Randomized comparison of 3 different-sized biopsy forceps for quality of sampling in Barrett’s esophagus

PubMed Central

Gonzalez, Susana; Yu, Woojin M.; Smith, Michael S.; Slack, Kristen N.; Rotterdam, Heidrun; Abrams, Julian A.; Lightdale, Charles J.

2011-01-01

Background Several types of forceps are available for use in sampling Barrett’s esophagus (BE). Few data exist with regard to biopsy quality for histologic assessment. Objective To evaluate sampling quality of 3 different forceps in patients with BE. Design Single-center, randomized clinical trial. Patients Consecutive patients with BE undergoing upper endoscopy. Interventions Patients randomized to have biopsy specimens taken with 1 of 3 types of forceps: standard, large capacity, or jumbo. Main Outcome Measurements Specimen adequacy was defined a priori as a well-oriented biopsy sample 2 mm or greater in diameter and with at least muscularis mucosa present. Results A total of 65 patients were enrolled and analyzed (standard forceps, n = 21; large-capacity forceps, n = 21; jumbo forceps, n = 23). Compared with jumbo forceps, a significantly higher proportion of biopsy samples with large-capacity forceps were adequate (37.8% vs 25.2%, P = .002). Of the standard forceps biopsy samples, 31.9% were adequate, which was not significantly different from specimens taken with large-capacity (P = .20) or jumbo (P = .09) forceps. Biopsy specimens taken with jumbo forceps had the largest diameter (median, 3.0 mm vs 2.5 mm [standard] vs 2.8 mm [large capacity]; P = .0001). However, jumbo forceps had the lowest proportion of specimens that were well oriented (overall P = .001). Limitations Heterogeneous patient population precluded dysplasia detection analyses. Conclusions Our results challenge the requirement of jumbo forceps and therapeutic endoscopes to properly perform the Seattle protocol. We found that standard and large-capacity forceps used with standard upper endoscopes produced biopsy samples at least as adequate as those obtained with jumbo forceps and therapeutic endoscopes in patients with BE. PMID:21034895

Resorbable Self-Locking Implant for Lung Lobectomy Through Video-Assisted Thoracoscopic Surgery: First Live Animal Application.

PubMed

Guedes, Rogério Luizari; Höglund, Odd Viking; Brum, Juliana Sperotto; Borg, Niklas; Dornbusch, Peterson Triches

2018-04-01

The aim of this pilot test was to test a new self-locking resorbable implant for hilum occlusion during a video-assisted thoracoscopic lung lobectomy in a surviving pig model. Once the thoracic cavity was assessed and structures identified, the right middle lobe and its respective hilum were exposed. The implant was introduced with a semiclosed loop through a working channel and positioned around the pulmonary lobe. Occlusion was performed with a conventional Crile forceps and a laparoscopic Kelly forceps. Lobe section was done with laparoscopic Metzenbaum scissors and tissue removal through the dorsal access. No signs of pneumothorax or bleeding were observed during a 60-day follow-up. Necropsy findings showed minimal pleuritis in caudal access and in the lobar stump. A granulomatous formation was found around a dense, amorphous material, which was identified as remains of a small part of the implant. Histopathological findings showed signs of a chronic healing process without other alterations. The resorbable implant LigaTie appears to exhibit similar handling and application characteristics during surgery as nonsurgical tie wraps. The resorbable implant avoids the uncontrolled substances not suitable for implants of conventional ties. The results of this pilot test suggested the resorbable implant's mechanical properties provided effective tissue support to complete the healing of the pulmonary hilum.

Performance of disposable endoscopic forceps according to the manufacturing techniques.

PubMed

Kwon, Chang-Il; Kim, Gwangil; Moon, Jong Pil; Yun, Ho; Ko, Weon Jin; Cho, Joo Young; Hong, Sung Pyo

2018-03-05

Recently, to lower the production costs and risk of infection, new disposable biopsy forceps made using simple manufacturing techniques have been introduced. However, the effects of the manufacturing techniques are unclear. The aim of this study was to evaluate which types of biopsy forceps could obtain good-quality specimens according to the manufacturing techniques. By using an in vitro nitrile glove popping model, we compared the popping ability among eight different disposable biopsy forceps (one pair of biopsy forceps with cups made by a cutting method [cutting forceps], four pairs of biopsy forceps with cups made by a pressing method [pressing forceps], and three pairs of biopsy forceps with cups made using a injection molding method [molding forceps]). Using an in vivo swine model, we compared the penetration depth and quality of specimen among the biopsy forceps. In the in vitro model, the molding forceps provided a significantly higher popping rate than the other forceps (cutting forceps, 25.0%; pressing forceps, 17.5%; and molding forceps, 41.7%; p = 0.006). In the in vivo model, the cutting and pressing forceps did not provide larger specimens, deeper biopsy specimen, and higher specimen adequacy than those obtained using the molding forceps (p = 0.2631, p = 0.5875, and p = 0.2147, respectively). However, the molding forceps showed significantly more common crush artifact than the others (cutting forceps, 0%; pressing forceps, 5.0%; and molding forceps, 43.3%; p = 0.0007). The molding forceps provided lower performance than the cutting and pressing forceps in terms of crush artifact.

The universal scissor component: Optimization of a reconfigurable component for deployable scissor structures

NASA Astrophysics Data System (ADS)

Alegria Mira, Lara; Thrall, Ashley P.; De Temmerman, Niels

2016-02-01

Deployable scissor structures are well equipped for temporary and mobile applications since they are able to change their form and functionality. They are structural mechanisms that transform from a compact state to an expanded, fully deployed configuration. A barrier to the current design and reuse of scissor structures, however, is that they are traditionally designed for a single purpose. Alternatively, a universal scissor component (USC)-a generalized element which can achieve all traditional scissor types-introduces an opportunity for reuse in which the same component can be utilized for different configurations and spans. In this article, the USC is optimized for structural performance. First, an optimized length for the USC is determined based on a trade-off between component weight and structural performance (measured by deflections). Then, topology optimization, using the simulated annealing algorithm, is implemented to determine a minimum weight layout of beams within a single USC component.

THREE PORT LAPAROSCOPIC APPENDECTOMY TECHNIQUE WITH LOW COST AND AESTHETIC ADVANTAGE

PubMed Central

DOMENE, Carlos Eduardo; VOLPE, Paula; HEITOR, Frederico Almeida

2014-01-01

Introduction Despite dating more than 30 years after the first laparoscopic appendectomy, ileocecal appendix resection is still performed by laparotomy in more than 90% of cases, in our country. Aim To describe a technique for laparoscopic removal of the ileocecal appendix with three portals, at low cost and very good aesthetic appearance. Technique Three incisions, one umbilical and two suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner. Conclusion The proposed technique is safe and reproducible, easily teachable, at very low cost and can be applied in general hospitals with conventional laparoscopic equipment. PMID:25409972

Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port

PubMed Central

Mori, Hirohito; Kobayashi, Nobuya; Kobara, Hideki; Nishiyama, Noriko; Fujihara, Shintaro; Chiyo, Taiga; Ayaki, Maki; Nagase, Takashi; Masaki, Tsutomu

2016-01-01

AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not. METHODS: Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port. RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port. CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human. PMID:27053847

Flex-rigid pleuroscopic biopsy with the SB knife Jr is a novel technique for diagnosis of malignant or benign fibrothorax.

PubMed

Wang, Xiao-Bo; Yin, Yan; Miao, Yuan; Eberhardt, Ralf; Hou, Gang; Herth, Felix J; Kang, Jian

2016-11-01

Diagnosing pleural effusion is challenging, especially in patients with malignant or benign fibrothorax, which is difficult to sample using standard flexible forceps (SFF) via flex-rigid pleuroscopy. An adequate sample is crucial for the differential diagnosis of malignant fibrothorax (malignant pleural mesothelioma, metastatic lung carcinoma, etc.) from benign fibrothorax (benign asbestos pleural disease, tuberculous pleuritis, etc.). Novel biopsy techniques are required in flex-rigid pleuroscopy to improve the sample size and quality. The SB knife Jr, which is a scissor forceps that uses a mono-pole high frequency, was developed to allow convenient and accurate resection of larger lesions during endoscopic dissection (ESD). Herein, we report two patients with fibrothorax who underwent a pleural biopsy using an SB knife Jr to investigate the potential use of this tool in flex-rigid pleuroscopy when pleural lesions are difficult to biopsy via SFF. The biopsies were successful, with sufficient size and quality for definitive diagnosis. We also successfully performed adhesiolysis with the SB knife Jr in one case, and adequate biopsies were conducted. No complications were observed. Electrosurgical biopsy with the SB knife Jr during flex-rigid pleuroscopy allowed us to obtain adequate samples for the diagnosis of malignant versus benign fibrothorax, which is usually not possible with SFF. The SB knife Jr also demonstrated a potential use for pleuropulmonary adhesions.

Randomized, controlled trial of standard, large-capacity versus jumbo biopsy forceps for polypectomy of small, sessile, colorectal polyps.

PubMed

Draganov, Peter V; Chang, Myron N; Alkhasawneh, Ahmad; Dixon, Lisa R; Lieb, John; Moshiree, Baharak; Polyak, Steven; Sultan, Shahnaz; Collins, Dennis; Suman, Amitabh; Valentine, John F; Wagh, Mihir S; Habashi, Samir L; Forsmark, Chris E

2012-01-01

Polypectomy with cold biopsy forceps is a frequently used technique for removal of small, sessile, colorectal polyps. Jumbo forceps may lead to more effective polypectomy because of the larger size of the forceps cup. To evaluate the efficiency of cold jumbo biopsy forceps compared with standard forceps for polypectomy of small, sessile, colorectal polyps. Randomized, controlled trial. Outpatient endoscopy center. This study involved 140 patients found to have at least one eligible polyp defined as a sessile polyp measuring ≤6 mm. Polypectomy with cold biopsy forceps. Complete visual polyp eradication with one forceps bite. In 140 patients, a total of 305 eligible polyps were detected (151 removed with jumbo forceps and 154 with standard forceps). Complete visual eradication of the polyp with one forceps bite was achieved in 78.8% of the jumbo forceps group and 50.7% of the standard forceps group (P < .0001). Biopsies from the polypectomy sites of adenomatous polyps thought to be visually completely eradicated with one bite showed a trend toward a higher complete histologic eradication rate with the jumbo forceps (82.4%) compared with the standard forceps (77.4%), but the difference did not reach statistical significance (P = .62). The withdrawal time for visual inspection of the colon and time to perform polypectomies were significantly shorter in the jumbo forceps group (mean 21.43 vs 18.23 minutes; P = .02). Lack of blinding to the type of forceps used. The jumbo biopsy forceps is superior to the standard forceps in removing small, sessile polyps. ( NCT00855790.). Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Evaluating Quality and Adequacy of Gastrointestinal Samples Collected using Reusable or Disposable Forceps.

PubMed

Cartwright, J A; Hill, T L; Smith, S; Shaw, D

2016-07-01

Sample quality of gastrointestinal endoscopic biopsies is of paramount importance for accurate histological diagnosis. Many veterinary practices use reusable forceps as a result of perceived decreased cost. With reusable forceps, it remains unknown whether sample quality declines with repeated use and becomes inferior to single-use forceps and is therefore more or less cost effective than single-use forceps. The study hypothesis was that reusable forceps sample quality would deteriorate after repeated use as compared to single-use forceps. Sixty-five dogs undergoing gastrointestinal endoscopy for diagnostic investigations at the Hospital for Small Animals, Edinburgh University. A prospective, pathologist-blinded study comparing single-use and reusable alligator standard cup biopsy forceps (Olympus 2.0 mm 1550 mm) with 5 randomized reusable forceps. Sample quality (stomach, duodenum, ileum, and colon) was assessed by a single pathologist using the WSAVA guidelines. There was no difference in the adequacy, depth, villi number, or crush artifact in the 4 intestinal areas between forceps type with at least 10, and up to 15, repeated uses of the reusable forceps. This study demonstrates that reusable cup biopsy forceps provide equivalent biopsy quality after repeated uses to single-use forceps and are cost effective at 10-case use. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Scissor-type knife significantly improves self-completion rate of colorectal endoscopic submucosal dissection: Single-center prospective randomized trial.

PubMed

Yamashina, Takeshi; Takeuchi, Yoji; Nagai, Kengo; Matsuura, Noriko; Ito, Takashi; Fujii, Mototsugu; Hanaoka, Noboru; Higashino, Koji; Uedo, Noriya; Ishihara, Ryu; Iishi, Hiroyasu

2017-05-01

Colorectal endoscopic submucosal dissection (C-ESD) is recognized as a difficult procedure. Recently, scissors-type knives were launched to reduce the difficulty of C-ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors-type knife and a needle-type knife with a water-jet function (WJ needle-knife) for C-ESD compared with using the WJ needle-knife alone. This was a prospective randomized controlled trial in a referral center. Eighty-five patients with superficial colorectal neoplasms were enrolled and randomly assigned to undergo C-ESD using a WJ needle-knife alone (Flush group) or a scissor-type knife-supported WJ needle-knife (SB Jr group). Procedures were conducted by two supervised residents. Primary endpoint was self-completion rate by the residents. Self-completion rate was 67% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C-ESD was completed using the WJ needle-knife alone, the self-completion rate was significantly higher (63% vs 39%; P = 0.03). Median procedure time among the self-completion cases did not differ significantly between the two groups (59 vs 51 min; P = 0.14). No fatal adverse events were observed in either group. In this single-center phase II trial, scissor-type knife significantly improved residents' self-completion rate for C-ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study. © 2016 Japan Gastroenterological Endoscopy Society.

Hand cumulative trauma disorders in Nigerian custom tailors: the need for redesign of manual scissors.

PubMed

Adeleye, Adedoyin Abiodun; Akanbi, Olusegun Gabriel

2015-01-01

Cutting scissors are important working tools for Nigerian custom tailors (CTs) but its usage apparently does not meet the ergonomics need of these artisans. A survey was carried out amongst CTs using questionnaires to obtain their background social-occupational demographics and observation methods to study their work performance, use of scissors and any cumulative trauma disorder (CTD) in their hands. Thicknesses of various fabrics were measured and comparison between Western world's custom tailoring job and the Nigerian type was done. The results showed some CTD risk factors with finger contusions on the 71 CTs evaluated. The right-hand contusions were traced to the constant usage of unpadded manual scissors with ungloved hands. Disparity between Western and Nigerian tailoring practice may account for the high occurrence of disorders in Nigerian CTs. Since hand dimensions are crucial in the design of hand tools, it is therefore concluded that hand anthropometry of Nigerian CTs and soft padding of manual scissors may mitigate CTD burdens on CTs' hands. Cumulative trauma disorders on the hands of low-income Nigerian CTs needed investigation. This was done via self-assessment and observational methods of the artisans’ work system. Frequent usage of unpadded manual scissors with un-gloved hands cause and exacerbate the problem. Hand anthropometry of users is crucial in scissors manufacturing.

