Tube Leakage Research Articles

Evaluating the Impact of Elective Endotracheal Tube Replacement on Postoperative Outcomes in Esophageal Atresia: A STROBE-guided Study

ABSTRACT Background: Elective ventilation and paralysis have been shown to decrease the anastomosis-related complications following primary repair of esophageal atresia (EA). Repeated endotracheal tube (ETT) block and replacement can increase these complications. We evaluated the results of our strategy of electively changing the ETT just before shifting the patient to the postoperative ward for elective ventilation. Materials and Methods: A retrospective study was conducted using the case records of patients from July 2015 to February 2024 including all the patients of EA with tracheoesophageal fistula who underwent primary repair with end-to-end esophageal anastomosis. The patients were divided into two groups Group A: ETT was changed and Group B: ETT was not changed immediately before shifting. The groups were compared for anastomotic leak and ETT tube block in the first 48 h. Results: Ninety-one patients were included in the study, 36 in Group A and 55 in Group B. Elective replacement of ETT decreased the tube block rates in the first 48 h following surgery (P = 0.032). Tension in the anastomosis was associated with a higher leak rate. The leak was present in 58.3% and 3.6% in cases with and without tension in the anastomosis (P = 0.001). Overall, the anastomotic leak was similar in both groups. In the subgroup of patients with anastomosis under tension, the rate of anastomotic leak was higher in patients with ETT block (P = 0.028). Conclusion: Elective replacement of EET decreases the tube block rates and anastomotic leak rates in cases with anastomosis under tension.

Improved Early Detection of Tube Leaks Faults in Pulverised Coal-fired Boiler Using Deep Feed Forward Neural Network

Boiler tube leaks significantly reduce the operational availability of power units, yet their early detection and prediction have not been fully realised in the industry. This paper introduces a novel approach employing deep feedforward neural networks for early detection of boiler tube leaks in pulverised coal-fired boilers. Early detection enhances repair planning, minimising downtime and production losses. It also improves monitoring and control of boiler tube failures, thereby optimising power plant operations and revenue. Diverse deep neural network models were developed and rigorously tested by leveraging 9 years of operational data (2012–2020). Exhaustive hyper-parameter optimisation, involving seven parameters, substantially improved predictive accuracy. By achieving training and testing accuracies of 82.8% to 99.3%, the study assessed their ability to detect boiler tube leaks over the same 9-year span, providing insights into leak detection capabilities. The models notably predicted all 12 identified tube leak events, averaging a 14-day lead time before boiler shutdown. In addition to leak prediction, a leak detection matrix was devised to analyse residual behaviour and reduce the likelihood of false alarms. However, the models’ predictive performance was observed to be limited to the following year, with satisfactory results for 2021 only. Incorporating the 2021 data into retraining significantly improved the predictions for 2022. The study concludes that while the models demonstrate robust short-term prediction capabilities, they require continuous retraining to maintain accuracy and relevance. This ongoing refinement is essential for keeping the models up-to-date and reliable in predicting future boiler tube leaks.

Implementation of Anti-Abrasion Grid in Sumsel-5 580 t/h CFB Boiler (Reliability and Performance Evaluation)

CFB Boiler operated with turbulence model and fast fluidization. This model regime gives CFB boiler great heat distribution and increase boiler efficiency. Disadvantage of regime is due boiler furnace feed with coal, sand and limestone as bed material. Bed material with the high velocity and turbulence regime can be harmful for water and steam tube inside of furnace. Operational challenges such as abrasion and abrasion of boiler components will significantly affect their efficiency and increase possible force shutdown because of boiler tube leakage. This research investigated the implementation of anti-abrasion grids perpendicular to water wall tubes of Sumsel-5 CFB Boiler, installed horizontally and vertically to mitigate abrasion and enhance overall performance. The result showed that anti-abrasion grid installation could increase the lifespan of the CFB boiler, reduce the abrasion rate by more than 50%, and lead to enhanced boiler performance by 0,4%. Anti-abrasion grid installation could also reduce the maintenance cost due to water wall tube repair.

