Suture or Stapling Are Superior in Comparison to Bipolar Sealing for Closing the Bronchi

2016 ◽  
Vol 65 (05) ◽  
pp. 356-361 ◽  
Author(s):  
Katharina Waubke ◽  
Anika Pehl ◽  
Thorsten Steinfeldt ◽  
Detlef Bartsch ◽  
Andreas Kirschbaum
Keyword(s):  
Ex Vivo ◽  
Lung Resection ◽  
Nonparametric Test ◽  
Burst Pressure ◽  
Lung Protective Ventilation ◽  
Significance Level ◽  
Mean Width ◽  
Hematoxylin And Eosin ◽  
The Mean ◽  
Sealing Device

Background Every anatomical lung resection requires the airtight closure of at least one bronchus. In current clinical practice, these bronchi are sealed with sutures or staplers. This study investigated in an ex vivo pig model whether a new bipolar sealing device MARSEAL (KLS Martin, Tuttlingen, Germany) could be an alternative for this purpose. Methods Complete bronchial trees were prepared free from pig heart–lung blocks that were removed at a slaughterhouse. These preparations were taken to the laboratory, and main, lobar, and segmental bronchi were closed using sutures, staples, or bipolar sealing. Each trachea was then intubated and connected to a ventilating device. The initial airtight closure of the bronchus was first tested with lung-protective ventilation. After 15 minutes of ventilation, the inspiratory ventilation pressure was slowly increased and the burst pressure (in mbar) was recorded. Each group included 12 bronchus closures. Group mean burst pressures were compared using a nonparametric test (Mann–Whitney U test). The significance level was p < 0.05. Results The main bronchi closed both stapler magazines or sutures were all initially airtight during ventilation. The mean burst pressure was 60 ± 0 mbar for staplers and 57.92 ± 5.8 mbar for sutures. In contrast, 50% of main bronchi sealed with MARSEAL devices (5 or 10 mm) leaked air from the beginning. This was also noted in all lobar bronchi sealed with the MARSEAL 5-mm device and 80% of those sealed with the MARSEAL 10-mm device. The mean burst pressure of initially airtight lobar bronchi was 12.7 ± 7.25 mbar. In contrast, all segmental bronchi (mean width: 1.6 cm) were airtight when ventilated. Mean burst pressure was 14.64 ± 9.1 mbar with the MARSEAL 5-mm device and 29.64 ± 21.3 mbar with the MARSEAL 10-mm device. Histological investigation of the preparations (with hematoxylin and eosin staining) showed intact cartilaginous structures that were largely unaffected by bipolar coagulation. The airtight sealing of the segmental bronchi resulted from fusion of the peribronchial tissue and not the cartilage. Conclusion Bipolar sealing is an inappropriate tool for the closure of the bronchi in comparison to suture or stapling.

scholarly journals Ex vivo evaluation of a multilayered sealant patch for watertight dural closure: cranial and spinal models

2021 ◽  
Vol 32 (8) ◽  
Author(s):  
A. Kinaci ◽  
S. van Thoor ◽  
S. Redegeld ◽  
M. Tooren ◽  
T. P. C. van Doormaal
Keyword(s):  
Ex Vivo ◽  
Resistance Test ◽  
Burst Pressure ◽  
Cerebrospinal Fluid Leakage ◽  
Computer Assisted ◽  
Dural Defect ◽  
Test Results ◽  
Physiological Conditions ◽  
Dural Attachment ◽  
The Mean

AbstractCerebrospinal fluid leakage is a frequent complication after cranial and spinal surgery. To prevent this complication and seal the dura watertight, we developed Liqoseal, a dural sealant patch comprising a watertight polyesterurethane layer and an adhesive layer consisting of poly(DL-lactide-co-ε-caprolactone) copolymer and multiarmed N-hydroxylsuccinimide functionalized polyethylene glycol. We compared acute burst pressure and resistance to physiological conditions for 72 h of Liqoseal, Adherus, Duraseal, Tachosil, and Tisseel using computer-assisted models and fresh porcine dura. The mean acute burst pressure of Liqoseal in the cranial model (145 ± 39 mmHg) was higher than that of Adherus (87 ± 47 mmHg), Duraseal (51 ± 42 mmHg) and Tachosil (71 ± 16 mmHg). Under physiological conditions, cranial model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment during 72 hours as opposed to 3 of 3 for Adherus and Duraseal and 0 of 3 for Tachosil. The mean burst pressure of Liqoseal in the spinal model (233 ± 81 mmHg) was higher than that of Tachosil (123 ± 63 mmHg) and Tisseel (23 ± 16 mmHg). Under physiological conditions, spinal model resistance test results showed that 2 of 3 Liqoseal sealants maintained dural attachment for 72 hours as opposed to 3 of 3 for Adherus and 0 of 3 for Duraseal and Tachosil. This novel study showed that Liqoseal is capable of achieving a strong watertight seal over a dural defect in ex vivo models.