A randomised trial of sheathed versus standard forceps for obtaining uncontaminated biopsy specimens of microbiota from the terminal ileum.

PubMed

Dave, Maneesh; Johnson, Laura A; Walk, Seth T; Young, Vincent B; Stidham, Ryan W; Chaudhary, Meghana N; Funnell, Jessica; Higgins, Peter D R

2011-08-01

The study of intestinal microbiota has been revolutionised by the use of molecular methods, including terminal restriction fragment length polymorphism (T-RFLP) analysis. Microbiota studies of Crohn's disease patients have examined samples from stool or from the neoterminal ileum with a standard biopsy forceps, which could be contaminated by colonic bacteria when the forceps passes through the colonoscope channel. To determine whether sheathed biopsy forceps are able to obtain terminal ileal microbiota samples with less colonic bacterial contamination compared with unsheathed (standard) biopsy forceps. Prospective randomised single-centre study. Four (paired) biopsy specimens were obtained from adjacent locations in the terminal ileum using the sheathed and standard forceps of 27 consecutive subjects undergoing colonoscopy and the microbiota were characterised using T-RFLP. The Bray-Curtis similarity index between samples (sheathed vs unsheathed forceps) was calculated within patients and significant differences were tested for across all patients. There was not a significant difference in the microbial diversity of samples obtained using sheathed versus unsheathed forceps. The difference in microbial diversity between patients was much greater than the variability within patients by proximal versus distal site or by forceps type. T-RFLP is based on PCR amplification, so it is not always sensitive to rare bacterial species. Standard unsheathed forceps appear to be sufficient for microbiota sample collection from the terminal ileum.

21 CFR 874.4710 - Esophagoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the...

21 CFR 874.4710 - Esophagoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the...

Early-stage gastric cancers represented as dysplasia in a previous forceps biopsy: the importance of clinical management.

PubMed

Park, Jin Seok; Hong, Su Jin; Han, Jae Pil; Kang, Myung Soo; Kim, Hee Kyung; Kwak, Jeong Ja; Ko, Bong Min; Cho, Joo Young; Lee, Joon Seong; Lee, Moon Sung

2013-02-01

Because histological examination of gastric lesions by forceps biopsy is of limited accuracy, management on the basis of histological results is occasionally controversial. We examined the characteristics of early gastric cancers that presented as dysplasia resulting from a previous forceps biopsy. Between April 2007 and December 2010, 341 gastric adenocarcinoma lesions from 330 patients previously diagnosed histologically via endoscopic submucosal dissection were examined. We retrospectively assessed the characteristics of early gastric cancer according to their initial forceps biopsy results. In total, 183 EGCs were diagnosed as dysplasia (53.7%; 89 low-grade and 94 high-grade) and 158 (46.3%) as carcinoma by forceps biopsy before endoscopic submucosal dissection. Significant differences were noted with respect to histologic differentiation of carcinomas, Lauren histologic type, depth of invasion, lymphovascular invasion, and en bloc resection between the dysplastic group and carcinoma group, based on forceps biopsy results. A forceps biopsy result is not fully representative of the entire lesion and, thus, endoscopic submucosal dissection should be considered for lesions diagnosed as dysplasia via forceps biopsy in order to avoid the risk of missed carcinomas. Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

A Randomized Trial of Sheathed vs. Standard Forceps for Obtaining Uncontaminated Biopsy Specimens of Microbiota from the Terminal Ileum

PubMed Central

Dave, Maneesh; Johnson, Laura A.; Walk, Seth; Young, Vincent B.; Stidham, Ryan W.; Chaudhary, Meghana N.; FunNell, Jessica; Higgins, Peter D.R.

2014-01-01

Background The study of intestinal microbiota has been revolutionized by the use of molecular methods, including terminal restriction fragment length polymorphism (T-RFLP) analysis. A number of microbiota studies of Crohn’s disease patients have examined samples from stool or from the neoterminal ileum with a standard biopsy forceps, which could be contaminated by colonic bacteria when the forceps passes through the colonoscope channel. Objective To determine whether sheathed biopsy forceps are able to obtain terminal ileal microbiota samples with less colonic bacterial contamination compared to unsheathed (standard) biopsy forceps. Design Prospective randomized single center-study. Patients and Methods We obtained four (paired) biopsy specimens from adjacent locations in the terminal ileum using the sheathed and standard forceps of 27 consecutive subjects undergoing colonoscopy and characterized the microbiota using T-RFLP. We calculated the Bray Curtis similarity index (BCI) between samples (sheathed vs. unsheathed forceps) within patients and tested for significant differences across all patients. Results There was not a significant difference in the microbial diversity of samples obtained using sheathed vs. unsheathed forceps. The difference in microbial diversity between patients was much greater than the variability within patients by proximal vs. distal site or by forceps type. Limitations T-RFLP is based on PCR amplification, so it is not always sensitive to rare bacterial species. Conclusion Standard unsheathed forceps appear to be sufficient for microbiota sample collection from the terminal ileum. PMID:21317176

Are we all doing it wrong? Influence of stripping and cleaving methods of laser fibers on laser lithotripsy performance.

PubMed

Kronenberg, Peter; Traxer, Olivier

2015-03-01

We assessed whether stripping and cleaving the laser fiber tip with specialized tools, namely laser fiber strippers, or ceramic or metal scissors, would influence lithotripsy performance. Laser fiber tips were stripped with a specialized laser fiber stripper or remained coated. The tips were then cleaved with metal or ceramic scissors. Laser lithotripsy experiments were performed with the 4 fiber tip combinations using an automated laser fragmentation testing system with artificial stones made of plaster of Paris or BegoStone Plus (Bego, Lincoln, Rhode Island). High frequency-low pulse energy (20 Hz and 0.5 J) and low frequency-high pulse energy (5 Hz and 2.0 J) settings were used for 30 seconds. Fissure width, depth and volume, and laser fiber tip photos were analyzed. Coated laser fiber tips always achieved significantly higher ablation volumes (sometimes greater than 50%) than stripped laser fiber tips (p <0.00001) regardless of cleaving scissor type, stone material or lithotripter setting. Coated fiber tips cleaved with metal scissors ablated as well as those cleaved with ceramic scissors (p = 0.16). However, stripped fibers were much less ablative when they were cut with metal scissors compared to ceramic scissors (p <0.00001). Harder stone material decreased ablation volume (p <0.00001). Low frequency-high pulse energy settings were an average of 3 times more ablative than high frequency-low pulse energy settings (p <0.00001). Stripping the fibers, a harder stone material and low frequency-high pulse energy settings were associated with increased fiber tip degradation. Coated laser fibers provided better lithotripsy performance and metal scissors were as good as ceramic scissors to cleave coated fibers. This knowledge may improve and simplify the way that laser lithotripsy procedures are done worldwide. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Single use versus reuse of endoscopy biopsy forceps: A survey of patient preference.

PubMed

Davavala, Sandeep; Abraham, Philip; Desai, Devendra; Joshi, Anand; Gupta, Tarun; Samant, Hrishikesh

2016-01-01

Although there are no confirmatory data on this, we suspect that most endoscopy centres in India reuse single-use ('disposable') endoscopic biopsy forceps due to the cost of these forceps and the perceived low risk of infection transmission on reuse. Low-cost single-use biopsy forceps are now available in India, bringing into question the justification for such a practice. We aimed to determine the type of forceps (single-use or reused) patients would prefer during endoscopy for themselves, whether this is dependent on cost, and what cost would be acceptable to them. Among patients (conveniently selected from indoor or outdoor) reporting for endoscopy at the division of gastroenterology at a private tertiary-level hospital, we distributed an information sheet about the survey 30-45 minutes before the procedure. After they completed reading the sheet, an endoscopy nurse and/or doctor explained the study. The patient then completed a questionnaire of multiple choices with tick boxes. Of 151 patients approached, 4 declined to participate. Of 147 patients surveyed (age range 16-83 years; 82 men), 127 (86.4%) preferred single-use forceps, 16 (10.9%) preferred reused forceps, and 4 (2.7%) could not decide and left the decision to the physician. When informed that single-use forceps may be available for about ₹1000 (approximately US$ 15), 131 patients (89.1%) preferred these forceps, 11 (7.4%) preferred reused forceps, and 5 (3.4%) could not decide. Forty-four patients (33.1%) stated that an acceptable cost for a forceps for them would be ₹500 (approximately US$ 8), for 65 patients (48.9%) patients it was ₹1000, and for 24 (18.1%) it was ₹1500. About 90% of patients in this survey preferred single-use forceps; a cost of ₹1000 for single-use forceps was acceptable to over two-thirds of them.

Can the 1.8 mm transnasal biopsy forceps instead of standard 2.2 mm alter rapid urease test and histological diagnosis?

PubMed

Jeon, Su Jin; Shin, Sung Jae; Lee, Kee Myung; Lim, Sun Kyu; Lee, Yoon Chul; Lee, Myung Hee; Hwang, Jae Cheol; Cheong, Jae Youn; Yoo, Byung Moo; Kim, Jin Hong

2012-08-01

Biopsy specimens are taken during transnasal esophagogastroduodenoscopy with 1.8 mm forceps. The aims of this study were to compare the concordance of the Campylobacter-like organism (CLO) test and histological diagnoses between biopsies taken with 1.8 mm and 2.2 mm forceps and to determine whether the concordance of the CLO test could be improved by increasing the number of specimens using 1.8 mm forceps. A total of 200 patients were enrolled. We first performed the CLO test twice using each sample taken with both forceps in 100 patients. The CLO test was conducted three times again after confirming the difference in the CLO test between two forceps: (i) one sample with 1.8 mm forceps; (ii) two with 1.8 mm; and (iii) one with 2.2 mm in the other 100 patients. Additionally, each specimen was taken from the same gastric lesions in 200 patients for the histological diagnosis using both forceps types. The concordance rate of the CLO test between each sample with 1.8 mm and 2.2 mm forceps was 83% (κ-value, 0.64), and that between two samples with 1.8 mm and one with 2.2 mm was 92% (κ-value, 0.83). The concordance rate of the histological diagnosis with 1.8 and 2.2 mm was 97% (κ-value, 0.84). At least two samples using 1.8 mm forceps might be needed to obtain similar results on the CLO test using 2.2 mm. But, the size difference between two forceps did not influence the histological diagnosis. © 2012 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

Endoscope and System and Method of Operation Thereof

NASA Technical Reports Server (NTRS)

Manohara, Harish M. (Inventor); Liao, Anna (Inventor); Bae, Youngsam (Inventor); Shahinian, Hrayr Karnig (Inventor)

2017-01-01

An endoscope including a rigid section having opposed first and second ends and an opening situated between the first and second ends, the rigid section defining a longitudinal axis; a handle portion coupled to a first end of the rigid section and having first and second scissor-type handles suitable for grasping by a user; and a base part situated at the second end of the rigid section and coupled to the first handle of the scissor-type handles such that displacement of the first handle causes a rotation of the base part.

Endoscope and System and Method of Operation Thereof

NASA Technical Reports Server (NTRS)

Manohara, Harish M. (Inventor); Liao, Anna (Inventor); Bae, Youngsam (Inventor); Shahinian, Hrayr Karnig (Inventor)

2012-01-01

An endoscope including a rigid section having opposed first and second ends and an opening situated between the first and second ends, the rigid section defining a longitudinal axis; a handle portion coupled to a first end of the rigid section and having first and second scissor-type handles suitable for grasping by a user; and a base part situated at the second end of the rigid section and coupled to the first handle of the scissor-type handles such that displacement of the first handle causes a rotation of the base part.

21 CFR 874.4720 - Mediastinoscope and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... The device is made of materials such as stainless steel. This generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, and flexible biopsy curette, but excludes the fiberoptic light source and carrier. (b...

21 CFR 874.4720 - Mediastinoscope and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... The device is made of materials such as stainless steel. This generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, and flexible biopsy curette, but excludes the fiberoptic light source and carrier. (b...

21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... such as stainless steel or flexible plastic. This generic type of device includes the rigid ventilating... foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but...

21 CFR 874.4760 - Nasopharyngoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... made of materials such as stainless steel and flexible plastic. This generic type of device includes..., salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier...

21 CFR 874.4760 - Nasopharyngoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... made of materials such as stainless steel and flexible plastic. This generic type of device includes..., salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier...

FBG-based sensorized light pipe for robotic intraocular illumination facilitates bimanual retinal microsurgery.

PubMed

Horise, Yuki; He, Xingchi; Gehlbach, Peter; Taylor, Russell; Iordachita, Iulian

2015-01-01

In retinal surgery, microsurgical instruments such as micro forceps, scissors and picks are inserted through the eye wall via sclerotomies. A handheld intraocular light source is typically used to visualize the tools during the procedure. Retinal surgery requires precise and stable tool maneuvers as the surgical targets are micro scale, fragile and critical to function. Retinal surgeons typically control an active surgical tool with one hand and an illumination source with the other. In this paper, we present a "smart" light pipe that enables true bimanual surgery via utilization of an active, robot-assisted source of targeted illumination. The novel sensorized smart light pipe measures the contact force between the sclerotomy and its own shaft, thereby accommodating the motion of the patient's eye. Forces at the point of contact with the sclera are detected by fiber Bragg grating (FBG) sensors on the light pipe. Our calibration and validation results demonstrate reliable measurement of the contact force as well as location of the sclerotomy. Preliminary experiments have been conducted to functionally evaluate robotic intraocular illumination.

Minimally invasive surgery. Future developments.

PubMed

Wickham, J E

1994-01-15

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures.

Eponymous Instruments in Orthopaedic Surgery

PubMed Central

Buraimoh, M. Ayodele; Liu, Jane Z.; Sundberg, Stephen B.; Mott, Michael P.

