Ultrasound-Assisted versus Endoscopic Nasojejunal Tube Placement for Acute Pancreatitis: A Retrospective Feasibility Study

Objective. The optimal technique for nasojejunal tube (NJT) placement in terms of facilitating early enteral nutrition (EN) in patients with acute pancreatitis (AP) is unclear. In this study, we aimed to evaluate the impact of two common techniques on EN implementation and clinical outcomes in a group of AP patients. Methods. This is a retrospective study. All the data were extracted from an electronic database from August 2015 to October 2017. Patients with a diagnosis of AP requiring NJT placement were retrospectively analyzed. The primary outcome was the successful procedural rate. Results. A total of 53 eligible patients were enrolled, of whom 30 received an ultrasound-assisted technique and the rest received the endoscopy method ( n = 23 ). There was no difference in success rates of initial placement procedures between the two groups (93.3% and 95.7% in the ultrasound-assisted group and endoscopy group, respectively). The mean amount of EN delivery within the first three days after NJT placement was significantly higher in the ultrasound-assisted group (841.4 kcal (95% CI: 738.8, 944 kcal) vs. 652.5 kcal (95% CI: 562.5, 742.6 kcal), P = 0.018 ). Moreover, a slight increased postprocedural intra-abdominal pressure (IAP) was observed in patients undergoing endoscopic procedures, but not in the ultrasound-assisted group, especially at 6 hours after NJT placement (0.35 vs. -2.01 from baseline, P < 0.05 ). For clinical outcomes, we observed no difference between groups. Conclusion. Compared with endoscopic procedures, ultrasound-assisted NJT placement possesses the acceptable success rates of initial placement procedures.

Use of a Novel Silicone-Acrylic Drape with Negative Pressure Wound Therapy in Four Patients with Periwound Skin Breakdown

Introduction. Negative pressure wound therapy (NPWT) is applied using a foam dressing and an adhesive acrylic drape to create a seal. Removal of this drape can be painful and may play a role in periwound skin breakdown during dressing changes. A novel silicone-acrylic hybrid drape (HA-drape) has been developed for use with NPWT to allow for repositioning after initial placement and easier removal. Objective. This retrospective case series reports on the use of HA-drape in 4 patients who experienced periwound skin breakdown. The goal was to minimize skin breakdown while maintaining a seal on the dressing. Materials and Methods. Four patients with mild to moderate periwound skin breakdown were selected to receive NPWT with HA-drape. Negative pressure wound therapy was applied using a reticulated open cell foam dressing followed by placement of HA-drape to create a seal. Negative pressure wound therapy was initiated at -125 mm Hg with dressing changes occurring every 2 days. Wound healing, periwound healing, and patient-reported pain were assessed at dressing changes. Results. All 4 patients showed significant periwound skin improvement after the first dressing change. All patients reported a decrease in pain with dressing removal. Conclusions. In these 4 patients' wounds, use of NPWT with HA-drape resulted in intact periwound with improved periwound skin healing and reduction in patient-reported pain associated with dressing changes.

Superimposing holograms on real world objects using HoloLens 2 and its depth camera

Augmented Reality glasses such as HoloLens 2 may provide visual guidance during surgical interventions. To superimpose the holograms on real world objects (RWO), for instance a patient, spatial registration is required. In this work, we propose an approach to automatically register a hologram to the according RWO. To this end, the framework utilizes the depth camera of HoloLens 2 to acquire the point cloud (PC) of the RWO. A novel and recently published PC registration algorithm allows to register the PC of the RWO and the hologram after a rough initial placement without any need for pre-processing or outlier removal. The approach is evaluated by measuring displacements between certain known positions of the hologram and the RWO. The first metric relies on measuring points using an optically tracked stylus while the second is based on visually perceived positions. The median displacements were 22.3 mm, 35.6 mm, and 13.3 mm for the x-, y-, and z-axes in the first metric and 8.1 mm, 4.3 mm, and 11.9 mm for the second metric. Even though the accuracy is not yet adequate for many surgical interventions, the framework provides an initial step for a convenient marker less registration of holograms to an RWO.

Two-Roller Continuous Calibration Process by Compression for Submarine Pipelines

Submarine pipeline is a key part in the development of deep sea and ultra-deep sea oil and gas. In order to reduce the ovality of pipes and improve their compressive strength, a two-roller continuous calibration (TRCC) process by compression is proposed. A springback analysis of compress bending is carried out, and an analytical model is established, which predicts ovality after calibration and provides a theoretical basis for roller shape design and process parameter formulation. Numerical simulation and physical experiments are carried out. The distribution of stress and strain is analyzed. The effects of initial ovality, reduction ratio and initial placement angle on the ovality after calibration are studied. When the reduction ratio is about 1%, the ovality is optimal. The theoretical analysis shows that the ovality after calibration is about 0.03%, and the ovality after calibration by numerical simulation and experiment is less than 0.45%, proving the feasibility of the process.

