Search results for: catheter ablation
141 Blood Clot Emulsification via Ultrasonic Thrombolysis Device
Authors: Sun Tao, Lou Liang, Tan Xing Haw Marvin, Gu Yuandong Alex
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Patients with blood clots in their brains can experience problems with their vision or speech, seizures and general weakness. To treat blood clots, clinicians presently have two options. The first involves drug therapy to thin the blood and thus reduce the clot. The second choice is to invasively remove the clot using a plastic tube called a catheter. Both approaches carry a high risk of bleeding, and invasive procedures, such as catheter intervention, can also damage the blood vessel wall and cause infection. Ultrasonic treatment as a potential alternative therapy to break down clots is attracting growing interests due to the reduced adverse effects. To demonstrate the concept, in this investigation a microfabricated ultrasonic device was electrically packaged with printed circuit board to treat healthy human blood. The red blood cells could be broken down after 3-hour ultrasonic treatment.Keywords: microfabrication, blood clot, ultrasonic thrombolysis device, ultrasonic device
Procedia PDF Downloads 444140 A Reduced Ablation Model for Laser Cutting and Laser Drilling
Authors: Torsten Hermanns, Thoufik Al Khawli, Wolfgang Schulz
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In laser cutting as well as in long pulsed laser drilling of metals, it can be demonstrated that the ablation shape (the shape of cut faces respectively the hole shape) that is formed approaches a so-called asymptotic shape such that it changes only slightly or not at all with further irradiation. These findings are already known from the ultrashort pulse (USP) ablation of dielectric and semiconducting materials. The explanation for the occurrence of an asymptotic shape in laser cutting and long pulse drilling of metals is identified, its underlying mechanism numerically implemented, tested and clearly confirmed by comparison with experimental data. In detail, there now is a model that allows the simulation of the temporal (pulse-resolved) evolution of the hole shape in laser drilling as well as the final (asymptotic) shape of the cut faces in laser cutting. This simulation especially requires much less in the way of resources, such that it can even run on common desktop PCs or laptops. Individual parameters can be adjusted using sliders – the simulation result appears in an adjacent window and changes in real time. This is made possible by an application-specific reduction of the underlying ablation model. Because this reduction dramatically decreases the complexity of calculation, it produces a result much more quickly. This means that the simulation can be carried out directly at the laser machine. Time-intensive experiments can be reduced and set-up processes can be completed much faster. The high speed of simulation also opens up a range of entirely different options, such as metamodeling. Suitable for complex applications with many parameters, metamodeling involves generating high-dimensional data sets with the parameters and several evaluation criteria for process and product quality. These sets can then be used to create individual process maps that show the dependency of individual parameter pairs. This advanced simulation makes it possible to find global and local extreme values through mathematical manipulation. Such simultaneous optimization of multiple parameters is scarcely possible by experimental means. This means that new methods in manufacturing such as self-optimization can be executed much faster. However, the software’s potential does not stop there; time-intensive calculations exist in many areas of industry. In laser welding or laser additive manufacturing, for example, the simulation of thermal induced residual stresses still uses up considerable computing capacity or is even not possible. Transferring the principle of reduced models promises substantial savings there, too.Keywords: asymptotic ablation shape, interactive process simulation, laser drilling, laser cutting, metamodeling, reduced modeling
Procedia PDF Downloads 209139 Nosocomial Infections and Prevention in in Intensive Care Units and Intensive Care
Authors: Kaous Samira
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The lack of hand hygiene can contribute to nosocomial infections, including Central-venous-catheter-related bloodstream infections (CRBSI). An investigation from severally hospitals examined the frequency of hand hygiene in an OR among perioperative staff members who did not perform a surgical scrub. Among 50 operations (120 hours) that were observed, only 2% of staff members performed hand hygiene practices upon entering the OR, and 8.4% of staff performed hand hygiene upon leaving the OR. In addition, when performing radial arterial catheter placement, 0% of staff members wore gloves. Another study (A1170) surveyed healthcare providers regarding hand hygiene compliance. All of the 107 providers surveyed agreed that they should maintain hand hygiene, and most respondents believed that their own compliance was high. The author suggests that the low compliance problem associated with hand hygiene worldwide is a behavioral one among healthcare providers that requires acknowledgment and change.Keywords: aneshesia, investigation, IOP, SBP
Procedia PDF Downloads 27138 Thermodynamic and Immunochemical Studies of Antibody Biofunctionalized Gold Nanoparticles Mediated Photothermal Ablation in Human Liver Cancer Cells
Authors: Lucian Mocan, Flaviu Tabaran, Teodora Mocan, Cristian Matea, Cornel Iancu
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We present method of Gold Nanoparticle enhanced laser thermal ablation of HepG2 cells (Human hepatocellular liver carcinoma cell line), based on a simple gold nanoparticle carrier system, such as serum albumin (BSA), and demonstrate its selective therapeutic efficacy. Hyperspectral, contrast phase, and confocal microscopy combined immunochemical staining were used to demonstrate the selective internalization of HSA-GNPs via Gp60 receptors and the caveolin-mediated endocytosis inside HepG2 cells. We examined the ability of laser-activated carbon nanotubes to induce Hsp70 expression using confocal microscopy. Hep G2 cells heat-shocked (laser activated BSA-GNPs) to 42°C demonstrated an up-regulation of Hsp70 compared with control cells (BSA-GNPs treated cells without laser), which showed no detectable constitutive expression of Hsp70. We observed a time-dependent induction in Hsp70 expression in Hep G2 treated with BSA-GNPs and LASER irradiated. The post-irradiation apoptotic rate of HepG2 cells treated with HSA-GNPs ranged from 88.24% (for 50 mg/L) at 60 seconds, while at 30 minute the rate increased to 92.34% (50 mg/L). These unique results may represent a major step in liver cancer treatment using nanolocalized thermal ablation by laser heating.Keywords: gold nanoparticles, liver cancer, albumin, laser irradiation
Procedia PDF Downloads 292137 Application of Bundle Care to Reduce Invasive Catheter-Associated Infection in High Risk Units at a Medical Center
Authors: Hsin-Hsin Chang, Jann-Tay Wang, Wang-Huei Sheng
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Background: Hospital-associated infections (HAIs) have significant medical and social resource consumption. In view of medical technology change rapidly and the prolonged average life expectancy, the patients' chances of receiving invasive medical devices have also increased. As well as the potential disease of the patients, the aging, and immune dysfunction makes the disease more serious, raising the risk of HAIs. In our adult intensive care units, catheter-associated urinary tract infections (CAUTIs) have an average of 4.6% in 2014, which is much higher than that of the National Healthcare Safety Network (NHSN). Therefore, we started the intervention of CAUTI bundle care. Methods: This 3-year intervention was conducted in adults’ intensive care units (ICUs) during January 2015 to December 2017. The implementation of CAUTI bundle care in order to reduce invasive catheter-associated infections were built on evidence-based infection control measures. Prospective surveillance was performed on all patients admitted to hospital. The four major directions are 'Leader Engagement', 'Educate Personnel', 'Executive Multidisciplinary Teamwork', 'Innovation and Improvement of Tools'. Results: During the intervention period, there were 167,024 patient-days with a total of 508 episodes of CAUTIs in the entire adult ICUs identified. The incidence of CAUTIs in adult ICU was significantly decreased in the intervention period (from 2015 to 2017), from 4.6 to 3.6 per 1000 catheter days (p=0.05). Conclusion: The necessity for the implementation of CAUTI bundle care in the health care system plays an important role in the quality and policy of infection control. Multidisciplinary teamwork, education, a comprehensive checklist and from time to time audit feedback to improve healthcare workers’ compliance are the keys to success.Keywords: bundle care, hospital-associated infections, leader engagement, multidisciplinary team work
