Traction Device Research Articles

Evaluating collagenase Clostridium histolyticum administration protocols in the treatment of Peyronie's disease.

Treatment of Peyronie's disease with collagenase Clostridium histolyticum (CCh) has gained world-wide adoption following the phase III clinical trials IMPRESS I and II. However, the optimal treatment parameters remain largely unknown. Many groups have made modifications to CCh treatment in Peyronie's disease in recent years. This review aims to discuss the variations in CCh treatment reported and associated outcomes. Variations in CCh treatment protocols include administering higher CCh doses (0.9 mg) less frequently (q1month), use of home penile modeling, use of angulating penile traction devices, and vacuum therapy devices. Authors have reported different injection techniques to include three-point fans and tunneling techniques. Patient selection has expanded to include and evaluate responses among men with some extent of plaque calcification, and ventral curves. Since publication of the IMPRESS trials, several variations of CCh treatment have been reported with similar treatment responses to the original trials. However, future studies are required with prospective, randomized comparative designs to identify the optimal treatment strategies for men with Peyronie's disease.

Stable mechanical environments created by a low-tension traction device is beneficial for the regeneration and repair of degenerated intervertebral discs

BACKGROUNDBy blocking the cascade of reactions leading to intervertebral disc degeneration through immobilization-traction, a delay in intervertebral disc degeneration and its regeneration, to some extent, has been observed. However, the precise balance of regulation of the microenvironment of intervertebral disc biomechanics and coordination of the complex spatiotemporal reconstruction of the extracellular matrix have not yet been solved, and clinical results are far from successful. PURPOSEIn the present study, a mechanical degeneration model was constructed to evaluate the possibility and effectiveness of disc regeneration or repair through low-tension traction of degenerated discs so as to provide basic biomechanical information for clinical optimization of the traction device and to establish traction parameters for prevention and treatment of disc degeneration. STUDY DESIGNA macro-, micro-, and nano-level structural analysis of degenerative discs of rat tail before and after controlled traction. METHODSSix-month-old male Sprague-Dawley rats were randomly divided into seven groups: Group A: control group (instrumented with Kirschner [K]-wires only); Group B: Model group (caudal vertebrae immobilized using a custom-made external device to fix four caudal vertebrae [Co7−Co10], while Co8−Co9 vertebrae underwent 4 weeks of compression to induce disc degeneration); Group C: experimental control group (devices removed after the 4 week compression described in Group B, and recovered by themselves for 4 weeks). The remaining four groups represented intervention groups (Groups D and F: Co8−Co9 vertebrae compressed for 4 weeks followed by 2 or 4 weeks of in situ traction, respectively; Groups E and G: vertebrae compressed for 4 weeks followed by 2 or 4 weeks of excessive traction, respectively). X-ray and magnetic resonance imaging were performed at each time point to measure disc height and T2 signal intensity. At the end of the experiment, the animals were euthanized and tail vertebrae harvested for analysis of intervertebral disc histopathology, proteoglycan content, elastic modulus of fibers of the annulus fibrosus (AF) and nucleus pulposus (NP), and microstructure of the bony end plate. RESULTSAfter 2 to 4 weeks of continuous traction (in situ and excessive traction), the Co8–Co9 intervertebral disc space of rats in Groups D to G increased significantly compared with Groups B and C (p < .05). In addition, signs of tissue regeneration were apparent in all four intervention groups (D–G). In addition, histologic scores of the intervention groups (D–G) were significantly lower than those in the model and experimental control groups (Groups B and C, respectively), although no significant difference was found between those four groups. Compared with the model group (Group B), total proteoglycan content of the NP in the intervention groups (D–G) increased significantly (p < .05). After 2 to 4 weeks of intervention (in situ and excessive traction), the morphology of pores in the bony end plate, their number, and the diameter had recovered significantly compared with those in Group B. The in situ traction group was superior to the excessive traction group, and 4 weeks in situ group significantly superior to the 2 weeks group. In all intervention groups, in both the inner and outer AF, mean fibril diameter decreased significantly (p < .05), although they remained larger in the excessive traction group than that in the in situ traction group. Consistent with trend in collagen fiber diameter, the outer AF was stiffer than the inner, and the modulus of the AF in each intervention group not significantly different from that of the control group (Group A) except Group C. However, within the NP, the variation in trend in diameter and modulus of collagen fibers was essentially inconsistent with that of the AF. CONCLUSIONSDegenerated discs exhibit greater reconstruction after low tension traction. It is clear that the intervertebral disc mechanical microenvironment depends to a greater extent on low-tension traction than high-tension traction.

