, but overall septal or CSP was reliably achieved with few complications or need for lead revision or upgrade.

Methods and techniques for increasing the safety and efficacy of pulmonary vein isolation in patients with atrial fibrillation.

The most common type of sustained arrhythmia is atrial fibrillation (AF). Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation, which has emerged as the primary therapeutic strategy for atrial fibrillation patients. Unfortunately, about one-third of patients experience recurrent atrial arrhythmias after the procedure.

Fetal cardiac interventions: First‐year experience of a tertiary referral center in Turkey

To present the first-year experience of fetal cardiac interventions (FCIs) in a tertiary referral hospital and to evaluate the outcomes. This retrospective study consisted of four pregnant women who underwent fetal pulmonary or aortic balloon valvuloplasty between November 2020 and June 2021. The procedures were performed with a percutaneous cardiac puncture under the ultrasonography guidance. Gestational age at intervention, procedural success, complications, and perinatal outcomes were evaluated. Procedural complications defined as fetal bradyarrhythmia requiring treatment, pericardial effusion requiring drainage, balloon rupture, and fetal death. The procedure was considered technically successful if the valve was dilated with a balloon catheter. Ultimately successful procedure was defined as the discharge of infants alive with biventricular circulation. A total of 5 FCIs attempted between 26 + 3 and 28 + 2 gestational weeks. While the procedure was technically successful in 2 cases with pulmonary stenosis, both attempts were unsuccessful in the fetus with pulmonary atresia. Although the procedure was technically successful in the patient with critical aortic stenosis, it ultimately failed. No fetal death occurred in our series and there were no procedure-related significant maternal complications. However, three interventions were complicated by fetal bradycardia and pericardial effusion necessitating treatment, and balloon rupture cropped up in one case. FCIs may lead to improving the likelihood of a biventricular outcome for selected fetuses. Careful selection of patients and centralization of experience are essential for obtaining favorable outcomes. Operators should be aware of procedural complications. Improved procedural techniques with a lower complication rate will be achieved through advanced medical technology and special balloon catheters.

THE RELIABILITY OF URODYNAMIC ASSESSMENT IN CONFIRMATION OF STRESS URINARY INCONTINENCE IN RELATION TO BONNEY TEST.

According to the International Continence Society, stress (static) urinary incontinence is defined as any involuntary loss of urine on effort or physical exertion, due to which intravesical pressure overcomes urethral pressure, with no detrusor activity. Urodynamic testing accurately assesses the function of the bladder and urethra. The urodynamic assessment includes three tests: cystometry, uroflowmetry and profilometry (determination of urethral pressure profile). Prior to urodynamic assessment, it is mandatory to rule out urinary tract infection since it is an invasive test. Urethral profilometry is a technique that measures pressure in the urethra and bladder at rest, during stressful actions, and during the act of miction. Its main purpose is to evaluate the sphincter mechanism. During the examination, a special catheter is used, which is being slowly pulled out from the bladder neck throughout the urethra, with continuous recording of intraurethral pressure. In addition to measuring urethral pressures, stress urinary incontinence is also very successfully proven by the cough test and Bonney test. If, on forced cough, the urine escapes uncontrollably, and continence is restored by finger lifting the neck of the bladder, the diagnosis of static incontinence is confirmed. At our urogynecologic clinic, urodynamic examination is being routinely performed. In the present study, we included patients previously treated for urinary stress incontinence and compared their results of urodynamic assessment to the results of Bonney test. Of the 43 subjects in whom stress incontinence was proven with Bonney test, we recorded an appropriate profilometry result in 13 cases.

Determination of optimal stent length: a survey of urologic surgeons.