Procedia PDF Downloads 150136 Study on the Relative Factors of Introducing Table Vinegar in Reducing Urinary Tract Infection in Patients with Long-Term Indwelling Catheter
Authors: Yu-Ju Hsieh, Lin-Hung Lin, Wen-Hui Chang
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This study was designed as an interventional research and intended to validate whether the introduction of drinking vinegar every day can reduce and even prevent urinary tract infection in Taiwan home stayed disabilities who using indwelling catheter. The data was collected from the subjects who have received home care case at northern Taiwan, according to the questionnaire and a medical records retroactive methodology, the subjects were informed and consent to drink 15ml of table vinegar in a daily diet, and through routine urine testing and culture study. Home care nurses would assist collecting urine at the point of before and after a meal from total 35 studied subjects per month, and total collected 4 times for testing. The results showed that when the average age of study subjects was 65.46 years and catheter indwelling time was 15 years, drinking table vinegar could inhibit the activity of E. coli O157: H7 and reduce its breeding. Before drinking table vinegar daily, the subjects’ urine pH value was 7.0-8.0, and the average was 7.5, and the urine PH value dropped to 6.5 after drinking table vinegar for a month. There were two purple urine cases whose urine were changed from purple to normal color after two weeks of drinking, and the protein and bacteria values of urine gradually improved. Urine smell unpleasant before attending to this study, and the symptom improved significantly only after 1 week, and the urine smell returned to normal ammonia and became clean after 1 month later. None of these subjects received treatment in a hospital due to urinary tract infection, and there were no signs of bleeding in all cases during this study. The subjects of this study are chronic patients with a long-term bedridden catheterization; drinking cranberry juice is an economic burden for them, and also highly prohibited for diabetes patients. By adapting to use cheaper table vinegar to acidified urine and improve its smell and ease Purple Urine Syndrome, to furthermore, proven urinary tract infection, it can also to reduce the financial burden on families, the cost of social resources and the rate of re-admission.Keywords: table vinegar, urinary tract infection, disability patients, long-term indwelling catheter
Procedia PDF Downloads 255135 Effect of Lemongrass Oil Containing Polycaprolactone Nanofibers on Biofilm Formation of Proteus mirabilis
Authors: Gulcan Sahal, Behzad Nasseri, Ali Akbar Ebrahimi, Isil Seyis Bilkay
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Proteus mirabilis strains which are natural colonizers of healthy individuals’ gastrointestinal tract are also known as common causes of catheter-associated urinary tract infections. Nowadays, as a result of an increased resistance to various antimicrobial drugs, there has been a growing interest in natural products. Therefore, the aim of this study is to investigate biofilm formation of P. mirabilis strains on lemongrass oil containing polycaprolactone nanofibers. Polycaprolactone nanofibers with different lemongrass oil concentrations were successfully prepared by electrospinning and biofilm formation of P. mirabilis on these nanofibers were determined by ‘Crystal Violet Staining Assay’. According to our results, polycaprolactone nanofibers with some lemongrass oil concentrations, decreased biofilm formation of P. mirabilis and this effect increased in parallel with the increase in lemongrass oil concentration. Our results indicate that, polycaprolactone nanofibers with some concentrations of lemongrass oil may provide a treatment against catheter-associated urinary tract infections by means of causing an inhibition on biofilm formation of P. mirabilis.Keywords: anti-biofilm, biofilm formation, essential oils, nanofibers, proteus mirabilis
Procedia PDF Downloads 406134 Creation of GaxCo1-xZnSe0.4 (x = 0.1, 0.3, 0.5) Nanoparticles Using Pulse Laser Ablation Method
Authors: Yong Pan, Li Wang, Xue Qiong Su, Dong Wen Gao
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To date, nanomaterials have received extensive attention over the years because of their wide application. Various nanomaterials such as nanoparticles, nanowire, nanoring, nanostars and other nanostructures have begun to be systematically studied. The preparation of these materials by chemical methods is not only costly, but also has a long cycle and high toxicity. At the same time, preparation of nanoparticles of multi-doped composites has been limited due to the special structure of the materials. In order to prepare multi-doped composites with the same structure as macro-materials and simplify the preparation method, the GaxCo1-xZnSe0.4 (x = 0.1, 0.3, 0.5) nanoparticles are prepared by Pulse Laser Ablation (PLA) method. The particle component and structure are systematically investigated by X-ray diffraction (XRD) and Raman spectra, which show that the success of our preparation and the same concentration between nanoparticles (NPs) and target. Morphology of the NPs characterized by Transmission Electron Microscopy (TEM) indicates the circular-shaped particles in preparation. Fluorescence properties are reflected by PL spectra, which demonstrate the best performance in concentration of Ga0.3Co0.3ZnSe0.4. Therefore, all the results suggest that PLA is promising to prepare the multi-NPs since it can modulate performance of NPs.Keywords: PLA, physics, nanoparticles, multi-doped
Procedia PDF Downloads 164133 Fabrication of Carbon Nanoparticles and Graphene Using Pulsed Laser Ablation
Authors: Davoud Dorranian, Hajar Sadeghi, Elmira Solati
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Carbon nanostructures in various forms were synthesized using pulsed laser ablation of a graphite target in different liquid environment. The beam of a Q-switched Nd:YAG laser of 1064-nm wavelength at 7-ns pulse width is employed to irradiate the solid target in water, acetone, alcohol, and cetyltrimethylammonium bromide (CTAB). Then the effect of the liquid environment on the characteristic of carbon nanostructures produced by laser ablation was investigated. The optical properties of the carbon nanostructures were examined at room temperature by UV–Vis-NIR spectrophotometer. The crystalline structure of the carbon nanostructures was analyzed by X-ray diffraction (XRD). The morphology of samples was investigated by field emission scanning electron microscope (FE-SEM). Transmission electron microscope (TEM) was employed to investigate the form of carbon nanostructures. Raman spectroscopy was used to determine the quality of carbon nanostructures. Results show that different carbon nanostructures such as nanoparticles and few-layer graphene were formed in various liquid environments. The UV-Vis-NIR absorption spectra of samples reveal that the intensity of absorption peak of nanoparticles in alcohol is higher than the other liquid environments due to the larger number of nanoparticles in this environment. The red shift of the absorption peak of the sample in acetone confirms that produced carbon nanoparticles in this liquid are averagely larger than the other medium. The difference in the intensity and shape of the absorption peak indicated the effect of the liquid environment in producing the nanoparticles. The XRD pattern of the sample in water indicates an amorphous structure due to existence the graphene sheets. X-ray diffraction pattern shows that the degree of crystallinity of sample produced in CTAB is higher than the other liquid environments. Transmission electron microscopy images reveal that the generated carbon materials in water are graphene sheet and in the other liquid environments are graphene sheet and spherical nanostructures. According to the TEM images, we have the larger amount of carbon nanoparticles in the alcohol environment. FE-SEM micrographs indicate that in this liquids sheet like structures are formed however in acetone, produced sheets are adhered and these layers overlap with each other. According to the FE-SEM micrographs, the surface morphology of the sample in CTAB was coarser than that without surfactant. From Raman spectra, it can be concluded the distinct shape, width, and position of the graphene peaks and corresponding graphite source.Keywords: carbon nanostructures, graphene, pulsed laser ablation, graphite
