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Cardiovascular Engineering and... Jun 2024Acute ischemic stroke occurs when a blood clot occludes a cerebral artery. Mechanical interventions, primarily stent retrievers and aspiration thrombectomy, are used... (Review)
Review
Acute ischemic stroke occurs when a blood clot occludes a cerebral artery. Mechanical interventions, primarily stent retrievers and aspiration thrombectomy, are used currently for removing the occluding clot and restoring blood flow. Aspiration involves using a long catheter to traverse the cerebral vasculature to reach the blood clot, followed by application of suction through the catheter bore. Aspiration is also used in conjunction with other techniques such as stent retrievers and balloon guide catheters. Despite the wide use of aspiration, our physical understanding of the process and the causes of the failure of aspiration to retrieve cerebral clots in certain scenarios is not well understood. Experimental and computational studies can help develop the capability to provide deeper insights into the procedure and enable development of new devices and more effective treatment methods. We recapitulate the aspiration-based thrombectomy techniques in clinical practice and provide a perspective of existing engineering methods for aspiration. We articulate the current knowledge gap in the understanding of aspiration and highlight possible directions for future engineering studies to bridge this gap, help clinical translation of engineering studies, and develop new patient-specific stroke therapy.
PubMed: 38886306
DOI: 10.1007/s13239-024-00735-0 -
Expert Review of Medical Devices Jun 2024Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study...
BACKGROUND
Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures.
RESEARCH DESIGN AND METHODS
This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials.
RESULTS
The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements.
CONCLUSIONS
The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.
PubMed: 38884608
DOI: 10.1080/17434440.2024.2367688 -
American Journal of Medical Genetics.... Jun 2024This study investigates the long-term outcomes of palliative and definitive surgeries for esophageal atresia (EA) in patients with trisomy 18 syndrome. A retrospective...
This study investigates the long-term outcomes of palliative and definitive surgeries for esophageal atresia (EA) in patients with trisomy 18 syndrome. A retrospective study included 25 cases undergoing EA surgery at our center between 2008 and 2022. The Palliative group (n = 16) comprised 13 cases with esophageal banding and 3 with tracheoesophageal fistula (TEF) division. The Definitive group (n = 9) included 5 cases with primary repair and 4 with staged repair following TEF division. The patient characteristics exhibited no significant differences between the groups. In the Definitive group, 56% (5/9) were successfully weaned off mechanical ventilation, compared with none in the Palliative group (p = 0.002). Survival-to-discharge rates were 31% (5/16) in the Palliative group and 67% (6/9) in the Definitive group. Home ventilator management was required for all 5 cases that required ventilation in the Palliative group, whereas only 17% (1/6) in the Definitive group needed it. The Palliative group also required continuous oral suction for persistent saliva removal, with two cases undergoing laryngotracheal separation. Overall, definitive surgery for EA in patients with trisomy 18 syndrome may provide enhanced respiratory stability, thereby improving the survival-to-discharge rate and overall quality of life for patients and their families.
PubMed: 38884184
DOI: 10.1002/ajmg.a.63792 -
Journal of Thoracic Disease May 2024The adequacy of actual lower respiratory tract samples collected using the current collection technique is debated. Endotracheal aspiration is commonly insufficient and...
Feasibility of the modified mini-bronchoalveolar lavage techniques using a nasogastric suction catheter and polytetrafluoroethylene bronchoscopic suction catheter in diagnosing bilateral pneumonia: a pilot study.
BACKGROUND
The adequacy of actual lower respiratory tract samples collected using the current collection technique is debated. Endotracheal aspiration is commonly insufficient and can be contaminated with colonization from the proximal airway. Diagnostic bronchoscopy is the standard method for collecting specimens from the lower respiratory tract. However, it is usually unavailable in resource-limited settings. At present, noninvasive methods with the mini-bronchoalveolar lavage (BAL) catheter are used to collect specimens from the lower respiratory tract. Compared with the nasogastric (NG) tube, the polytetrafluoroethylene (PTFE) catheter, a modified mini-BAL catheter that suctions the more distal part of the tracheobronchial tree, can collect actual lower respiratory tract specimens.