scholarly journals Evaluation of Plasmodium falciparum K13 gene polymorphism and susceptibility to dihydroartemisinin in an endemic area

2018 ◽  
Vol 5 (9) ◽  
pp. 2651-2657
Author(s):  
Titilope M. Dokunmu ◽  
Grace I. Olasehinde ◽  
David O. Oladejo ◽  
Cynthia U. Adjekukor ◽  
Adesola E. Akinbohun ◽  
...  
Keyword(s):  
Plasmodium Falciparum ◽  
Endemic Area ◽  
Ex Vivo ◽  
Artemisinin Resistance ◽  
High Sensitivity ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Significance Level ◽  
Artemisinin Derivatives ◽  
The Mean

Introduction: Plasmodium falciparum has developed resistance to artemisinin drugs in Southeast Asia, and its reduced sensitivity has been reported in other regions. This study aims to determine parasite susceptibility to the bioactive form of artemisinin derivatives- dihydroartemisinin (DHA)-, and to detect the K13 polymorphism in isolates from an endemic area of Nigeria. Methods: Ex-vivo response in 55 parasites isolates obtained from malaria-positive patients were exposed to pulse DHA concentration and cultured for 66 hours ex-vivo. Parasite ring stage survival (RSAex-vivo) relative to unexposed matched control was determined by microscopy, and parasite growth was compared using Mann-Whitney U-test at a significance level of P<0.05. The Kelch propeller gene was amplified using specific primers, then sequenced and analyzed for single nucleotide polymorphisms (SNPs), which were compared to reference PF3D7_1343700. Results: Overall, 151 of 375 (40.2%) individuals were positive during the study period. In 55 selected isolates, there was increased growth in unexposed wells but growth was inhibited in DHA-exposed wells, with growth rate between 14.9 – 96.7%. The mean RSAex-vivo value was 0.18 ± 0.09%, 95% CI (0.15-0.20). There was no significant mutation of the K13 gene in the parasite isolates evaluated. Conclusions: Plasmodium falciparum isolates from this endemic area show high sensitivity to dihydroartemisinin ex-vivo, with no mutations conferring artemisinin resistance. Continuous monitoring of parasite susceptibility to artemisinin combination drugs should be intensified to reduce chances of artemisinin resistance in endemic areas.

POTRET PERILAKU RELIGIUS MAHASISWA UIN SAYARIF HIDAYATULLAH JAKARTA

Al-Risalah ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. 126-148
Author(s):  
Ay Maryani
Keyword(s):  
Religious Behavior ◽  
Male And Female ◽  
Mean Values ◽  
Significance Level ◽  
Average Value ◽  
Environment Variable ◽  
Independent Variable ◽  
The Mean ◽  
Gender Factor ◽  
Level 2