Procedia PDF Downloads 308132 Interaction between Unsteady Supersonic Jet and Vortex Rings
Authors: Kazumasa Kitazono, Hiroshi Fukuoka, Nao Kuniyoshi, Minoru Yaga, Eri Ueno, Naoaki Fukuda, Toshio Takiya
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The unsteady supersonic jet formed by a shock tube with a small high-pressure chamber was used as a simple alternative model for pulsed laser ablation. Understanding the vortex ring formed by the shock wave is crucial in clarifying the behavior of unsteady supersonic jet discharged from an elliptical cell. Therefore, this study investigated the behavior of vortex rings and a jet. The experiment and numerical calculation were conducted using the schlieren method and by solving the axisymmetric two-dimensional compressible Navier–Stokes equations, respectively. In both, the calculation and the experiment, laser ablation is conducted for a certain duration, followed by discharge through the exit. Moreover, a parametric study was performed to demonstrate the effect of pressure ratio on the interaction among vortex rings and the supersonic jet. The interaction between the supersonic jet and the vortex rings increased the velocity of the supersonic jet up to the magnitude of the velocity at the center of the vortex rings. The interaction between the vortex rings increased the velocity at the center of the vortex ring.Keywords: computational fluid dynamics, shock-wave, unsteady jet, vortex ring
Procedia PDF Downloads 465131 Radiofrequency Ablation: A Technique in the Management of Low Anal Fistula
Authors: R. Suresh, C. B. Singh, A. K. Sarda
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Background: Over the decades, several surgical techniques have been developed to treat anal fistulas with variable success rates and complications. Large amount of work has been done in radiofrequency excision of the fistula for several years but no work has been done for ablating the tract. Therefore one can consider for obliteration ofanal fistula by Radiofrequency ablation (RFA). Material and Methods: A randomized controlled clinical trial was conducted at Lok Nayak Hospital, where a total of 40 patients were enrolled in the study and they were randomly assigned to Group I (fistulectomy)(n=20) and Group II (RFA) (n=20). Aim of the study was to compare the efficacy of RFA of fistula versus fistulectomy in the treatment of a low anal fistula and to evaluate RFA as an effective alternative to fistulectomy with respect to time taken for wound healing as primary outcome and post-operative pain, time taken to return to work as secondary outcomes. Patients with simple low anal fistulas, single internal and external opening, not more than two secondary tracts were included. Patients with high complex fistula, fistulas communicating with cavity, fistula due to condition like tuberculosis, Crohn's, malignancy were excluded from the study. Results: Both groups were comparable with respect to age, sex ratio, type of fistula. Themean healing time was significantly shorter in group II (41.02 days) than in group I(62.68 days).The mean operative time was significantly shorter in groupII (21.40 min) than in group I(28.50 min). The mean time taken to return to work was significantly shorter in group II(8.30 days)than in group I(12.01 days).There was no significant difference in the post operative hospital stay, mean postoperative pain score, wound infection and recurrence between the two groups. Conclusion: The patients who underwent RFA of fistula had shorter wound healing time, operative time and time taken to return to work when compared to those who underwent fistulectomy and therefore RFA shows outcome comparable to fistulectomy in the treatment of low anal fistula.Keywords: fistulectomy, low anal fistula, radio frequency ablation, wound healing
Procedia PDF Downloads 338130 Volatile Organic Compounds Detection by Surface Acoustic Wave Sensors with Nanoparticles Embedded in Polymer Sensitive Layers
Authors: Cristian Viespe, Dana Miu
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Surface acoustic wave (SAW) sensors with nanoparticles (NPs) of various dimensions and concentrations embedded in different types of polymer sensing films for detecting volatile organic compounds (VOCs) were studied. The sensors were ‘delay line’ type with a center frequency of 69.4 MHz on ST-X quartz substrates. NPs with different diameters of 7 nm or 13 nm were obtained by laser ablation with lasers having 5 ns or 10 ps pulse durations, respectively. The influence of NPs dimensions and concentrations on sensor properties such as frequency shift, sensitivity, noise and response time were investigated. To the best of our knowledge, the influence of NP dimensions on SAW sensor properties with has not been investigated. The frequency shift and sensitivity increased with increasing NP concentration in the polymer for a given NP dimension and with decreasing NP diameter for a given concentration. The best performances were obtained for the smallest NPs used. The SAW sensor with NPs of 7 nm had a limit of detection (LOD) of 65 ppm (almost five times better than the sensor with polymer alone), and a response time of about 9 s for ethanol.Keywords: surface acoustic wave sensor, nanoparticles, volatile organic compounds, laser ablation
Procedia PDF Downloads 146129 Retrospective Assessment of the Safety and Efficacy of Percutaneous Microwave Ablation in the Management of Hepatic Lesions
Authors: Suang K. Lau, Ismail Goolam, Rafid Al-Asady
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Background: The majority of patients with hepatocellular carcinoma (HCC) are not suitable for curative treatment, in the form of surgical resection or transplantation, due to tumour extent and underlying liver dysfunction. In these non-resectable cases, a variety of non-surgical therapies are available, including microwave ablation (MWA), which has shown increasing popularity due to its low morbidity, low reported complication rate, and the ability to perform multiple ablations simultaneously. Objective: The aim of this study was to evaluate the validity of MWA as a viable treatment option in the management of HCC and hepatic metastatic disease, by assessing its efficacy and complication rate at a tertiary hospital situated in Westmead (Australia). Methods: A retrospective observational study was performed evaluating patients that underwent MWA between 1/1/2017–31/12/2018 at Westmead Hospital, NSW, Australia. Outcome measures, including residual disease, recurrence rates, as well as major and minor complication rates, were retrospectively analysed over a 12-months period following MWA treatment. Excluded patients included those whose lesions were treated on the basis of residual or recurrent disease from previous treatment, which occurred prior to the study window (11 patients) and those who were lost to follow up (2 patients). Results: Following treatment of 106 new hepatic lesions, the complete response rate (CR) was 86% (91/106) at 12 months follow up. 10 patients had the residual disease at post-treatment follow up imaging, corresponding to an incomplete response (ICR) rate of 9.4% (10/106). The local recurrence rate (LRR) was 4.6% (5/106) with follow-up period up to 12 months. The minor complication rate was 9.4% (10/106) including asymptomatic pneumothorax (n=2), asymptomatic pleural effusions (n=2), right lower lobe pneumonia (n=3), pain requiring admission (n=1), hypotension (n=1), cellulitis (n=1) and intraparenchymal hematoma (n=1). There was 1 major complication reported, with pleuro-peritoneal fistula causing recurrent large pleural effusion necessitating repeated thoracocentesis (n=1). There was no statistically significant association between tumour size, location or ablation factors, and risk of recurrence or residual disease. A subset analysis identified 6 segment VIII lesions, which were treated via a trans-pleural approach. This cohort demonstrated an overall complication rate of 33% (2/6), including 1 minor complication of asymptomatic pneumothorax and 1 major complication of pleuro-peritoneal fistula. Conclusions: Microwave ablation therapy is an effective and safe treatment option in cases of non-resectable hepatocellular carcinoma and liver metastases, with good local tumour control and low complication rates. A trans-pleural approach for high segment VIII lesions is associated with a higher complication rate and warrants greater caution.Keywords: hepatocellular carcinoma, liver metastases, microwave ablation, trans-pleural approach