Les thérapeutiques non chirurgicales de la maladie de Lapeyronie : état des lieux des connaissances actuelles

BackgroundPeyronie's disease is an inflammatory disorder of the penis, where scar tissue creates a plaque at the level of the albuginea, limits its extension, and leads to a bent and shorter penis during erections. There are no international standards for the evaluation and the treatment of the disease. The aim of this article is to review the current knowledge about the management of Peyronie's disease and to suggest an algorithm to help physicians evaluate and manage this condition. Material and methodsA literature review was conducted through PubMed database following PRISMA guidelines using the Mesh terms: Peyronie, disease, treatment and diagnosis. Results are presented in a descriptive manner. ResultsMultiple treatment strategies have been proposed, but no conclusive randomized clinical trial is done to assess their efficacies. The oral treatment was shown to be more beneficial in the setting of a multi-modal approach to treat the acute phase. The non-steroidal anti-inflammatories and the potassium para-aminobenzoate are superior to the other molecules of oral therapy for pain management. Local treatment with topical verapamil, iontophoresis and intra-lesional injection of verapamil, interferon alfa-2b and collagenase clostridium histolyticum (CCH) revolutionized the management of the disease by the modification of the plaque size and angulation. Alternative treatments using extra-corporeal shock wave or traction devices are promising. Intra-lesional injection of CCH is the only therapy approved by the Food and Drug Administration for this condition after the stabilization of the disease. The channeling of the plaque before CCH injections is making better results than the initial protocol, concerning angulation improvement. ConclusionMultiple therapeutic strategies exist for the management of the Peyronie's disease, but they lack evidence based data. Further randomized clinical trials are needed to evaluate the current practices and to study more efficient treatments.