Comprehensive Inspection Solution for Boiler Water Wall Tube Corrosion

A substantial number of domestic coal-fired boilers, most of which have been in operation for numerous years, are susceptible to corrosion and tube ruptures within their high-temperature environment, often resulting in unplanned shutdowns. Despite the annual planned maintenance shutdowns, which involve routine inspections of water wall and furnace tubes to detect potential corrosion and erosion, the current non-destructive testing methods are generally localized. This approach, particularly with the considerable height variation of the water wall tubes (ranging from approximately 10 to 25 meters), may overlook segments with severe corrosion during localized ultrasonic thickness gauging. Although the experience of inspection teams reduces the chance of defect oversight, the demand for a comprehensive and effective inspection technique remains a priority for boiler operators. This study utilizes the characteristic of guided waves to propagate over a certain distance along pipelines, initiating an exploration into a comprehensive inspection solution for water wall tubes. Finite element simulation results demonstrate the suitability of utilizing a 120 kHz frequency for shear horizontal mode (SH0) testing on the fire side of water wall tubes. This mode effectively screens for localized corrosion within a 3-meter range. In the field of on-site boiler inspection, electromagnetic coils are employed to generate guided waves within water wall tubes. The gathered signals from each electromagnetic guided wave testing (EMGWT) are consolidated into a distribution map, indicating suspicious signal locations. Pulse eddy current testing (PECT) is employed to identify potential issues with guided waves without requiring surface preparation. If PECT reveals anomalies, the affected surface is polished, and phased array ultrasonic testing (PAUT) is conducted to quantitatively measure the remaining wall thickness due to corrosion. The theoretical exploration and on-site inspection outcomes affirm the feasibility of this approach, aimed at enhancing operational safety for boiler water wall tubes and mitigating the risks of tube ruptures and leaks. This comprehensive inspection solution amalgamates three advanced detection technologies, each capitalizing on its unique inspection characteristics to facilitate corrosion screening, corrosion scanning, and wall thickness sizing. Through the integration of these technologies, the overall inspection strategy ensures the utmost level of reliability.

Evaluation of the blood flow in reconstructed gastric tube and its relation to anastomosis leakage

ObjectivesAnastomotic leakage in esophageal cancer surgery may be reduced by evaluating the blood flow to the reconstructed organ, but quantitative evaluation of arterial and venous blood flow is difficult. This study aimed to quantitatively assess blood flow using a new technique, as well as determine the relationship between the blood flow in the gastric tube and anastomotic leakage using near-infrared spectroscopy.MethodsThis single-center, observational study included 50 patients aged 51–82 years who underwent radical esophagectomy with gastric tube reconstruction for esophageal cancer between June 2022 and January 2023. Regional tissue oxygen saturation was measured at the antrum (point X), the anastomotic point (point Z), and the midpoint between points X and Z (point Y) before and after gastric tube formation. These three points of oxygen saturation were investigated in relation to anastomotic leakage.ResultsWhen comparing the presence of leakage to its absence, regional tissue oxygen saturation at points X and Z after gastric tube formation was significantly lower (X: p = 0.03, Z: p = 0.02), with the decreasing rate significantly higher at point Z (p = 0.01). There was no significant difference in the decreasing rate of regional tissue oxygen saturation between points X and Y (X: p = 0.052, Y: p = 0.83).ConclusionRegional tissue oxygen saturation levels may be useful for measuring blood flow and could be a predictor of anastomotic leakage.

Effect of liposomal bupivacaine for preoperative erector spinae plane block on postoperative pain following video-assisted thoracoscopic lung surgery: a protocol for a multicenter, randomized, double-blind, clinical trial.