The Power of Place: The Effect of Forced Placement on Refugee Naturaliza-tion

Does initial placement matter for refugee integration? I provide new evidence for the effect of placement on refugee integration. Using Danish register data, I exploit that refugees who obtained residency after January 1 1999 were subject to forced dispersal whereas refugees who obtained res-idency before this cutoff were subject to voluntary dispersal. In a regression discontinuity design, I show that forced dispersal—that induced exogenous variation in initial placement—had a large im-pact on refugees’ likelihood of naturalization. Forced placed refugees are about 26 percent less like-ly to naturalize compared to voluntary placed refugees. Moreover, my findings suggest that this placement effect operates on a synergy mechanism between places and individuals’ characteristics: forced placement affects refugee naturalization negatively because it deteriorates their ability to select into locations that match their own characteristics. Consistent with this mechanism, the drop in naturalization rates is concentrated among the most disadvantaged refugees.

Factors Associated with Umbilical Venous Catheter Malposition in Newborns: A Tertiary Center Experience

Objective Umbilical venous catheters (UVC) are widely used in neonatal intensive care (NICU). Noncentral catheter position is known to be associated with multiple adverse complications; however, risk factors for catheter malposition are unclear. This work aimed to identify clinical risk factors and complications associated with UVC malposition in neonates admitted in an NICU. Study Design A retrospective chart review was performed of inborn babies admitted to BC Women's Hospital NICU with UVC inserted in their first 7 days between July 2016 and June 2018. Infant and maternal demographic, radiograph, UVC-related data, and complications were reviewed. Results A total of 257 infants had UVC placed; 158 (61%) and 99 (39%) were in central and noncentral positions after initial placement, respectively. Of initially central-placed UVCs, a further 35 (22%) were pulled back or migrated to malposition on follow-up X-ray. Multivariable logistic regression analysis revealed the use of larger UV (5 Fr) catheter (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.1–5.6, p = 0.026) and escalation of respiratory support mode (OR: 1.7, 95% CI: 1.0–2.8, p = 0.049) as significant predictors of catheter malposition. Conclusion Noncentral UVC position as well as migration were common after initial placement in this cohort. The use of larger size UV catheters and increasingly invasive respiratory support were risk factors associated with higher incidence of UVC malposition. Ongoing surveillance of UVC position is thus recommended. Key Points

Paradoxical reaction to increased doses of intrathecal baclofen in a patient with Leigh syndrome

In clinical practice, intrathecal baclofen (ITB) therapy is used to control spasticity. After initial placement of the ITB pump, clinicians incrementally increase the dose until effectiveness in alleviating spasms and spasticity is optimized. However, this case describes a 4-year-old male with Leigh syndrome who developed a paradoxical worsening of spasticity and pain with incremental increase of his ITB pump. In this rare genetic disease with a poor prognosis, an ITB pump was trialed and implanted and titrated upwards with initial improvement. However, his spasticity and pain then began to worsen with each dosage increase. Subsequently, his symptoms improved significantly when the dose was weaned. This is the first case that describes this paradoxical reaction in a pediatric population and discusses recommendations about how clinicians should safely titrate the pump for patient care.

Chemical pumps and flexible sheets spontaneously form self-regulating oscillators in solution

The synchronization of self-oscillating systems is vital to various biological functions, from the coordinated contraction of heart muscle to the self-organization of slime molds. Through modeling, we design bioinspired materials systems that spontaneously form shape-changing self-oscillators, which communicate to synchronize both their temporal and spatial behavior. Here, catalytic reactions at the bottom of a fluid-filled chamber and on mobile, flexible sheets generate the energy to “pump” the surrounding fluid, which also transports the immersed sheets. The sheets exert a force on the fluid that modifies the flow, which in turn affects the shape and movement of the flexible sheets. This feedback enables a single coated (active) and even an uncoated (passive) sheet to undergo self-oscillation, displaying different oscillatory modes with increases in the catalytic reaction rate. Two sheets (active or passive) introduce excluded volume, steric interactions. This distinctive combination of the hydrodynamic, fluid–structure, and steric interactions causes the sheets to form coupled oscillators, whose motion is synchronized in time and space. We develop a heuristic model that rationalizes this behavior. These coupled self-oscillators exhibit rich and tunable phase dynamics, which depends on the sheets’ initial placement, coverage by catalyst and relative size. Moreover, through variations in the reactant concentration, the system can switch between the different oscillatory modes. This breadth of dynamic behavior expands the functionality of the coupled oscillators, enabling soft robots to display a variety of self-sustained, self-regulating moves.

Dating the megalithic culture of laos: Radiocarbon, optically stimulated luminescence and U/Pb zircon results

The megalithic jar sites of Laos (often referred to as the Plain of Jars) remain one of Southeast Asia’s most mysterious and least understood archaeological cultures. The sites, recently inscribed as UNESCO World Heritage, host hollowed stone jars, up to three metres in height, which appear scattered across the landscape, alone or clustered in groups of up to more than 400. Until now, it has not been possible to estimate when the jars were first placed on the landscape or from where the stone was sourced. Geochronological analysis using the age of detrital zircons demonstrates a likely quarry source for one of the largest megalithic jar sites. Optically Stimulated Luminescence (OSL) dating suggests the jars were positioned at the sites potentially as early as the late second millennium BC. Radiocarbon dating of skeletal remains and charcoal samples places mortuary activity around the jars from the 9-13th century AD, suggesting the sites have maintained ritual significance from the period of their initial placement until historic times.