Tip Angulation Research Articles

SwiftNINJA steerable microcatheter: a new kid on the block for selective catheterization of vascular and valvular congenital lesions.

SwiftNINJA (Merit Medical Systems, USA) is a novel steerable microcatheter intended for coronary and peripheral vascular interventions. We evaluate and report the first use of SwiftNINJA in pediatric catheterization of congenital heart defects (CHDs). We performed a retrospective clinical data review of children with CHDs in whom SwiftNINJA was used during cardiac catheterization between April 2022 and June 2023. Utility, application, and standard safety were described comprehensively. We identified 19 patients (78.9% males) with a median age of 5.3 months (IQR, 2-13.9), and a median weight of 5.3 kg (IQR, 4-7.7). 36.8% of the catheterizations were transarterial and 78.9% were interventional. SwiftNINJA was applied upfront in 3/19 patients to cannulate precisely the right pulmonary artery and eliminate the risk of dislocating a freshly implanted left pulmonary flow restrictor. In 16/19 patients, SwiftNINJA was applied after a median of 5 (IQR, 5-7) failed catheterization attempts using various combinations of catheters, microcatheters, and wires to cannulate challenging vasculature in seven, engage the lumen of stented vessels in five, cross complex aortic valve stenosis in three, and cross an apical ventricular septal defect in one patient with Damus-Kaye-Stansel repair. After the SwiftNINJA application, catheterization was done from the first attempt in 12/16 patients and from the second attempt in 4/16 patients. The median applied tip angulation was 90 degrees (IQR, 85-95). All procedures were completed successfully. No device malfunction or adverse events occurred. SwiftNINJA is a valuable addition for selective catheterization of challenging vasculatures or valvular anatomies in children with CHDs.

Laboratory Analysis of Causative Factors for the Final Incision Size due to Intraocular Lens Injector Insertion

In intraocular lens (IOL) implantation, insertion of the IOL injector enlarges the clear corneal incision. A larger incision size (IS) is associated with a higher risk for surgically induced astigmatism and endophthalmitis. The goal of this study was to determine which parameters most influence the final IS. Experimental study. A total of 126 cadaver porcine eyes were included in this study. We analyzed 409 clear corneal incisions made with 126 injectors from 13 injector models. We noted the vertical diameter and the tip angulation for every model. The corneal thickness of each incision location was measured using Scheimpflug tomography. The IS was measured before and after injector insertion and described as preoperative and final ISs, respectively. During surgery, the insertion depth and incision length were documented. A mixed effects model was applied to analyze the influence of the parameters on the final IS. Influence on the final IS. Increases in the vertical diameter of the injector tip, the preoperative IS and the insertion depth, and a reduction of incision length were all significantly associated with increased final IS (P<0.05). The conditional Pseudo-R2-Measure was 0.92. The preoperative IS had the largest standardized estimated effect on the final IS, followed by the vertical diameter of the injector tip, insertion depth, and lastly, incision length. Neither corneal thickness nor the tip angle of the injector had a significant effect on the final IS (P>0.05). The IOL injector's vertical diameter should be as small as possible to ensure a minimal final IS. The injector's insertion depth may be minimized, and the incision length should be long enough to reduce the final IS. Further studies are needed to confirm the findings in human autopsy eyes and in clinical practice. Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article..

PO-03-009 3830 LEAD TIP POSITION ON COMPUTED TOMOGRAPHY AND ELECTROPHYSIOLOGIC OUTCOMES IN LEFT BUNDLE BRANCH AREA PACING