There is still a controversy about the superiority of liposomal bupivacaine (LB) over traditional local anesthetics in postoperative analgesia after thoracic surgery. This study aims to determine the effect of LB versus bupivacaine hydrochloride (HCl) for preoperative ultrasound-guided erector spinae plane block (ESPB) on postoperative acute and chronic pain in patients undergoing video-assisted thoracoscopic lung surgery. This multicenter, randomized, double-blind, controlled trial will include 272 adult patients scheduled for elective video-assisted thoracoscopic lung surgery. Patients will be randomly assigned, 1:1 and stratified by site, to the liposomal bupivacaine (LB) group or the bupivacaine (BUPI) HCl group. All patients will receive ultrasound-guided ESPB with either LB or bupivacaine HCl before surgery and patient-controlled intravenous analgesia (PCIA) as rescue analgesia after surgery. The numeric rating scale (NRS) score will be assessed after surgery. The primary outcome is the area under the curve of pain scores at rest for 0-72 h postoperatively. The secondary outcomes include the total amount of opioid rescue analgesics through 0-72 h postoperatively, time to the first press on the PCIA device as rescue analgesia, the area under the curve of pain scores on activity for 0-72 h postoperatively, NRS scores at rest and on activity at different time points during the 0-72 h postoperative period, Quality of Recovery 15 scores at 72 h after surgery, and NRS scores on activity on postsurgical day 14 and postsurgical 3 months. Adverse events after the surgery are followed up to the postsurgical day 7, including postoperative nausea and vomiting, fever, constipation, dizziness, headache, insomnia, itching, prolonged chest tube leakage, new-onset atrial fibrillation, severe ventricular arrhythmia, deep venous thrombosis, pulmonary embolism, pulmonary atelectasis, cardiac arrest, ileus, urinary retention, chylothorax, pneumothorax, and organ failure. Analyzes will be performed first according to the intention to treat principle and second with the per-protocol analysis. We hypothesize that LB for preoperative ultrasound-guided ESPB would be more effective than bupivacaine HCl in reducing postoperative pain in video-assisted thoracoscopic lung surgery. Our results will contribute to the optimization of postoperative analgesia regimens for patients undergoing video-assisted thoracoscopic lung surgery.Clinical trial registration:http://www.chictr.org.cn, identifier ChiCTR2300074852.

Glycopyrrolate as an Adjunct in the Management of Anastomotic Leak Following Repair of Esophageal Atresia: A Clinicoradiological Perspective.

Anastomotic leak after primary repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a well-known complication and can represent a challenging clinical scenario. The present study aimed to evaluate the role of glycopyrrolate as an adjunct in the treatment of anastomotic leak after primary repair of EA Vogt type 3b. A retrospective study was carried out in our tertiary care teaching institute from January 2015 to December 2022. Neonates with EA with distal TEF with primary repair who had developed anastomotic leak, managed by the author(s), were studied. The study included patients with major, minor, and radiological leaks. Glycopyrrolate was administered in the dose of 4 μg/kg 8 hourly. The outcomes of the study were either resolution or progression of the leak. There were 21 patients who were managed with glycopyrrolate in addition to the classical treatment of the anastomotic leak following repair of EA with distal TEF. The male: female ratio was 1:1.1. All the cases had anastomotic leaks with either clinically detectable in the chest tube (15) or radiological leak (6). The leaks were detected early in patients with major leak (mean = 3.2 ± 0.84 days) compared to minor leak (mean =4.9 ± 1.29 days). Radiological leaks were detected in all the neonates on postoperative day 7. In five patients with major leak, there was a negligible reduction in the amount of chest tube output, and were subjected to diversion procedures. There were a total of three deaths out of five in this group. In 10 patients with minor leak, there was complete resolution of anastomotic leak in eight patients (80%); there was one patient each with mortality and diversion procedure. The patients with a radiological leak (6) did not show any deterioration, and they were fed 1-5 days after the esophagogram. Glycopyrrolate may be an advantageous postoperative adjunct in the management of minor and radiological leak after tracheoesophageal repair.

Time-dependent change in occurrence rate of steam generator tube leak in sodium-cooled fast reactors—Phenix and BN-600

Time-dependent change in occurrence rate of steam generator tube leak in sodium-cooled fast reactors—Phenix and BN-600

Helium Leak Rate Measurements of Flight-like Mars 2020 Sample Tubes.

The sample tubes on board NASA's Perseverance rover are designed to contain rocks, regolith, and atmospheric gases and are hermetically sealed on the surface of Mars to minimize sample loss, alteration, and contamination. Following a robust testing program during mission development, it was determined that the helium (He) leak rates of flight-like sample tubes sealed under a range of conditions were typically no greater than ∼10-10 standard cubic centimeters per second (scc/s); leak rates below this value could not be measured since this is the detection limit of commercially available He leak detectors. This limit was adequate to meet mission requirements. However, some scientific objectives could be compromised by sample tube leak rates even below 10-10 scc/s, thus motivating a more sensitive technique for establishing leak rates. This study investigated He leak rates on six flight-like sample tubes using a static mode mass spectrometer. Room temperature He leak rates of the six sample tubes ranged from ∼8.8 × 10-17 to ∼4.6 × 10-14 scc/s. One sample tube was analyzed at eight different temperatures, ranging from -51°C to +42°C, and yielded He leak rates correlated with temperature that varied from ∼1.7 × 10-15 to ∼1.4 × 10-13 scc/s, respectively. Our results confirm and extend previous findings demonstrating that the Mars 2020 sample tube seals are likely to be very leak-tight, with leak rates <10-13 scc/s. These leak rates are sufficiently low that the impact of gas egress or ingress is expected to be negligible.