MP45-19 USE OF RESTOREX PENILE TRACTION THERAPY FOR TREATMENT OF PENILE LENGTH LOSS IN DIABETIC MEN

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II (MP45)1 Apr 2020MP45-19 USE OF RESTOREX PENILE TRACTION THERAPY FOR TREATMENT OF PENILE LENGTH LOSS IN DIABETIC MEN Madeleine Manka*, Joshua Savage, David Yang, Kevin Wymer, and Trost Landon Madeleine Manka*Madeleine Manka* More articles by this author , Joshua SavageJoshua Savage More articles by this author , David YangDavid Yang More articles by this author , Kevin WymerKevin Wymer More articles by this author , and Trost LandonTrost Landon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000900.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Penile length loss and erectile dysfunction (ED) are common complaints among men with diabetes mellitus (DM), with some data suggesting a mean 1 cm loss. Recently, a randomized controlled trial evaluating the efficacy of a novel penile traction device, RestoreX (PTTRx), demonstrated significant improvements in penile length and erectile function in men with Peyronie’s Disease. Given these findings, we sought to determine the efficacy of RestoreX in improving penile length and erectile function in DM men. METHODS: A randomized, controlled trial (NCT18006696) is ongoing to evaluate the impact of PTT with RestoreX in 100 men with DM. Men are randomized to one of four groupings for 6 months: Group 1 - no therapy (control); Group 2 - Restorex for 30 minutes 2x/day x 3 months, followed by no use x 3 months; Group 3 – Restorex for 30 minutes 2x/day x 3 months, followed by once weekly x 30 minutes x 3 months; Group 4 - Restorex for 30 minutes 2x/day x 6 months. Assessments of stretched penile length, erectile function, and standardized and non-standardized questionnaires are administered at each visit to evaluate sexual function. RESULTS: A total of 88 men (mean age 54.9) have been enrolled to date, with 3-month data available on 56 (control=17, traction=39). Mean duration of DM was 10.7 years (HbA1c 7.1), with men taking a median of 2 medications (33% on insulin). Seventy-four percent of men had ED (median duration 3 years), while 84% reported penile shortening (mean 4.1 cm). Baseline International Index of Erectile Function Erectile Function Domain (IIEF-EFD) scores were 19 (median), and baseline penile length to corona and tip were 13 cm and 16 cm, respectively. Following 3-months of treatment, PTT men demonstrated a 0.9 cm greater improvement in penile length compared to controls (p<0.01), with 79% of PTT men experiencing length gains. Among men with baseline ED, PTT resulted in a 5 point IIEF-EFD improvement vs 0.3 in controls (p<0.05). The Intercourse Satisfaction Domain demonstrated non-statistically significant improvements (+1.75 vs -0.7, p=0.12), while the Overall Satisfaction Domain was significantly improved (+1.8 vs -0.5, p<0.01). There were no significant or long-term adverse events associated with device use. CONCLUSIONS: Based on preliminary data, PTT with RestoreX results in statistically significant objective and subjective improvements in penile length, erectile function, and overall sexual satisfaction in men with DM. RestoreX therefore represents a viable treatment option for this common but difficult to treat problem. Source of Funding: Path Right Medical provided devices to patients free of charge & Internal institutional funding from Mayo Clinic © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e671-e672 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeleine Manka* More articles by this author Joshua Savage More articles by this author David Yang More articles by this author Kevin Wymer More articles by this author Trost Landon More articles by this author Expand All Advertisement PDF downloadLoading ...

Development of medical physio device for stroke patients

Physiotherapy may be a technique for relaxing the stresses in muscles in several parts of the body. This system needs the physiotherapist supervision and a daily visit to the hospitals to be at this system we came with an answer by using simple mechanisms like slider crank mechanism, wiper and rack and pinion mechanism. With the assistance of simple robot, physio treatment is completed automatically and maybe done reception with none assistance. Moreover, Home traction devices have also meant that patients once advised by the therapist regarding the weights and duration of traction treatment are ready to apply traction themselves.

A modern review of penile traction monotherapy and combination therapy for the treatment of peyronie's disease.

Peyronie's disease (PD)-related penile deformity is managed with multiple treatment modalities including oral medications, intralesional injections, and surgery. Penile traction therapy (PTT) is one such modality with purported benefits, albeit with notable differences in the characteristics of available traction devices and published study protocols. We provide a comprehensive review of the available data supporting PTT for PD treatment. We performed a rigorous database search to identify all studies pertaining to PTT for the treatment of PD through November 2019. Seventeen trials explored use of PTT as monotherapy or in combination with surgical or nonsurgical treatment, using over five different commercially available devices. All devices were well tolerated, although compliance and daily duration of use were highly variable. PTT resulted in variable improvements in stretched penile length and penile curvature, depending on study protocol, patient population, and device. PTT appears to be a safe and well-tolerated treatment for PD as monotherapy or in combination with other nonsurgical and surgical treatments, and for men in both the acute and chronic phases. Further studies are needed to compare available devices, evaluate device characteristics associated with treatment success, differentiate outcomes in acute vs. chronic PD populations, and determine the optimal duration of use.

External Orthopaedic Implants in the Magnetic Resonance Environment: Current Concepts and Controversies.

