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Sensors (Basel, Switzerland) Mar 2024Computer vision (CV)-based systems using cameras and recognition algorithms offer touchless, cost-effective, precise, and versatile hand tracking. These systems allow...
Computer vision (CV)-based systems using cameras and recognition algorithms offer touchless, cost-effective, precise, and versatile hand tracking. These systems allow unrestricted, fluid, and natural movements without the constraints of wearable devices, gaining popularity in human-system interaction, virtual reality, and medical procedures. However, traditional CV-based systems, relying on stationary cameras, are not compatible with mobile applications and demand substantial computing power. To address these limitations, we propose a portable hand-tracking system utilizing the Leap Motion Controller 2 (LMC) mounted on the head and controlled by a single-board computer (SBC) powered by a compact power bank. The proposed system enhances portability, enabling users to interact freely with their surroundings. We present the system's design and conduct experimental tests to evaluate its robustness under variable lighting conditions, power consumption, CPU usage, temperature, and frame rate. This portable hand-tracking solution, which has minimal weight and runs independently of external power, proves suitable for mobile applications in daily life.
Topics: Humans; Forearm; Upper Extremity; Hand; Algorithms; Wearable Electronic Devices
PubMed: 38610437
DOI: 10.3390/s24072227 -
Journal of Vascular Surgery Aug 2023The LEOPARD (Looking at EVAR Outcomes by Primary Analysis of Randomized Data) trial is a randomized controlled trial comparing the outcomes of endovascular aneurysm... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The LEOPARD (Looking at EVAR Outcomes by Primary Analysis of Randomized Data) trial is a randomized controlled trial comparing the outcomes of endovascular aneurysm repair (EVAR) using commercially available devices in a real-world population.
METHODS
A prospective, randomized, multi-center trial was performed to compare the anatomically fixated (AF) AFX/AFX2 endograft system (Endologix) with endografts with proximal fixation (PF) (Cook Medical Zenith Flex; Gore Excluder; and Medtronic Endurant II) in patients with infrarenal abdominal aortic aneurysms. The primary endpoint was freedom from aneurysm-related complications (ARCs), a composite endpoint consisting of perioperative death (≤30 days), aneurysm rupture, conversion to open surgical repair, postoperative endoleaks, endograft migration (≥10 mm), aneurysm enlargement (≥5 mm), endograft limb occlusion, and device- or aneurysm-related reintervention.
RESULTS
The study population was 455 patients enrolled at 56 United States centers: 235 patients were treated with AF devices and 220 with PF devices. The primary endpoint supported noninferiority of the AF cohort at 1 year. The 5-year freedom from ARC Kaplan-Meier estimates were 63.8% for AF patients and 55.5% for PF patients (P = .10). Kaplan-Meier estimates for freedom from aneurysm-related mortality were 98.7% and 97.0% in the AF group and 99.5% and 98.5% in the PF group at 1 and 5 years. There was no difference in aneurysm-related mortality, all-cause mortality, rupture, secondary interventions, and type I and type III endoleak between the two cohorts. The type III endoleak rate at 5 years for the AFX cohort was 1.5% and 0.0% for the comparator cohort (P = .11). There was a lower type II endoleak rate in the AF group at 5 years (78.8% vs 68.4%; P = .037). There were zero open surgical conversions (0.0%) in the AF group and four (2.0%) in the PF group.
CONCLUSIONS
The 5-year results from the LEOPARD study demonstrated that there was no clinically significant difference in overall aneurysm-related outcomes between patients randomized to the AFX endograft system or commercially available endografts with proximal fixation.
Topics: Humans; United States; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Aortic Aneurysm, Abdominal; Prospective Studies; Treatment Outcome; Prosthesis Design; Endovascular Procedures; Stents; Retrospective Studies
PubMed: 37068528
DOI: 10.1016/j.jvs.2023.04.011 -
Medicina (Kaunas, Lithuania) Dec 2023: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) provide protection against sudden cardiac death from outside the cardiovascular system. ECG screening is...
