Design of a Mechatronic Interface with Compliant Manipulator for Robot Assisted Echocardiography

A compliant manipulator with a compound soft actuator is proposed for robot-assisted echocardiography. The target application is devoted to the TOE echo (Trans-oesophageal echocardiography), which is conventionally performed by medical practitioners. The manual manipulation of the echocardiography probe shows significant risks such as human errors, exposure to ionizing radiation, and multitasking complexity. Automation of TOE provides advantages in terms of control, safety, and workload of the operator. This paper proposes a teleoperated robotic system assisting the physician to perform TOE, to be used in cardiac catheterization laboratories as well as hybrid operation theatres. A system containing a holder with master-slave Dynamixel servos and a manipulator with soft actuators has been developed. To alleviate the major lack of the previous designs in conducting the insertion tube, a robotic arm with a soft structure is proposed that has not hazards of conventional robot manipulators. The fundamental equations and relations for quasi-static control of the system are developed in this paper.

Prototype single-balloon enteroscopy with passive bending and high force transmission improves depth of insertion in the small intestine

Background/Aims: We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE.Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points.Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (<i>P</i>=0.03, Wilcoxon’s signed-rank test).Conclusions: In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)

An Electro-Thermal Actuation Method for Resonance Vibration of a Miniaturized Optical-Fiber Scanner for Future Scanning Fiber Endoscope Design

Medical professionals increasingly rely on endoscopes to carry out many minimally invasive procedures on patients to safely examine, diagnose, and treat a large variety of conditions. However, their insertion tube diameter dictates which passages of the body they can be inserted into and, consequently, what organs they can access. For inaccessible areas and organs, patients often undergo invasive and risky procedures—diagnostic confirmation of peripheral lung nodules via transthoracic needle biopsy is one example from oncology. Hence, this work sets out to present an optical-fiber scanner for a scanning fiber endoscope design that has an insertion tube diameter of about 0.5 mm, small enough to be inserted into the smallest airways of the lung. To attain this goal, a novel approach based on resonance thermal excitation of a single-mode 0.01-mm-diameter fiber-optic cantilever oscillating at 2–4 kHz is proposed. The small size of the electro-thermal actuator enables miniaturization of the insertion tube. Lateral free-end deflection of the cantilever is used as a benchmark for evaluating performance. Experimental results show that the cantilever can achieve over 0.2 mm of displacement at its free end. The experimental results also support finite element simulation models which can be used for future design iterations of the endoscope.

Association Between Storage Interval and Contamination of Reprocessed Flexible Endoscopes in a Pediatric Gastrointestinal Procedural Unit

OBJECTIVEThe maximum safe storage interval after endoscope reprocessing remains unknown. We assessed the association between storage interval and endoscope contamination to evaluate the need for scope reprocessing prior to use.METHODSWe conducted a study in 2 phases. In phase 1, we cultured 9 gastrointestinal (GI) endoscopes that had been stored for at least 7 days since reprocessing. Each scope was cultured in 3 places: external surfaces of hand piece, insertion tube, and internal channels. In phase 2, after reprocessing these scopes, we hung and cultured them prospectively in a similar fashion at 1-, 2-, 4-, 6-, and 8-week intervals without patient use. We defined clinically relevant contamination as >100 colony-forming units per milliliter (CFU/mL).RESULTSIn phase 1, median hang time was 69 days (range, 8–555 days). Considering the 27 total cultures, 3 of 27 GI endoscopes (11.1%) had positive cultures, all with nonpathogenic skin flora at ≤100 CFU/mL. Median hang time was not statistically different between scopes with positive and negative cultures (P=.82). In phase 2, 7 of 131 prospective cultures (5.3%) from 6 of 9 GI endoscopes at varying storage intervals were positive, all at ≤100 CFU/mL. At 56 days after reprocessing (the longest storage interval studied), 1 of 24 cultures (4.2%) was positive (100 CFU/mL ofBacillusspecies from external biopsy/suction ports).CONCLUSIONSNo endoscopes demonstrated clinically relevant contamination at hang times ranging from 7 to 555 days, and most scopes remained uncontaminated up to 56 days after reprocessing. Our data suggest that properly cleaned and disinfected GI endoscopes could be stored safely for longer intervals than currently recommended.Infect. Control Hosp. Epidemiol.2017;38:131–135

Unintended Avulsion of Hypertrophic Adenoids in Posterior Nasopharynx: A Case Report of a Rare Complication Caused by Nasotracheal Intubation

The enlarged adenoid serves as a mechanical obstacle on the nasopharynx to intricate nasotracheal intubation. No matter what video or direct laryngoscopic techniques are applied, nasotracheal tube navigation from the nasal valve area through the nasal cavity to the nasopharynx is always blind; trauma is not uncommon. Here we report a case of unintended avulsed adenoids that plugged the tube tip while the nasotracheal tube blindly navigated through the nasopharyngeal space. After failing to insert a bent tip of gum elastic bougie passing through the nasopharynx, an alternative method of NTI was performed by mounting the nasotracheal tube on a fiberoptic bronchoscope. The nasotracheal tube was successfully railroaded along the insertion tube of the fiberscope to the trachea.

Study on Performance of Automobiles Muffler Based on Sound Transfer Matrix Theory

According to the characteristics of automobiles exhaust noise of high pressure level and middle-low frequency, combining sound transfer matrix theory and FEM-Fluid analysis method, simulations of the transmission loss with non-insertion tube expansion chamber muffler, single insertion tube expansion chamber muffler and dual insertion tube expansion chamber muffler are carried out, which obtain the transmission loss curves of mufflers in different structures and different perforation rates. The results show that the max transmission loss and the average transmission loss of the muffler with perforation rate of 5% are greater than that of 3% and 10% below the low frequency of 200Hz; dual insertion tube expansion chamber muffler not only can increase the transmission loss below the frequency of 4000Hz, but also can effectively improve the performance of the mufflers in which have non-perforation tube and single insertion tube at some frequency points. The results of research can provide technical reference for exhaust muffler design of automotive.

Rinsability of Orthophthalaldehyde from Endoscopes

Orthophthalaldehyde high level disinfectants are contraindicated for use with urological instruments such as cystoscopes due to anaphylaxis-like allergic reactions during surveillance of bladder cancer patients. Allergic reactions and mucosal injuries have also been reported following colonoscopy, laryngoscopy, and transesophageal echocardiography with devices disinfected using orthophthalaldehyde. Possibly these endoscopes were not adequately rinsed after disinfection by orthophthalaldehyde. We examined this possibility by means of a zone-of-inhibition test, and also a test to extract residues of orthophthalaldehyde with acetonitrile, from sections of endoscope insertion tube materials, to measure the presence of alkaline glutaraldehyde, or glutaraldehyde plus 20% w/w isopropanol, or ortho-phthalaldehyde that remained on the endoscope materials after exposure to these disinfectants followed by a series of rinses in water, or by aeration overnight. Zones of any size indicated the disinfectant had not been rinsed away from the endoscope material. There were no zones of inhibition surrounding endoscope materials soaked in glutaraldehyde or glutaraldehyde plus isopropanol after three serial water rinses according to manufacturers' rinsing directions. The endoscope material soaked in orthophthalaldehyde produced zones of inhibition even after fifteen serial rinses with water. Orthophthalaldehyde was extracted from the rinsed endoscope material by acetonitrile. These data, and other information, indicate that the high level disinfectant orthophthalaldehyde, also known as 1,2-benzene dialdehyde, cannot be rinsed away from flexible endoscope material with any practical number of rinses with water, or by drying overnight.