Pelaksanaan Quality Control Pesawat Sinar X di Pelayanan Radiodiagnostik

Background: Quality Control can be used as a monitoring of the reliability of X-Ray Unit during the validity period of the Conformity Test Certificate. During the use of X-ray Unit, there is the potential for damage to components during the validity period of the certificate of passing the Compliance Test. If the X-Ray Unit Reliability Test is only carried out during the Compliance Test, then if there is a decrease in the quality and safety of the X-ray Unit it cannot be immediately known. This has the potential to endanger patients, radiation workers and the public. In Banyumas Regency, there are 80 Radiation Source Utilization Permits spread across 34 radiodiagnostic installation. Preliminary studies show that not all radiodiagnostic installation carry out routine X-ray machine reliability tests according to the Keputusan Menteri Kesehatan Republik Indonesia Nomor 1250/Menkes/SK/XII/2009 Tentang Pedoman Kendali Mutu (Quality Control) Peralatan Radiodiagnostik.&#x0D; Method: This research type is qualitative with survey of 20 radiodiagnostic installation using a questionnaire instrument. Quality control conducted periodically includes kVp accuracy test, linearity and reproducibility mA, exposure time accuracy test, tube leak test, collimator beam suitability test, collimator shutter efficiency test, collimator light strength test, HVL measurement, implementation of reject analysis program and availability and qualifications of quality control officers and availability of quality control equipment. Then the data will be grouped based on research objectives and presented descriptively.&#x0D; Result: From the results of data collection, 1 hospital did not have a quality control officer and 4 hospitals had a quality control officer with an educational background of Diploma IV in Radiology Engineering without any Radiology Equipment Quality Control training. Meanwhile, 15 hospitals have quality control officers with an educational background in the Medical Physics Undergraduate Program and have attended training in Quality Control of Radiology Equipment. Of the 20 hospital radiology installations, there were 7 hospitals that did not carry out the Reject Analysis Program. This was done with the assumption that Digital Radiography had been used in both the CR and DR modalities. A number of 13 hospitals continued to carry out the Reject Analysis Program even though they had used Digital Radiography. Of the 20 hospital radiology installations, there are 6 hospitals that independently carry out X-ray unit testing within the framework of a quality control program. However, only 1 hospital conducts regular testing. Testing is also limited to the accuracy of the collimator field and the strong light of the collimator. Fourteen hospitals did not carry out a quality control program independently but only carried out an X-ray unit calibration test once a year which was carried out by BPFK and an X-ray unit distributor company.&#x0D; Conclusion: The implementation of quality control of x-ray machines on a regular basis has not been carried out by all radiodiagnostic services, even though they already have quality control officers. One of the reasons is the availability of quality control equipment needed for testing and supervision of radiodiagnostic service management. The role of management of radiodiagnostic services is needed to overcome these problems.&#x0D; &#x0D; Keyword : Quality Control Programe, Compliance Test, X-Ray Unit

Effect of the leak port area and tube length on suppression of spontaneous ignition of high-pressure hydrogen

Suppression of high-pressure hydrogen spontaneous combustion is essential for the sustainable development of hydrogen energy. Previous studies have shown that suppressing hydrogen spontaneous combustion by reducing the area of the leak port is a feasible method. However, the effect of some factors, such as tube length, on this suppression method has not received attention. Therefore, the effect of leakage port areas of 10 mm, 8 mm, 6.6 mm, and 4.5 mm on the suppression of hydrogen spontaneous combustion was investigated experimentally and simulated for different pipe lengths. The results show that reducing the leak port area increases the hydrogen-air mixing path, which raises the combustible concentration. However, by reducing the leak port area, the intensity of shock waves and the maximum temperature in the tube decreased significantly, and the possibility of hydrogen spontaneous combustion decreased. This indicates that reducing the leak port area can inhibit hydrogen spontaneous combustion. In addition, within a certain leak area, increasing the tube length weakens the performance of this inhibition method. However, the effect of tube length on this method disappears as the leak area decreases. Finally, the leakage port area is reduced, changing the flow field at the nozzle, so that the spontaneous combustion flame in the near field of the nozzle undergoes extinguishment and re-ignition. The results show that reducing the area of the leakage port can effectively inhibit hydrogen self-ignition and is not affected by the length of the tube, providing a way to inhibit hydrogen self-ignition.