Prior studies have evaluated the impact of lead tip distance from the LV blood pool on pacing parameters during left bundle branch area pacing (LBBAP). Few studies to date have evaluated lead tip angulation within the interventricular septum (IVS) in relation to pacing morphology on surface 12-lead ECG. To establish the observed lead tip trajectories within the interventricular septum encountered during LBBAP. Patients who underwent LBBAP implantation between 02/2019-07/2022 were retrospectively analyzed. Patients who underwent computed tomography (CT) of the chest or thorax post-implantation for any indication were included for analysis. Lead distance from the mitral annulus, lead tip distance from LV blood pool (DEBP), lead tip angle of incidence (AOI), and post-implantation electrocardiographic and pacing parameters were analyzed (Figure 1a). 38 pts were identified, out of whom 37 pts had CT images available for analysis. In the 20 pts with contrast enhanced imaging, DEBP was 2.1±1.8mm. Average observed AOI was 10.9±20.6 degrees in the axial plane (long axis; Figure 1b) and 12.4±22.2 degrees in the saggital plane (short axis; Figure 1c). Lead impedance at time of implant did not correlate strongly with axial or sagittal angle of incidence (R2=0.01 and 0.03 respectively) or with distance from LV endocardial blood pool (R2=0.04). The most commonly encountered lead insertion locations included the mid-septal (22, 59.5%), basal septal (4, 10.8%), and mid antero-septal (3, 8.1%) positions (Figure 1d). Average lead tip distance from the AV annulus was 36.6±8.2mm. Mean paced QRSd for the basal, mid, and apical cohorts were 122.5±8.1ms, 118.5±10.7ms, and 120±15.9ms, respectively. Left ventricular activation time in lead V6 numerically decreased for more apical positions, with basal, mid and apical values of 84.4±11.9ms, 73.9±10.6ms, and 69.5±6.0ms, respectively. Lead threshold, impedance, and sensed R waves were stable at time of 2 year follow-up. No analyzed patients underwent lead revision. Multiple lead tip orientations are observed in relation to the IVS during successful LBBAP. More apical lead tip positioning may result in numerically lower LVAT values, despite similar overall QRS duration.

3 - General Knowledge of Light-Curing Units Among Dentists in Saudi Arabia

Light curing a restorative material is an essential step that is typically downplayed. The knowledge about light-curing unit (LCU) types, curing technique, and parameters on which dentists select an LCU are necessary to maximize the restoration longevity and provide optimum dental care. Therefore, clinicians should have sufficient knowledge regarding LCUs. This study was conducted to explore the level of dentists’ knowledge in Saudi Arabia regarding LCUs, current practice, and the parameters on which dentists choose to purchase them. An electronic questionnaire was formulated. Face and content validation were performed. The questionnaire was piloted and sent to dentists in governmental and private universities and clinics in Saudi Arabia. The questionnaire included several domains: demographic information, knowledge about different LCU devices, LCU selection parameters, participants current light curing practice, monitoring and care of the LCUs. Chi-square tests were performed. A total of 292 respondents participated in this study. One-third of them were dental students, 35.6% were general dentists, and 27.8% were specialists or consultants. While 54.5% believed that they received sufficient undergraduate education regarding LCUs, 52.7% did not know the type of their LCU and 64% did not know their LCU irradiance. It was interesting that only 51.7% believed that increasing the curing time or light irradiance affects the pulp. Of the known consequences of inadequate polymerization, the least proportion of respondents believed that toxic reaction (13.4%) and allergic reaction (19.2%) were possible consequences. Moving the LCU tip during curing (51%), light-guide tip diameter (53.1%), and light-guide tip angulation (56.2%) were the least mentioned clinical factors to affect the quality of resin polymerization. The most important parameter in purchasing LCU for respondents was irradiance (14.9%), while the most important parameter when purchasing a composite was brand reputation (33.2%). When comparing LCU decision makers versus others, a higher proportion of decision-making dentists (by 60.4%) knew the irradiance of their LCU compared to non-decision makers (p<0.0001). Despite that, decision makers were not more knowledgeable regarding LCU optimum distance, factors affecting curing time, or adverse effects on pulp compared to non-decision makers. Knowledge about LCUs needs to be reinforced in dental curricula so they would graduate knowing on what basis to purchase an LCU. Also, reinforcing dentists knowledge through continuous educational courses is recommended in an attempt to deliver high standard patient care.

Errors in light-emitting diodes positioning when curing bulk fill and incremental composites: impact on properties after aging.

ObjectivesThis study aimed to evaluate the effect of improper positioning single-peak and multi-peak lights on color change, microhardness of bottom and top, and surface topography of bulk fill and incremental composites after artificial aging for 1 year.Materials and MethodsBulk fill and incremental composites were cured using multi-peak and single-peak light-emitting diode (LED) following 4 clinical conditions: (1) optimal condition (no angulation or tip displacement), (2) tip-displacement (2 mm), (3) slight tip angulation (α = 20°) and (4) moderate tip angulation (α = 35°). After 1-year of water aging, the specimens were analyzed for color changes (ΔE), Vickers hardness, surface topography (Ra, Rt, and Rv), and scanning electron microscopy.ResultsFor samples cured by single-peak LED, the improper positioning significantly increases the color change compared to the optimal position regardless of the type of composite (p < 0.001). For multi-peak LED, the type of resin composite and the curing condition displayed a significant effect on ΔE (p < 0.001). For both LEDs, the Vickers hardness and bottom/top ratio of Vickers hardness were affected by the type of composite and the curing condition (p < 0.01).ConclusionsThe bulk fill composite presented greater resistance to wear, higher color stability, and better microhardness than the incremental composite when subjected to improper curing. The multi-peak LED improves curing under improper conditions compared to single-peak LED. Prevention of errors when curing composites requires the attention of all personnel involved in the patient's care once the clinical relevance of the appropriate polymerization reflects on reliable long-term outcomes.