2017-01-01

Abstract Every day surgeons call for instruments devised by surgeon trailblazers. This article aims to give an account of commonly used eponymous instruments in orthopaedic surgery, focusing on the original intent of their designers in order to inform how we use them today. We searched PubMed, the archives of longstanding medical journals, Google, the Internet Archive, and the HathiTrust Digital Library for information regarding the inventors and the developments of 7 instruments: the Steinmann pin, Bovie electrocautery, Metzenbaum scissors, Freer elevator, Cobb periosteal elevator, Kocher clamp, and Verbrugge bone holding forceps. A combination of ingenuity, necessity, circumstance and collaboration produced the inventions of the surgical tools numbered in our review. In some cases, surgical instruments were improvements of already existing technologies. The indications and applications of the orthopaedic devices have changed little. Meanwhile, instruments originally developed for other specialties have been adapted for our use. Although some argue for a transition from eponymous to descriptive terms in medicine, there is value in recognizing those who revolutionized surgical techniques and instrumentation. Through history, we have an opportunity to be inspired and to better understand our tools. PMID:28852360

The effect of opponent type on human performance in a three-alternative choice task.

PubMed

Lie, Celia; Baxter, Jennifer; Alsop, Brent

2013-10-01

Adult participants played computerised games of "Paper Scissors Rock". Participants in one group were told that they were playing against the computer, and those in the other group were told that they were playing against another participant in the adjacent room. The participant who won the most games would receive a $50 prize. For both groups however, the opponent's responses (paper, scissors, or rock) were generated by the computer, and the distribution of these responses was varied across four blocks of 126 trials. Results were analysed using the generalised matching law for the three possible pairs of alternatives (paper vs. scissors, paper vs. rock, and scissors vs. rock) across all participants in each group. Overall, significantly higher estimates of sensitivity to the distribution of opponent's responses were obtained from participants who were told their opponent was a computer compared to participants who were told their opponent was another participant. While adding to the existing literature showing that the generalised matching law is an adequate descriptor of human three-alternative choice behaviour, these findings show that external factors such as perceived opponent type can affect the efficacy of reinforcer contingencies on human behaviour. This suggests that generalising the results from tasks performed against a computer to real-life human-to-human interactions warrants some caution. Copyright © 2013 Elsevier B.V. All rights reserved.

Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

PubMed Central

2011-01-01

Here we report the method of anastomosis based on double stapling technique (hereinafter, DST) using a trans-oral anvil delivery system (EEATM OrVilTM) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod were made completely linear, the anvil and the main unit were connected with each other and firing was carried out. Then, DST-based anastomosis was completed with no dog-ear. The method may facilitate safe laparoscopic anastomosis between the esophagus and reconstructed intestine. This is also considered to serve as a useful anastomosis technique for upper levels of the esophagus in laparotomy. PMID:21599911

21 CFR 880.6820 - Medical disposable scissors.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Medical disposable scissors. 880.6820 Section 880...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Miscellaneous Devices § 880.6820 Medical disposable scissors. (a) Identification. Medical disposable scissors are...

21 CFR 880.6820 - Medical disposable scissors.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical disposable scissors. 880.6820 Section 880...) MEDICAL DEVICES GENERAL HOSPITAL AND PERSONAL USE DEVICES General Hospital and Personal Use Miscellaneous Devices § 880.6820 Medical disposable scissors. (a) Identification. Medical disposable scissors are...

Can we improve the biopsy quality of upper urinary tract urothelial tumors? Single-center preliminary results of a new biopsy forceps.

PubMed

Al-Qahtani, Saeed M; Legraverend, Dorian; Gil-Diez de Medina, Sixtina; Sibony, Mathilde; Traxer, Olivier

2014-01-01

Our aim was to evaluate the biopsy quality of upper urinary tract urothelial transitional cell carcinoma with a new biopsy forceps (BIGopsy®, Cook Medical) compared to a classic biopsy forceps (Piranha®, Boston Scientific). From December 2009 to December 2011, 20 patients with upper urinary tract urothelial transitional cell carcinoma underwent conservative treatment endoscopically. All lesions were evaluated and biopsied with 3 Fr cup forceps using both types of forceps (BIGopsy and Piranha). A single pathologist blindly analyzed the specimens in order to determine the optimal biopsy for each patient. Specimen histopathology results were graded; however, they were staged if the lamina propria was not invaded (T1) or if the tumor was detected at the lamina propria (T1+). Of the 20 upper urinary tract lesions, 12 (60%) were in the renal pelvis, 3 (15%) in the upper calyx, 1 (5%) in the middle calyx, 1 (5%) in the lower calyx, 1 (5%) in the upper third of the ureter and 2 (10%) in the middle third of the ureter. We did not detect T1 in all biopsies. One patient had no valid biopsies by both forceps. A diagnosis of urothelial carcinoma was made in 17 BIGopsy biopsies compared to 7 Piranha biopsies. Despite the limited number of cases, our study demonstrated the advantage of the new forceps (BIGopsy) in obtaining a valid biopsy of upper urinary tract urothelial tumors. Therefore, we recommend it in evaluating this pathology for optimal treatment. © 2014 S. Karger AG, Basel.

Ergonomic design and evaluation of new surgical scissors.

PubMed

Shimomura, Yoshihiro; Shirakawa, Hironori; Sekine, Masashi; Katsuura, Tetsuo; Igarashi, Tatsuo

2015-01-01

The purpose of this study is to design a new surgical scissors handle and determine its effectiveness with various usability indices. A new scissors handle was designed that retains the professional grip but has the shapes of the eye rings modified to fit the thumb and ring finger and finger rests for the index and little finger. The newly designed scissors and traditional scissors were compared by electromyography, subjective evaluation and task performance in experiments using cutting and peeling tasks. The newly designed scissors reduced muscle load in both hand during cutting by the closing action, and reduced the muscle load in the left hand during peeling by the opening action through active use of the right hand. In evaluation by surgeons, task performance improved in addition to the decrease in muscle load. The newly designed scissors used in this study demonstrated high usability. A new scissors handle was designed that has the eye rings modified to fit the thumb and ring finger. The newly designed scissors reduced muscle load and enabled active use of the right hand. In evaluation by surgeons, task performance improved in addition to the decrease in muscle load.

Improved specimen adequacy using jumbo biopsy forceps in patients with Barrett's esophagus

PubMed Central

Martinek, Jan; Maluskova, Jana; Stefanova, Magdalena; Tuckova, Inna; Suchanek, Stepan; Vackova, Zuzana; Krajciova, Jana; Kollar, Marek; Zavoral, Miroslav; Spicak, Julius

2015-01-01

AIM: To assess the sampling quality of four different forceps (three large capacity and one jumbo) in patients with Barrett’s esophagus. METHODS: This was a prospective, single-blind study. A total of 37 patients with Barrett’s esophagus were enrolled. Targeted or random biopsies with all four forceps were obtained from each patient using a diagnostic endoscope during a single endoscopy. The following forceps were tested: A: FB-220K disposable large capacity; B: BI01-D3-23 reusable large capacity; C: GBF-02-23-180 disposable large capacity; and jumbo: disposable Radial Jaw 4 jumbo. The primary outcome measurement was specimen adequacy, defined as a well-oriented biopsy sample 2 mm or greater with the presence of muscularis mucosa. RESULTS: A total of 436 biopsy samples were analyzed. We found a significantly higher proportion of adequate biopsy samples with jumbo forceps (71%) (P < 0.001 vs forceps A: 26%, forceps B: 17%, and forceps C: 18%). Biopsies with jumbo forceps had the largest diameter (median 2.4 mm) (P < 0.001 vs forceps A: 2 mm, forceps B: 1.6 mm, and forceps C: 2mm). There was a trend for higher diagnostic yield per biopsy with jumbo forceps (forceps A: 0.20, forceps B: 0.22, forceps C: 0.27, and jumbo: 0.28). No complications related to specimen sampling were observed with any of the four tested forceps. CONCLUSION: Jumbo biopsy forceps, when used with a diagnostic endoscope, provide more adequate specimens as compared to large-capacity forceps in patients with Barrett’s esophagus. PMID:25954107

Improved specimen adequacy using jumbo biopsy forceps in patients with Barrett's esophagus.

PubMed

Martinek, Jan; Maluskova, Jana; Stefanova, Magdalena; Tuckova, Inna; Suchanek, Stepan; Vackova, Zuzana; Krajciova, Jana; Kollar, Marek; Zavoral, Miroslav; Spicak, Julius

2015-05-07

To assess the sampling quality of four different forceps (three large capacity and one jumbo) in patients with Barrett's esophagus. This was a prospective, single-blind study. A total of 37 patients with Barrett's esophagus were enrolled. Targeted or random biopsies with all four forceps were obtained from each patient using a diagnostic endoscope during a single endoscopy. The following forceps were tested: A: FB-220K disposable large capacity; B: BI01-D3-23 reusable large capacity; C: GBF-02-23-180 disposable large capacity; and jumbo: disposable Radial Jaw 4 jumbo. The primary outcome measurement was specimen adequacy, defined as a well-oriented biopsy sample 2 mm or greater with the presence of muscularis mucosa. A total of 436 biopsy samples were analyzed. We found a significantly higher proportion of adequate biopsy samples with jumbo forceps (71%) (P < 0.001 vs forceps A: 26%, forceps B: 17%, and forceps C: 18%). Biopsies with jumbo forceps had the largest diameter (median 2.4 mm) (P < 0.001 vs forceps A: 2 mm, forceps B: 1.6 mm, and forceps C: 2mm). There was a trend for higher diagnostic yield per biopsy with jumbo forceps (forceps A: 0.20, forceps B: 0.22, forceps C: 0.27, and jumbo: 0.28). No complications related to specimen sampling were observed with any of the four tested forceps. Jumbo biopsy forceps, when used with a diagnostic endoscope, provide more adequate specimens as compared to large-capacity forceps in patients with Barrett's esophagus.

Cryobiopsy: should this be used in place of endobronchial forceps biopsies?

PubMed

Rubio, Edmundo R; le, Susanti R; Whatley, Ralph E; Boyd, Michael B

2013-01-01

Forceps biopsies of airway lesions have variable yields. The yield increases when combining techniques in order to collect more material. With the use of cryotherapy probes (cryobiopsy) larger specimens can be obtained, resulting in an increase in the diagnostic yield. However, the utility and safety of cryobiopsy with all types of lesions, including flat mucosal lesions, is not established. Demonstrate the utility/safety of cryobiopsy versus forceps biopsy to sample exophytic and flat airway lesions. Teaching hospital-based retrospective analysis. Retrospective analysis of patients undergoing cryobiopsies (singly or combined with forceps biopsies) from August 2008 through August 2010. Statistical Analysis. Wilcoxon signed-rank test. The comparative analysis of 22 patients with cryobiopsy and forceps biopsy of the same lesion showed the mean volumes of material obtained with cryobiopsy were significantly larger (0.696 cm(3) versus 0.0373 cm(3), P = 0.0014). Of 31 cryobiopsies performed, one had minor bleeding. Cryopbiopsy allowed sampling of exophytic and flat lesions that were located centrally or distally. Cryobiopsies were shown to be safe, free of artifact, and provided a diagnostic yield of 96.77%. Cryobiopsy allows safe sampling of exophytic and flat airway lesions, with larger specimens, excellent tissue preservation and high diagnostic accuracy.

Performance and Cost of Disposable Biopsy Forceps in Upper Gastrointestinal Endoscopy: Comparison with Reusable Biopsy Forceps

PubMed Central

Lim, Chul-Hyun; Kim, Won Chul; Kim, Jin Soo; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Kim, Sang Woo; Choi, Kyu Yong; Chung, In-Sik

2012-01-01

Background/Aims It is believed that disposable biopsy forceps are more costly than reusable biopsy forceps. In this study, we evaluated performance and cost of disposable forceps versus reusable forceps in esophagogastroduodenoscopic biopsy. Methods Between October 2009 and July 2010, we enrolled 200 patients undergoing esophagogastroduodenoscopic biopsy at Seoul St. Mary's Hospital. Biopsies were performed with 100 disposable or 5 reusable forceps by random assignment. Seventy-five additional patients were studied to estimate durability of reusable forceps. The assisting nurses estimated the performance of the forceps. The evaluation of costs included purchase prices and reprocessing costs. The adequacy of the sample was estimated according to the diameter of the obtained tissue. Results Performance of disposable forceps was estimated as excellent in 97.0%, good in 2.0% and adequate in 1.0%. Reusable forceps were estimated as excellent in 36.0%, good in 36.0%, adequate in 25.1% and inadequate in 2.9%. The performance of reusable forceps declined with the number of uses. The reprocessing cost of reusable forceps for one biopsy session was calculated as ₩8,021. The adequacy of the sample was excellent for both forceps. Conclusions Disposable forceps showed excellent performance. Considering the reprocessing costs of reusable forceps, usage of disposable forceps with a low price should be considered. PMID:22741133

An Experimental Investigation of Dextrous Robots Using EVA Tools and Interfaces

NASA Technical Reports Server (NTRS)

Ambrose, Robert; Culbert, Christopher; Rehnmark, Frederik

2001-01-01

This investigation of robot capabilities with extravehicular activity (EVA) equipment looks at how improvements in dexterity are enabling robots to perform tasks once thought to be beyond machines. The approach is qualitative, using the Robonaut system at the Johnson Space Center (JSC), performing task trials that offer a quick look at this system's high degree of dexterity and the demands of EVA. Specific EVA tools attempted include tether hooks, power torque tools, and rock scoops, as well as conventional tools like scissors, wire strippers, forceps, and wrenches. More complex EVA equipment was also studied, with more complete tasks that mix tools, EVA hand rails, tethers, tools boxes, PIP pins, and EVA electrical connectors. These task trials have been ongoing over an 18 month period, as the Robonaut system evolved to its current 43 degree of freedom (DOF) configuration, soon to expand to over 50. In each case, the number of teleoperators is reported, with rough numbers of attempts and their experience level, with a subjective difficulty rating assigned to each piece of EVA equipment and function. JSC' s Robonaut system was successful with all attempted EVA hardware, suggesting new options for human and robot teams working together in space.

Minimally invasive surgery. Future developments.

PubMed Central

Wickham, J. E.