Procedia PDF Downloads 129128 Totally Implantable Venous Access Device for Long Term Parenteral Nutrition in a Patient with High Output Enterocutaneous Fistula Due to Advanced Malignancy
Authors: Puneet Goyal, Aarti Agarwal
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Background and Objective: Nutritional support is an integral part of palliative care of advanced non-resectable abdominal malignancy patients, though is frequently neglected aspect. Non-Healing high output Entero-cutaneous fistulas sometimes require long term parenteral nutrition, to take care of catabolism and replacement of nutrients. We present a case of inoperable pancreatic malignancy with high output entero-cutaneous fistula, which was provided parenteral nutritional support with the use of Totally Implantable Venous Access Device (TIVAD). Method and Results: 55 year old man diagnosed with carcinoma pancreas had developed high entero-cutaneous fistula. His tumor was found to be inoperable and was on total parenteral nutrition through routine central line. This line was difficult to maintain as he required it for a long term TPN. He was planned to undergo Totally Implantable Venous Access Device (TIVAD) implantation. 8Fr single lumen catheter with Groshong non-return Valve (Bard Access Systems, Inc. USA) was inserted through right internal jugular vein, under fluoroscopic guidance. The catheter was tunneled subcutaneously and brought towards infraclavicular pocket, cut at appropriate length and connected to port and locked. Port was sutured in floor of pocket. Free flow of blood aspirated, flushed with heparinized saline. There was no kink observed in entire length of catheter under fluoroscopy. Skin over infraclavicular pocket was sutured. Long term catheter care and associated risks were explained to patient and relatives. Patient continued to receive total parenteral nutrition as well as other supportive therapy though TIVAD for next 6 weeks, till his demise. Conclusion: TIVADs are standard of care for long term venous access solutions in cancer patients requiring chemotherapy. In this case, we extended its use for providing parenteral nutrition and other supportive therapy. TIVADs can be implanted in advanced cancer patients for providing venous access solution required for various palliative treatments and medications. This will help in improving quality of life and satisfaction amongst terminally ill cancer patients.Keywords: parenteral nutrition, totally implantable venous access device, long term venous access, interventions in anesthesiology
Procedia PDF Downloads 238127 Severe Post Operative Gas Gangrene of the Liver: Off-Label Treatment by Percutaneous Radiofrequency Ablation
Authors: Luciano Tarantino
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Gas gangrene is a rare, severe infection with a very high mortality rate caused by Clostridium species. The infection causes a non-suppurative localized producing gas lesion from which harmful toxins that impair the inflammatory response cause vessel damage and multiple organ failure. Gas gangrene of the liver is very rare and develops suddenly, often as a complication of abdominal surgery and liver transplantation. The present paper deals with a case of gas gangrene of the liver that occurred after percutaneous MW ablation of hepatocellular carcinoma, resulting in progressive liver necrosis and multi-organ failure in spite of specific antibiotics administration. The patient was successfully treated with percutaneous Radiofrequency ablation. Case report: Female, 76 years old, Child A class cirrhosis, treated with synchronous insertion of 3 MW antennae for large HCC (5.5 cm) in the VIII segment. 24 hours after treatment, the patient was asymptomatic and left the hospital . 2 days later, she complained of fever, weakness, abdominal swelling, and pain. Abdominal US detected a 2.3 cm in size gas-containing area, eccentric within the large (7 cm) ablated area. The patient was promptly hospitalized with the diagnosis of anaerobic liver abscess and started antibiotic therapy with Imipenem/cilastatine+metronidazole+teicoplanine. On the fourth day, the patient was moved to the ICU because of dyspnea, congestive heart failure, atrial fibrillation, right pleural effusion, ascites, and renal failure. Blood tests demonstrated severe leukopenia and neutropenia, anemia, increased creatinine and blood nitrogen, high-level FDP, and high INR. Blood cultures were negative. At US, unenhanced CT, and CEUS, a progressive enlargement of the infected liver lesion was observed. Percutaneous drainage was attempted, but only drops of non-suppurative brownish material could be obtained. Pleural and peritoneal drainages gave serosanguineous muddy fluid. The Surgeon and the Anesthesiologist excluded any indication of surgical resection because of the high perioperative mortality risk. Therefore, we asked for the informed consent of the patient and her relatives to treat the gangrenous liver lesion by percutaneous Ablation. Under conscious sedation, percutaneous RFA of GG was performed by double insertion of 3 cool-tip needles (Covidien LDT, USA ) into the infected area. The procedure was well tolerated by the patient. A dramatic improvement in the patient's condition was observed in the subsequent 24 hours and thereafter. Fever and dyspnea disappeared. Normalization of blood tests, including creatinine, was observed within 4 days. Heart performance improved, 10 days after the RFA the patient left the hospital and was followed-up with weekly as an outpatient for 2 months and every two months thereafter. At 18 months follow-up, the patient is well compensated (Child-Pugh class B7), without any peritoneal or pleural effusion and without any HCC recurrence at imaging (US every 3 months, CT every 6 months). Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients non-responder to antibiotics and when surgery and liver transplantation are not feasible. A fast and early indication is needed in case of rapid worsening of patient's conditions.Keywords: liver tumor ablation, interventional ultrasound, liver infection, gas gangrene, radiofrequency ablation
Procedia PDF Downloads 73126 Whole Body Cooling Hypothermia Treatment Modelling Using a Finite Element Thermoregulation Model
Authors: Ana Beatriz C. G. Silva, Luiz Carlos Wrobel, Fernando Luiz B. Ribeiro
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This paper presents a thermoregulation model using the finite element method to perform numerical analyses of brain cooling procedures as a contribution to the investigation on the use of therapeutic hypothermia after ischemia in adults. The use of computational methods can aid clinicians to observe body temperature using different cooling methods without the need of invasive techniques, and can thus be a valuable tool to assist clinical trials simulating different cooling options that can be used for treatment. In this work, we developed a FEM package applied to the solution of the continuum bioheat Pennes equation. Blood temperature changes were considered using a blood pool approach and a lumped analysis for intravascular catheter method of blood cooling. Some analyses are performed using a three-dimensional mesh based on a complex geometry obtained from computed tomography medical images, considering a cooling blanket and a intravascular catheter. A comparison is made between the results obtained and the effects of each case in brain temperature reduction in a required time, maintenance of body temperature at moderate hypothermia levels and gradual rewarming.Keywords: brain cooling, finite element method, hypothermia treatment, thermoregulation