: Subcutaneous implantable cardioverter-defibrillators (S-ICDs) provide protection against sudden cardiac death from outside the cardiovascular system. ECG screening is a prerequisite for implantation, but the reproducibility of its results post-operatively in the device is only partial. We aimed to compare the results of ECG screening with device-based sensing vector analysis. : We screened the hospital records of all S-ICD recipients in our clinic. All of them had pre-operative ECG screening performed (primary, secondary, and alternate vectors). The results were compared with device-based vector analysis to determine the relation of the pre- and post-operative vector availability. : Complete ECG screening and device-based vector analysis were obtained for 103 patients. At least two acceptable vectors were found in 97.1% of the patients pre-operatively and in 96.1% post-operatively. When comparing vectors in terms of agreement (OK or FAIL) pre- and post-operatively, in 89.3% of the patients, the result for the primary vector was the same in both situations; for the secondary, it was in 84.5%, and for the alternate, it was in 74.8% of patients, respectively. In 55.3% of patients, all three vectors were labeled the same (OK or FAIL); in 37.9%, two vectors had the same result, and in 6.8%, only one vector had the same result pre- and post-operatively. The number of available vectors was the same pre- and post-operatively in 62.1% of patients, while in 15.5%, it was lower, and in 22.3% of patients, it was higher than observed during screening. : Routine clinical pre-operative screening allowed for a good selection of candidates for S-ICD implantation. All patients had at least one vector available post-operatively. The final number of vectors available in the device-based analysis in most patients was at least the same (or higher) than during screening. The repeatability of the positive result for a single vector was high.
Topics: Humans; Defibrillators, Implantable; Reproducibility of Results; Electrocardiography; Patient Selection; Electric Countershock
PubMed: 38138289
DOI: 10.3390/medicina59122186 -
Magma (New York, N.Y.) Jul 2023Low-field MRI systems are expected to cause less RF heating in conventional interventional devices due to lower Larmor frequency. We systematically evaluate RF-induced...
OBJECTIVE
Low-field MRI systems are expected to cause less RF heating in conventional interventional devices due to lower Larmor frequency. We systematically evaluate RF-induced heating of commonly used intravascular devices at the Larmor frequency of a 0.55 T system (23.66 MHz) with a focus on the effect of patient size, target organ, and device position on maximum temperature rise.
MATERIALS AND METHODS
To assess RF-induced heating, high-resolution measurements of the electric field, temperature, and transfer function were combined. Realistic device trajectories were derived from vascular models to evaluate the variation of the temperature increase as a function of the device trajectory. At a low-field RF test bench, the effects of patient size and positioning, target organ (liver and heart) and body coil type were measured for six commonly used interventional devices (two guidewires, two catheters, an applicator and a biopsy needle).
RESULTS
Electric field mapping shows that the hotspots are not necessarily localized at the device tip. Of all procedures, the liver catheterizations showed the lowest heating, and a modification of the transmit body coil could further reduce the temperature increase. For common commercial needles no significant heating was measured at the needle tip. Comparable local SAR values were found in the temperature measurements and the TF-based calculations.
CONCLUSION
At low fields, interventions with shorter insertion lengths such as hepatic catheterizations result in less RF-induced heating than coronary interventions. The maximum temperature increase depends on body coil design.
Topics: Humans; Heating; Radio Waves; Magnetic Resonance Imaging; Temperature; Phantoms, Imaging; Hot Temperature
PubMed: 37195365
DOI: 10.1007/s10334-023-01099-7 -
Biomolecules & Biomedicine Nov 2023Pregnancy-related physiologic and anatomic changes affect oxygenation and airway management, and it is widely believed that airway difficulty may be more common in... (Review)
Review
Pregnancy-related physiologic and anatomic changes affect oxygenation and airway management, and it is widely believed that airway difficulty may be more common in obstetric patients as a result. In addition, most obstetric intubations are performed under emergency conditions, and preoperative airway assessment poorly predicts airway management outcomes. These considerations necessitate special protocols for airway care in the obstetric population, and the evolution of the videolaryngoscope represents one of the most important milestones in recent decades. However, recommendations for the use of videolaryngoscopy in obstetrics remain unclear. A considerable body of evidence affirms that videolaryngoscopy improves laryngeal visualisation, increases first-attempt and overall intubation success rates, shortens intubation time, and facilitates team communication and education. In contrast, a significant number of studies have also reported conflicting results regarding comparative clinical outcomes and have highlighted other limitations regarding the adoption of videolaryngoscopy in routine obstetric care. Nevertheless, considering the peculiarities of obstetric intubation, the Macintosh-style videolaryngoscope can be suggested as the primary intubation device as it offers the benefits of both videolaryngoscopy and direct laryngoscopy. However, more rigorous evidence is needed to clarify the current blind spots and controversies regarding the role of videolaryngoscopy in obstetrics.