1994-01-01

The rapid development of minimally invasive surgery means that there will be fundamental changes in interventional treatment. Technological advances will allow new minimally invasive procedures to be developed. Application of robotics will allow some procedures to be done automatically, and coupling of slave robotic instruments with virtual reality images will allow surgeons to perform operations by remote control. Miniature motors and instruments designed by microengineering could be introduced into body cavities to perform operations that are currently impossible. New materials will allow changes in instrument construction, such as use of memory metals to make heat activated scissors or forceps. With the reduced trauma associated with minimally invasive surgery, fewer operations will require long hospital stays. Traditional surgical wards will become largely redundant, and hospitals will need to cope with increased through-put of patients. Operating theatres will have to be equipped with complex high technology equipment, and hospital staff will need to be trained to manage it. Conventional nursing care will be carried out more in the community. Many traditional specialties will be merged, and surgical training will need fundamental revision to ensure that surgeons are competent to carry out the new procedures. Images Fig 1 Fig 2 Fig 3 Fig 4 Fig 5 PMID:8312776

Improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus.

PubMed

Wang, Hong-De; Li, Tong; Gao, Shi-Jun

2017-10-30

Discoid medial meniscus is an extremely rare abnormality of the knee. During arthroscopic meniscectomy for symptomatic discoid medial meniscus, it is difficult to remove the posterior portion of the meniscus because of the confined working space within the compartment and the obstruction caused by the anterior cruciate ligament and the tibial intercondylar eminence. To overcome these problems, we describe an improved arthroscopic technique for one-piece excision of symptomatic discoid medial meniscus through three unique portals. Three improved portals were made in the injured knee: a standard anteromedial portal, a central transpatellar tendon portal, and a high anterolateral portal. The anterior side of the discoid medial meniscus was cut 7 mm from the periphery of the meniscus. Next, the anterior portion of the free discoid meniscus fragment was pulled in the anterolateral direction with tension. A curve-shaped cut was made along the longitudinal tear to the posterior horn using basket forceps through the standard anteromedial portal. Then, the anterior portion of the free discoid meniscus was pulled in the anteromedial direction. Pulling the fragment under tension made it easier to cut the posterior side of the discoid meniscus. The posterior side of the discoid meniscus was cut 7 mm from the periphery of the meniscus with straight scissors or basket forceps through the central transpatellar tendon portal. This technique resulted in satisfactory results. Excellent visualization of the posterior part of the discoid medial meniscus was gained during the procedure, and it was easy to cut the posterior part of the discoid medial meniscus. No recurrent symptoms were found. This improved arthroscopic one-piece excision technique for the treatment of symptomatic discoid medial meniscus enables the posterior part of the meniscus to be cut satisfactorily. Moreover, compared with previous techniques, this novel technique causes less formation of foreign bodies and less damage to the anterior cruciate ligament, medial collateral ligament, and cartilage and requires a shorter procedural time.

Clustering Effect on the Dynamics in a Spatial Rock-Paper-Scissors System

NASA Astrophysics Data System (ADS)

Hashimoto, Tsuyoshi; Sato, Kazunori; Ichinose, Genki; Miyazaki, Rinko; Tainaka, Kei-ichi

2018-01-01

The lattice dynamics for rock-paper-scissors games is related to population theories in ecology. In most cases, simulations are performed by local and global interactions. It is known in the former case that the dynamics is usually stable. We find two types of non-random distributions in the stationary state. One is a cluster formation of endangered species: when the density of a species approaches zero, its clumping degree diverges to infinity. The other is the strong aggregations of high-density species. Such spatial pattern formations play important roles in population dynamics.

Cryobiopsy: Should This Be Used in Place of Endobronchial Forceps Biopsies?

PubMed Central

Rubio, Edmundo R.; le, Susanti R.; Whatley, Ralph E.; Boyd, Michael B.

2013-01-01

Forceps biopsies of airway lesions have variable yields. The yield increases when combining techniques in order to collect more material. With the use of cryotherapy probes (cryobiopsy) larger specimens can be obtained, resulting in an increase in the diagnostic yield. However, the utility and safety of cryobiopsy with all types of lesions, including flat mucosal lesions, is not established. Aims. Demonstrate the utility/safety of cryobiopsy versus forceps biopsy to sample exophytic and flat airway lesions. Settings and Design. Teaching hospital-based retrospective analysis. Methods. Retrospective analysis of patients undergoing cryobiopsies (singly or combined with forceps biopsies) from August 2008 through August 2010. Statistical Analysis. Wilcoxon signed-rank test. Results. The comparative analysis of 22 patients with cryobiopsy and forceps biopsy of the same lesion showed the mean volumes of material obtained with cryobiopsy were significantly larger (0.696 cm3 versus 0.0373 cm3, P = 0.0014). Of 31 cryobiopsies performed, one had minor bleeding. Cryopbiopsy allowed sampling of exophytic and flat lesions that were located centrally or distally. Cryobiopsies were shown to be safe, free of artifact, and provided a diagnostic yield of 96.77%. Conclusions. Cryobiopsy allows safe sampling of exophytic and flat airway lesions, with larger specimens, excellent tissue preservation and high diagnostic accuracy. PMID:24066296

Early correction of unilateral scissor bite using transforce appliance and modified twin block appliance

PubMed Central

Chandorikar, Harshal; Nagrik, Arun; Bhad, Wasundhara A; Chavan, Santosh J; Doshi, Umal H

2017-01-01

Early treatment of scissor bite has been advocated mainly to prevent function jaw shift that can eventually lead to permanent skeletal asymmetry and temporomandibular joint pathosis. Although unilateral scissor bite is more common, most of the times, bilateral mandibular expansion is indicated. Lingual transforce appliance can be useful in such cases. This article presents a patient with unilateral scissor bite in mixed dentition with alveolar narrowing. Transforce appliance was used for scissor bite correction followed by modified twin block appliance for stabilization and settling of occlusion till the eruption of premolars. The case was finished with fixed mechanotherapy. Two years after completion of treatment, results were well maintained. Our results suggest that lingual transforce appliance along with careful management of occlusion is effective in the early management of severe unilateral scissor bite. PMID:28546961

Development of novel force-limiting grasping forceps with a simple mechanism.

PubMed

Sakaguchi, Yasuto; Sato, Toshihiko; Yutaka, Yojiro; Muranishi, Yusuke; Komatsu, Teruya; Yoshizawa, Akihiko; Nakajima, Naoki; Nakamura, Tatsuo; Date, Hiroshi

2018-06-06

In endoscopic surgery, fragile tissues may be damaged by the application of excessive force. Thus, we developed novel endoscopic forceps with a simple force-limiting mechanism. The novel forceps were constructed with a leaf spring, and the spring thickness determines grasping pressure. We established an evaluation system (maximum score is 11 points) for lung tissue damage leading to complications. We tested the conventional forceps (186.8 kPa) and 3 novel spring forceps with the following thicknesses: 1.3 mm (53.0 kPa), 2.2 mm (187.7 kPa) and 2.8 mm (369.2 kPa). After grasping, peripheral canine lung tissues were microscopically examined for acute- and late-phase damages. In the acute phase (20 sites), the novel forceps caused capillary congestion and haemorrhage in the subpleural tissue, whereas the conventional forceps caused deep tissue and pleural damages. In the late phase (30 sites), both forceps caused fibroblast formation and interstitial thickening, which progressed to the deeper tissues as grasping pressure increased. In the acute phase, the median scores were 2.0 and 6.0 for the novel and conventional forceps, respectively (P = 0.003). In the late phase, the median scores were 2.0, 2.5 and 5.0 for 1.3-, 2.2- and 2.8-mm thick forceps, respectively, and 5.0 for the conventional forceps (P < 0.001). In both phases, the novel forceps with grasping pressure set below 187.7 kPa (2.2 mm) caused significantly less lung tissue damage than the conventional forceps. The novel endoscopic forceps are able to regulate the tissue-grasping pressure and induce less damage in lung tissues than conventional forceps.

Comparison of Pelican single-use multibite biopsy forceps and traditional double-bite forceps: evaluation in a porcine model.

PubMed

Zaidman, Jeffrey S; Frederick, William G; Furth, Emma E; Su, Chinyu G; Ginsberg, Gregory G

2006-10-01

The multibite biopsy forceps is intended for consecutive acquisition of numerous tissue specimens with a single pass. The Pelican multibite forceps is equipped with a sleeve for tissue retention that allows up to 6 specimens to be obtained with each pass of the device through the accessory channel. Reducing the need for device exchange could decrease the total procedure time for colon cancer surveillance in patients with longstanding inflammatory bowel disease (IBD). The aim of this study was to evaluate a new multibite biopsy forceps in comparison with a standard double-bite forceps. Prospective randomized animal model trial. Multicenter university and community hospitals. By using a live porcine model, multiple colonoscopic biopsy specimens were obtained with both the Pelican multibite forceps and the Radial Jaw 3 (RJ3) double-bite forceps to mimic colorectal cancer surveillance in patients with IBD. Six biopsy specimens were obtained with each of 6 passes when using the Pelican forceps, and 2 biopsy specimens were obtained with each of 18 passes when using the RJ3 forceps. All trials were timed. Two independent pathologists blinded to the forceps used evaluated the specimens. Tissue acquisition when using the Pelican multibite forceps was significantly faster than with a standard double-bite forceps. The devices compared equivalently for specimen retention and quality. The operator could not be blinded to the devices used. This study uses an animal model to extrapolate how the devices might perform in human use. These findings support the evaluation of the Pelican forceps for colon cancer surveillance in patients with longstanding IBD.

Carpal tunnel syndrome in women working in tea agriculture

PubMed Central

Devrimsel, Gul; Kirbas, Serkan; Yildirim, Murat; Turkyilmaz, Aysegul Kucukali; Sahin, Nilay

2014-01-01

OBJECTIVE: The aim of this cross-sectional study was to determine the frequency of carpal tunnel syndrome (CTS) among women using tea leaf scissors and compare it with normal population. METHODS: Two hundred hands of 100 women using tea leaf scissors (tea leaf scissors group) and 112 hands of 56 healthy women (control group) were clinically and electrophysiologically evaluated for CTS. Women using tea leaf scissors were evaluated with visual analog scale (VAS) for pain and Boston Carpal Tunnel Syndrome Questionnaire for symptoms and functional status. RESULTS: Carpal tunnel syndrome was diagnosed bilaterally in 62 (62%) and unilaterally in 7 (7%) women using tea leaf scissors, whereas 2 (3.57%) bilateral and 6 (10.71%) unilateral cases of CTS was diagnosed in controls. The differences in demographic factors were not statistically significant. In women with CTS using tea leaf scissors, mean symptom severity, functional status, and VAS scores were 2.73±0.60, 2.42±0.71 and 5.19±1.84, respectively. There was statistically significant difference in the frequency of CTS between women using tea leaf scissors and the control group and the risk of having CTS among women using tea leaf scissors was approximately 12 times greater (p<0.001). CONCLUSION: In tea agriculture, working with repetitive flexions and extensions of the wrist highly increases the risk of developing CTS. PMID:28058318

Comparison of different biopsy forceps models for tissue sampling in eosinophilic esophagitis.

PubMed

Bussmann, Christian; Schoepfer, Alain M; Safroneeva, Ekaterina; Haas, Nadine; Godat, Sébastien; Sempoux, Christine; Simon, Hans-Uwe; Straumann, Alex

2016-12-01

Background and aims: Eosinophilic esophagitis (EoE) is a mixed inflammatory and fibrostenotic disease. Unlike superficial inflammatory changes, subepithelial fibrosis is not routinely sampled in esophageal biopsies. This study aimed to evaluate the efficacy and safety of deep esophageal sampling with four different types of biopsy forceps. Patients and methods: In this cross-sectional study, esophageal biopsies were taken in 30 adult patients by one expert endoscopist. Biopsies sampled from distal esophagus using a static jaw forceps (Olympus, FB-11K-1) were compared with proximal biopsies sampled with static jaw (Olympus, FB-45Q-1), alligator jaw (Olympus, FB-210K), and large-capacity forceps (Boston Scientific, Radial Jaw 4). One pathologist calculated the surface area of epithelial and subepithelial layers in hematoxylin and eosin (H&E)-stained biopsies. Results: Subepithelial tissue was acquired in 97 % (static jaw FB-11K-1), 93 % (static jaw FB-45Q-1), 80 % (alligator jaw), and 55 % (large-capacity) of samples. Median (interquartile [IQR]) ratios of surface area of epithelial to subepithelial tissue were: static jaw FB-45Q-1, 1.07 (0.65 - 4.465); static jaw FB-11K-1, 1.184 (0.608 - 2.545); alligator jaw, 2.353 (1.312 - 4.465); and large-capacity, 2.71 (1.611 - 4.858). The static jaw models obtained a larger surface area of subepithelial tissue compared with the alligator jaw ( P  < 0.001 and P  = 0.037, for FB-11K-1 and FB-45Q-1, respectively) and the large-capacity forceps ( P  < 0.001, for both static jaw models). No esophageal perforations occurred. Conclusions: The static jaw forceps models allowed sampling of subepithelial tissue in > 90 % of biopsies and appear to be superior to alligator or large-capacity forceps in sampling larger amounts of subepithelial tissue. © Georg Thieme Verlag KG Stuttgart · New York.

Serial Casting as an Adjunct to Botulinum Toxin Type A Treatment in Children With Cerebral Palsy and Spastic Paraparesis With Scissoring of the Lower Extremities.

PubMed

Dai, Alper I; Demiryürek, Abdullah T

2017-06-01

The purpose of this study was to examine whether combination therapy of serial casting and botulinum toxin type A injection can further enhance the effects of botulinum toxin type A in children with cerebral palsy with scissoring of both legs. This study was a prospective and randomized trial. The children were divided into 2 groups, one of which received serial casting after botulinum toxin type A (n = 40), and the other which only received botulinum toxin type A (n = 40). Serial casting started 3 weeks after the botulinum toxin type A. Both groups received physiotherapy. Groups were assessed at baseline then compared at 6 and 12 weeks following the intervention. Significant improvements in Gross Motor Function Measure-66 and Caregiver Health Questionnaire were recorded in both groups ( P < .001). The modified Ashworth scale improved significantly following botulinum toxin type A in the serial casting group ( P < .05), but not in botulinum toxin type A only group. These results suggest that serial casting after botulinum toxin type A can enhance the benefits of botulinum toxin type A in children with cerebral palsy.