Effects of the light tip position on the degree of conversion and dentin bond strength of a universal adhesive

Introduction/Objectives. To measure the degree of conversion (DC), immediate and long-term microshear bond strength (?SBS) to dentin of a universal adhesive relative to the light tip position and adhesive application protocol. Methods. Mid-coronal flat dentin of 48 human third molars was exposed and split in halves. Single Bond Universal (SBU; 3M) adhesive was applied to each half following ?total-etch? (TE) or ?self-etch? (SE) approach. Depending on the light tip (Bluephase G2, Ivoclar Vivadent, Schaan, Liechtenstein) angle and distance from adhesive surface, three groups were compared: ?1 mm_90?? (control); ?8 mm_90?? and ?8 mm_60??. Cylindrical composite build-ups (o1.7mm, Filtek Z250, 3M) were prepared in each half. DC was measured using Raman spectroscopy. ?SBS was measured after 24 hours and six months storage in distilled water at 37?C. Fracture types were analyzed. Results. No significant difference in DC was detected between groups ?1 mm_90?? (89.1 ? 6.2%) and ?8 mm_90?? (94.6 ? 1.2%) (p &gt; 0.05), both showing significantly higher DC (p &lt; 0.05) than ?8 mm_60?? group (74.9 ? 9.5%) (p &lt; 0.05). Initially, there were no significant differences in ?SBS between groups (p &gt; 0.05). Group ?1 mm_90?? TE (12.8 ? 4.3 MPa) and group ?8 mm_60?? TE (14.7 ? 5.7 MPa) showed significantly lower ?SBS after aging (8.4 ? 4.3 MPa and 9.2 ? 2.6 MPa, respectively) (p &lt; 0.05). Adhesive fractures were predomintantly detected. Conclusion. Initially, both application protocols resulted in similar bond strength to dentin of a universal adhesive in suboptimal curing conditions. In the long-term, SE showed greater adhesive resistance to degradation resulting in smaller decrease in bond strength compared to TE. Light tip angulation affected DC and ?SBS more than tip-to-surface distance.

P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke

Abstract Background Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source. Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS. Methods and materials In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively. LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, &gt;110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT). Results LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p&lt;0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p&lt;0.001, OR 2.64; 95% CI: 1.63–4.29, p&lt;0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis. Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p&lt;0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p&lt;0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index. LAA and LA morphology in CTA. Conclusion In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.

515 Are All Endoscopic-Related Musculoskeletal Injuries Created Equal?: Results of a National Gender-Based Survey

INTRODUCTION: Endoscopy- related injury (ERI) is common in gastroenterologists. This study aimed to evaluate the prevalence of self-reported ERI, patterns of injury and knowledge of ergonomic strategies in endoscopists who are ACG physician members. METHODS: A 38-item survey was developed and initially piloted at three academic medical centers. Through the ACG Women in GI Committee and ACG Governing Board sponsorship, the survey was administered to ACG physician members. Statistical analysis was performed using SAS Enterprise Guide 7.0 (SAS Institute Inc., Cary, NC); chi-square tests and descriptive analysis evaluating associations between multiple variables and ERI. RESULTS: Of the 14759 total surveys sent, 5940 were opened, and only completed surveys were included (n = 1133). ERI was reported by 71% of the respondents including 49% of trainees. More than half of the respondents reported pain in the thumbs (64%), hand/fingers (59%), neck (57%), and lower back (54 %). The most common causes of ERI reported were torqueing with the right hand (64%), adjusting tip angulation with left hand (53%), standing for prolonged periods of time (59%), and standing in awkward positions while supporting an endoscope (58 %). While no differences were noted in characteristics associated with overall ERI, including sex (P = 0.77), performance of interventional endoscopy or a focus in another GI domain (P = 0.55) women were more likely to have upper extremity pain and upper back pain (see Table 2). There were statistically significant differences between genders in the mechanisms of ERI (see Table 3). Most respondents did not receive training during fellowship (68%), or discuss ergonomic strategies in their current practice (63%). Those without training in ergonomics were more likely to report ERI (P = 0.02). 81 % of respondents noted a desire for more training in ergonomic strategies to reduce ERI. CONCLUSION: The results of this study show an overwhelming occurrence of ERI in all GI physicians and in nearly half of the trainee respondents. Preliminary analysis shows a significant difference between men and women with regards to specific areas of ERI and contributing mechanisms. Results strongly support training and a desire for continued education in ergonomic strategies as a preventative strategy. Education and prevention of ERI represent rich opportunities for improving key aspects of clinical practice, reducing burden on physicians, and decreasing interruptions to clinical care.