This study describes the religious behavior of UIN Syarif Hidayatullah Jakarta students. The variables used are internal and external environment as independent variable and religious behavior as dependent variable. The internal environment variable consists of gender factor, (male and female). The external environmental variables comprise the faculty environment, the present resident and the place to grow. The present resident consist of dormitories, boarding houses and parents' homes and the place to grow consist of urban and rural environment. Religious behavior variables consist of habluminallah behavior and habluminannas behavior. Habluminallah's behavior measured by (1) knowledge of faith and worship, (2) attitudes toward faith and worship, and (3) practice of faith and worship. The habluminannas variable measured by (1) Islamic behavior for them self, like honest, discipline and good work / studyethics, trust and concern on legality, (2) Islamic behavior with others, like generous, cooperation, caring, respect to the people's rights and tolerance and (3) Islamic behavior for the natural surroundings, like love of nature and nature conservation efforts. The methodology used was (1) Statistical descriptive, (2) MANOVA (Multivariate Analysis of Variance) and (3) Independent sample t-test. The results showed the religious behavior UIN Syarif Hidayatullah Jakarta students has a very good category. This is indicated by the mean values for the behavior of haluminallah and habluminannas of 158.85 and 178.76,  espectively. The average value of habluminallah behaviour in the range of values "145-180" with the category of "very good" and habluminannas behavior in the range value "165-205" with the category "very good. Habluminallah and habluminannas behavior are different for each faculty. This is indicated by the significance level of Pillai Trace, Wilk Lambda, Hotelling Trace, Roy's Largest Root of 0.00 (<0.05). Habluminallah and habluminannas behavior are the same for respondents who live in dormitories, boarding houses, and parents' homes. This is indicated by the value of F test and significance at Wilk's Lambda respectively for 2.055 and 0.085 (>0.05). Habluminallah and habluminannas behaviors are similar for urban and rural respondents. This is known from the sig level. (2-tailed) for habluminallah and habluminannas behavior of 0.317 and 0.245 (> 0.05), respectively. Habluminallah and habluminannas behaviors are similar for male and female. This is known from the sig level. (2-tailed) for habluminallah and habluminannas behavior of 0.950 and 0.307 (> 0.05),respectively. The results of this study are expected to be used to develop university policies that can enhance the Islamic values of UIN Syarif Hidayatullah Jakarta.

scholarly journals Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Minhui Amy Chan ◽  
Farah Ibrahim ◽  
Arjunan Kumaran ◽  
Kailing Yong ◽  
Anita Sook Yee Chan ◽  
...  
Keyword(s):  
Relative Position ◽  
Ethmoid Sinus ◽  
Decompression Surgery ◽  
Ethnic Variation ◽  
Sinus Wall ◽  
Orbital Wall ◽  
Mean Width ◽  
Significant Difference ◽  
The Mean ◽  
Medial Orbital Wall

Abstract Background To describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects. Methods Single-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA). Results There were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively. Conclusions No inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

scholarly journals Electrochemical treatment of ex vivo human abdominal skin and potential use in scar management: A pilot study

2021 ◽  
Vol 7 ◽  
pp. 205951312098853
Author(s):  
Dana M Hutchison ◽  
Amir A Hakimi ◽  
Avin Wijayaweera ◽  
Soohong Seo ◽  
Ellen M Hong ◽  
...  
Keyword(s):  
Color Change ◽  
Ex Vivo ◽  
Low Cost ◽  
Histological Evaluation ◽  
Ph Change ◽  
Level Of Evidence ◽  
Abdominal Skin ◽  
Electrochemical Therapy ◽  
Mean Width ◽  
Scar Management

Introduction: Scar treatments aim to address pathologic collagen deposition; however, they can be expensive or difficult to control. Electrochemical therapy (ECT) offers a simple alternative treatment. The purpose of this study is to examine the acid-base and histological changes in ex vivo human abdominal skin following ECT. Methods: Forty-two ex vivo human panniculus tissue sections collected from six individuals were tumesced with normal saline. ECT was performed by inserting two platinum needle electrodes connected to a DC power supply into each specimen. Voltage was varied (3–6 V) and applied for 5 minutes. Each specimen was sectioned across both electrode insertion sites and immediately stained with pH sensitive dye. The width of dye color change for each dosimetry pair was calculated. Hematoxylin and eosin staining was used to evaluate samples. Results and Discussion: ECT caused a spatially localised and dose-dependent increased area of acidic and basic pH around the anode and cathode, respectively. A significantly greater mean width of pH change was generated at the cathode compared to the anode in all treatment groups. Histological evaluation displayed broad condensation and hyalinisation of dermal collagen. Conclusion: ECT triggered dermal pH alterations and changed the underlying structural framework of the specimen. This technology may serve as a low-cost, minimally invasive local soft-tissue remodeling technique with potential application in scar management. Level of Evidence: 5 Lay Summary Electrochemical therapy is a novel treatment that causes spatially selective dermal injury in areas of interest. This study measures the effects of electrochemical therapy when applied to abdominal skin. Electrochemical therapy appears to have beneficial effects by causing a highly localised reduction in collagen content or local softening of tissue, which is consistent with other studies on scar therapies, including chemexfoliation, radiofrequency technologies, and lasers. However, electrochemical therapy can be performed at a fraction of the costs of these aforementioned modalities.