MRI provides diagnostic three-dimensional imaging and remains extremely important in the diagnosis and management of spinal trauma as well as other acute traumatic injuries, including those of the extremities. The American Society for Testing and Materials has created standards against which all implantable medical devices are tested to ensure safety in an MR environment. Most implantable passive orthopaedic devices can undergo MRI without consequence to the patient. However, the American Society for Testing and Materials has recently updated its terminology resulting in confusion among providers and institutions. Primary safety concerns are radiofrequency-induced heating and magnetically induced torque or displacement. These safety concerns have emerged as a recent source of debate, particularly regarding the imaging of patients with external fixation and cervical immobilization devices in place. Surveys have shown a lack of consensus among radiologists regarding this issue. Having an institutional protocol in place for the imaging of these patients streamlines the diagnosis and early stabilization of certain polytraumatized patients. The purpose of this review is to summarize the pertinent literature as well as the current industry recommendations regarding the safety of commonly used external fixation, cervical immobilization, and traction devices in the MR environment.

Extraperitoneal uterosacral ligament suspension by using the cervix as a traction device

The present video demonstrates extraperitoneal uterosacral ligament suspension (ULS) while performing vaginal hysterectomy for POP-Q stage 3 prolapse. The ULS bites were taken before severing the uterosacral ligament using the cervix as a traction device. Two ULS sutures were applied on each side to the distal half of the intermediate part. Superior 1st ULS suture with permanent material (polypropylene) was applied to the uppermost exposed area. Inferior 2nd ULS suture with delayed absorbable material (polyglactin) was 0.5-1 cm distal to the superior suture. Next, the usual first clamp of the vaginal hysterectomy (VH) on a cardinal-uterosacral ligament was applied about 1cm below the second ULS suture. The VH was completed. The ULS sutures were anchored to the vault via either the vesico-vaginal septum or the recto-vaginal septum. Permanent sutures were not brought outside the vaginal epithelium. In 51 cases there was no urological injury. On follow-up (average 2.3years), 8.3% cases had stage 1 POP, 91.6% had no POP.

Enhanced Visualization of the Cervical Vertebra during Intraoperative Fluoroscopy Using a Shoulder Traction Device.

Study DesignA retrospective, matched cohort study of a prospective database.PurposeTo evaluate the efficacy and safety of the Cervision system (Spinologics, Montreal, Canada), a new shoulder traction device that improves the fluoroscopic visualization of the lower cervical spine using caudal traction of the shoulders out of the radiographic field.Overview of LiteratureOperating at a wrong level is a common error that may be committed by nearly 50% of surgeons during their career. Intraoperative fluoroscopy of the cervical vertebrae is an extremely important step in cervical spine surgery. Optimal lateral cervical radiography of the C1–T1 vertebrae is not always possible due to overlap of the shoulders.MethodsIn this study, a group of patients (n=33, device group) underwent surgery with the new device used to apply caudal traction to both shoulders, and another group of patients (n=33, matched control group) had surgery with the tape traction. Data about the lowest vertebra visible on lateral fluoroscopic view, installation time, skin irritation under the traction area, and postoperative brachial palsy were recorded, and these parameters were analyzed using the t-test.ResultsThe mean numbers of visible cervical vertebra were 6.3±0.41 in the device group and 5.6±0.32 in the matched control group (p <0.01, unpaired t-test). The mean installation times were 83.9±5.15 minutes in the device group and 73.7±6.32 minutes in the matched control group (p <0.02). Seven patients from the matched control group presented with skin irritation. However, none of the patients from the device group had the condition (p =0.005, Pearson chi-square test). Postoperative brachial palsy was not observed in both groups.ConclusionsThe Cervision system is more effective and superior to tape traction in pulling the shoulders down to improve the visualization of the cervical vertebra on lateral fluoroscopic view during cervical spine surgery.