Evaluation of the tip-bending response in clinically used endoscopes.

Background and study aims: Endoscopic interventions require accurate and precise control of the endoscope tip. The endoscope tip response depends on a cable pulling system, which is known to deliver a significantly nonlinear response that eventually reduces control. It is unknown whether the current technique of endoscope tip control is adequate for a future of high precision procedures, steerable accessories, and add-on robotics. The aim of this study was to determine the status of the tip response of endoscopes used in clinical practice. Materials and methods: We evaluated 20 flexible colonoscopes and five gastroscopes, used in the endoscopy departments of a Dutch university hospital and two Dutch teaching hospitals, in a bench top setup. First, maximal tip bending was determined manually. Next, the endoscope navigation wheels were rotated individually in a motor setup. Tip angulation was recorded with a USB camera. Cable slackness was derived from the resulting hysteresis plot. Results: Only two of the 20 colonoscopes (10 %) and none of the five gastroscopes reached the maximal tip angulation specified by the manufacturer. Four colonoscopes (20 %) and none of the gastroscopes demonstrated the recommended cable tension. Eight colonoscopes (40 %) had undergone a maintenance check 1 month before the measurements were made. The tip responses of these eight colonoscopies did not differ significantly from the tip responses of the other colonoscopes. Conclusion: This study suggests that the majority of clinically used endoscopes are not optimally tuned to reach maximal bending angles and demonstrate adequate tip responses. We suggest a brief check before procedures to predict difficulties with bending angles and tip responses.

Microscopic view of scaling influence on the root, using different power and time settings.

The aim of this paper was to identify the appropriate power setting and operation time required to achieve optimal efficiency in calculus debridement while preventing excessive cementum loss. The study included 30 extracted molars with heavy deposits of calculus, visible to the the naked eye. Experimental areas (3 × 4 mm) were delineated below the cementoenamel junction. The teeth were cut cross-sectionally and randomly allocated into three groups: low, medium, and high power settings. A magnetostrictive ultrasonic scaler with Dentsply slimline plain insert was used with light force at 0-degree tip angulation for a 10 second interval. Before and after treatment, the samples were visualized using digital stereo microscopy at 100× magnification. Mean time required for dental calculus removal was 70, 50, and 30 seconds for low, medium, and high power settings, respectively. Root calculus removal rates for low, medium, and high power settings were 4.5, 6.7, and 8.2 μm/s, respectively (P = .0045, P < .01). Mean time required for dental cementum removal was 30, 30, and 20 seconds for low, medium, and high power settings, respectively. Cementum removal rates for low, medium, and high power settings were 1.7, 2.2, and 3.3 μm/s, respectively (P = .0127, P < .05). The most efficient dental calculus removal occurred within the first 30 seconds using a high power setting with light force at 0-degree tip angulation, which was recommended for roots with heavy calculus. Later on, to minimize cementum loss, the low power setting should be used for less than 30 seconds to balance between rapid calculus removal and a potential risk of cementum loss resulting in dental sensitivity. Ultrasonic scaling using the high power setting in the first 30 seconds, followed by continuous scaling for less than 30 seconds, using the low power setting, is recommended for roots with heavy calculus.

Colonoscopy: do operator motions and posture count?

Colonoscopy: do operator motions and posture count?