Ureteral double-J stent length is an important factor affecting stent-related symptoms. Multiple techniques exist to determine ideal stent length for a given patient, however, little is known about what techniques urologists rely on. Our objective was to identify how urologists determine optimal stent length. An online survey was e-mailed in 2019 to all members of the Endourology Society. The survey sought to assess what methods are commonly used to determine choice of stent length, along with frequency of stent placement post ureteroscopy, duration of stenting, availability of different stent lengths and the use of stent tether. 301 urologists (15.1%) responded to our survey. Following ureteroscopy, 84.5% of respondents would stent at least 50% of the time. Following uncomplicated ureteroscopy, most respondents (52.0%) would leave a stent for 2-7 days. Patient height was most commonly ranked first as the method of choice in determining stent length (47.0%), followed by estimation based on experience only (20.6%) and intra-operative direct measurement of ureteric length (19.1%). Most respondents utilized multiple methods in determination of optimal stent length. Most respondents (66.5%) were interested in a simple intra-operative technique utilizing a special ureteral catheter that would help choose the most appropriate stent length. Post-ureteroscopy stent insertion is common and patient height is the most common method of choice used in determining optimal stent length. Most respondents were interested in using a simple, novel ureteral catheter device that would allow them to more accurately select optimal stent length.

Less invasive surfactant administration via infant feeding tube versus InSurE method in preterm infants: a randomized control trial

There is growing evidence that less invasive surfactant administration (LISA) is a better alternative to the standard Intubate-surfactant-extubate (InSurE) procedure in spontaneously breathing preterm infants with RDS. The infant feeding tube is easily available and cost-effective in comparison to special catheters used for surfactant administration in various studies on LISA and cost-effective health care is the need of the hour for countries like ours which are Low and middle-income countries(LMICs).The present study was planned to compare the total duration of respiratory support in preterm babies between 26 to 34 weeks of gestation with RDS requiring surfactant therapy administered by LISA technique using an infant feeding tube or InSurE method. In this unblinded randomised controlled trial, 150 infants were allocated to LISA (n = 74) or InSurE group (n = 76). An 8F feeding tube was used for surfactant delivery in the LISA group. The primary outcome was the total duration of respiratory support required and secondary outcomes included the proportion of babies developing BPD, IVH, PDA, NEC, ROP, air leaks, CPAP failure, and those requiring a repeat dose of surfactant along with the duration of hospitalization, time to regain birth weight and Death. The baseline variables including birth weight and gestation age were similar in the two groups. Nearly 27% of the mothers did not receive any dose of antenatal steroids (ANS) while around 37% of the mothers received complete course of ANS. A high proportion of babies (57%) were delivered by cesarean section. Intrapharyngeal reflux was significantly more in babies who received surfactant with the LISA method in comparison to InSurE technique (32% v/s 3%, p < 0.001). There was no statistically significant difference in the primary outcome of the total duration of respiratory support in both groups with a median duration of 120 h, 95% CI (69–235), and p = 0.618. The need for invasive mechanical ventilation was significantly lower in the LISA group (p = 0.017) with RR (95% CI) 0.498 (0.259–0.958). The rate of CPAP failure was significantly lower in the LISA group (p = 0.005) with RR (95% CI) 0.55 (0.34–0.89). In this study, the total duration of hospital stay was reduced in the LISA group (19 days) compared to InSurE group (26 days), although the same was not statistically significant. LISA with an 8F feeding tube is feasible and an effective strategy for surfactant administration which resulted in a significant reduction in CPAP failure and the need for invasive mechanical ventilation.Trial registration: www.ctri.nic.in id CTRI/2020/05/025360. Trial was registered at CTRI on 26/05/2020. First case of trial was enrolled on 28/05/2020.

Novel Endovascular Interventional Surgical Robotic System Based on Biomimetic Manipulation

Endovascular therapy has emerged as a crucial therapeutic method for treating vascular diseases. Endovascular surgical robots have been used to enhance endovascular therapy. However, to date, there are no universal endovascular surgical robots that support molds of different types of devices for treating vascular diseases. We developed a novel endovascular surgical robotic system that can independently navigate the intravascular region, advance and retract devices, and deploy stents. This robot has four features: (1) The bionic design of the robot can fully simulate the entire grasping process; (2) the V-shaped relay gripper waived the need to redesign special guidewires and catheters for continuous rotation; (3) the handles designed based on the feedback mechanism can simulate push resistance and reduce iatrogenic damage; and (4) the detachable design of the grippers can reduce cross-infection risk and medical costs. We verified its performance by demonstrating six different types of endovascular surgeries. Early evaluation of the novel endovascular robotic system demonstrated its practicability and safety in endovascular surgeries.