Topics: Humans; Laryngoscopy; Intubation, Intratracheal; Laryngoscopes; Larynx; Airway Management
PubMed: 37021834
DOI: 10.17305/bb.2023.9154 -
BMC Emergency Medicine Aug 2023Our study aimed to assess the ability of nonmedical civilians to self-apply extremity tourniquets in cold weather conditions while wearing insulating technical clothing...
BACKGROUND
Our study aimed to assess the ability of nonmedical civilians to self-apply extremity tourniquets in cold weather conditions while wearing insulating technical clothing after receiving basic training.
METHODS
A field study was conducted among 37 voluntary participants of an expedition party to the Spanish Antarctic base. The researchers assessed the participant's ability to self-apply five commercial extremity tourniquets (CAT, OMNA, RMT, SWAT-T, and RATS) over cold-weather clothing and their achieved effectiveness for vascular occlusion. Upper extremity self-application was performed with a single-handed technique (OHT), and lower extremity applying a two-handed technique (THT). Perceptions of self-application ease mean values ± standard deviation (SD) were compared by applying a 5% statistical significance threshold. Frequency count determined tourniquet preference.
RESULTS
All the tested ETs, except the SWAT-T, were properly self-applied with an OHT, resulting in effective vascular occlusion in the upper extremity. The five devices tested were self-applied correctly in the lower extremities using THT. The ratcheting marine-designed OMNA ranked the highest for application easiness on both the upper and lower extremities, and the windlass CAT model was the preferred device by most participants.
CONCLUSIONS
Civilian extremity tourniquet self-application on both upper and lower extremities can be accomplished in cold weather conditions despite using cold-weather gloves and technical clothing after receiving brief training. The ratcheting marine-designed OMNA ranked the highest for application ease, and the windlass CAT model was the preferred device.
Topics: Humans; Tourniquets; Extremities; Weather
PubMed: 37653492
DOI: 10.1186/s12873-023-00871-1 -
Korean Journal of Anesthesiology Jun 2024The use of cardiac implantable electronic devices (CIEDs) has increased significantly in recent years. Consequently, more patients with CIEDs will undergo surgery during... (Review)
Review
The use of cardiac implantable electronic devices (CIEDs) has increased significantly in recent years. Consequently, more patients with CIEDs will undergo surgery during their lifetime, and thus the involvement of anesthesiologists in the perioperative management of CIEDs is increasing. With ongoing advancements in technology, many types of CIEDs have been developed, including permanent pacemakers, leadless pacemakers, implantable cardioverter defibrillators, cardiac resynchronization therapy-pacemakers/defibrillators, and implantable loop recorders. The functioning of CIEDs exposed to an electromagnetic field can be affected by electromagnetic interference, potential sources of which can be found in the operating room. Thus, to prevent potential adverse events caused by electromagnetic interference in the operating room, anesthesiologists must have knowledge of CIEDs and be able to identify each type. This review focuses on the perioperative management of patients with CIEDs, including indications for CIED implantation to determine the baseline cardiovascular status of patients; concerns associated with CIEDs before and during surgery; perioperative management of CIEDs, including magnet application and device reprogramming; and additional perioperative provisions for patients with CIEDs. As issues such as variations in programming capabilities and responses to magnet application according to device can be challenging, this review provides essential information for the safe perioperative management of patients with CIEDs.
Topics: Humans; Perioperative Care; Defibrillators, Implantable; Pacemaker, Artificial; Electromagnetic Fields
PubMed: 38287213
DOI: 10.4097/kja.23826 -
Europace : European Pacing,... Nov 2023Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the...
AIMS
Transvenous lead extraction (TLE) is important in the management of cardiac implantable electronic devices but carries risk. It is most commonly completed from the superior access, often with 'bail-out' support via the femoral approach. Superior and inferior access may be used in tandem, which has been proposed as an advance in safety and efficacy. The aim of this study is to evaluate the safety and efficacy of the Tandem approach.