Procedia PDF Downloads 307125 Comparison of Regional and Local Indwelling Catheter Techniques to Prolong Analgesia in Total Knee Arthroplasty Procedures: Continuous Peripheral Nerve Block and Continuous Periarticular Infiltration
Authors: Jared Cheves, Amanda DeChent, Joyce Pan
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Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia
Procedia PDF Downloads 85124 Effect of Smartphone Applications on Patients' Knowledge of Surgery-Related Adverse Events during Hospitalization
Authors: Eunjoo Lee
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Background: As the number of surgeries increases, the incidence of adverse events is likely to become more prevalent. Patients who are somewhat knowledgeable about surgery-related adverse events are more likely to engage in safety initiatives to prevent them. Objectives: To evaluate the impact of a smartphone application developed during the study to enhance patients’ knowledge of surgery-related adverse events during hospitalization. Design: Non-randomized, one group, measured pre- and post-intervention. Participants: Thirty-six hospitalized patients admitted to the orthopedics unit of a general hospital in South Korea. Methods. First, a smartphone application to enhance patients’ knowledge of surgery-related adverse events was developed through an iterative process, which included a literature review, expert consultation, and pilot testing. The application was installed on participants’ smartphones, and research assistants taught the participants to use it. Twenty-five true/false questions were used to assess patients’ knowledge of preoperative precautions (eight items), surgical site infection (five items), Foley catheter management (four items), drainage management (four items), and anesthesia-related complications (four items). Results: Overall, the percentage of correct answers increased significantly, from 57.02% to 73.82%, although answers related to a few specific topics did not increase that much. Although the patients’ understanding of drainage management and the Foley catheter did increase substantially after they used the smartphone application, it was still relatively low. Conclusions: The smartphone application developed during this study enhanced the patients’ knowledge of surgery-related adverse events during hospitalization. However, nurses must make an additional effort to help patients to understand certain topics, including drainage and Foley catheter management. Relevance to clinical practice: Insufficient patient knowledge increases the risk of adverse events during hospitalization. Nurses should take active steps to enhance patients’ knowledge of a range of safety issues during hospitalization, in order to decrease the number of surgery-related adverse events.Keywords: patient education, patient participation, patient safety, smartphone application, surgical errors
Procedia PDF Downloads 241123 The Improvement in Clinical Outcomes with the Histological Presence of Nidus Following Radiofrequency Ablation (RFA) for Osteoid Osteoma (OO)
Authors: Amirul Adlan, Motaz AlAqeel, Scott Evans, Vaiyapuri sumathi, Mark Davies, Rajesh Botchu
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Background & Objectives: Osteoid osteoma (OO) is a benign tumor of the bone commonly found in childhood and adolescence, causing bone pain, especially during the night. CT-guided radiofrequency ablation (RFA) is currently the mainstay treatment for OO. There is currently no literature reporting the outcomes of OO following RFA based on the histological presence of a nidus seen on a biopsy taken at the time of RFA. The primary aim of this study was to compare the clinical outcomes of OO between the group of patients with the presence of nidus on biopsy samples from RFA with those without nidus. Secondly, we aimed to examine other factors that may affect the outcomes of OO, reflecting our experience as a tertiary orthopedic oncology center. Methods: We retrospectively reviewed 88 consecutive patients diagnosed with osteoid osteoma treated with RFA between November 2005 and March 2015, consisting of 63 males (72%) and 25 females (28%). Sixty-six patients (75%) had nidus present in their biopsy samples. Patients’ mean age was 17.6 years (4-53). The median duration of follow-up was 12.5 months (6-20.8). Lesions were located in the appendicular skeleton in seventy-nine patients (90%), while nine patients (10%) had an OO in the axial skeleton. Outcomes assessed were based on patients’ pain alleviation (partial, complete, or no pain improvement) and the need for further interventions. Results: Pain improvement in the patient group with nidus in the histology sample was significantly better than in the group without nidus (OR 7.4, CI 1.35-41.4, p=0.021). The patient group with nidus on biopsy demonstrated less likelihood of having a repeat procedure compared to the group without nidus(OR 0.092, CI 0.016-0.542, p=0.008). Our study showed significantly better outcomes in pain improvement in appendicular lesions compared to the axially located lesions (p = 0.005). Patients with spinal lesions tend to have relatively poor pain relief than those with appendicular or pelvic lesions (p=0.007). Conclusions: Patients with nidus on histology had better pain alleviation compared to patients without nidus. The histological presence of nidus significantly reduces the chance of repeat interventions. The pain alleviation of osteoid osteoma following RFA is better in patients with appendicular lesions than spinal or axially located lesions.Keywords: osteoid osteoma, benign tumour, radiofrequency ablation, oncology
Procedia PDF Downloads 145122 Magnetic Bio-Nano-Fluids for Hyperthermia
Authors: Z. Kolacinski, L. Szymanski. G. Raniszewski, D. Koza, L. Pietrzak
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Magnetic Bio-Nano-Fluid (BNF) can be composed of a buffer fluid such as plasma and magnetic nanoparticles such as iron, nickel, cobalt and their oxides. However iron is one of the best elements for magnetization by electromagnetic radiation. It can be used as a tool for medical diagnosis and treatment. Radio frequency (RF) radiation is able to heat iron nanoparticles due to magnetic hysteresis. Electromagnetic heating of iron nanoparticles and ferro-fluids BNF can be successfully used for non-invasive thermal ablation of cancer cells. Moreover iron atoms can be carried by carbon nanotubes (CNTs) if iron is used as catalyst for CNTs synthesis. Then CNTs became the iron containers and they screen the iron content against oxidation. We will present a method of CNTs addressing to the required cells. For thermal ablation of cancer cells we use radio frequencies for which the interaction with human body should be limited to minimum. Generally, the application of RF energy fields for medical treatment is justified by deep tissue penetration. The highly iron doped CNTs as the carriers creating magnetic fluid will be presented. An excessive catalyst injection method using electrical furnace and microwave plasma reactor will be presented. This way it is possible to grow the Fe filled CNTs on a moving surface in continuous synthesis process. This also allows producing uniform carpet of the Fe filled CNTs carriers. For the experimental work targeted to cell ablation we used RF generator to measure the increase in temperature for some samples like: solution of Fe2O3 in BNF which can be plasma-like buffer, solutions of pure iron of different concentrations in plasma-like buffer and in buffer used for a cell culture, solutions of carbon nanotubes (MWCNTs) of different concentrations in plasma-like buffer and in buffer used for a cell culture. Then the targeted therapies which can be effective if the carriers are able to distinguish the difference between cancerous and healthy cell’s physiology are considered. We have developed an approach based on ligand-receptor or antibody-antigen interactions for the case of colon cancer.Keywords: cancer treatment, carbon nano tubes, drag delivery, hyperthermia, iron
Procedia PDF Downloads 408121 Evaluation of Non-Pharmacological Method-Transcervical Foley Catheter and Misoprostol to Intravaginal Misoprostol for Preinduction Cervical Ripening
Authors: Krishna Dahiya, Esha Charaya