Artificial Insemination in Queens in the Clinical Practice Setting: Protocols and challenges.

Despite substantial advances in assisted reproductive techniques having been recently reported in cats, the use of these is limited and routine application is still far from being a reality in veterinary clinics. Nevertheless, there is an increasing demand from domestic cat breeders for artificial insemination (AI) techniques that are already commonly used in dogs. Where natural breeding is not possible in tom cats and queens of high breeding value, AI could offer a solution. Clinical challenges: AI in cats is more difficult than in other species - both in terms of semen collection/handling and oestrous cycle management given that ovulation must be induced. For practitioners wishing to perform AI in queens, there are challenges to overcome, and a good understanding of the techniques and procedures involved is pivotal. This review aims to contribute to improved knowledge by providing an overview of AI protocols, encompassing choice of breeding animals, procedures for semen collection, oestrus and ovulation induction, AI techniques and equipment. Depending on the animals involved and the specific AI technique chosen, essential equipment may include an artificial vagina, electroejaculator, endoscope (sialendoscope, which can be fairly expensive) and special catheters for transcervical insemination. Other instrumentation and materials needed are typically readily available in a veterinary clinic. In general, no particular skills are needed to perform the procedures described in this review, with the exception of endoscopic transcervical catheterisation, where the ability to use an endoscope is required. The information and advice/recommendations provided are based on specific feline research and reviews published in scientific peer-reviewed journals, animal reproduction textbooks, and presentations at national and international congresses. The authors also drew on their own clinical experience with regard to the choice of protocols and procedures presented in this review.

Nondestructive evaluation of nanostructured components using Eddy current microsensor

Nanostructured materials (NMs) are used in the manufacture of microsensors and some MEMS devices, include nanoscale wires, carbon nanotubes, biomaterials, etc. Nondestructive evaluation of structural integrity of NMs can be carried out by optical (SEM, EBDS) and electromagnetic methods (eddy current). Due to small dimensions of the objects to be tested, the eddy current sensors used in detection of possible discontinuities requires miniaturization so that the answer in amplitude and phase shall allow their localization. In the case of thin tubes made of 304 hard stainless steel, with outer diameters 332μm and wall thickness 38 μm used in medical devices, intended for special catheters, their small dimensions and possible discontinuities require encircling sensor working at high frequencies of the order of MHz. The paper presents the investigation of small diameter tubes using an Eddy current microsensor and the results obtained at the detection of artificial flaws in order to increase the probability of detection (POD), for a high reliability coefficient.

In Memoriam: Louis L. Leatherman, Jr., MD (1937–2022)