METHODS
This prospective open-label pilot study included patients aged >18 years who were diagnosed with bilateral pneumonia and who required mechanical ventilation. Lower respiratory tract samples were collected via endotracheal aspiration, mini-BAL using an NG tube, and mini-BAL using a PTFE bronchoscopic catheter. Data on return fluid volume, white blood cell (WBC) count, microbiologic information obtained via quantitative culture, and each procedure-related complication were recorded.
RESULTS
The return fluid volumes of the NG tube and PTFE groups were 50 and 40 mL, respectively. The median WBC counts were 245 cells/cumm in the NG tube group and 305 cells/cumm in the PTFE group. Culture from endotracheal aspiration detected polymicrobial organisms in 8 (20.0%) patients. Further, 19 (47.5%) patients in the NG tube group and 18 (45.0%) in the PTFE group presented with polymicrobial organisms. Approximately 10% of patients developed mini-BAL-related complications, including arrhythmia (2.5%), mild hypoxemia (2.5%), and mild bleeding (5.0%).
CONCLUSIONS
The two modified mini-BAL techniques are feasible in diagnosing patients with pneumonia requiring mechanical ventilation. The mini-BAL technique is more likely to detect polymicrobial organisms compared with endotracheal aspiration, which can then identify the causative polymicrobial organism of ventilator associated pneumonia (VAP) and lead to antibiotic adjustment. Moreover, it is easy to perform, can yield adequate specimens, and has few complications.
PubMed: 38883667
DOI: 10.21037/jtd-23-1573 -
Cureus May 2024Pharyngocutaneous fistula (PCF) is an abnormal connection between the pharynx and skin that can occur after laryngectomy surgery. It can have a significant negative...
Pharyngocutaneous fistula (PCF) is an abnormal connection between the pharynx and skin that can occur after laryngectomy surgery. It can have a significant negative impact on patient recovery, delaying wound healing, requiring prolonged nil-per-oral (NPO) status, and reducing quality of life. Traditionally, the management of PCF has relied on conservative measures or surgical intervention. However, negative pressure wound therapy (NPWT) offers a promising alternative approach. This case study involves three patients who underwent laryngectomy and developed postoperative PCF. All patients received NPWT with a modified suction catheter and low negative pressure (20-40 mmHg). With NPWT, all patients achieved complete wound closure, with healing times ranging from two weeks to six weeks. This suggests that NPWT may significantly accelerate PCF healing compared to traditional methods. However, maintaining an airtight dressing on the neck region can be challenging. This study highlights the potential of NPWT for faster PCF closure after laryngectomy. Further research is needed to optimize NPWT application techniques, explore the impact on long-term outcomes, and establish guidelines for broader clinical use.
PubMed: 38883062
DOI: 10.7759/cureus.60457 -
Anaesthesia Reports 2024Operating theatre fires are rare but can result in significant morbidity. A 76-year-old male with complex airway disease sustained superficial facial burns during an...
Operating theatre fires are rare but can result in significant morbidity. A 76-year-old male with complex airway disease sustained superficial facial burns during an elective airway debulking procedure. His airway was being managed with high-flow nasal oxygen at 70 l.min and FiO 1.0 delivered by Optiflow™ (Fisher and Paykel Healthcare Limited, Auckland, New Zealand). When suction monopolar diathermy was used to excise hyperkeratotic tissue beside his epiglottis, an arc was created to the tip of the suspension laryngoscope, followed by a jet of flame as the Optiflow circuit ignited. This resulted in burns to the patient's face and shoulder. He required admission to the intensive care unit and had a complicated postoperative course that included the need for surgical tracheostomy to facilitate weaning from mechanical ventilation. This case highlights the dangers of using high-flow nasal oxygen alongside an ignition source.
PubMed: 38882448
DOI: 10.1002/anr3.12309 -
Heliyon Jun 2024A turbulence model study was performed to analyze the flow around the Tubercle Leading Edge (TLE) wing. Five turbulence models were selected to evaluate aerodynamic...