Jumbo forceps are superior to standard large-capacity forceps in obtaining diagnostically adequate inflammatory bowel disease surveillance biopsy specimens.

PubMed

Elmunzer, B Joseph; Higgins, Peter D R; Kwon, Yong M; Golembeski, Christopher; Greenson, Joel K; Korsnes, Sheryl J; Elta, Grace H

2008-08-01

In inflammatory bowel disease (IBD) surveillance colonoscopy, an increased number of biopsy specimens correlates with a higher dysplasia detection rate. Larger biopsy specimens may also increase the diagnostic yield. To compare a new jumbo forceps with a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. Prospective single-center study. Twenty-four patients who were undergoing an IBD surveillance colonoscopy were enrolled. As part of standard IBD surveillance, 8 paired biopsy specimens were obtained from the rectosigmoid by using the jumbo forceps and a standard large-capacity forceps. Biopsy specimens were deemed adequate if they met all 3 of the following criteria: (1) length > or =3 mm, (2) penetration into the muscularis mucosa, and (3) < 20% crush artifact. The proportion of adequate biopsy specimens obtained with the jumbo forceps was significantly higher than that obtained with the large-capacity control forceps (67% vs 48%, P < .0001). The average length of the biopsy specimen obtained with the jumbo forceps was 4.00 mm (95% CI, 3.81-4.20 mm) compared with 3.19 mm (95% CI, 2.99-3.38 mm) with the large-capacity (control) forceps. (1) No validated outcome measurement for the quality of GI biopsy specimens exists and (2) in this study, interobserver variability between pathologists was high. The jumbo forceps was superior to a standard large-capacity forceps in obtaining diagnostically adequate IBD surveillance biopsy specimens. Because biopsy specimens obtained with the jumbo forceps were larger, the use of this forceps for IBD surveillance will allow the endoscopist to sample a larger colonic mucosal surface area, potentially resulting in an increased dysplasia detection rate.

Experimental status of the nuclear spin scissors mode

NASA Astrophysics Data System (ADS)

Balbutsev, E. B.; Molodtsova, I. V.; Schuck, P.

2018-04-01

With the Wigner function moments (WFM) method the scissors mode of the actinides and rare earth nuclei are investigated. The unexplained experimental fact that in 232Th a double hump structure is found finds a natural explanation within WFM. It is predicted that the lower peak corresponds to an isovector spin scissors mode whereas the higher-lying states corresponds to the conventional isovector orbital scissors mode. The experimental situation is scrutinized in this respect concerning practically all results of M 1 excitations.

Scissors modes: The first overtone

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hatada, Keisuke; INFN Laboratori Nazionali di Frascati, c.p. 13, I-00044 Frascati; Hayakawa, Kuniko

2011-07-15

Scissors modes were predicted in the framework of the two-rotor model. This model has an intrinsic harmonic spectrum, so that the level above the scissors mode, the first overtone, has excitation energy twice that of the scissors mode. Because the latter is of the order of 3 MeV in the rare-earth region, the energy of the overtone is below threshold for nucleon emission, and its width should remain small enough for the overtone to be observable. We find that B(E2){up_arrow}{sub overtone}=(1/64 {theta}{sub 0}{sup 2})B(E2){up_arrow}{sub scissors}, where {theta}{sub 0} is the zero-point oscillation amplitude, which in the rare-earth region is ofmore » order 10{sup -1}.« less

Comparison of sterilization of reusable endoscopic biopsy forceps by autoclaving and ethylene oxide gas.

PubMed

Yoon, Jai Hoon; Yoon, Byung Chul; Lee, Hang Lak; Lee, Jun Kyu; Kim, Yong-Tae; Lee, Dong Ho; Choi, Il Ju; Lee, Don Haeng; Kim, Dong Hee

2012-02-01

Every country has standardized reprocessing guidelines for reducing the risk of microorganism transmission via reusable biopsy forceps. Sterilization is performed either by autoclaving or with the use of ethylene oxide (EO) gas. However, there are no clear standard global recommendations. The aim of this study was to determine whether EO gas or autoclaving is a safer and more effective method for the sterilization of reusable forceps. This was a prospective study conducted at multiple tertiary referral centers. Seventy reusable biopsy forceps that had been reused at least 20 times each were collected from six endoscopy centers. In all, 61 forceps from five centers were sterilized using EO gas, and the nine forceps from the remaining center were placed in an autoclave. We performed real-time polymerase chain reaction (RT-PCR) for Mycobacterium tuberculosis and hepatitis B virus and performed bacterial cultures on the reusable forceps, which were cut into 2- to 3-cm sections. The forceps were also scanned with an electron microscope (EM) to detect surface damage and contamination. Escherichia coli bacteria were cultured from 2 of the 61 (3.3%) reusable biopsy forceps sterilized with EO gas. On EM scanning, abundant debris and tissue materials remained on the cup surfaces of the reused biopsy forceps and on their inner wires. No microorganisms were found on the autoclaved forceps. Sterilization with EO gas may be inadequate because the complicated structure of the forceps may interfere with sterilization. Therefore, for optimum safety, reusable biopsy forceps should be sterilized by autoclaving.

Intraocular biopsy using special forceps: a new instrument and refined surgical technique.

PubMed

Akgul, Harun; Otterbach, Friedrich; Bornfeld, Norbert; Jurklies, Bernhard

2011-01-01

The aim was to investigate the Essen biopsy forceps as a new instrument and surgical approach for biopsy of intraocular tumours. Biopsy is indicated for assessment of any uncertain intraocular process or confirmation for presumed diagnosis before treatment. There is increasing interest for further genetic and immunocytological information in order to characterise the neoplasm, especially grading and prognosis of micrometastasis in uveal melanoma. The authors have developed a new surgical technique using special intraocular biopsy forceps. Twenty patients with uncertain intraocular subretinal tumour underwent biopsies carried out using the special Essen biopsy forceps. Biopsies were obtained through sutureless 23-gauge three-port vitrectomy. A small retinotomy tumour specimen was taken by the forceps branches. For further processing, the specimens were flushed out into a sterile tube and then sent to pathologists. The prebioptical tumour had a mean thickness of 3.48 mm (1.1 to 9.8 mm). In all cases (n=20) biopsies (0.3-2.1 mm in size) were obtained, in 19 cases (95%) allowing precise histological and immunohistochemical typing of the lesions following cytoblock embedding. Uveal melanoma was diagnosed in 50% (n=10), choroidal metastasis in 15% (n=3) and choroidal naevus in 15% (n=3); other diagnoses (n=3) included choroidal haemangioma, B cell lymphoma and old subretinal haemorrhage. Apart from three patients with temporary punctual bleeding on the surface, there were no intra- and postoperative complications. Biopsy using special forceps is a promising new approach and precise surgical procedure. Especially for small intraocular tumours, this technique has the advantage in providing enough tissue for improved histological examination and presenting a low risk for complications.

Scissors: More than a Cut Above

ERIC Educational Resources Information Center

Suzanne, Teri

2005-01-01

Scissors are a unique interactive tool when successfully used, allowing teachers and students to recognize and explore each other's creative ability while nurturing mutual communication. Freehand cutting gives children freedom to create as they cut. Scissors have the power to improve fine motor skills, stimulate creative imagination, reinforce…

Comparison of Performance Characteristics of Oval Cup Forceps Versus Serrated Jaw Forceps in Gastric Biopsy.

PubMed

Sussman, Daniel A; Deshpande, Amar R; Shankar, Uday; Barkin, Jodie A; Medina, Ana Maria; Poppiti, Robert J; Cubeddu, Luigi X; Barkin, Jamie S

2016-08-01

Obtaining quality endoscopic biopsy specimens is vital in making successful histological diagnoses. The influence of forceps cup shape and size on quality of biopsy specimens is unclear. To identify whether oval cup or two different serrated jaw biopsy forceps could obtain specimens of superior size. Secondary endpoints were tissue adequacy, depth of tissue acquisition, and crush artifact. A single-center, prospective, pathologist-masked, randomized controlled trial was performed. In total 136 patients with a clinical indication for esophagogastroduodenoscopy with biopsy were randomized to receive serial biopsies with a large-capacity serrated forceps with jaw diameter 2.2 mm (SER1) and either a large-capacity oval forceps with jaw diameter 2.4 mm (OVL) or large-capacity serrated biopsy forceps with jaw diameter 2.4 mm (SER2) in two parallel groups. SER2 provided significantly larger specimens than did the other forceps (SER2 3.26 ± 1.09 vs. SER1 2.92 ± 0.88 vs. OVL 2.92 ± 0.76; p = 0.026), with an average size difference of 0.34 mm greater with SER2 compared to SER1 and OVL. OVL provided significantly deeper biopsies compared to SER1 and SER2 (p = 0.02), with 31 % of OVL biopsies reaching the submucosa. SER2 had significantly less crush artifact than SER1 and OVL (p < 0.0001). Serrated forceps provided larger samples compared to oval jaw forceps of the same size, with SER2 providing the largest specimen size. Oval cup forceps had deeper penetration of epithelium, while the larger jaw diameter serrated jaw forceps had less crush artifact. All three forceps provided specimens adequate for diagnostic purposes.

Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire.

PubMed

Dolas, Siddhesh Gajanan; Chitko, Shrikant Shrinivas; Kerudi, Veerendra Virupaxappa; Patil, Harshal Ashok; Bonde, Prasad Vasudeo

2016-03-01

Unilateral scissor bite is a relatively rare malocclusion. However, its correction is often difficult and a challenge for the clinician. This article presents simple and efficient technique for the correction of severe unilateral scissor bite in a 14 year old boy, using 0.020 S.S. A. J. Wilcock wire (premium plus) out of the spool, with minimal adjustments and placed in mandibular arch. After about six weeks time, good amount of correction was seen in the lower arch and the lower molar had been relieved of scissor bite.

Modeling the forces of cutting with scissors.

PubMed

Mahvash, Mohsen; Voo, Liming M; Kim, Diana; Jeung, Kristin; Wainer, Joshua; Okamura, Allison M

2008-03-01

Modeling forces applied to scissors during cutting of biological materials is useful for surgical simulation. Previous approaches to haptic display of scissor cutting are based on recording and replaying measured data. This paper presents an analytical model based on the concepts of contact mechanics and fracture mechanics to calculate forces applied to scissors during cutting of a slab of material. The model considers the process of cutting as a sequence of deformation and fracture phases. During deformation phases, forces applied to the scissors are calculated from a torque-angle response model synthesized from measurement data multiplied by a ratio that depends on the position of the cutting crack edge and the curve of the blades. Using the principle of conservation of energy, the forces of fracture are related to the fracture toughness of the material and the geometry of the blades of the scissors. The forces applied to scissors generally include high-frequency fluctuations. We show that the analytical model accurately predicts the average applied force. The cutting model is computationally efficient, so it can be used for real-time computations such as haptic rendering. Experimental results from cutting samples of paper, plastic, cloth, and chicken skin confirm the model, and the model is rendered in a haptic virtual environment.

[Applicability of the da Vinci robotic system in the skull base surgical approach. Preclinical investigation].

PubMed

Fernandez-Nogueras Jimenez, Francisco J; Segura Fernandez-Nogueras, Miguel; Jouma Katati, Majed; Arraez Sanchez, Miguel Ángel; Roda Murillo, Olga; Sánchez Montesinos, Indalecio

2015-01-01

The role of robotic surgery is well established in various specialties such as urology and general surgery, but not in others such as neurosurgery and otolaryngology. In the case of surgery of the skull base, it has just emerged from an experimental phase. To investigate possible applications of the da Vinci surgical robot in transoral skull base surgery, comparing it with the authors' experience using conventional endoscopic transnasal surgery in the same region. A transoral transpalatal approach to the nasopharynx and medial skull base was performed on 4 cryopreserved cadaver heads. We used the da Vinci robot, a 30° standard endoscope 12mm thick, dual camera and dual illumination, Maryland forceps on the left terminal and curved scissors on the right, both 8mm thick. Bone drilling was performed manually. For the anatomical study of this region, we used 0.5cm axial slices from a plastinated cadaver head. Various skull base structures at different depths were reached with relative ease with the robot terminals Transoral robotic surgery with the da Vinci system provides potential advantages over conventional endoscopic transnasal surgery in the surgical approach to this region. Copyright © 2014 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

Manual versus automated methods for cleaning reusable accessory devices used for minimally invasive surgical procedures.

PubMed

Alfa, M J; Nemes, R

2004-09-01

We undertook a simulated-use study using quantitative methods to evaluate the cleaning efficacy of ported and non-ported accessory devices used in minimally invasive surgery. We chose laparoscopic scissors and forceps to represent worst-case devices which were inoculated with artificial test soil containing 10(6) cfu/mL Enterococcus faecalis and Geobacillus stearothermophilus and allowed to dry for 1 h. Cleaning was performed manually, as well as by the automated SI-Auto Narrow lumen cleaner. Manual cleaning left two- to 50-fold more soil residuals (protein, haemoglobin and carbohydrate) inside the lumen of non-ported versus ported laparoscopic accessory devices. The SI-Auto Narrow lumen cleaner was more efficient than manual cleaning and achieved >99% reduction in soil parameters in both non-ported (using retro-flushing) and ported laparoscopic devices. Only the automated cleaning of ported devices achieved 10(3)-10(4)-fold reduction in bacterial numbers. Sonication alone (no flushing of inner channel) did not effectively remove soil or organisms from the inner channel. Our findings indicate that non-ported accessory devices cannot be as reliably cleaned as ported devices regardless of the cleaning method used. If non-ported accessory devices are reprocessed, they should be cleaned using retro-flushing in an automated narrow lumen cleaner.

Comparative Evaluation of Efficacy of Physics Forceps versus Conventional Forceps in Orthodontic Extractions: A Prospective Randomized Split Mouth Study.