Louis Levy Leatherman, Jr., MD, died peacefully on 11 January 2022. Born on 17 April 1937, he was the eldest son of Gertrude Leatherman and Louis Levy Leatherman, Sr. His desire to become a physician was motivated by his father's death of heart disease when Louis Jr. was 16 years old.Dr. Leatherman studied at Louisiana College, then earned his medical degree from Louisiana State University Medical School in 1962. His internship was at Martin Army Community Hospital in Fort Benning, Georgia (1962–1963), and his internal medicine residency at Confederate Memorial Medical Center in Shreveport, Louisiana (1965–1967).He moved to Houston in 1968 for his cardiology fellowship, sponsored by Baylor College of Medicine (BCM). During his training at St. Luke's Episcopal Hospital (SLEH) and the Texas Heart Institute (THI), he grew to appreciate his colleagues' aggressive management of heart and vascular disease. Their varied approaches to diseases and problems taught him to think flexibly when he evaluated his own patients. He participated in SLEH's first heart transplant program and considered it “fantastically exciting.”Cardiologists were also seeking alternatives to open heart surgery for treating blockages in coronary arteries. In the late 1970s, a new technique, percutaneous transluminal coronary angioplasty (PTCA), enabled special catheters to be threaded into coronary arteries and inflated to reopen blocked blood vessels. Dr. Leatherman, along with Dr. Paolo Angelini, brought PTCA to THI after studying under Dr. Andreas Gruentzig. In 1979, the National Heart, Lung, and Blood Institute chose THI as a test site, and, by April 1980, THI physicians had performed 100 PTCA procedures.Dr. Leatherman established a private practice at the Medical Clinic of Houston while also serving as attending physician at SLEH and THI, Clinical Associate Professor of Medicine at BCM, consulting staff member at Texas Children's Hospital, and teaching staff member at Ben Taub General Hospital and Jefferson Davis Hospital. He retired in 1995 after a 30-year career.In 1972, Dr. Leatherman purchased a ranch near Bertram, Texas, where he and his family enjoyed escaping the rigors of his medical practice. He loved nature and wildlife. In 1994, he married Mary Gail Swift, and when he retired, they moved to the ranch permanently. The couple traveled monthly to Ruston, Louisiana, to help run a corporate wellness clinic for a good friend.Dr. Leatherman was preceded in death by his parents and by his first wife and mother of his children, Charlotte Wheeler Leatherman. He is survived by his wife Mary Gail Leatherman; daughter Dr. Martha Leatherman (and husband Dr. James Moore); son Mark Leatherman (and wife Peggy); brothers Dr. Edward H. and Malcolm L. Leatherman; grandchildren Jameson, Jonathan, and Rachel Moore, and Ashley and Hunter Leatherman; stepchildren Curt Swift and Shelly Swift Roeder; and step-grandchildren Jackson and Mia Swift, and Levon and Iva Mae Roeder.Dr. Leatherman, a pioneer in advancing the treatment of heart disease, was deeply committed to his patients. They, along with his colleagues and family, will cherish his memory and contributions.

INTRAPLEURAL AMPHOTERICIN B INSTILLATION: A NOVEL APPROACH TO THE TREATMENT OF CHRONIC PULMONARY COCCIDIOIDOMYCOSIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coccidioidomycosis is transmitted by inhalation of fungal spores commonly found in southwestern border of United States and South America. Most primary coccidioidomycosis cases are asymptomatic and do not require treatment. Symptomatic progressive coccidioidomycosis affect people with certain risk factors: ethnic origin, advanced age, pregnancy, and immunosuppressive state. Most cases are effectively treated with oral triazoles. Intravenous (IV) amphotericin B (AMB) is reserved for severe cases. Although intrapleural instillation of AMB has been reported in cases for aspergillus empyema, it has not been reported for other diseases (1). We are reporting the first known case of successful novel use of intrapleural instillation of amphotericin B in the treatment of chronic progressive pulmonary coccidioidomycosis. CASE PRESENTATION: A 48-year-old Hawaiian man with diabetes mellitus type 2 presented with 10 days of epigastric pain, anorexia, constipation, chills, progressive shortness of breath, and low-grade fever. He had a 9-month nonproductive cough after returning from Las Vegas. He was admitted to another facility where he was diagnosed with cryptogenic organizing pneumonia and treated with moderate dose prednisone for over 6 months. Initial chest x-ray here revealed a large left pneumothorax. Chest tube insertion did not provide significant improvement. Subsequent chest computerized tomography (CT) revealed a large hydropneumothorax with lingular and left lung base consolidation. Transbronchial biopsy showed coccidioides. After 7 days of hospitalization, patient was discharged home with fluconazole. He was readmitted 2 weeks later due to recurrence of same set of symptoms. Chest CT scan now revealed progression of multifocal necrotizing pneumonia. Based on continued deterioration despite IV AMB, there was a high suspicion of persisting intrapleural infection with coccidioides. A left pneumonectomy with placement of a special drainage catheter for intrapleural instillation was performed, in addition to continued IV AMB. He tolerated 7 days of intrapleural AMB well and discharged home 9 days afterward with continued fluconazole. One year later he was able to resume all normal activities. DISCUSSION: Our patient developed progressive coccidioidomycosis due to uncontrolled diabetes mellitus from prednisone prolonged use. He has progressive pneumonia, pulmonary nodules and cavities, fever, cough, chills, hemoptysis, abdominal pain, anorexia, weight loss, and weakness. Due to the many adverse reactions of AMB, it is generally reserved for severe cases; in our case, the addition of intrapleural instillation was successful in conjunction with his pneumonectomy and IV antifungal therapy. CONCLUSIONS: This is the first known reported case of intrapleural amphotericin B instillation, in combination with conventional therapy, in the successful treatment of chronic progressive coccidioidomycosis. REFERENCE #1: Almuhareb, A., & Habib, Z. (2018). Management of Aspergillus Pleural Empyema with Combined Systemic and Intrapleural Antifungal Therapy in a Pediatric Patient: Case Report. Journal of Infection and Public Health, 11(2), 280-282. DISCLOSURES: No relevant relationships by Angelica Guzman Paz, source=Web Response No relevant relationships by Takkin Lo, source=Web Response