Knowledge and Practice among Nurses of Traction in Patients: In a Tertiary Care Center

Background and purpose: The role of nursing care among the traction patients is vital and they should be competent, experienced and educated well about the traction devices used and care to minimize the traction associated complications and infections. This study was designed to access the knowledge and practice regarding care and management of the patients with traction in orthopedic trauma by Nurses.&#x0D; Material and method: A cross sectional descriptive study was conducted on 100 eligible nursing staffs from Kathmandu Medical College Teaching Hospital. Non-probability purposive sampling technique and a self administered structured questionnaire were used to collect data. The statistical analysis was done by using the SPSS version 16. The association between the demographic factors was analyzed by using chi square test.&#x0D; Result: The working area and traction training has significant relation to knowledge and other, such as age, education, work experience, worked in orthopedic ward has no significance. There is adequate knowledge as the percentage value is 88 and practice regarding care of the patient on traction is 98%.&#x0D; Conclusion: The knowledge regarding traction care seems sufficient in this study and every orthopedic nursing should be master in traction knowledge, application and nursing care to acquire early patient recovery without significant deformity and complications.

Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection.

This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of traction-assisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection.

A New Silicon Sling Device for Traction During Robotic Gynecologic Surgery.

Background:One of the challenges of robotic gynecologic surgery is the appropriate traction of the organs and other structures surrounding the surgical field.Methods:We developed a novel traction device, VESOPASTA, that can be used for organ traction during robotic gynecologic surgery. This study describes the utility and the safety of the use of VESOPASTA for ureteral traction during robotic-assisted laparoscopic radical hysterectomy in five cervical cancer patients.Results:Ureteral suspension was successfully and safely performed using VESOPASTA during robotic-assisted laparoscopic radical hysterectomy in cervical cancer patients without causing any complications. The average time required for this procedure was less than 5 min.Conclusions:We have developed a novel device, VESOPASTA, which can be used for organ traction during robotic surgery. This new device allows easy ureteral traction, facilitate the identification of ureter and prevent ureteral injuries during robotic-assisted laparoscopic radical hysterectomy.

Design and Development of a Novel Pneumatic Cervical Traction Device

Design and Development of a Novel Pneumatic Cervical Traction Device

Development of a Forward Leaning Posture and Foot Traction Device to Support the Improvement of Running Form with Reduced Landing Impact

Development of a Forward Leaning Posture and Foot Traction Device to Support the Improvement of Running Form with Reduced Landing Impact

The Use of an Intraoperative Skeletal Traction Device for Delayed Reduction in Pelvic Fractures in Two Dogs

AbstractTwo large-breed dogs underwent delayed surgical repair of pelvic fractures with the aid of a skeletal traction device. Distraction and reduction in the fractures using the skeletal traction device were monitored by direct visualization and intraoperative fluoroscopy. Postoperative radiographs revealed good to near-anatomical bone reduction and fracture alignment without narrowing of the pelvic canal. Both dogs had complete functional recovery with no evidence of neurological deficits. The use of a skeletal traction device should be considered for reduction and fixation of delayed pelvic fractures.

Functional Changes in Patients and Morphological Changes in the Lumbar Intervertebral Disc after Applying Lordotic Curve-Controlled Traction: A Double-Blind Randomized Controlled Study.

Background and Objectives: Lumbar traction is widely used as a non-operative treatment for lumbar intervertebral disc disease. The effect of traditional traction (TT) using linear-type traction devices remains controversial for various reasons, including technical limitations. Thus, the purpose of this study was to compare the effects of the newly developed lumbar lordotic curve-controlled traction (L-LCCT) and TT on functional changes in patients and morphological changes in the vertebral disc. Materials and Methods: A total of 40 patients with lumbar intervertebral disc disease at the L4/5 or L5/S1 level as confirmed by magnetic resonance imaging were recruited and divided into two groups (L-LCCT or TT). The comprehensive health status changes of the patients were recorded using pain and functional scores (the visual analogue scale, the Oswestry Disability Index, and the Roland–Morris Disability Questionnaire) and morphological changes (in the lumbar central canal area) before and after traction treatment. Results: Pain scores were significantly decreased after traction in both groups (p < 0.05). However, functional scores and morphological changes improved significantly after treatment in the L-LCCT group only (p < 0.05). Conclusions: We suggest that L-LCCT is a viable option for resolving the technical limitations of TT by maintaining the lumbar lordotic curve in patients with lumbar intervertebral disc disease.