Comparison of Different Ultrasonic Tip Angulations on Time Required for Cast Post Removal

ABSTRACT Aim The aim of this study was to design, develop and compare ultrasound tips with different angulations on time required for cast post removal. Materials and methods To test and compare the ultrasonic tips developed, 36 metal patterns were fabricated from tin bars, on a mechanical precision lathe. Each metal pattern simulated an endodontically treated tooth, without coronal remaining, prepared to receive a cast post with 10 mm long. The cast posts were cemented with zinc phosphate cement. The metal patterns with their respective intraradicular posts cemented were stored at 37°C, at relative humidity 100%, for a period of 48 hours. After this period, the specimens were randomly divided into three groups, and each group was submitted to the action of one of the ultrasonic tips (n = 12): G1—tip with 30° angulation; G2—tip with 45° angulation and G3—tip without angulation (straight tip). Each ultrasonic tip was used on the surfaces of the cast posts (mesial, distal, buccal, lingual and incisal) for 5 seconds, at maximum power, until the cast post removal using an ultrasound device (Jet Sonic, Satelec System, Gnatus, Ribeirão Preto, SP, Brazil). The time required for cast posts removal was recorded and the data statistically analyzed by the ANOVA and Tukey tests (p &lt; 0.05). Results The means of time evaluated for cast posts removal were G1: 59.25s; G2: 119.0s and G3: 48.4s. Group 2 presented the highest mean value in seconds, differing statistically from G1 and G3. No significant differences were observed between G1 and G3. Conclusion It may be concluded that the ultrasonic tip angulation had a direct influence on the time required for cast posts removal by ultrasound. When the different ultrasonic tips were compared, the 30° angulation and the straight tips required a shorter ultrasonic vibration time. All cast posts luted with zinc phosphate were successfully removed in a relatively short time by the different ultrasonic tips analyzed. How to cite this article da Silva EG, Xavier ACC, Kamozaki MBB, Gomes APM, Torres CRG, Pagani C. Comparison of Different Ultrasonic Tip Angulations on Time Required for Cast Post Removal. World J Dent 2014;5(3):147-151.

The Latest Generation in Flexible Bronchoscopes

Since the introduction of the flexible bronchoscope over 50 years ago, bronchoscopists have seen vast improvement in the technology available for diagnostics and therapeutics in the bronchoscopy laboratory. We set forth to evaluate the latest evolution in flexible bronchoscopes with features designed to improve imaging and airway navigation. The BF-Q190, BF-H190, and/or BF-1TH190 bronchoscopes were evaluated prospectively in 105 patients undergoing bronchoscopy from November 2010 to August 2011 at 2 tertiary care centers in the United States. Data collected from each procedure included method of insertion, airway images, and therapeutic interventions. At the completion of the study, 10 bronchoscopists were surveyed using a 7-point Likert scale to identify the perceived benefits of the design. Insertion methods included nasal, oral, laryngeal mask airway or endotracheal tube, and tracheostomy. Procedures performed included bronchoalveolar lavage, endobronchial biopsy or brushing, transbronchial biopsy, transbronchial needle aspiration or injection, peripheral navigation, and large airway therapeutic interventions. Survey of bronchoscopists revealed that when compared with current bronchoscopes, the features rated as having the most significant impact on functionality are the 210-degree tip angulation (average 2.4/3) and rotational capability of the insertion tube (average 2.4/3). The new-generation flexible bronchoscope offers improvement in image quality, magnification options, unique insertion tube rotation, and an increased 210-degree distal tip angulation over currently available flexible bronchoscopes. The bronchoscopes are an overall improvement to the current generation of bronchoscopes. The increased tip angulation and novel rotating insertion tube add the most to improvement in functionality.

Influence of tip wear of piezoelectric ultrasonic scalers on root surface roughness at different working parameters. A profilometric and atomic force microscopy study

Roughness on tooth surfaces is reported to facilitate the reestablishment of microbial dental plaque. Hence, the main goal of dental scaling is to remove bacterial plaque and obtain smoother tooth surfaces. This study was aimed to assess the influence of tip wear of ultrasonic scaler inserts on root surface roughness at different working parameters. Twenty piezoelectric ultrasonic scaler inserts (10 worn/10 new) were selected to examine the erosion ratio (ER) on the scaler tips and to assess the influence of tip wear on root surface roughness. Erosion on the tip surfaces was evaluated under atomic force microscopy (AFM). Root samples were prepared and instrumented by new (Group I) and worn (Group II) inserts at different working parameters. Roughness change (Rc) on root surfaces after instrumentation was examined under profilometer and compared between and within the groups. Statistically significant differences were found between the mean ERs of new and worn tips (P<0.01). The results of this study showed that tip angulation and instrument power strongly influenced the Rc values on instrumented samples (P<0.05). It was also revealed that tip wear influenced the Rc values on root surfaces especially at 45° tip angulation (P<0.05). Therefore, tip wear should also be considered as much as the other parameters to minimize the surface roughness during ultrasonic treatment.