A turbulence model study was performed to analyze the flow around the Tubercle Leading Edge (TLE) wing. Five turbulence models were selected to evaluate aerodynamic force coefficients and flow mechanism by comparing with existing literature results. The selected models are realizable , Shear Stress Transport (SST), ( ) SST model, Transition model and Stress- ω Reynolds Stress Model (RSM). For that purpose, the TLE wing model was developed by using the NACA0021 airfoil profile. The wing model is designed with tubercle wavelength of 0.11c and amplitude of 0.03c. Numerical simulation was performed at chord-based Reynolds number of Re = 120,000. The Computational Fluid Dynamic (CFD) simulation reveals that among the selected turbulence models, Stress- ω RSM estimated aerodynamic forces (i.e. lift and drag) coefficients closest to that of the experimental values followed by realizable , ( ) SST model, SST model and model. However, at a higher angle of attacks i.e. at 16° & 20° SST model predicted closest drag and lift coefficient to that of the experimental values. Additionally, the critical observation of pressure contour confirmed that at the lower angle of attack Stress- ω RSM predicted strong Leading Edge (LE) suction followed by realizable , ( )SST model, SST model and model. Thus, the superiority of Stress- ω RSM in predicting the aerodynamic force coefficients is shown by the flow behavior. In addition to this pressure contours also confirmed that model failed to predict tubercled wing aerodynamic performance. At higher angles of attacks SST model estimated aerodynamic force coefficients closest to that of the experimental values, thus SST model is used at 16° & 20° AoAs. The observed streamline behavior for different turbulence models showed that the Stress- ω RSM model and model failed to model flow behavior at higher AoAs, whereas SST model is a better approach to model separated flows that experience strong flow recirculation zone.
PubMed: 38882326
DOI: 10.1016/j.heliyon.2024.e32148 -
Scientific Reports Jun 2024To elucidate the distribution law of the multiphase coupling slag discharge flow field in gas-lift reverse circulation during drilling shaft sinking, a numerical...
To elucidate the distribution law of the multiphase coupling slag discharge flow field in gas-lift reverse circulation during drilling shaft sinking, a numerical analysis model of gas-liquid-solid multiphase coupling slag discharge was established by CFD-DEM (Coupling of computational fluid dynamics and discrete element method) method, taking the drilling of North Wind well in Taohutu Coal Mine as an example. This model presented the distribution of the multiphase flow field in the slag discharge pipe and at the bottom hole, and was validated through experimentation and theoretical analysis. Finally, the impact of factors, including bit rotation speed, gas injection rate, air duct submergence ratio, and mud viscosity on the slag discharge flow field was clarified. The results indicated that the migration of rock slag at the bottom of the well was characterized by "slip, convergence, suspension, adsorption, and lifting". The slag flow in the discharge pipe exhibited the states of "high density, low flow rate" and "low density, high flow rate", respectively. The multiphase fluid flow patterns in the well bottom and slag discharge pipe were horizontal and axial flows, respectively. The model test of the gas lift reversed circulation slag discharge and the theoretical model of the bottom hole fluid velocity distribution confirmed the accuracy of the multiphase coupling slag discharge flow field distribution model. The rotation speed of the drill bit had the most significant impact on the bottom hole flow field. Increasing the rotation speed of the drill bit can significantly enhance the tangential velocity of the bottom hole fluid, increase the pressure difference between the bottom hole and annular mud column, and improve the adsorption capacity of the slag suction port. These findings can provide valuable insights for gas lift reverse circulation well washing in western drilling shaft sinking.
PubMed: 38879578
DOI: 10.1038/s41598-024-64519-1 -
Respiratory Investigation Jul 2024Cryobiopsy use is anticipated to become more common in diagnosing lung diseases. In Japan, inserting a Fogarty catheter through a suction channel above the endotracheal... (Comparative Study)
Comparative Study
BACKGROUND
Cryobiopsy use is anticipated to become more common in diagnosing lung diseases. In Japan, inserting a Fogarty catheter through a suction channel above the endotracheal tube's cuff for hemostasis is common practice. However, the rigid nature of the endotracheal tube poses challenges to tracheal intubation using a bronchoscope. The endotracheal tube cuff must be removed to prevent interference during Fogarty catheter insertion. To simplify the procedure and enhance safety, we devised and implemented a method of inserting a hemostatic Fogarty catheter with a suction tube externally attached to a softer endotracheal tube. This study aimed to evaluate the sustainability of this Fogarty catheter insertion method using suction tubes.
METHODS
The hemostatic Fogarty catheter insertion method was retrospectively validated. We compared outcomes between 60 patients who underwent the conventional method with a suction channel above the cuff and 50 patients who underwent the novel approach with an externally attached suction tube.