Subsea Multilateral Oil Producer Evaluated With Acoustic and Production-Logging Tools

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 210299, “A Subsea Multilateral Oil Producer, Completed With AICD Sand Screens and Selective Inflow Valves, Is Evaluated by Combined Acoustic and Production-Logging Tools, Identifying the Sand-Producing Branch and a Tubing Leak in a Single Operation,” by Duncan Troup, SPE, Archer; Tim Griffin, SPE, Three60Energy; and Minh Pham, Aker BP, et al. The paper has not been peer reviewed. _ A horizontally completed subsea multilateral well exhibited unexpected sand production and a tubing leak, leading to the well being shut in. The complete paper discusses the novel tools and techniques used to localize the tubing leak, identify the bore responsible for sand production, and provide relative sand quantification at differing flow rates. Well Background and History The well was drilled and completed as a subsea producer to be tied back to an existing floating production, storage, and offloading (FPSO) vessel by means of a subsea flowline. After drilling of the first lateral, the decision was taken not to complete it. A second lateral was then drilled and completed. The main and secondary bores were drilled into different zones of the reservoir. Both lower completions used standalone sand screens, autonomous inflow-control-device nozzles, and swell packers set in open hole. Each of the lower completions was fitted with a hydraulically actuated inflow control valve (ICV) for managing production flow from the reservoir zones, providing the ability to produce each leg independently or commingle them. The upper completion is equipped with two gas lift valves (GLV) to provide artificial lift, a chemical injection mandrel, and a surface-controlled subsea safety valve (SCSSV). After approximately 6 months of flowing the well, water cut was seen to increase and a series of “popping” events occurred in which productivity increased markedly for short periods. Significant quantities of sand soon began to accumulate in the FPSO topside facilities. Approximately 1.5 years after startup, well productivity decreased sharply over a few months while the water cut continued to increase. As the productivity continued to decline, the leak rates exhibited by the SCSSV and one GLV fell outside the acceptable criteria. The pressure responses indicated a high leak rate. The well was shut in pending diagnostic logging and repair of the leak. Sand-Source Investigation The subsea wellhead of this well was fitted with an acoustic sand detector, but this had only indicated minor amounts of solids in the flowstream over the producing lifetime of the well. An extensive investigation concluded that the makeup of the collected sand was most likely to have originated in the case study well and that the amounts involved were likely to have been a contributing factor in the loss of well integrity. Because the well was producing from two different branches, a probability existed that only one of these was suffering from sand production. The well completion was designed to allow independent control of the branches by use of ICVs, so an intervention to assess the status of each of the branches with respect to water and sand production was planned, with the additional objective of diagnosing the well-integrity failure.

ANALYSIS OF DENICKELIFICATION PHENOMENON ON HEAT EXCHANGER TUBE

DeNickelification is common phenomenon which occurs for alloy metal containing sufficient amounts of Nickel when it is exposed at high temperature in long time periode. One of component which is made of alloy metal containing Nickel is heat exchangers tube.  Heat exchanger is a part of processing unit that use for transfering heat from hot fluid to colder fluid through the combined mechanisms of conduction and convection.  When the heat exchanger leaks, all of the processing system could be affected. In this research a leakage heat exchanger tube is investigated by failure analysis methods to find the root cause of failure. Several tests and examinations such as fractography, metallography examinations, SEM and EDS, hardnes as well as chemical compositions test are carried out to this tube to obtain detailed information for further analysis.&#x0D; Result of this reseach shows that some Cu residue, Ni, aggressive/corrosive ion such as Cl- and S2- at the leak area of heat exchanger tube is found. These evidences indicated that denickelification was occurred on inner surface of heat exchanger tube caused by potential difference between Ni2+ion and Cu2+ ion to form a galvanic cell.  Furthermore, since the tube is flown by fluid material which contains aggressive / corrosive ions such as Cl- ion and S2- then pitting corrosion on inner surface of tube is formed. This mechanism had been taken place continuously during operation of heat exchanger and pitting corrosion keep growing until the tube leaks.