Peritoneal Dialysis Catheters, Insertion Methods and Complications

The success of peritoneal dialysis (PD) and the PD program lies in a well-functioning catheter without infections. There are various types of catheters available and various insertion methods, although the difference in function and the outcome results are not markedly differentiated. In this review the types of commonly used peritoneal catheters and the variety of insertion methods will be introduced, along with special techniques and special catheters. This article will also list the complications that arise early, within 30 days of insertion. Comparing the main standard catheter variations and insertion methods, there is no difference in function and complications.

Isolation of Primary Rat Hepatocytes with Multiparameter Perfusion Control.

Primary hepatocytes are widely used in basic research on liver diseases and for toxicity testing in vitro. The two-step collagenase perfusion procedure for primary hepatocyte isolation is technically challenging, especially in portal vein cannulation. The procedure is also prone to occasional contamination and variations in perfusion conditions due to difficulties in the assembly, optimization, or maintenance of the perfusion setup. Here, a detailed protocol for an improved two-step collagenase perfusion procedure with multiparameter perfusion control is presented. Primary rat hepatocytes were successfully and reliably isolated by taking the necessary technical precautions at critical steps of the procedure, and by reducing the operational difficulty and mitigating the variability of perfusion parameters through the adoption of a special intravenous catheter, standardized sterile disposable tubing, temperature control, and real-time monitoring and alarm system. The isolated primary rat hepatocytes consistently exhibit high cell viability (85%-95%), yield (2-5 x 108 cells per 200-300 g rat) and functionality (albumin, urea and CYP activity). The procedure was complemented by an integrated perfusion system, which is compact enough to be set up in the laminar flow hood to ensure aseptic operation.

Catheter ablation of complex cardiac arrhythmias: Single-centre experience in Armed Forces

BackgroundComplex arrhythmia ablation remains a technical challenge despite advances in hardware and mapping techniques. The aim of the study was to analyse the efficacy of radiofrequency ablation of arrhythmias requiring complex electrophysiological procedures at a tertiary-care centre. MethodsA retrospective study was done for catheter ablation of arrhythmias performed at a single centre from Aug 2012 to Nov 2016 (4 years 4 months). The standard ablation involved conventional catheters with antegrade right heart and retrograde left heart access. The procedure was considered complex, if it involved 3 D electro-anatomical (EA) guidance for mapping or required special hardware and/or trans-septal puncture. ResultsOf 333 electrophysiology (EP) cases 265 qualified for ablation. The cohort of arrhythmias requiring complex procedure (n = 94) comprised of supraventricular 15 (15.9%), atrioventricular 43 (44.7%) and ventricular 36 (38.3%). The procedure used three-dimensional EA mapping in 31; trans-septal puncture for left atrial access in 40; and use of special catheters and sheaths in all 94 procedures. The overall success in the complex group after the first procedure was 87.2% versus 88.3% (P < 0.05), and after redo procedure it was 90.4% vs 94.7% (P < 0.05). There were three complications (pericardial perforation: 2; cardioembolism: 1) only in the complex group. The fluoroscopy time for complex was longer than that of the standard procedure (25.10 ± 6.32 versus 15.23 ± 5.33 min, P = 2.54). ConclusionArrhythmias requiring complex electrophysiological procedure for ablation have a comparable success rate to standard ablation procedure but at the cost of extra hardware, complications and fluoroscopy time.