scholarly journals Ex vivo accuracy of three electronic apex locators using different apical file sizes

2012 ◽  
Vol 23 (3) ◽  
pp. 199-204 ◽  
Author(s):  
Bruno Carvalho de Vasconcelos ◽  
Leonardo de Alencar Matos ◽  
Elilton Cavalcante Pinheiro-Júnior ◽  
Antônio Sérgio Teixeira de Menezes ◽  
Nilton Vivacqua-Gomes
Keyword(s):  
Root Canal ◽  
Ex Vivo ◽  
Chi Square ◽  
Apical Constriction ◽  
Visual Measurement ◽  
Chi Square Test ◽  
The Mean

This study evaluated the accuracy of three electronic apex locators (Root ZX, Novapex, and Justy II) in root canal length determinations using different apical file sizes, considering the apical constriction (AC) and the major foramen (MF) as anatomic references. The diameter of the apical foramina of 40 single-rooted teeth was determined by direct visual measurement and the master apical file was established. Electronic measurements were then performed using 3 instruments: the selected master apical file (adjusted file), one size smaller (intermediate file), and two sizes smaller (misfit file). The distances from the tip of files fixed in the canals to the MF and to the AC were measured digitally. Precision at AC and at MF for the misfit, intermediate and adjusted apical files was as follows: 80%/88%/83% and 78%/83%/95% (Root ZX); 80%/85%/80% and 68%/73%/73% (Novapex); and 78%/80%/78% and 65%/78%/70% (Justy II). Considering the mean discrepancies, statistically significant differences were found only for the adjusted file at MF, with Root ZX presenting the best results at MF. The chi-square test showed significant differences between the acceptable measurements at AC and at MF for the Justy II and Novapex (± 0.5 mm) regardless of file adjustment. Under the conditions of the present study, all devices provided acceptable electronic measurements regardless of file adjustment, except for Root ZX which had its performance improved significantly when the precisely fit apical file was used. Justy II and Novapex provided electronic measurements nearest to the AC.

scholarly journals Investigating the feasibility of cerebellar transcranial direct current stimulation to facilitate post-stroke overground gait performance in chronic stroke: a partial least-squares regression approach

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Dhaval Solanki ◽  
Zeynab Rezaee ◽  
Anirban Dutta ◽  
Uttama Lahiri
Keyword(s):  
Field Strength ◽  
Electric Field ◽  
Electric Field Strength ◽  
Chronic Stroke ◽  
Least Squares Regression ◽  
Significance Level ◽  
Gait Performance ◽  
Wilcoxon Rank Sum Test ◽  
Gait Parameters ◽  
The Mean

Abstract Background Investigation of lobule-specific electric field effects of cerebellar transcranial direct current stimulation (ctDCS) on overground gait performance has not been performed, so this study aimed to investigate the feasibility of two lobule-specific bilateral ctDCS montages to facilitate overground walking in chronic stroke. Methods Ten chronic post-stroke male subjects participated in this repeated-measure single-blind crossover study, where we evaluated the single-session effects of two bilateral ctDCS montages that applied 2 mA via 3.14 cm2 disc electrodes for 15 min targeting (a) dentate nuclei (also, anterior and posterior lobes), and (b) lower-limb representations (lobules VIIb-IX). A two-sided Wilcoxon rank-sum test was performed at a 5% significance level on the percent normalized change measures in the overground gait performance. Partial least squares regression (PLSR) analysis was performed on the quantitative gait parameters as response variables to the mean lobular electric field strength as the predictors. Clinical assessments were performed with the Ten-Meter walk test (TMWT), Timed Up & Go (TUG), and the Berg Balance Scale based on minimal clinically important differences (MCID). Results The ctDCS montage specific effect was found significant using a two-sided Wilcoxon rank-sum test at a 5% significance level for 'Step Time Affected Leg' (p = 0.0257) and '%Stance Time Unaffected Leg' (p = 0.0376). The changes in the quantitative gait parameters were found to be correlated to the mean electric field strength in the lobules based on PLSR analysis (R2 statistic = 0.6574). Here, the mean electric field strength at the cerebellar lobules, Vermis VIIIb, Ipsi-lesional IX, Vermis IX, Ipsi-lesional X, had the most loading and were positively related to the 'Step Time Affected Leg' and '%Stance Time Unaffected Leg,' and negatively related to the '%Swing Time Unaffected Leg,' '%Single Support Time Affected Leg.' Clinical assessments found similar improvement in the TMWT (MCID: 0.10 m/s), TUG (MCID: 8 s), and BBS score (MCID: 12.5 points) for both the ctDCS montages. Conclusion Our feasibility study found an association between the lobular mean electric field strength and the changes in the quantitative gait parameters following a single ctDCS session in chronic stroke. Both the ctDCS montages improved the clinical outcome measures that should be investigated with a larger sample size for clinical validation. Trial registration: Being retrospectively registered.