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Induction of labour is a common obstetrical intervention. Around 1 in every 4 patient undergo induction of labour for different indications Purpose: To study the efficacy of the combination of Foley bulb and vaginal misoprostol in comparison to vaginal misoprostol alone for cervical ripening and induction of labour. Methods: A prospective randomised study was conducted on 150 patients with term singleton pregnancy admitted for induction of labour. Seventy-five patients were induced with both Foley bulb, and vaginal misoprostol and another 75 were given vaginal misoprostol alone for induction of labour. Both groups were then compared with respect to change in Bishop score, induction to the active phase of labour interval, induction delivery interval, duration of labour, maternal complications and neonatal outcomes. Data was analysed using statistical software SPSS version 11.5. Tests with P,.05 were considered significant. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (2.99 ± 1.72 and 2.17 ± 1.48 respectively with statistically significant difference (p=0.001 S, 95% C.I. -0.1978 to 0.8378). Mean induction to delivery interval was significantly lower in the combination group (11.76 ± 5.89 hours) than misoprostol group (14.54 ± 7.32 hours). Difference was of 2.78 hours (p=0.018,S, 95% CI -5.1042 to -0.4558). Induction to delivery interval was significantly lower in nulliparous women of combination group (13.64 ± 5.75 hours) than misoprostol group (18.4±7.09 hours), and the difference was of 4.76 hours (p=0.002, S, 95% CI 1.0465 to 14.7335). There was no difference between the groups in the mode of delivery, infant weight, Apgar score and intrapartum complications. Conclusion: From the present study it was concluded that addition of Foley catheter to vaginal misoprostol have the synergistic effect and results in early cervical ripening and delivery. These results suggest that the combination may be used to achieve timely and safe delivery in the presence of an unfavorable cervix. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications.Keywords: Bishop score, Foley catheter, induction of labor, misoprostol
Procedia PDF Downloads 303120 Incidence and Risk Factors of Central Venous Associated Infections in a Tunisian Medical Intensive Care Unit
Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour
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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors
Procedia PDF Downloads 357119 Findings in Vascular Catheter Cultures at the Laboratory of Microbiology of General Hospital during One Year
Authors: P. Christodoulou, M. Gerasimou, S. Mantzoukis, N. Varsamis, G. Kolliopoulou, N. Zotos
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Abstract— Purpose: The Intensive Care Unit (ICU) environment is conducive to the growth of microorganisms. A variety of microorganisms gain access to the intravascular area and are transported throughout the circulatory system. Therefore, examination of the catheters used in ICU patients is of paramount importance. Material and Method: The culture medium is a catheter tip, which is enriched with Tryptic soy broth (TSB). After one day of incubation, the broth is passaged in the following selective media: Blood, Mac conkey No. 2, chocolate, Mueller Hinton, Chapman, and Saboureaud agar. The above selective media is incubated for 2 days. After this period, if any number of microbial colonies is detected, gram staining is performed and then the microorganisms are identified by biochemical techniques in the automated Microscan (Siemens) system followed by a sensitivity test in the same system using the minimum inhibitory concentration (MIC) technique. The sensitivity test is verified by a Kirby Bauer test. Results: In 2017, the Microbiology Laboratory received 84 catheters from the ICU. 42 were found positive. Of these, S. epidermidis was identified at 8, A. baumannii in 10, K. pneumoniae in 6, P. aeruginosa in 6, P. mirabilis in 3, S. simulans in 1, S. haemolyticus in 4, S. aureus in 3 and S. hominis in 1. Conclusions: The results show that the placement and maintenance of the catheters in ICU patients are relatively successful, despite the unfavorable environment of the unit.Keywords: culture, intensive care unit, microorganisms, vascular catheters
Procedia PDF Downloads 277118 The Asymptotic Hole Shape in Long Pulse Laser Drilling: The Influence of Multiple Reflections
Authors: Torsten Hermanns, You Wang, Stefan Janssen, Markus Niessen, Christoph Schoeler, Ulrich Thombansen, Wolfgang Schulz
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In long pulse laser drilling of metals, it can be demonstrated that the ablation shape approaches a so-called asymptotic shape such that it changes only slightly or not at all with further irradiation. These findings are already known from ultra short pulse (USP) ablation of dielectric and semiconducting materials. The explanation for the occurrence of an asymptotic shape in long pulse drilling of metals is identified, a model for the description of the asymptotic hole shape numerically implemented, tested and clearly confirmed by comparison with experimental data. The model assumes a robust process in that way that the characteristics of the melt flow inside the arising melt film does not change qualitatively by changing the laser or processing parameters. Only robust processes are technically controllable and thus of industrial interest. The condition for a robust process is identified by a threshold for the mass flow density of the assist gas at the hole entrance which has to be exceeded. Within a robust process regime the melt flow characteristics can be captured by only one model parameter, namely the intensity threshold. In analogy to USP ablation (where it is already known for a long time that the resulting hole shape results from a threshold for the absorbed laser fluency) it is demonstrated that in the case of robust long pulse ablation the asymptotic shape forms in that way that along the whole contour the absorbed heat flux density is equal to the intensity threshold. The intensity threshold depends on the special material and radiation properties and has to be calibrated be one reference experiment. The model is implemented in a numerical simulation which is called AsymptoticDrill and requires such a few amount of resources that it can run on common desktop PCs, laptops or even smart devices. Resulting hole shapes can be calculated within seconds what depicts a clear advantage over other simulations presented in literature in the context of industrial every day usage. Against this background the software additionally is equipped with a user-friendly GUI which allows an intuitive usage. Individual parameters can be adjusted using sliders while the simulation result appears immediately in an adjacent window. A platform independent development allow a flexible usage: the operator can use the tool to adjust the process in a very convenient manner on a tablet during the developer can execute the tool in his office in order to design new processes. Furthermore, at the best knowledge of the authors AsymptoticDrill is the first simulation which allows the import of measured real beam distributions and thus calculates the asymptotic hole shape on the basis of the real state of the specific manufacturing system. In this paper the emphasis is placed on the investigation of the effect of multiple reflections on the asymptotic hole shape which gain in importance when drilling holes with large aspect ratios.Keywords: asymptotic hole shape, intensity threshold, long pulse laser drilling, robust process
Procedia PDF Downloads 208117 Added Value of 3D Ultrasound Image Guided Hepatic Interventions by X Matrix Technology
Authors: Ahmed Abdel Sattar Khalil, Hazem Omar