Evaluation of the Truview™ EVO2 laryngoscope for nasotracheal intubation

Background:The Truview™ EVO2 laryngoscope, with its unique optical lens system and blade tip angulation, has proved its usefulness in providing adequate laryngeal exposure and intubation via the oral route. However, the same has not been evaluated for nasotracheal intubation.Aim:We evaluated the suitability of the Truview™ EVO2 laryngoscope for nasotracheal intubation.Methods:Fifty ASA grade I and II elective surgical patients were studied. Patients aged below 15 years or having difficult airway were excluded. Under standard anesthesia protocol, nasotracheal intubation was performed using a Truview™ EVO2 laryngoscope and, in cases of inability to complete intubation in three attempts, the Macintosh laryngoscope was used. Time taken for intubation, use of Magill's forceps and need for optimization maneuvers were noted. The primary outcome was percentage of successful intubation, while hemodynamic changes and duration of intubation were taken as secondary outcomes.Results:Majority (94%) could be intubated successfully with the Truview™ EVO2 laryngoscope. Average time taken for intubation was 50.1 s. The hemodynamic changes were not clinically significant. Regression analysis revealed lack of association between duration of intubation and hemodynamic changes. There were no serious complications.Conclusion:The Truview™ EVO2 laryngoscope is a useful tool in performing nasotracheal intubation, ensuring a high level of success rate among patients with normal airway anatomy.

Flexible-Tip Laparo-Endoscopic Surgery: A Bridge to Single Port Appendicectomy in Children

Single port surgery (SPS) has been demonstrated to have some advantages over conventional laparoscopy. However, currently available port sizes may limit the application in younger children or those with a small umbilicus. Moreover, the consultant learning curve required to master single port surgery may have a negative impact on surgical training. We report the first series of children who were treated with a reduced incision technique for appendicectomy using flexible-tip laparo-endoscopic surgery (FLES). FLES was set up using one 11-mm and 2 × 5-mm bladeless ports (Ethicon XCEL™) via umbilical and low left iliac fossa incisions. A 10-mm flexible-tip laparo-endoscope was utilized. Tip angulation ensured visibility while minimising instrument clashing. A database of children undergoing FLES was kept prospectively. Demographic and peri-operative information and complications were recorded. Data are presented as medians with ranges. Between March and June 2010, 5 children (4 females) aged 9 (4-13) years underwent FLES for right iliac fossa pain. 2 procedures were performed by the admitting consultant, 3 by a supervised inexperienced laparoscopic trainee. 4 children had acute appendicitis including 1 with an inflammatory mass. Another had a haemorrhagic ovarian cyst. Appendicectomy was performed in all. The duration of surgery was 104 (93-130) min, and postoperative hospital stay was 2 (1-6) days. At 7 (5-8) months' follow-up no complications have been recorded. At follow-up, the cosmetic results were judged to be excellent in all by the children, their parents and the reviewing surgeon. FLES is an alternative to standard laparoscopy and SPS in children, and be performed effectively and safely by junior trainees. Cosmetic results are excellent. It may represent a bridge technology, particularly for younger children, until single port products and techniques more suitable for appendicectomy in this age group are available. Finally, flexible-tip technology may play a useful role as SPS evolves.

Effect of the bedside arm droop venepuncture

Objective To explore the effect of the bedside arm droop venepuncture for promoting success rate of venepuncture and relieving patients' pain. Methods 1 000 patients were randomly divided into observation group and control group. There were 500 cases in each group. The patients' forearm were drooped for 30 seconds in the observation group, so that venous filling exposed. Tied a tourniquet 6 ～8 centimeters upon the puncture point, The forearm was placed on the side of the body and would not make a fist. To fix the skin of puncture site by left thumb and make needle tip and skin angulation of 35 ～40°by right hand. The needle would be pricked into the blood vessels quickly along the vein, after seeing the return of blood into the needle lowered angle of the needle and then transferred into 0.2cm and routinely fixed. The control group used traditional method. The venous filling degrees and puncture success rate of the two groups were compared. Results Venous filling full of the observation group and control group were 81.6% and 20. 0% respectively. There was significant difference between the two groups ( P ＜0. 01 ); the success rate of vein puncture only by once was 98.4% in the observation group while 90.0% in the control group and there was significant difference between the two groups (P ＜0. 05 ).Conclusions The bedside arm droop veinpuncture can gets veins filling exposed and have a high success rate. It can relieve the patients' pain and make drug located rapidly, accurately and safely. Key words: Arm drooping; Vein puncture; Nursing

Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system

Colonoscopy requires training and experience to ensure accuracy and safety. Currently, no objective, validated process exists to determine when an endoscopist has attained technical competence. Kinematics data describing movements of laparoscopic instruments have been used in surgical skill assessment to define expert surgical technique. We have developed a novel system to record kinematics data during colonoscopy and quantitatively assess colonoscopist performance. To use kinematic analysis of colonoscopy to quantitatively assess endoscopic technical performance. Prospective cohort study. Tertiary-care academic medical center. This study involved physicians who perform colonoscopy. Application of a kinematics data collection system to colonoscopy evaluation. Kinematics data, validated task load assessment instrument, and technical difficulty visual analog scale. All 13 participants completed the colonoscopy to the terminal ileum on the standard colon model. Attending physicians reached the terminal ileum quicker than fellows (median time, 150.19 seconds vs 299.86 seconds; p<.01) with reduced path lengths for all 4 sensors, decreased flex (1.75 m vs 3.14 m; P=.03), smaller tip angulation, reduced absolute roll, and lower curvature of the endoscope. With performance of attending physicians serving as the expert reference standard, the mean kinematic score increased by 19.89 for each decrease in postgraduate year (P<.01). Overall, fellows experienced greater mental, physical, and temporal demand than did attending physicians. Small cohort size. Kinematic data and score calculation appear useful in the evaluation of colonoscopy technical skill levels. The kinematic score appears to consistently vary by year of training. Because this assessment is nonsubjective, it may be an improvement over current methods for determination of competence. Ongoing studies are establishing benchmarks and characteristic profiles of skill groups based on kinematics data.

Influence of the angle of irradiation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and root wear: In vitro study

To evaluate the influence of the working tip angulation of the Er,Cr:YSGG laser on the morphology, attachment of blood components, roughness, and wear on irradiated root surfaces compared to scaling and root planing (SRP). The present study used 45 teeth, of which 25 were used for the analysis of the morphology and the attachment of blood components and 20 were used for the analysis of the roughness and of the root wear. The teeth were randomly divided into five groups according to the treatment applied: (G1) Laser Er,Cr:YSGG-30°; (G2) Laser Er,Cr:YSGG-45°; (G3) Laser Er,Cr:YSGG-60°; (G4) Laser Er,Cr:YSGG-90°; and (G5) SRP. The root surfaces irradiated with the Er,Cr:YSGG laser working angulation tip of 45° and 60°, and the samples scaled with manual instruments presented greater attachment of blood components than the group where the Er,Cr:YSGG laser irradiated at working tip angulation of 30° and 90° (P<0.05). The samples irradiated with the Er,Cr:YSGG laser were rougher than the samples scaled with manual instruments (P<0.05). The group that was irradiated with the Er,Cr:YSGG laser at an angle of 30° presented the least wear in comparison to all the other treatments (P<0.01). The irradiated root surfaces proved to be rougher than those scaled with manual instruments; however, irradiation at working tip angulations of 45° and 60° produced results of attachment of blood components and root wear comparable with those obtained with manual instrumentation.

Experience with the New 4-Way, 5.5-mm Ultrathin Endoscope: A Case Series

Use of ultrathin (ut) endoscopes is sometimes limited by their design (outer diameter, tip angulation and image quality). New ut-endoscopes are being designed to address these limitations. A new ut-endoscope, XGIF-PV70N5 (Olympus America Inc.), with an outer diameter of 5.5 mm, 4-way angulation and narrow band imaging has recently been introduced. In this study, we report our subjective experience with this prototype ut-endoscope and discuss the practical uses of its new features. In this prospective case series, ut-endoscopy was performed on selected patients scheduled for endoscopy at a tertiary referral center. Ut-endoscopy was successfully performed on 15 patients with varied indications. The 4-way angulation proved advantageous but not necessary. Narrow band imaging was not very useful in this group of patients. The image quality was satisfactory. The prototype ut-endoscope can be used for a broad range of indications. The 4-way angulation may prove advantageous in specific situations and the role of narrow-band imaging remains to be defined.