A boundary crossing probability for the Bessel process

1998 ◽  
Vol 30 (3) ◽  
pp. 807-830 ◽  
Author(s):  
Rebecca A. Betensky
Keyword(s):  
Nonparametric Test ◽  
Bessel Process ◽  
Boundary Crossing ◽  
Test Statistic ◽  
Boundary Crossing Probability ◽  
Significance Level ◽  
Straight Line ◽  
Crossing Probability ◽  
Nonparametric Test Statistic ◽  
First Crossing Time

Analytic approximations are derived for the distribution of the first crossing time of a straight-line boundary by a d-dimensional Bessel process and its discrete time analogue. The main ingredient for the approximations is the conditional probability that the process crossed the boundary before time m, given its location beneath the boundary at time m. The boundary crossing probability is of interest as the significance level and power of a sequential test comparing d+1 treatments using an O'Brien-Fleming (1979) stopping boundary (see Betensky 1996). Also, it is shown by DeLong (1980) to be the limiting distribution of a nonparametric test statistic for multiple regression. The approximations are compared with exact values from the literature and with values from a Monte Carlo simulation.

Effects of Relationship Enrichment Training on Improving Marital Satisfaction of Infertile Couples: A Randomized Control Trial

2021 ◽  
Vol 17 ◽  
Author(s):  
Seyedeh Zahra Masoumi ◽  
Khodayar Oshvandi ◽  
Masoumeh Rostami-Moez ◽  
Arezoo Shayan ◽  
Farideh Kazemi
Keyword(s):  
Marital Satisfaction ◽  
Intervention Group ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Chi Square ◽  
Significance Level ◽  
Significant Difference ◽  
The Mean ◽  
Infertile Couples ◽  
Relationship Enrichment

Background: Infertility can cause low marital satisfaction. Marital satisfaction has an important effect on infertile couples’ health. Objective: This study aimed to assess the effect of relationship enrichment training on improving the marital satisfaction of infertile couples. Methods: This randomized clinical trial was conducted on 50 infertile couples in the infertility center of Fatemieh Hospital in Hamadan, Iran in 2018. Participants were matched for demographic characteristics and randomly assigned to intervention and control groups (each group had 25 couples). Informed consent was obtained from all participants. The Enrich Marital Satisfaction questionnaire and demographic information were used to collect data before the study and two months after the intervention. Two trained midwifery students taught only the intervention group the relationship enrichment topics in seven sessions (each session = 90 minutes). The data were analyzed by SPSS Statistics version 21 using analysis of covariance, independent t-test, chi-square, and Mann–Whitney. The significance level was set at p ≤ 0.05. Results: There was no significant difference in demographic and obstetric information between the two groups (p >0.05). The mean of marital satisfaction in the intervention group significantly increased among women and men from 151.00 ±28.61 to 154.88 ±22.62 and from 152.56 ±27.33 to 159.24 ±22.14, respectively, (p <0.001). Conversely, the mean of marital satisfaction decreased among women and men from 158.13 ±13.86 to 146.25 ±19.53 and from 164.25 ±17.00 to 153.17 ±27.50 in the control group (p=0.02). Conclusion: Relationship enrichment training can be effective in promoting the marital satisfaction of infertile couples. Registration number: The National Center for Strategic Research in medical education, No. 960185.

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