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Background: Image-guided hepatic interventions are integral to the management of infective and neoplastic liver lesions. Over the past decades, 2D ultrasound was used for guidance of hepatic interventions; with the recent advances in ultrasound technology, 3D ultrasound was used to guide hepatic interventions. The aim of this study was to illustrate the added value of 3D image guided hepatic interventions by x matrix technology. Patients and Methods: This prospective study was performed on 100 patients who were divided into two groups; group A included 50 patients who were managed by 2D ultrasonography probe guidance, and group B included 50 patients who were managed by 3D X matrix ultrasonography probe guidance. Thermal ablation was done for 70 patients, 40 RFA (20 by the 2D probe and 20 by the 3D x matrix probe), and 30 MWA (15 by the 2D probe and 15 by the 3D x matrix probe). Chemical ablation (PEI) was done on 20 patients (10 by the 2D probe and 10 by the 3D x matrix probe). Drainage of hepatic collections and biopsy from undiagnosed hepatic focal lesions was done on 10 patients (5 by the 2D probe and 5 by the 3D x matrix probe). Results: The efficacy of ultrasonography-guided hepatic interventions by 3D x matrix probe was higher than the 2D probe but not significantly higher, with a p-value of 0.705, 0.5428 for RFA, MWA respectively, 0.5312 for PEI, 0.2918 for drainage of hepatic collections and biopsy. The complications related to the use of the 3D X matrix probe were significantly lower than the 2D probe, with a p-value of 0.003. The timing of the procedure was shorter by the usage of 3D x matrix probe in comparison to the 2D probe with a p-value of 0.08,0.34 for RFA and PEI and significantly shorter for MWA, and drainage of hepatic collection, biopsy with a P-value of 0.02,0.001 respectively. Conclusions: 3D ultrasonography-guided hepatic interventions by  x matrix probe have better efficacy, less complication, and shorter time of procedure than the 2D ultrasonography-guided hepatic interventions.Keywords: 3D, X matrix, 2D, ultrasonography, MWA, RFA, PEI, drainage of hepatic collections, biopsy
Procedia PDF Downloads 91116 Efficacy of Erector Spinae Plane Block for Postoperative Pain Management in Coronary Artery Bypass Graft Patients
Authors: Santosh Sharma Parajuli, Diwas Manandhar
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Background: Perioperative pain management plays an integral part in patients undergoing cardiac surgery. We studied the effect of Erector Spinae Plane block on acute postoperative pain reduction and 24 hours opioid consumption in adult cardiac surgical patients. Methods: Twenty-five adult cardiac surgical patients who underwent cardiac surgery with sternotomy in whom ESP catheters were placed preoperatively were kept in group E, and the other 25 patients who had undergone cardiac surgery without ESP catheter and pain management done with conventional opioid injection were placed in group C. Fentanyl was used for pain management. The primary study endpoint was to compare the consumption of fentanyl and to assess the numeric rating scale in the postoperative period in the first 24 hours in both groups. Results: The 24 hours fentanyl consumption was 43.00±51.29 micrograms in the Erector Spinae Plane catheter group and 147.00±60.94 micrograms in the control group postoperatively which was statistically significant (p <0.001). The numeric rating scale was also significantly reduced in the Erector Spinae Plane group compared to the control group in the first 24 hours postoperatively. Conclusion: Erector Spinae Plane block is superior to the conventional opioid injection method for postoperative pain management in CABG patients. Erector Spinae Plane block not only decreases the overall opioid consumption but also the NRS score in these patients.Keywords: erector, spinae, plane, numerical rating scale
Procedia PDF Downloads 61115 Temporary Ureteric Catheterization after Ureteropyeloscopy: Experience from Regional Australia
Authors: Jake Tempo, Jack Crozier, Huay Ann Chia, Philip Tan
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Purpose: A prospective study was performed to determine whether temporary ureteric catheterization should be eliminated as a prophylactic method for preventing ureteric obstruction after uncomplicated ureteropyeloscopic lithotripsy. Material and Methods: From 2010 to 2014, 227 patients underwent uncomplicated ureteroscopic and/or pyeloscopic lithotripsy. Three patient-groups based on postoperative drainage method were analysed: temporary uretericcatheter (TUC), -ureteric JJ stent, and no-stent groups. Exclusion criteria included urosepsis, ureteric injury, and non-surgical complications delaying hospital-discharge. Outcome measures included parenteral analgesic requirements, prolonged hospitalization ≥2 days due to postoperative-pain, and readmissions rate. Results: Delayed discharge was reported in 14.5%(9 of 62) patients in the TUC group compared to 3.4%(4 of 119) in theureteric JJ stent group and 8.7%(4 of 46) in the no-drainage-group (p=0.02). Odds ratio for delayed-discharge between catheter- versus-ureteric JJ stent is 4.9 (95% CI = 1.6-15.0; p < 0.01). Parenteral analgesic requirements in the TUC group (12.9%) was also significantly higher than theureteric JJ stent group (1.7%; p=0.003). Readmissions were negligible between groups. Conclusions: Patients with ureteric catheters after uncomplicated ureteroscopy have a prolonged hospital stay with increased pain and parenteral analgesic requirements. There is a 7.6-fold increased requirement for parenteral analgesia and a 4.2-fold increased risk of delayed-discharge compared to a patient with a ureteric JJ stent.Keywords: ureteric catheter, ureteric stent, ureteroscopy, pyeloscopy
Procedia PDF Downloads 137114 Design of Smart Catheter for Vascular Applications Using Optical Fiber Sensor
Authors: Lamiek Abraham, Xinli Du, Yohan Noh, Polin Hsu, Tingting Wu, Tom Logan, Ifan Yen
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In the field of minimally invasive, smart medical instruments such as catheters and guidewires are typically used at a remote distance to gain access to the diseased artery, often negotiating tortuous, complex, and diseased vessels in the process. Three optical fiber sensors with a diameter of 1.5mm each that are 120° apart from each other is proposed to be mounted into a catheter-based pump device with a diameter of 10mm. These sensors are configured to solve the challenges surgeons face during insertion through curvy major vessels such as the aortic arch. Moreover, these sensors deal with providing information on rubbing the walls and shape sensing. This study presents an experimental and mathematical models of the optical fiber sensors with 2 degrees of freedom. There are two eight gear-shaped tubes made up of 3D printed thermoplastic Polyurethane (TPU) material that are connected. The optical fiber sensors are mounted inside the first tube for protection from external light and used TPU material as a prototype for a catheter. The second tube is used as a flat reflection for the light intensity modulation-based optical fiber sensors. The first tube is attached to the linear guide for insertion and withdrawal purposes and can manually turn it 45° by manipulating the tube gear. A 3D hard material phantom was developed that mimics the aortic arch anatomy structure in which the test was carried out. During the insertion of the sensors into the 3D phantom, datasets are obtained in terms of voltage, distance, and position of the sensors. These datasets reflect the characteristics of light intensity modulation of the optical fiber sensors with a plane project of the aortic arch structure shape. Mathematical modeling of the light intensity was carried out based on the projection plane and experiment set-up. The performance of the system was evaluated in terms of its accuracy in navigating through the curvature and information on the position of the sensors by investigating 40 single insertions of the sensors into the 3D phantom. The experiment demonstrated that the sensors were effectively steered through the 3D phantom curvature and to desired target references in all 2 degrees of freedom. The performance of the sensors echoes the reflectance of light theory, where the smaller the radius of curvature, the more of the shining LED lights are reflected and received by the photodiode. A mathematical model results are in good agreement with the experiment result and the operation principle of the light intensity modulation of the optical fiber sensors. A prototype of a catheter using TPU material with three optical fiber sensors mounted inside has been developed that is capable of navigating through the different radius of curvature with 2 degrees of freedom. The proposed system supports operators with pre-scan data to make maneuverability and bendability through curvy major vessels easier, accurate, and safe. The mathematical modelling accurately fits the experiment result.Keywords: Intensity modulated optical fiber sensor, mathematical model, plane projection, shape sensing.