METHOD
The 'Tandem' procedure entailed grasping of the targeted lead in the right atrium to provide countertraction as a rotational dissecting sheath was advanced over the lead from the subclavian access. Consecutive 'Tandem' procedures performed by a single operator between December 2020 and March 2023 in a single large-volume TLE centre were included and compared with the conventional superior approach (control) using 1:1 propensity score matching; patients were statistically matched for demographics.
RESULTS
The Tandem in comparison with the conventional approach extracted leads of much greater dwell time (148.9 ± 79 vs. 108.6 ± 77 months, P < 0.01) in a shorter procedure duration (96 ± 36 vs. 127 ± 67 min, P < 0.01) but requiring more fluoroscopy (16.4 ± 10.9 vs. 10.8 ± 14.9 min, P < 0.01). The Tandem and control groups had similar clinical (100% vs. 94.7%, P = 0.07) and complete (94.8% vs. 92.8%, P = 0.42) success, with comparable minor (4% vs. 6.7%, P = 0.72) and major (0% vs. 4%, P = 0.25) complications; procedural (0% vs. 1.3%, P = 1) and 30-day (1.3% vs. 4%, P = 0.62) mortality were also similar.
CONCLUSION
The Tandem procedure is as safe and effective as the conventional TLE. It can be applied to leads of a long dwell time with a potentially shorter procedure duration.
Topics: Humans; Defibrillators, Implantable; Pacemaker, Artificial; Device Removal; Time Factors; Fluoroscopy; Treatment Outcome; Retrospective Studies
PubMed: 37936325
DOI: 10.1093/europace/euad331 -
BMC Nursing Jun 2024A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related...
BACKGROUND
A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.
METHODS
The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.
RESULTS
Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1-96.7% before intervention to 0.3-53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.
CONCLUSIONS
In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.
TRIAL REGISTRATION
The review protocol was registered (PROSPERO registration number: CRD42022346450).
PubMed: 38886734
DOI: 10.1186/s12912-024-02080-y -
Clinical Oral Investigations Aug 2023The effects of water flossing on dental plaque removal have been suggested, but its ecological impact on dental plaque microbiota needs further investigation. In... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
The effects of water flossing on dental plaque removal have been suggested, but its ecological impact on dental plaque microbiota needs further investigation. In addition, whether this plaque control measure by water flossing promotes the control of halitosis still needs clinical validation. The aim of this study was to evaluate the effects of water flossing on gingival inflammation and supragingival plaque microbiota.
MATERIALS AND METHODS
Seventy participants with gingivitis were randomly assigned to control (toothbrushing) and experimental (toothbrushing + water flossing) groups (n = 35). Participants were recalled at 4, 8, and 12 weeks, and their gingival index, sulcus bleeding index, bleeding on probing, dental plaque index, and oral malodor values were measured. The microbiota of supragingival plaque was further investigated using 16S rRNA sequencing and qPCR.
RESULTS
Sixty-three participants completed all revisits (control: n = 33; experimental: n = 30). The experimental and control groups exhibited similar clinical characteristics and dental plaque microbiota at baseline. Adjunctive water flossing effectively reduced the gingival index and sulcus bleeding index as compared to the toothbrushing control group. The water-flossing group showed reduced oral malodor at week 12 as compared to the baseline. Consistently, the water-flossing group exhibited altered dental plaque microbiota at week 12, characterized by a depletion of Prevotella at genus level and Prevotella intermedia at species level as compared to the toothbrushing control. In addition, the plaque microbiota of water-flossing group exhibited a more aerobic phenotype, while the control group was more anaerobic.
CONCLUSIONS
Daily water flossing can effectively alleviate gingival inflammation and reduce oral malodor, possibly by depleting oral anaerobes and altering the oral microbiota to a more aerobic phenotype.
CLINICAL RELEVANCE
Water flossing adjunctive to toothbrushing effectively alleviated gingival inflammation, representing a promising oral hygiene practice to promote oral health.
CLINICAL TRIAL REGISTRATION
The trial was registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/showprojen.aspx?proj=61797 , #ChiCTR2000038508) on September 23, 2020.
Topics: Humans; Dental Devices, Home Care; Dental Plaque; Halitosis; Water; RNA, Ribosomal, 16S; Dental Plaque Index; Toothbrushing; Gingivitis; Inflammation
PubMed: 37231271
DOI: 10.1007/s00784-023-05081-4