Evaluation Of Transtracheal Wash (Ttw) And Tracheal Wash (Tw) In Dromedary Camels With Respiratory Disorders

This study aims to analyse Transtracheal Wash (TTW) and Tracheal Wash (TW) samples cytologically from healthy camels and those affected by respiratory disorders. Endoscopy was used to examine the lower respiratory tract and to take TW samples, while TTW was done through using a special needle and catheter. Cytological analysis of TTW and TW fluid were analysed for fifteen camels, six healthy camels and nine camels affected by respiratory disorders. Oral cells were found in the TW sample due to contamination while inserting the endoscope. The TTW procedure is easier, quicker and without the use of an endoscope, compared to the TW procedure. The concentration of neutrophils in the TTW and TW samples of affected camels were higher, compared to the concentration in samples from healthy camels. A lower concentration of macrophages was present in the TTW and TW samples from affected animals, compared to the samples from healthy camels. The cytological analysis of the TTW and TW samples indicated that there was no significant difference between healthy and affected camels.

Focused Ultrasound and Microbubbles-Mediated Drug Delivery to Brain Tumor.

The presence of blood–brain barrier (BBB) and/or blood–brain–tumor barriers (BBTB) is one of the main obstacles to effectively deliver therapeutics to our central nervous system (CNS); hence, the outcomes following treatment of malignant brain tumors remain unsatisfactory. Although some approaches regarding BBB disruption or drug modifications have been explored, none of them reach the criteria of success. Convention-enhanced delivery (CED) directly infuses drugs to the brain tumor and surrounding tumor infiltrating area over a long period of time using special catheters. Focused ultrasound (FUS) now provides a non-invasive method to achieve this goal via combining with systemically circulating microbubbles to locally enhance the vascular permeability. In this review, different approaches of delivering therapeutic agents to the brain tumors will be discussed as well as the characterization of BBB and BBTB. We also highlight the mechanism of FUS-induced BBB modulation and the current progress of this technology in both pre-clinical and clinical studies.

Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study

OBJECTIVETo determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODSThis was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTSNine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21−45) years and median body mass index was 23 (range, 16−41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1−16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0−10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSIONHYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.

First clinical experience with KODEX-EPD: a novel dielectric imaging and navigation system for catheter ablation

Abstract Background Current electroanatomic mapping systems for catheter ablation often require pre-procedural cardiac imaging, and special catheters. KODEX-EPD is a novel open-platform system that uses dielectric imaging to provide real-time, high-resolution cardiac images, with a potential for tissue characterisation and wall thickness to guide ablation. Purpose We report our initial experience with the KODEX-EPD system. Methods The KODEX-EPD uses body surface patches (“sensors”) to emit and receive radiofrequency waves across the thorax. Anatomical structures cause gradients in the electrical field, which are measured by a standard electrophysiology catheter and used to generate an anatomical shell of the cardiac chambers. The system requires no direct physical surface contact or fluoroscopy to acquire anatomical information. If direct physical surface contact is added, a voltage map can be created. After mapping with the KODEX-EPD, ablation was continued according to standard of care using radiofrequency or cryoablation. Results Since November 2019, 26 patients were included (mean age 57.7 (±13.2), 16 (61.5%) male). Ablations were performed for atrial fibrillation in 13 (50.0%) patients, atrial flutter in 10 (38.5%), atrial tachycardia in 1 (3.8%), AVNRT in 1 (3.8%), AVRT in 2 (7.7%) and ventricular extrasystole in 2 (7.7%). The median procedure time was 99.5 [68.8; 112.3] minutes, and fluoroscopy time 14.4 [10.0; 16.9] minutes. All procedures were successful. No adverse events occurred during follow up. Conclusion KODEX-EPD is a novel electroanatomic system for cardiac mapping as well as anatomical imaging that can be safely and effectively utilised for a variety of cardiac arrhythmia ablations. Future versions will allow wall thickness measurement and lesion quality to optimise the ablation process. KODEX-EPD CTI Ablation Funding Acknowledgement Type of funding source: None