Procedia PDF Downloads 245113 Effect of Laser Ablation OTR Films on the Storability of Endive and Pak Choi by Baby Vegetables in Modified Atmosphere Condition
Authors: In-Lee Choi, Min Jae Jeong, Jun Pill Baek, Ho-Min Kang
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As the consumption trends of vegetables become different from the past, it is increased using vegetable more convenience such as fresh-cut vegetables, sprouts, baby vegetables rather than an existing hole piece of vegetables. Selected baby vegetables have various functional materials but they have short shelf life. This study was conducted to improve storability by using suitable laser ablation OTR (oxygen transmission rate) films. Baby vegetable of endive (Cichorium endivia L.) and pak choi (Brassica rapa chinensis) for this research, around 10 cm height, cultivated in glass greenhouse during 3 weeks. Harvested endive and pak choi were stored at 8 ℃ for 5 days and were packed by PP (Polypropylene) container and covered different types of laser ablation OTR film (DaeRyung Co., Ltd.) such as 1,300 cc, 10,000 cc, 20,000 cc, 40,000 cc /m2•day•atm, and control (perforated film) with heat sealing machine (SC200-IP, Kumkang, Korea). All the samples conducted 5 times replication. Statistical analysis was carried out using a Microsoft Excel 2010 program and results were expressed as standard deviations. The fresh weight loss rate of both baby vegetables were less than 0.3 % in treated films as maximum weight loss rate. On the other hands, control in the final storage day had around 3.0 % weight loss rate and it followed decreasing quantity. Endive had less 2.0 % carbon dioxide contents as maximum contents in 20,000 cc and 40,000 cc. Oxygen contents was maintained between 17 and 20 % in endive, 19 and 20 % in pak choi. Ethylene concentration of both vegetables maintained little lower contents in 20,000 cc treatments than others at final storage day without statistical significance. In the case of hardness, 40,000 cc film was shown little higher value at both baby vegetables without statistical significance. Visual quality was good at 10,000 cc and 20,000 cc in endive and pak choi, and off-flavor was not appeard any off-flavor in both vegetables. Chlorophyll (SPAD-502, Minolta, Japan) value of endive was shown as similar result with initial in all treatments except 20,000 cc as little lower. And chlorophyll value of pak choi decreased in all treatments compared with initial value but was not shown significantly difference each other. Color of leaves (CR-400, Minolta, Japan) changed significantly in 40,000 cc at endive. In an event of pak choi, all the treatments started yellowing by increasing hunter b value, among them control increased substantially. As above the result, 10,000 cc film was most reasonable packaging film for storing at endive and 20,000 cc at pak choi with good quality.Keywords: carbon dioxide, shelf-life, visual quality, pak choi
Procedia PDF Downloads 785112 Effect of Laser Ablation OTR Films and High Concentration Carbon Dioxide for Maintaining the Freshness of Strawberry ‘Maehyang’ for Export in Modified Atmosphere Condition
Authors: Hyuk Sung Yoon, In-Lee Choi, Min Jae Jeong, Jun Pill Baek, Ho-Min Kang
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This study was conducted to improve storability by using suitable laser ablation oxygen transmission rate (OTR) films and effectiveness of high carbon dioxide at strawberry 'Maehyang' for export. Strawberries were grown by hydroponic system in Gyeongsangnam-do province. These strawberries were packed by different laser ablation OTR films (Daeryung Co., Ltd.) such as 1,300 cc, 20,000 cc, 40,000 cc, 80,000 cc, and 100,000 cc•m-2•day•atm. And CO2 injection (30%) treatment was used 20,000 cc•m-2•day•atm OTR film and perforated film was as a control. Temperature conditions were applied simulated shipping and distribution conditions from Korea to Singapore, there were stored at 3 ℃ (13 days), 10 ℃ (an hour), and 8 ℃ (7 days) for 20 days. Fresh weight loss rate was under 1% as maximum permissible weight loss in treated OTR films except perforated film as a control during storage. Carbon dioxide concentration within a package for the storage period showed a lower value than the maximum CO2 concentration tolerated range (15 %) in treated OTR films and even the concentration of high OTR film treatment; from 20,000cc to 100,000cc were less than 3%. 1,300 cc had a suitable carbon dioxide range as over 5 % under 15 % at 5 days after storage until finished experiments and CO2 injection treatment was quickly drop the 15 % at storage after 1 day, but it kept around 15 % during storage. Oxygen concentration was maintained between 10 to 15 % in 1,300 cc and CO2 injection treatments, but other treatments were kept in 19 to 21 %. Ethylene concentration was showed very higher concentration at the CO2 injection treatment than OTR treatments. In the OTR treatments, 1,300 cc showed the highest concentration in ethylene and 20,000 cc film had lowest. Firmness was maintained highest in 1,300cc, but there was not shown any significant differences among other OTR treatments. Visual quality had shown the best result in 20,000 cc that showed marketable quality until 20 days after storage. 20,000 cc and perforated film had better than other treatments in off-odor and the 1,300 cc and CO2 injection treatments have occurred strong off-odor even after 10 minutes. As a result of the difference between Hunter ‘L’ and ‘a’ values of chroma meter, the 1,300cc and CO2 injection treatments were delayed color developments and other treatments did not shown any significant differences. The results indicate that effectiveness for maintaining the freshness was best achieved at 20,000 cc•m-2•day•atm. Although 1,300 cc and CO2 injection treatments were in appropriate MA condition, it showed darkening of strawberry calyx and excessive reduction of coloring due to high carbon dioxide concentration during storage. While 1,300cc and CO2 injection treatments were considered as appropriate treatments for exports to Singapore, but the result was shown different. These results are based on cultivar characteristics of strawberry 'Maehyang'.Keywords: carbon dioxide, firmness, shelf-life, visual quality
Procedia PDF Downloads 396