PubMed

Patel, Harsh S; Managutti, Anil M; Menat, Shailesh; Agarwal, Arvind; Shah, Dishan; Patel, Jigar

2016-07-01

Tooth extraction is one of the most commonly performed procedures in dentistry. It is usually a traumatic procedure often resulting in immediate destruction and loss of alveolar bone and surrounding soft tissues. Various instruments have been described to perform atraumatic extractions which can prevent damage to the paradental structures. Recently developed physics forceps is one of the instruments which is claimed to perform atraumatic extractions. The aim of the present study was to compare the efficacy of physics forceps with conventional forceps in terms of operating time, prevention of marginal bone loss & soft tissue loss, postoperative pain and postoperative complications following bilateral premolar extractions for orthodontic purpose. In this prospective split-mouth study, outcomes of the 2 groups (n = 42 premolars) requiring extraction of premolars for orthodontic treatment purpose using Physics forceps and Conventional forceps were compared. Clinical outcomes in form of time taken, loss of buccal soft tissue and buccal cortical plate based on extraction defect classification system, postoperative pain and other complication associated with extraction were recorded and compared. Statistically significant reduction in the operating time was noted in physics forceps group. Marginal bone loss and soft tissue loss was also significantly lesser in physics forceps group when compared to conventional forceps group. However, there was no statistically significant difference in severity of postoperative pain between both groups. The results of the present study suggest that physics forceps was more efficient in reducing operating time and prevention of marginal bone loss & soft tissue loss when compared to conventional forceps in orthodontically indicated premolar extractions.

Obstetrical Forceps

NASA Technical Reports Server (NTRS)

2004-01-01

Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire

PubMed Central

Dolas, Siddhesh Gajanan; Chitko, Shrikant Shrinivas; Kerudi, Veerendra Virupaxappa; Bonde, Prasad Vasudeo

2016-01-01

Unilateral scissor bite is a relatively rare malocclusion. However, its correction is often difficult and a challenge for the clinician. This article presents simple and efficient technique for the correction of severe unilateral scissor bite in a 14 year old boy, using 0.020 S.S. A. J. Wilcock wire (premium plus) out of the spool, with minimal adjustments and placed in mandibular arch. After about six weeks time, good amount of correction was seen in the lower arch and the lower molar had been relieved of scissor bite. PMID:27231682

Effect of endoscopic forceps on quality of duodenal mucosal biopsy in healthy dogs.

PubMed

Goutal-Landry, C M; Mansell, J; Ryan, K A; Gaschen, F P

2013-01-01

Limited data exist regarding influence of endoscopic forceps on duodenal mucosal biopsy quality and adequacy for histologic examination/assessment in dogs. Hypothesizing that larger forceps would procure superior specimens, we evaluated effect of 6 disposable forceps on duodenal biopsy weight, depth, crush artifact, and adequacy for histologic examination/assessment. Seventeen healthy adult dogs. Prospective study. Two operators each obtained 4 duodenal specimens from each dog with each forceps. Lightest sample discarded. One pathologist evaluated blindly other 3 specimens. A total of 612 specimens evaluated. Results analyzed by one-way ANOVA of forceps effects with dog as blocking factor. Posthoc pairwise comparisons examined with Tukey's test when indicated. Biopsies performed with large capacity forceps heavier (10.56 ± 0.90 and 11.6 ± 0.62 mg (mean ± SD) versus 5.55 ± 0.53 to 8.61 ± 0.49; P < .0001) and adequacy for histologic examination/assessment superior to standard oval and 'pediatric' (scores 2.52 ± 0.41 and 2.58 ± 0.37 versus 2.08 ± 0.33 and 2.14 ± 0.29; P < .0001). No statistically significant difference in depth scores. Large capacity forceps with spike associated with less crush artifact than all smaller forceps (scores 1.19 ± 0.16 versus 1.38 ± 0.21 to 1.52 ± 0.21; P < .0001). In same size forceps, presence of spike had no effect on crush artifact and adequacy for histologic examination/assessment (P < .0001). Large capacity forceps are superior, providing higher quality and greater numbers of samples achieving adequacy for histologic examination/assessment. Choice of endoscopic biopsy forceps for duodenal samples influences sample volume and diagnostic utility. Copyright © 2013 by the American College of Veterinary Internal Medicine.

Hot biopsy forceps vs. endoscopic ultrasonography in determining the depth of gastric epithelial neoplasia: a simple novel method to decide whether or not to perform endoscopic submucosal dissection.

PubMed

Huikai, Li; Enqiang, Linghu

2013-01-01

It is of vital importance to determine the depth of lesions to be treated by endoscopic submucosal dissection. This study aimed to compare the accuracy of using hot biopsy forceps method with endoscopic ultrasonography for determination of the depth of gastric epithelial neoplasia. Hot biopsy forceps method and/or endoscopic ultrasonography were used to determine the depth of lesions in 27 patients. With hot biopsy forceps method, we assumed a lesion completely lifted up by a hot biopsy forceps to be confined to the mucosal layer, and one partly lifted up to be located beyond the mucosal layer. The accuracy of hot biopsy forceps method and endoscopic ultrasonography in determining the depth of lesions were compared. Of the 27 patients, 25 underwent endoscopic submucosal dissection and 2 underwent surgery. The total accuracy of hot biopsy forceps method in determining the depth of lesions was 92.6% and that of endoscopic ultrasonography was 81.8%. Overestimation of hot biopsy forceps method and endoscopic ultrasonography were 3.7% vs. 13.6%, respectively. The sensitivity and the specificity of hot biopsy forceps method were 95.5% and 80.0% and those of EUS were 83.3% and 75.0%. Hot biopsy forceps method has a trend towards higher accuracy and lower overestimation than endoscopic ultrasonography.

Systematics of Scissors Mode in Gd Nuclei from Experiments with the DANCE Detector

NASA Astrophysics Data System (ADS)

Kroll, J.; Agvaanluvsan, U.; Baramsai, B.; Becker, J. A.; Bečvář, F.; Bredeweg, T. A.; Chyzh, A.; Couture, A.; Dashdorj, D.; Haight, R. C.; Jandel, M.; Keksis, A. L.; Krtička, M.; Mitchell, G. E.; O'Donnell, J. M.; Parker, W.; Rundberg, R. S.; Ullmann, J. L.; Valenta, S.; Vieira, D. J.; Walker, C. L.; Wilhelmy, J. B.; Wouters, J. M.; Wu, C. Y.

2014-05-01

Multi-step cascade γ-ray spectra from neutron capture at isolated resonances of 152,154-158Gd nuclei were measured at the LANSCE/DANCE time-of-flight facility in Los Alamos National Laboratory. The main objective of these experiments was to obtain new information on photon strength functions with emphasis on the role of the M1 scissors mode vibration. An analysis of the data obtained shows that the scissors mode plays a significant role in the ground state transitions, as well as in the transitions populating all excited states of the studied nuclei. The estimates of the scissors mode strength indicate that for 157,159Gd this strength is significantly higher than in neighboring even-even nuclei 156,158Gd. The results are compared with the (γ,γ‧) data for the ground-state scissors mode and the results from 3He-induced reactions.

Fluoroscopic percutaneous brush cytology, forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction.

PubMed

Boos, Johannes; Yoo, Raphael J; Steinkeler, Jennifer; Ayata, Gamze; Ahmed, Muneeb; Sarwar, Ammar; Weinstein, Jeffrey; Faintuch, Salomao; Brook, Olga R

2018-02-01

To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction. A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated. A total of 232 interventions in 129 patients (70.8 ± 11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6-48.7%), 42.7% (32.4-53.0%) and 55.8% (44.7-66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96. Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction. • Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy. • Brush cytology may help to overcome "crush artefacts" from forceps biopsy. • The cost per diagnosed malignancy may warrant tandem procedure in all patients.

Estimation of M 1 scissors mode strength for deformed nuclei in the medium- to heavy-mass region by statistical Hauser-Feshbach model calculations

NASA Astrophysics Data System (ADS)

Mumpower, M. R.; Kawano, T.; Ullmann, J. L.; Krtička, M.; Sprouse, T. M.

2017-08-01

Radiative neutron capture is an important nuclear reaction whose accurate description is needed for many applications ranging from nuclear technology to nuclear astrophysics. The description of such a process relies on the Hauser-Feshbach theory which requires the nuclear optical potential, level density, and γ -strength function as model inputs. It has recently been suggested that the M 1 scissors mode may explain discrepancies between theoretical calculations and evaluated data. We explore statistical model calculations with the strength of the M 1 scissors mode estimated to be dependent on the nuclear deformation of the compound system. We show that the form of the M 1 scissors mode improves the theoretical description of evaluated data and the match to experiment in both the fission product and actinide regions. Since the scissors mode occurs in the range of a few keV to a few MeV, it may also impact the neutron capture cross sections of neutron-rich nuclei that participate in the rapid neutron capture process of nucleosynthesis. We comment on the possible impact to nucleosynthesis by evaluating neutron capture rates for neutron-rich nuclei with the M 1 scissors mode active.

Manual methods are suboptimal compared with automated methods for cleaning of single-use biopsy forceps.

PubMed

Alfa, M J; Nemes, R; Olson, N; Mulaire, A

2006-08-01

Most reusable biopsy forceps and all of the currently available single-use biopsy forceps do not have a port that allows fluid flow down the inner tubular shaft of the device. Reusable biopsy forceps are widely used and reprocessed in healthcare facilities, and single-use biopsy forceps are reprocessed either in-house (eg, in Canada and Japan) or by third-party reprocessors (eg, in the United States). The objective of this study was to determine the cleaning efficacy of automated narrow-lumen sonic irrigation cleaning, sonication-only cleaning, and manual cleaning for biopsy forceps. A simulated-use study was performed by inoculating the inner channel of single-use biopsy forceps with artificial test soil containing both Enterococcus faecalis and Geobacillus stearothermophilus at concentrations of 10(6) colony-forming units per milliliter. The cleaning methods evaluated were manual cleaning, sonication-only cleaning, and "retroflush" cleaning by an automated narrow-lumen irrigator. Bioburden and organic soil reduction after washing was evaluated. Forceps used in biopsies of patients were also tested to determine the worst-case soiling levels. Only retroflush irrigation cleaning could effectively remove material from within the shaft portion of the biopsy forceps: it achieved an average reduction of more than 95% in levels of protein, hemoglobin, carbohydrate, and endotoxin. However, even this method of cleaning was not totally effective, as only a 2 log10 reduction in bioburden could be achieved, and there were low residual levels of hemoglobin and carbohydrate. The data from this evaluation indicate that manual and sonication-only cleaning methods for biopsy forceps were totally ineffective in removing material from within the biopsy forceps. Even the use of retroflush cleaning was not totally effective. These findings suggest that in-hospital reprocessing of biopsy forceps with currently available equipment and cleaning methods is suboptimal.

21 CFR 876.4300 - Endoscopic electrosurgical unit and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... accessories is a device used to perform electrosurgical procedures through an endoscope. This generic type of device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode...

Chemical scissors cut phosphorene and their novel electronic properties

NASA Astrophysics Data System (ADS)

Peng, Xihong; Wei, Qun

2015-03-01

Phosphorene, a recently fabricated two-dimensional puckered honeycomb structure of black phosphorus, showed promising properties for applications in nano-electronics. In this work, we report a chemical scissors effect on phosphorene, using first principles density-functional methods. It was found that chemical species, such as H, OH, F, and Cl, can act as scissors to cut phosphorene. Phosphorus nanochains and nanoribbons can be obtained using such chemical scissors. The scissors effect results from the strong bonding between the chemical species and phosphorus atoms. Other species such as O, S and Se fail to cut phosphorene due to their weak bonding with phosphorus. The electronic structures of the produced P-chains reveal that the hydrogenated P-chain is an insulator; however, the pristine P-chain is a one-dimensional Dirac material, in which the charge carriers are massless fermions travelling at an effective speed of light approximately 8x105 m/s. The obtained zigzag phosphorene nanoribbons show either metallic or semiconducting behaviors, depending on the treatment of the edge phosphorus atoms.

Estimation of M 1 scissors mode strength for deformed nuclei in the medium- to heavy-mass region by statistical Hauser-Feshbach model calculations

DOE PAGES

Mumpower, Matthew Ryan; Kawano, Toshihiko; Ullmann, John Leonard; ...

2017-08-17

Radiative neutron capture is an important nuclear reaction whose accurate description is needed for many applications ranging from nuclear technology to nuclear astrophysics. The description of such a process relies on the Hauser-Feshbach theory which requires the nuclear optical potential, level density, and γ-strength function as model inputs. It has recently been suggested that the M1 scissors mode may explain discrepancies between theoretical calculations and evaluated data. We explore statistical model calculations with the strength of the M1 scissors mode estimated to be dependent on the nuclear deformation of the compound system. We show that the form of the M1more » scissors mode improves the theoretical description of evaluated data and the match to experiment in both the fission product and actinide regions. Since the scissors mode occurs in the range of a few keV to a few MeV, it may also impact the neutron capture cross sections of neutron-rich nuclei that participate in the rapid neutron capture process of nucleosynthesis. As a result, we comment on the possible impact to nucleosynthesis by evaluating neutron capture rates for neutron-rich nuclei with the M1 scissors mode active.« less

Learning the rules of the rock-paper-scissors game: chimpanzees versus children.

PubMed

Gao, Jie; Su, Yanjie; Tomonaga, Masaki; Matsuzawa, Tetsuro

2018-01-01

The present study aimed to investigate whether chimpanzees (Pan troglodytes) could learn a transverse pattern by being trained in the rules of the rock-paper-scissors game in which "paper" beats "rock," "rock" beats "scissors," and "scissors" beats "paper." Additionally, this study compared the learning processes between chimpanzees and children. Seven chimpanzees were tested using a computer-controlled task. They were trained to choose the stronger of two options according to the game rules. The chimpanzees first engaged in the paper-rock sessions until they reached the learning criterion. Subsequently, they engaged in the rock-scissors and scissors-paper sessions, before progressing to sessions with all three pairs mixed. Five of the seven chimpanzees completed training after a mean of 307 sessions, which indicates that they learned the circular pattern. The chimpanzees required more scissors-paper sessions (14.29 ± 6.89), the third learnt pair, than paper-rock (1.71 ± 0.18) and rock-scissors (3.14 ± 0.70) sessions, suggesting they had difficulty finalizing the circularity. The chimpanzees then received generalization tests using new stimuli, which they learned quickly. A similar procedure was performed with children (35-71 months, n = 38) who needed the same number of trials for all three pairs during single-paired sessions. Their accuracy during the mixed-pair sessions improved with age and was better than chance from 50 months of age, which indicates that the ability to solve the transverse patterning problem might develop at around 4 years of age. The present findings show that chimpanzees were able to learn the task but had difficulties with circularity, whereas children learned the task more easily and developed the relevant ability at approximately 4 years of age. Furthermore, the chimpanzees' performance during the mixed-pair sessions was similar to that of 4-year-old children during the corresponding stage of training.