2139 Modification of Vecchietti's Laparoscopic Technique for Neovagina in a Mexico

Study Objective To show the success obtained in the development of a low cost modified technique for neovagina by traction and use of balloon with laparoscopic assistance, based on anatomical and functional results. Design Retrospective study in female adult patients with Mayer-Rokitansky-Küster-Hauser syndrome treated by using our low cost modified technique, during the period of January 2010-January 2018. Setting N/A Patients or Participants Female patients, over 18 years of age diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome, treated by our group with a neovagina using traction and balloon with laparoscopic assistance technique in the period from January 2010 to January 2018. Interventions After informed consent, in a total of 15 patients were operated with a modified surgery of Vecchietti's laparoscopic technique using an inexpensive traction device. Our group evaluated both functional outcomes and anatomical/aesthetic results. By te functional, one the female sexual function index of Rosen R. et al. was evaluated, and the anatomical/aesthetic results was evaluated with vaginoscopy exam. Measurements and Main Results A total of 15 patients were evaluated who met the inclusion criteria in a period of ten years, with a mean age of 19 years, who reported with sexual functionality and satisfaction of it after 3 years since surgery follow-up. According to the functional evaluation, the total score obtained in our study was on average of 26 pts, ruling out sexual dysfunction. The anatomical result was evaluated by vaginoscopy with a vaginal length of 11 +/-2 cm; in 3 months after surgery follow-up. Conclusion Our group concluded that the modification of Vecchietti´s laparoscopic technique, decreases widelly material costs (material cost of this technique is estimated of $10.000 dls, making it a more accessible treatment option for patients in public health institutions in Mexico. To show the success obtained in the development of a low cost modified technique for neovagina by traction and use of balloon with laparoscopic assistance, based on anatomical and functional results. Retrospective study in female adult patients with Mayer-Rokitansky-Küster-Hauser syndrome treated by using our low cost modified technique, during the period of January 2010-January 2018. N/A Female patients, over 18 years of age diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome, treated by our group with a neovagina using traction and balloon with laparoscopic assistance technique in the period from January 2010 to January 2018. After informed consent, in a total of 15 patients were operated with a modified surgery of Vecchietti's laparoscopic technique using an inexpensive traction device. Our group evaluated both functional outcomes and anatomical/aesthetic results. By te functional, one the female sexual function index of Rosen R. et al. was evaluated, and the anatomical/aesthetic results was evaluated with vaginoscopy exam. A total of 15 patients were evaluated who met the inclusion criteria in a period of ten years, with a mean age of 19 years, who reported with sexual functionality and satisfaction of it after 3 years since surgery follow-up. According to the functional evaluation, the total score obtained in our study was on average of 26 pts, ruling out sexual dysfunction. The anatomical result was evaluated by vaginoscopy with a vaginal length of 11 +/-2 cm; in 3 months after surgery follow-up. Our group concluded that the modification of Vecchietti´s laparoscopic technique, decreases widelly material costs (material cost of this technique is estimated of $10.000 dls, making it a more accessible treatment option for patients in public health institutions in Mexico.