Numerical simulations, experimental investigation and optimization of hybrid space thermal radiators

Spacecraft thermal management is a critical issue as power requirements for high-capacity satellites and human space flights continue to grow. Radiators play a vital role in heat transportation and act as sinks in this process. This study focuses on the optimization of a novel space thermal radiator. Conventionally, space thermal radiators have parallel tubes. Recent studies have evaluated the performance of serial radiators for heat transportation in spacecraft. In this study, a hybrid radiator that combines the advantages of both parallel and serial radiators is proposed for space applications. Performance analysis through conjugate heat transfer analysis is conducted on hybrid radiators and compared with parallel and serial radiators. Hybrid radiators effectively reduce the impact of micro-meteoroids and orbital debris. By appropriately isolating the leaking tube, hybrid radiators can maintain 95.4% heat rejection even in the event of tube leaks caused by orbital debris impact. Using Taguchi signal-to-noise ratio analysis, the optimal radiator geometry only incurs a 10 Pa pressure drop, compared to the 572 Pa baseline configuration, and has a lower mass of 4.3 kg instead of 6.8 kg. The study also found that when reduction in pressure drop is a priority, increasing tube diameter is crucial, but when mass reduction is important, decreasing fin thickness should be prioritized. The study demonstrates that hybrid radiator is a better alternative to parallel and serial radiators in spacecraft heat transportation process, especially when reduction in mass and pressure drop are equally crucial.

Bio-corrosion Phenomenon of Titanium Grade 2 Tubes in Condenser of a Steam Power Plant

Titanium is widely applied for the tube condenser in Indonesia’s powerplant especially those that use seawater for the cooling system, because it has excellent properties both mechanical and physical. Leak in titanium in seawater environment occurred, but on the contrary, the leak of titanium tube in the brackish environment frequently occurs. Many defense tasks such as plugging, cleaning, and adjusting operations have taken, but the result remains the same. Until it was decided to perform an overhaul for the condenser and tube mapping using ECT. It was discovered that 80% of the total tube have been wall lost thickness so that total retubing must be conducted. Chemical elements consist of oxygen (O), sulfur (S), and chlor (Cl) were found during DT and NDT. This study aims to analyze the factors causing this severe titanium tube leak in the condenser. This case is like previous research even though it occurred in different equipment and water feed. Sulfur elements came from the excretion of aquatic biota such as mussel. Plentiful mussels grow along the cooling condenser line because biocide injection is difficult to perform. The method used to find the root cause of the problem is performing several tests of titanium tubes samples. The results show titanium tube from the condenser has experienced bio-corrosion. This is supported by the presence of three elements that allow the bio-corrosion reaction to occur by forming titanium sulfide, namely O, S, and Cl.

(115) Mechanical and Anatomic Indications for Inflatable Penile Prosthesis Revision

Abstract Introduction Implantation of an inflatable penile prosthesis (IPP) is considered the gold standard for definitive treatment of men with refractory erectile dysfunction. As mechanical devices, IPPs have a finite lifespan, thus often requiring surgical revision or replacement of components over time. Objective To characterize the location of IPP mechanical component failure in patients presenting for revision or explant and stratify them by device manufacturer [Boston Scientific (BSc) and Coloplast (CP)]. Methods A retrospective chart review of our large, single-surgeon, tertiary referral center penile prosthesis database between 2007-2022 was completed to identify all men who underwent IPP revision (partial or full device) or explant. Only cases having intraoperative documentation of cause for IPP failure and device manufacturer were included. Reasons for revision or replacement surgery were categorized into mechanical (tubing, cylinder, or reservoir leak and pump malfunction) and non-mechanical (component herniation, erosion, or crossover). All revisions performed due to non-mechanical reasons were excluded from analysis. Chi-square analysis was used to assess failure rates and causes. A Student’s T-test was used to assess time to revision and demographics. Results Among 933 IPP cases, we identified 133 patients who underwent 272 revision procedures; 154 met inclusion criteria (96 BSc and 58 CP). Forty-four (29%) of those surgeries were revisions of devices placed by outside surgeons, and 110 (71%) were revisions of IPPs inserted at our institution. Average patient age was 67 years for BSc and 63 years for CP (p = 0.086), and the average BMI was 28.7 for BSc and 30.8 for CP (p = 0.122). Time to revision was similar between brands at an average of 39 months for BSc and 56 months for CP (p = 0.11). Eighty-one (53%) of the surgeries were revisions of one affected implant component, 56 (36%) were full device removal/replacement, and 17 (11%) were full explants. Coloplast devices required revision more frequently due to tubing fracture (p &amp;lt; 0.01), and BSc devices required revision more frequently due to pump malfunction (p = 0.02). Both devices rarely failed due to cylinder or reservoir defects (Figure). Conclusions Although time to revision was similar between the two brands, CP devices malfunctioned more often due to tubing fracture whereas BSc devices failed more often due to pump malfunction. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast

Numerical Investigation on the Ventilated Supercavity around a Body under Free Surface Effect

Reducing vessel resistance by using ventilated cavities has been a highly researched topic in the marine industry. There is limited literature on ventilated supercavities near the free surface, which indicates that their dynamic behavior is more complex than conventional ventilated cavities due to the effect of the free surface. This paper employs numerical simulations to study the dynamic behavior of the ventilated supercavity, taking into account the effect of the free surface. Numerical simulations can predict gas leakage behaviors, cavity geometry, and internal flow structures. The influence of the free surface shortens the length of the ventilated cavity and increases the diameter. The presence of the free surface mainly changes the vertical velocity distribution between the free surface and the cavity. The results show that there are two typical gas leakage mechanisms under different immersion depths: twin-vortex tube leakage mode and re-entrant jet leakage mode. The internal flow field of ventilated supercavity is classified into three regions: the internal boundary layer, the ventilation influence region, and the reverse flow region. As the distance between the free surface and the ventilated supercavity decreases, the ventilated supercavity is affected by both the free surface effect and the gravity effect.

PD42-10 MECHANICAL INDICATIONS FOR INFLATABLE PENILE PROSTHESIS REVISION

You have accessJournal of UrologyCME1 Apr 2023PD42-10 MECHANICAL INDICATIONS FOR INFLATABLE PENILE PROSTHESIS REVISION Ashton M. Smelser, Maia E. VanDyke, Samantha W. Nealon, Shervin Badkhshan, Brian T. Langford, Bryce P. Franzen, and Allen F. Morey Ashton M. SmelserAshton M. Smelser More articles by this author , Maia E. VanDykeMaia E. VanDyke More articles by this author , Samantha W. NealonSamantha W. Nealon More articles by this author , Shervin BadkhshanShervin Badkhshan More articles by this author , Brian T. LangfordBrian T. Langford More articles by this author , Bryce P. FranzenBryce P. Franzen More articles by this author , and Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003352.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite advances in design, inflatable penile prostheses (IPPs) remain susceptible to mechanical degradation with repeated use. We sought to characterize IPP component failure at time of device revision and stratify by manufacturer [American Medical Systems (AMS) and Coloplast (CP)]. METHODS: Retrospective review of our penile prosthesis database between July 2007 – May 2022 was conducted, identifying men who underwent revision surgery. Mechanical indications for surgery were categorized by location (e.g. tubing, cylinder, or reservoir leak and pump malfunction). Non-mechanical revisions (e.g. component herniation, erosion, or crossover) and patient satisfaction were not analyzed. AMS™ 700 (silicone reservoir and cylinders) component failure rates were compared to those of Coloplast Titan® (Bioflex® reservoir and cylinders) components. Categorical variables were assessed with Fisher’s Exact or Chi-square analysis; Student’s t-test and Mann Whitney U were used for continuous variables. RESULTS: Among 1105 IPP procedures performed at our center over the 15-year study period, we identified 276 revision procedures, 76 of which were due to mechanical failure (53 AMS and 23 CP). Coloplast devices failed most often due to tubing fracture (19/23, 83%), and rarely elsewhere. AMS devices showed no predominant site of failure. When comparing manufacturers, tubing failure was more common in CP devices (19/23 vs 15/53 for AMS, p<.01), while pump failure was more common among AMS devices (15/53 versus CP 1/23, p=.02, Figure 1). Revised Coloplast cylinders were longer than AMS cylinders (median length 20 cm vs. 18 cm, p<.01). Median time to revision was longer for Coloplast devices (55.2 months versus AMS: 27.8 months, p<.01). Mechanical failure rate for virgin cases was similar between brands (26/581 AMS, 10/165 CP, p=.500). CONCLUSIONS: Coloplast devices commonly failed at the tubing and rarely elsewhere. Pump malfunction was more common among AMS devices. Time to failure was significantly longer for Coloplast devices. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1115 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashton M. Smelser More articles by this author Maia E. VanDyke More articles by this author Samantha W. Nealon More articles by this author Shervin Badkhshan More articles by this author Brian T. Langford More articles by this author Bryce P. Franzen More articles by this author Allen F. Morey More articles by this author Expand All Advertisement PDF downloadLoading ...