Occurrence of Children's Echoic Responses According to Interlocutory Question Types.

ERIC Educational Resources Information Center

Fay, Warren H.

Dialogues with 22 echoic 3-year-old children were analyzed according to question type to determine whether some questions are more likely than others to trigger echoic responses. The children were asked to identify and manipulate toy objects such as a car, to identify a group of familiar objects such as a key or scissors, and to respond to…

Zealotry promotes coexistence in the rock-paper-scissors model of cyclic dominance

NASA Astrophysics Data System (ADS)

Verma, Gunjan; Chan, Kevin; Swami, Ananthram

2015-11-01

Cyclic dominance models, such as the classic rock-paper-scissors (RPS) game, have found real-world applications in biology, ecology, and sociology. A key quantity of interest in such models is the coexistence time, i.e., the time until at least one population type goes extinct. Much recent research has considered conditions that lengthen coexistence times in an RPS model. A general finding is that coexistence is promoted by localized spatial interactions (low mobility), while extinction is fostered by global interactions (high mobility). That is, there exists a mobility threshold which separates a regime of long coexistence from a regime of rapid collapse of coexistence. The key finding of our paper is that if zealots (i.e., nodes able to defeat others while themselves being immune to defeat) of even a single type exist, then system coexistence time can be significantly prolonged, even in the presence of global interactions. This work thus highlights a crucial determinant of system survival time in cyclic dominance models.

Diagnostic yield and safety of jumbo biopsy forceps in patients with subepithelial lesions of the upper and lower GI tract.

PubMed

Buscaglia, Jonathan M; Nagula, Satish; Jayaraman, Vijay; Robbins, David H; Vadada, Deepak; Gross, Seth A; DiMaio, Christopher J; Pais, Shireen; Patel, Kal; Sejpal, Divyesh V; Kim, Michelle K

2012-06-01

EUS-FNA often fails to make a definitive diagnosis in the evaluation of subepithelial lesions. The addition of jumbo biopsy forceps has the potential to improve diagnostic yield, but published series are limited. To assess the likelihood of definitive diagnosis for subepithelial lesions by using jumbo biopsy forceps during EUS examination. Pooled retrospective analysis. 6 tertiary referral centers. All patients having undergone EUS examination for a subepithelial lesion in which jumbo biopsy forceps were used for tissue acquisition. Diagnostic yield of jumbo biopsy forceps use, complication rates, and comparison of diagnostic yield with that of EUS-FNA. A total of 129 patients underwent EUS with jumbo biopsy forceps; 31 patients (24%) had simultaneous EUS-FNA. The lesion locations were stomach (n = 98), esophagus (n = 14), duodenum (n = 11), colon (n = 5), and jejunum (n = 1). The average lesion size was 14.9 mm ± 9.3 mm. Overall, definitive diagnosis was obtained in 87 of 129 patients (67.4%) by using either method. A definitive diagnosis was provided by jumbo biopsy forceps use in 76 of 129 patients (58.9%) and by FNA in 14 of 31 patients (45.1%) (P = .175). The results in third-layer lesions were definitive with jumbo biopsy forceps in 56 of 86 lesions (65.1%) and with FNA in 6 of 16 lesions (37.5%) (P = .047). For fourth-layer lesions, the results with jumbo biopsy forceps were definitive in 10 of 25 (40.0%) and with FNA in 8 of 14 (57.1%) (P = .330). Forty-five of 129 patients (34.9%) experienced significant bleeding after biopsy with jumbo forceps and required some form of endoscopic hemostasis. Retrospective study. Jumbo forceps are a useful tool for the definitive diagnosis of subepithelial lesions. The greatest benefit appears to be with third-layer (submucosal) lesions. The risk of bleeding is significant. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases.

PubMed

Gershman, Evgeni; Fruchter, Oren; Benjamin, Fox; Nader, Abed Rahman; Rosengarten, Dror; Rusanov, Victoria; Fridel, Ludmila; Kramer, Mordechai R

2015-01-01

Transbronchial biopsy (TBB) which is performed with metal forceps (forceps TBB) has been accepted as a useful technique in establishing diagnoses of diffuse lung diseases (DLDs). The use of cryoprobes to obtain alveolar tissue (cryo-TBB) is a new method which is currently used by our institute as well as others with excellent results. To assess the safety of cryo-TBB compared with conventional forceps TBB. We performed a retrospective data evaluation of 300 consecutive patients who underwent cryo-TBB between January 2012 and April 2014 and compared them with historical cases treated with forceps TBB between 2010 and 2012. The results of both diagnostic modalities were compared based on pathological reports. The major complications (significant bleeding and pneumothorax) were compared, along with postprocedural hospitalization. Pneumothorax was observed in 15 cases (4.95%) treated with cryo-TBB versus 9 cases (3.15%) treated with forceps TBB, with no significant difference (p = 0.303). The insertion of a chest tube was necessary in 6 (2%) and 4 (1.3%) of the cases having undergone cryo-TBB or forceps TBB, respectively (p = 0.8). In the cryo-TBB group, bleeding was encountered in 16 cases (5.2%), and it occurred in 13 cases (4.5%) of the forceps TBB group, with no significant difference in rates (p = 0.706). Also, there was no significant difference in hospital admission rates between the groups [cryo-TBB: 10 (3.3%); forceps TBB: 4 (1.44%); p = 0.181]. The safety profile of cryo- and forceps TBB remained the same even when stratified according to indications for TBB, i.e. immunocompromised hosts, patients after lung transplantation and those with DLDs. In patients with DLDs, cryo-TBB is as safe as forceps TBB.

21 CFR 868.5780 - Tube introduction forceps.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Identification. Tube introduction forceps (e.g., Magill forceps) are a right-angled device used to grasp a tracheal tube and place it in a patient's trachea. (b) Classification. Class I (general controls). The...

21 CFR 868.5780 - Tube introduction forceps.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Identification. Tube introduction forceps (e.g., Magill forceps) are a right-angled device used to grasp a tracheal tube and place it in a patient's trachea. (b) Classification. Class I (general controls). The...

21 CFR 868.5780 - Tube introduction forceps.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Identification. Tube introduction forceps (e.g., Magill forceps) are a right-angled device used to grasp a tracheal tube and place it in a patient's trachea. (b) Classification. Class I (general controls). The...

21 CFR 868.5780 - Tube introduction forceps.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Identification. Tube introduction forceps (e.g., Magill forceps) are a right-angled device used to grasp a tracheal tube and place it in a patient's trachea. (b) Classification. Class I (general controls). The...

21 CFR 868.5780 - Tube introduction forceps.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Identification. Tube introduction forceps (e.g., Magill forceps) are a right-angled device used to grasp a tracheal tube and place it in a patient's trachea. (b) Classification. Class I (general controls). The...

Biopsy of the buccal mucosa in oral lichen planus: the traditional method versus the use of a new pressure forceps.

PubMed

Bermejo-Fenoll, Ambrosio; López-Jornet, María Pía; Jiménez-Torres, María José; Camacho-Alonso, Fabio; Orduña-Domingo, Albina

2007-07-01

The authors designed a pressure forceps, called the "B forceps," for use in performing biopsies. They compared biopsy specimens taken with and without the aid of the B forceps from buccal mucosa of 84 patients divided equally into two groups, all of whom satisfied the World Health Organization's diagnostic criteria for oral lichen planus. They analyzed the advantages and disadvantages of using this instrument. The 42 patients in group A underwent a conventional biopsy (29 with a scalpel and 13 with a punch). The 42 patients in group B underwent a biopsy performed with the B forceps and a punch. The authors studied artifacts of fragmentation, pseudocysts, crushing, fissures and hemorrhages histologically in both groups. There were no significant differences within group A between the subjects who had undergone either the scalpel or the punch biopsy. There were, however, significant differences between groups A and B. Group B experienced less fragmentation (P = .021), fewer fissures (P = .001) and fewer hemorrhages (P = .001). The new B forceps was a useful aid in the performance of biopsies. It improved visibility and reduced the time needed for the procedure. Biopsy specimens taken with the B forceps also had histologically fewer artifacts than did those taken without the B forceps. This technique using the B forceps has several advantages, including speed, because the ischemia produced by the clamp stabilizes the tissue and increases visibility, facilitating dissection. The time needed for surgical removal thus is shortened.

Cannulation method for intra-diverticular papilla with long oral protrusion using biopsy forceps for axis alignment.

PubMed

Takenaka, Mamoru; Minaga, Kosuke; Kudo, Masatoshi

2018-06-22

Intra-diverticular papilla is considered as a difficult anatomical orientation for biliary cannulation. 1 2 3 To our knowledge, this is the first report to show the usefulness of biopsy forceps for cannulation not only to expose the ampulla in the case of an intra-diverticular papilla but also for axis alignment.An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography for a common bile duct (CBD) stone. A duodenoscope (TJF TYPE 260V; Olympus Medical Systems, Tokyo, Japan) was inserted into Vater's papilla. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Prospective, Randomized, Pathologist-Blinded Study of Disposable Alligator-Jaw Biopsy Forceps for Gastric Mucosal Biopsy

PubMed Central

Abudayyeh, Suhaib; Hoffman, Jill; El-Zimaity, Hala T.; Graham, David Y.

2010-01-01

Background Endoscopic biopsy forceps differ in the size and shape of the biopsy cup and the presence or absence of a needle. Methods We compared 4 different “large cup” forceps (3 with needles designed for 2.8 mm biopsy channels. A gastric antral and corpus biopsy were obtained with each. Parameters examined included: weight (mg), length (mm), orientation (poor, good), intactness (1, 2, or 3 pieces), depth (superficial, above muscularis mucosae, included muscularis mucosae), crush artifact (yes, no), and overall adequacy (inadequate, suboptimal, adequate). Results 24 patients were enrolled (191 biopsies). The median length was approximately 5 mm (range 1.1 to 8.2 mm). Histologically inadequate specimens were present in 4% with the forceps without needle compared to 16% of those with needles (P = 0.061) and there were significantly fewer specimens in 3 or more pieces than did the forceps with needles 2.1% vs. 12..6% (P<0.05). Conclusions Current alligator style forceps provide a high proportion of acceptable specimens with only minor differences between brands. Forceps from one source were least preferred by endoscopy assistants and had the highest rates of inadequate biopsies and biopsies with crush artifact. Forceps without needles provide histologically acceptable samples slightly more frequently than those with needles. PMID:18799373

Prospective, randomized, pathologist-blinded study of disposable alligator-jaw biopsy forceps for gastric mucosal biopsy.

PubMed

Abudayyeh, S; Hoffman, J; El-Zimaity, H T; Graham, D Y

2009-05-01

Endoscopic biopsy forceps differ in the size and shape of the biopsy cup and the presence or absence of a needle. We compared four different "large cup" forceps (three with needles) designed for 2.8mm biopsy channels. A gastric antral and corpus biopsy were obtained with each. Parameters examined included: weight (mg), length (mm), orientation (poor, good), intactness (1, 2, or 3 pieces), depth (superficial, above muscularis mucosae, included muscularis mucosae), crush artefact (yes, no), and overall adequacy (inadequate, suboptimal, adequate). Twenty-four patients were enrolled (191 biopsies). The median length was approximately 5mm (range 1.1-8.2mm). Histologically inadequate specimens were present in 4% with the forceps without needle compared to 16% of those with needles (P=0.061) and there were significantly fewer specimens in three or more pieces than did the forceps with needles 2.1% vs. 12.6% (P<0.05). Current alligator style forceps provide a high proportion of acceptable specimens with only minor differences between brands. Forceps from one source were least preferred by endoscopy assistants and had the highest rates of inadequate biopsies and biopsies with crush artefact. Forceps without needles provide histologically acceptable samples slightly more frequently than those with needles.

Naegele Forceps Delivery and Association between Morbidity and the Number of Forceps Traction Applications: A Retrospective Study.

PubMed

Matsumoto, Naoki; Takenaka, Toshifumi; Ikeda, Nobuyuki; Yazaki, Satoshi; Sato, Yuichi

2015-01-01

To present the method of Naegele forceps delivery clinically practiced by the lead author, its success rate, and morbidity and to evaluate the relationship between morbidity and the number of forceps traction applications. Naegele forceps delivery was performed when the fetal head reached station +2 cm, the forceps were applied in the maternal pelvic application, and traction was slowly and gently performed. In the past two years, Naegele forceps delivery was attempted by the lead author in 87 cases, which were retrospectively reviewed. The numbers of traction applications were one in 64.7% of cases, two in 24.7%, and three or more in 10.7%. The success rate was 100%. No severe morbidity was observed in mothers or neonates. Neonatal facial injury occurred most commonly in cases with fetal head malrotation, elevated numbers of traction applications, and maternal complications. Umbilical artery acidemia most commonly occurred in cases with nonreassuring fetal status. The significant crude odds ratio for three or more traction applications was 20 in cases with malrotation. Naegele forceps delivery has a high success rate, but multiple traction applications will sometimes be required, particularly in cases with malrotation. Malrotation and elevated numbers of traction applications may lead to neonatal head damage.

Use of Magill Forceps to Remove Foreign Bodies in Children.

PubMed

Oncel, Murat; Sunam, Guven Sadi; Elsurer, Cagdas; Yildiran, Huseyin

2017-04-01

Introduction  Esophageal foreign body (FB) in all age groups can cause serious morbidity or mortality. The study aims to report our experience retrieving FBs from the upper esophagus in children using Magill forceps. Materials and Methods  In this study, 88 patients (45 males [51.1%] and 43 females [48.9%]) were presented with suspected FB ingestion. FB ingestion was determined via endoscopic analysis, or lateral and posterior-anterior radiographies, including oropharynx, neck, chest, and abdomen. Cases were classified into seven groups, according to history, diagnostic method, and postintervention findings, as follows: (1) coins, (2) toys, (3) metals, (4) bones, (5) battery, (6) glass, and (7) food. A laryngoscope was used to elevate the larynx and expose the esophageal entrance. Magill forceps were advanced into the esophagus and opened to observe and extract the FB. Results  All 88 patients who underwent endoscopic examination due to suspected FB ingestion were confirmed to have ingested a FB. Median age was 12 years; 15 patients were aged < 5 years; 63 (71.5%) were diagnosed based on routine radiographic findings, and others were diagnosed based on physical findings and history. The most common type of FB was coins ( n  = 51 [57.9%]). Mean surgical duration was 20 minutes. Conclusion  FBs located at cervical esophageal level are usually the most difficult to remove. Magill forceps should be used before other methods.