RESULTS
The physicians performing bronchoscopy and inserting the Fogarty catheter in the group in which the suction tube was externally attached for Fogarty catheter insertion had little experience. However, the overall bronchoscopy time was shorter; the two groups showed no significant differences in complications.
CONCLUSION
Regarding cryobiopsy procedures, using an externally attached suction tube for Fogarty catheter insertion was practical and comparable to the conventional method of using a suction channel above the cuff. This method made the procedure more simple and safe.
Topics: Humans; Retrospective Studies; Intubation, Intratracheal; Suction; Bronchoscopy; Male; Female; Aged; Biopsy; Middle Aged; Catheters; Cryosurgery
PubMed: 38878626
DOI: 10.1016/j.resinv.2024.06.001 -
The Lancet. Neurology Jul 2024Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective... (Randomized Controlled Trial)
Randomized Controlled Trial
Safety and efficacy of stent retrievers plus contact aspiration in patients with acute ischaemic anterior circulation stroke and positive susceptibility vessel sign in France (VECTOR): a randomised, single-blind trial.
BACKGROUND
Positive susceptibility vessel sign (SVS) in patients with acute ischaemic stroke has been associated with friable red blood cell-rich clots and more effective recanalisation using stent retrievers versus contact aspiration. We compared the safety and efficacy of stent retrievers plus contact aspiration (combined technique) versus contact aspiration alone as the first-line thrombectomy technique in patients with acute ischaemic anterior circulation stroke and SVS-positive occlusions.
METHODS
Adaptive Endovascular Strategy to the Clot MRI in Large Intracranial Vessel Occlusion (VECTOR) was a prospective, randomised, open-label study with blinded evaluation. Patients with SVS-positive anterior circulation occlusions on pretreatment MRI and arterial puncture within 24 h of symptom onset were enrolled from 22 centres in France. A centralised web-based method was used by interventional neuroradiologists for dynamic randomisation by minimisation. Patients were randomly assigned 1:1 to the combined technique or contact aspiration alone. The primary outcome was expanded Thrombolysis in Cerebral Infarction (eTICI) grade 2c or 3 reperfusion after three or fewer passes on post-treatment angiogram, adjudicated by a blinded independent central imaging core laboratory. The intention-to-treat population was used to assess the primary and secondary outcomes. This trial is registered with ClinicalTrials.gov (NCT04139486) and is complete.
FINDINGS
Between Nov 26, 2019, and Feb 14, 2022, 526 patients were enrolled, of whom 521 constituted the intention-to-treat population (combined technique, n=263; contact aspiration alone, n=258). The median age of participants was 74·9 years (IQR 64·4-83·3); 284 (55%) were female and 237 (45%) male. The primary outcome did not differ significantly between groups (152 [58%] of 263 patients for the combined technique vs 135 [52%] of 258 for contact aspiration; odds ratio [OR] 1·27; 95% CI 0·88-1·83; p=0·19). Procedure-related adverse events occurred in 32 (12%) of 263 patients in the combined technique group and 27 (11%) of 257 in the contact aspiration group (OR 1·14; 0·65-2·00; p=0·65). The most common adverse event was intracerebral haemorrhage (146 [56%] of 259 patients for the combined technique vs 123 [49%] of 251 for contact aspiration; OR 1·32; 0·91-1·90; p=0·13). All-cause mortality at 3 months occurred in 57 (23%) of 251 patients in the combined technique group and 48 (19%) of 247 in the contact aspiration group (OR 1·19; 0·76-1·86; p=0·45), none of which was treatment-related.
INTERPRETATION
The results of the VECTOR trial do not show superiority of the combined stent retriever plus contact aspiration technique over contact aspiration alone in patients with SVS-positive occlusion with respect to achieving eTICI 2c-3 within three passes. These findings support the use of either the combined technique or contact aspiration alone as the initial thrombectomy strategy in patients with acute anterior circulation stroke with SVS on pretreatment MRI.
FUNDING
Cerenovus.
Topics: Humans; Female; Male; Aged; France; Single-Blind Method; Ischemic Stroke; Thrombectomy; Middle Aged; Stents; Aged, 80 and over; Endovascular Procedures; Prospective Studies; Treatment Outcome; Suction
PubMed: 38876748
DOI: 10.1016/S1474-4422(24)00165-0