The PhLIP team: Feasibility of a physiotherapy-led intensive prone positioning team initiative during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of patients with refractory hypoxaemic respiratory failure being admitted to the intensive care unit (ICU). Prone positioning can improve oxygenation but requires a team of skilled personnel to complete safely. Critical care physiotherapists (PTs) are ideally suited to lead proning teams, due to their expertise in moving critically unwell, invasively ventilated patients. ObjectivesThe aim of this study was to describe the feasibility of implementing a physiotherapy-led intensive proning (PhLIP) team to support the critical care team during surges. MethodsThis study involves descriptive evaluation of feasibility and implementation of the PhLIP team, a novel model of care, during the Delta wave of the COVID-19 pandemic, through a retrospective, observational audit of PhLIP team activity, ICU clinical activity, and a description of clinical outcomes. ResultsBetween 17 September and 19 November 2021, 93 patients with COVID-19 were admitted to the ICU. Fifty-one patients (55%) were positioned prone, a median [interquartile range] 2 [2, 5] times, for a mean (±standard deviation) duration of 16 (±2) h, across 161 episodes. Twenty-three PTs were upskilled and deployed to the PhLIP team, adding 2.0 equivalent full time to the daily service. Ninety-four percent of prone episodes (154) were led by the PhLIP PTs with a median 4 [interquartile range: 2, 8] turns per day. Potential airway adverse events occurred on three occasions (1.8%) and included an endotracheal tube leak, displacement, and obstruction. Each incident was promptly managed without prolonged impact on the patient. No manual handling injuries were reported. ConclusionThe implementation of a physiotherapy-led proning team was safe and feasible and can release critical care-trained medical and nursing staff to other duties in the ICU.

Delivering Low Tidal Volume With Anesthesia and ICU Ventilators in a Neonatal Lung Model.

Mechanical ventilation of the neonate requires ventilators than can deliver precise and accurate tidal volume (VT) and PEEP to avoid lung injury. Due to small neonatal VT and the disproportionate effect of endotracheal tube leak in these patients, accomplishing precise and accurate VT delivery is difficult. Whereas neonatal ICU ventilators are validated in this population, thorough studies testing the performance of anesthesia ventilators in delivering small VT in neonates are lacking. Three anesthesia ventilators, Dräger Apollo, GE Avance, and Getinge Flow-i; and 2 ICU ventilators, Medtronic PB980 and Nihon Kohden NKV-550, were tested under volume control mode at VT of 5, 20, 40, and 60 mL. Three combinations of lung compliance and airway resistance were tested using a Servo ASL 5000 lung simulator. In a scenario without leak, the measured VT was greater than the set VT by > 10% in the Apollo (21.0% [18.8-26.0]); measured VT was less than the set VT by > 10% in the Flow-i (-19% [-20.8 to -18.7]). The Avance, PB980, and NKV-550 presented a volume error < 10% (-9.50% [-10.8 to -4.4], -5.8% [-11.8 to -3.5], and 5.4% [-4.5 to 18.9], respectively). Considering all combinations of set VT, leaks, and respiratory mechanics, none of the anesthesia ventilators were able to deliver a median measured VT within a 10% error. The bias between measured VT and set VT varied widely among ventilators (from 4.27 mL to -10.59 mL). Additionally, in the Apollo ventilator, PEEP was underdelivered with the largest leak value. Our results suggest that in comparison with the 2 neonatal ICU ventilators tested, the anesthesia ventilators did not greatly differ in terms of VT delivery in the presence of a gas leak.