1513 Efficacy of the Traction Device “S-O Clip” Assisted ESD for the Colonic Tumor Involving a Diverticulum

INTRODUCTION: Background: Endoscopic submucosal dissection (ESD) allows en bloc resection of large gastrointestinal neoplasms regardless of the size. However, technical difficulties associated with ESD in the colorectum make it less widely applied in the treatment of tumors in this region. To address this difficulty, we designed a traction device, called S-O clip and reported previously (Endoscopy2008, Gastrointest Endosc 2009). ESD with this device was effective for complete resection of large tumors (LSTs) (Surgical Endoscopy2014). Although the lesions of unusual sites such as within the appendix and diverticulum are very difficultto remove by ESD and sometime surgical treatment is required, We reported the first case of aLSTs involving a diverticulum successfully treated by ESD with this device (Gastrointest Endosc 2016). Aim: To evaluate the efficacy and safety of S-O clip assisted ESD for the tumor of the colon involving a diverticulum. CASE DESCRIPTION/METHODS: Results: 4 cases are LSTs involving a diverticulum in the ascending colon. One case is in the sigmoid colon. All 5 cases were removed safely and successfully en bloc without any complications. Procedure time s were 67, 145, 25, 68 and 64 minutes, with resected specimens measuring 20, 32, 20, 18 and 30 mm, respectively. DISCUSSION: Conclusion: This limited case series demonstrate that S-O clip-assisted ESD is safe and effective for en bloc resection of the colonic lesion involving a diverticulum.

A Descriptor System Approach for Estimation of Incipient Faults With Application to High-Speed Railway Traction Devices

In this paper, a novel descriptor estimator-based incipient fault estimation scheme is designed for Lipschitz nonlinear descriptor systems with process disturbances and measurement output noises. By using the proposed estimator, incipient sensor faults, abrupt actuator faults, and measurement noises can be estimated asymptotically. Application results conducted on a three-phase inverter system of China railway high-speed trains are given to illustrate the effectiveness of the developed approach. The main contributions are summarized in two aspects: 1) the unified framework designed for actuator and sensor fault reconstruction/estimation problem is capable of dealing with actuator and sensor faults at the same time and 2) a linear matrix inequality optimization method is formulated to achieve optimal performance of signal estimation.

Outcomes of a Novel Penile Traction Device in Men with Peyronie's Disease: A Randomized, Single-Blind, Controlled Trial.

Current penile traction therapy devices have significant limitations, including the need to use them for 3 to 8 hours per day. Given these issues, the novel RestoreX® penile traction therapy device was developed in cooperation with Mayo Clinic. We performed a randomized, controlled, single-blind, intent to treat trial (ClinicalTrials.gov NCT03389854) in men with Peyronie's disease who were assigned to the penile traction therapy device for 30 to 90 minutes per day or to no therapy for 3 months. Study inclusion criteria were curvature 30 degrees or greater with no study exclusions due to complex curvature, hourglass deformity, prior Peyronie's disease therapy or surgery, or calcification. The primary outcome was safety and secondary outcomes were penile length and curvature, and questionnaire responses. A total of 110 men were randomized 3:1 to the penile traction therapy group or the control group. The cohorts were well matched with a mean age of 58.4 years, a 49.7-month Peyronie's disease history and 59.3 degree curvature. Overall penile traction therapy was well tolerated with only transient and mild adverse events reported. At 3 months men undergoing penile traction therapy demonstrated significant improvements over controls in penile length (1.5 vs 0 cm, p <0.001), curvature (-11.7 vs 1.3 degrees, p <0.01) and erectile function (4.3 vs -0.7, p = 0.01) according to the International Index of Erectile Function-Erectile Function among men with erectile dysfunction. Overall 77% of the men on penile traction therapy experienced improved curvature (mean -17.2 degrees in 28.2% of responders) while 94% achieved increased length (1.6 cm in 10.9%). Counter bending and the white line indicator improved efficacy, validating key device innovations. Of men who had previously used other penile traction therapy devices 100% preferred the RestoreX device. Penile traction therapy with the RestoreX device for 30 to 90 minutes per day was safe, and resulted in significant and clinically meaningful improvements in penile curvature and length in men with Peyronie's disease, and in erectile function in men with erectile dysfunction and Peyronie's disease with no significant adverse events. To our knowledge these data represent the only reported improvements for any device used less than 3 to 8 hours per day.