[EFFECTIVENESS COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION IN SUPINE "SCISSORS" POSITION AND IN LITHOTOMY POSITION TO TREAT FEMORAL INTERTROCHANTERIC FRACTURES OF OLD PATIENTS].

PubMed

Du, Shihao; Yin, Fei; Wei, Xuming; Song, Sheng; Gu, Sanjun; Sun, Zhenzhong; Rui, Yongjun

2016-02-01

To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) between in the supine "scissors" position and in the lithotomy position for treating femoral intertrochanteric fractures of old patients. A retrospective study was performed on 58 patients with femoral intertrochanteric fractures treated with PFNA between January 2013 and January 2015. Fracture was treated with PFNA in the lithotomy position in 28 cases (group A) and in the supine "scissors" position in 30 cases (group B). There was no significant difference in gender, age, side, cause of injury, fracture type, and interval from injury to operation between 2 groups (P>0.05). The incision length, operation time, perspective times, intraoperative blood loss, complications, and fracture healing time were recorded; Harris hip score was used to access the effectiveness. The wound healed by first intention without infection, pressure sores, deep vein thrombosis of lower extremity, and other complications. There was no significant difference in incision length between 2 groups (t=1.313, P=0.212). Group B was significantly better than group A in operation time, perspective times, and intraoperative blood loss (P<0.05). All patients were followed up 10-31 months (mean, 15.3 months). Stretch injury at normal side and perineal discomfort occurred in 1 case and 5 cases of group A respectively, and no nonunion and other complications was observed in the other patients. There was no significant difference in fracture healing time and Harris hip score at last follow-up between 2 groups (P>0.05). PFNA in the supine "scissors" position has exact effectiveness and advantages of shorter operation time, less intraoperative blood loss, less perspective times, and fewer complications.

Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma.

PubMed

Weber, Andreas; von Weyhern, Claus; Fend, Falko; Schneider, Jochen; Neu, Bruno; Meining, Alexander; Weidenbach, Hans; Schmid, Roland M; Prinz, Christian

2008-02-21

To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma. Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangio-pancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005. Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology). Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings.

[Ultrasonic scissors. New vs resterilized instruments].

PubMed

Gärtner, D; Münz, K; Hückelheim, E; Hesse, U

2008-02-01

The aim of this study was to compare reliability in handling and function of resterilized and single-use disposable ultrasonic scissors. In a prospective randomized study, the surgeon blindly tested new and resterilized ultrasonographic scissors. The parameters were force of activation, cutting effect, coagulation effect, error messages, and disturbing generator noise. Fifty-one new and 49 resterilized instruments in 94 operations were evaluated. The differences in force of activation, cutting effect, and coagulation were not significant. Error messages and disturbing noises were rare in both groups. Six new instruments and two resterilized instruments had to be exchanged because of problems during surgery. This study demonstrates comparable reliability in function and handling of resterilized and new ultrasonic scissors. The use of resterilized instruments leads to distinctly reduced costs and could contribute to efficiency in laparoscopic surgery.

Forceps Delivery Volumes in Teaching and Nonteaching Hospitals: Are Volumes Sufficient for Physicians to Acquire and Maintain Competence?

PubMed Central

Kyser, Kathy L.; Lu, Xin; Santillan, Donna; Santillan, Mark; Caughey, Aaron B.; Wilson, Mark C.; Cram, Peter

2015-01-01

Purpose The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined: (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. Method The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. Results The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Conclusions Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures. PMID:24280847

Learning From Experience: Qualitative Analysis to Develop a Cognitive Task List for Kielland Forceps Deliveries.

PubMed

Simpson, Andrea N; Hodges, Ryan; Snelgrove, John; Gurau, David; Secter, Michael; Mocarski, Eva; Pittini, Richard; Windrim, Rory; Higgins, Mary

2015-05-01

Fetal malposition is a common indication for Caesarean section in the second stage of labour. Rotational (Kielland) forceps are a valuable tool in select situations for successful vaginal delivery; however, learning opportunities are scarce. Our aim was to identify the verbal and non-verbal components of performing a safe Kielland forceps delivery through filmed demonstrations by expert practitioners on models to develop a task list for training purposes. Labour and delivery nurses at three university-affiliated hospitals identified clinicians whom they considered skilled in Kielland forceps deliveries. These physicians gave consent and were filmed performing Kielland forceps deliveries on a model, describing their assessment and technique and sharing clinical pearls based on their experience. Two clinicians reviewed the videos independently and recorded verbal and non-verbal components of the assessment; thematic analysis was performed and a core task list was developed. The algorithm was circulated to participants to ensure consensus. Eleven clinicians were identified; eight participated. Common themes were prevention of persistent malposition where possible, a thorough assessment to determine suitability for forceps delivery, roles of the multidisciplinary team, description of the Kielland forceps and technical aspects related to their use, the importance of communication with the parents and the team (including consent, debriefing, and documentation), and "red flags" that indicate the need to stop when safety criteria cannot be met. Development of a cognitive task list, derived from years of experience with Kielland forceps deliveries by expert clinicians, provides an inclusive algorithm that may facilitate standardized resident training to enhance education in rotational forceps deliveries.

Cytological Sampling Versus Forceps Biopsy During Percutaneous Transhepatic Biliary Drainage and Analysis of Factors Predicting Success

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tapping, C. R.; Byass, O. R.; Cast, J. E. I., E-mail: james.cast@hey.nhs.uk

Purpose: To assess the accuracy of cytological sampling and forceps biopsy in obstructing biliary lesions and to identify factors predictive of success. Methods: Consecutive patients (n = 119) with suspected malignant inoperable obstructive jaundice treated with percutaneous transhepatic biliary drainage during 7 years were included (60 male; mean age 72.5 years). All patients underwent forceps biopsy plus cytological sampling by washing the forceps device in cytological solution. Patient history, procedural and pathological records, and clinical follow-up were reviewed. Statistical analysis included chi-square test and multivariate regression analysis. Results: Histological diagnosis after forceps biopsy was more successful than cytology: Sensitivity wasmore » 78 versus 61%, and negative predictive value was 30 versus 19%. Cytology results were never positive when the forceps biopsy was negative. The cytological sample was negative and forceps sample positive in 2 cases of cholangiocarcinoma, 16 cases of pancreatic carcinoma, and 1 case of benign disease. Diagnostic accuracy was predicted by low bilirubin (p < 0.001), aspartate transaminase (p < 0.05), and white cell count (p {<=} 0.05). Conclusions: This technique is safe and effective and is recommended for histological diagnosis during PTBD in patients with inoperable malignant biliary strictures. Diagnostic yield is greater when bilirubin levels are low and there is no sepsis; histological diagnosis by way of forceps biopsy renders cytological sampling unnecessary.« less

Use of a new jumbo forceps improves tissue acquisition of Barrett's esophagus surveillance biopsies.

PubMed

Komanduri, Sri; Swanson, Garth; Keefer, Laurie; Jakate, Shriram

2009-12-01

The major risk factors for the development of esophageal adenocarcinoma remain long-standing GERD and resultant Barrett's esophagus (BE). Finding the exact method of adequate tissue sampling for surveillance of dysplasia in BE remains a dilemma. We prospectively compared standard large-capacity biopsy forceps with a new jumbo biopsy forceps for dysplasia detection in BE. Prospective, single-center investigation. We prospectively enrolled 32 patients undergoing surveillance endoscopy for BE. Biopsy samples were obtained in paired fashion alternating between the experimental (jumbo) and control (large-capacity) forceps. Each sample was assessed for histopathology, specimen size, and adequacy. A total of 712 specimens were available for analysis for this investigation. Six patients were found to have dysplasia, and in 5 of those patients, the dysplasia was only detected with the jumbo forceps. The mean width was significantly greater in the Radial Jaw 4 jumbo group (3.3 mm vs 1.9 mm [P < .005]) as was the mean depth (2.0 mm vs 1.1 mm [P < .005]). Sixteen percent of samples obtained with the standard forceps provided an adequate sample, whereas the jumbo forceps provided an adequate sample 79% of the time (P < .05). A lack of a validated index for assessment of tissue adequacy in BE. The Radial Jaw 4 jumbo biopsy forceps significantly improves dysplasia detection and adequate tissue sampling in patients undergoing endoscopy for BE.

Is forceps more useful than visualization for measurement of colon polyp size?

PubMed Central

Kim, Jae Hyun; Park, Seun Ja; Lee, Jong Hoon; Kim, Tae Oh; Kim, Hyun Jin; Kim, Hyung Wook; Lee, Sang Heon; Baek, Dong Hoon; (BIGS), Busan Ulsan Gyeongnam Intestinal Study Group Society

2016-01-01

AIM: To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon polyp size. METHODS: We recorded colonoscopy video clips that included scenes visualizing the polyp and scenes using open biopsy forceps in association with the polyp, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society (BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated polyp size on the exam paper. When analyzing the results of the exam, we assessed inter-observer differences, diagnostic accuracy, and error range in the measurement of the polyp size. RESULTS: The overall intra-class correlation coefficients (ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804 (95%CI: 0.731-0.873, P < 0.001) and 0.743 (95%CI: 0.656-0.828, P < 0.001), respectively. The ICCs of each group for forceps estimation were higher than those for visual estimation (Beginner group, 0.761 vs 0.693; Expert group, 0.887 vs 0.840, respectively). The overall diagnostic accuracy for visual estimation was 0.639 and for forceps estimation was 0.754 (P < 0.001). In the beginner group and the expert group, the diagnostic accuracy for the forceps estimation was significantly higher than that of the visual estimation (Beginner group, 0.734 vs 0.613, P < 0.001; Expert group, 0.784 vs 0.680, P < 0.001, respectively). The overall error range for visual estimation and forceps estimation were 1.48 ± 1.18 and 1.20 ± 1.10, respectively (P < 0.001). The error ranges of each group for forceps estimation were significantly smaller than those for visual estimation (Beginner group, 1.38 ± 1.08 vs 1.68 ± 1.30, P < 0.001; Expert group, 1.12 ± 1.11 vs 1.42 ± 1.11, P < 0.001, respectively). CONCLUSION: Application of the open biopsy forceps method when measuring colon polyp size could help reduce inter-observer differences and error rates. PMID:27003999

Is forceps more useful than visualization for measurement of colon polyp size?

PubMed

Kim, Jae Hyun; Park, Seun Ja; Lee, Jong Hoon; Kim, Tae Oh; Kim, Hyun Jin; Kim, Hyung Wook; Lee, Sang Heon; Baek, Dong Hoon; Bigs, Busan Ulsan Gyeongnam Intestinal Study Group Society

2016-03-21

To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon polyp size. We recorded colonoscopy video clips that included scenes visualizing the polyp and scenes using open biopsy forceps in association with the polyp, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society (BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated polyp size on the exam paper. When analyzing the results of the exam, we assessed inter-observer differences, diagnostic accuracy, and error range in the measurement of the polyp size. The overall intra-class correlation coefficients (ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804 (95%CI: 0.731-0.873, P < 0.001) and 0.743 (95%CI: 0.656-0.828, P < 0.001), respectively. The ICCs of each group for forceps estimation were higher than those for visual estimation (Beginner group, 0.761 vs 0.693; Expert group, 0.887 vs 0.840, respectively). The overall diagnostic accuracy for visual estimation was 0.639 and for forceps estimation was 0.754 (P < 0.001). In the beginner group and the expert group, the diagnostic accuracy for the forceps estimation was significantly higher than that of the visual estimation (Beginner group, 0.734 vs 0.613, P < 0.001; Expert group, 0.784 vs 0.680, P < 0.001, respectively). The overall error range for visual estimation and forceps estimation were 1.48 ± 1.18 and 1.20 ± 1.10, respectively (P < 0.001). The error ranges of each group for forceps estimation were significantly smaller than those for visual estimation (Beginner group, 1.38 ± 1.08 vs 1.68 ± 1.30, P < 0.001; Expert group, 1.12 ± 1.11 vs 1.42 ± 1.11, P < 0.001, respectively). Application of the open biopsy forceps method when measuring colon polyp size could help reduce inter-observer differences and error rates.

Deeper rectal biopsies and better yield of neuronal structures with Scheye vs Noblett forceps--preliminary results.

PubMed

Campeotto, Florence; Barbet, Patrick J; Kalach, Nicolas; Arhan, Pierre; Devroede, Ghislain; Beaudoin, Sylvie; Dupont, Christophe

2011-03-01

The aim of the study was to compare 2 different forceps designed to perform biopsies of the rectal mucosa, those of Noblett and Scheye, the latter having a similar design and differing by the disposable cutting system. This historical study compares biopsies obtained with the Noblett forceps in 13 girls and 20 boys (mean ± SD age, 13 ± 30 months) and biopsies obtained with the Scheye forceps in 19 girls and 21 boys (mean ± SD age, 8.5 ± 19 months). The thickness of the material obtained with the Scheye forceps was significantly greater for the specimens obtained with the Scheye forceps (total biopsy: 1.74 ± 0.46 mm vs 0.67 ± 0.2 mm, P < .0001; submucosa: 1.12 ± 0.4 mm vs 0.14 ± 0.17 mm, P < .001). The Scheye forceps considerably increased the yield of neuronal structures, both for submucosal plexus (P < .003) and ganglia (P < .0001). No complication occurred in either group. The Scheye disposable rectal biopsy system provides larger mucosal biopsy samples than the Noblett with increased recovery of neuronal structures. Copyright © 2011 Elsevier Inc. All rights reserved.

Endoscopic transpapillary brush cytology and forceps biopsy in patients with hilar cholangiocarcinoma

PubMed Central

Weber, Andreas; von Weyhern, Claus; Fend, Falko; Schneider, Jochen; Neu, Bruno; Meining, Alexander; Weidenbach, Hans; Schmid, Roland M; Prinz, Christian

2008-01-01

AIM: To evaluate the sensitivity of brush cytology and forceps biopsy in a homogeneous patient group with hilar cholangiocarcinoma. METHODS: Brush cytology and forceps biopsy were routinely performed in patients with suspected malignant biliary strictures. Fifty-eight consecutive patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) including forceps biopsy and brush cytology in patients with hilar cholangiocarcinoma between 1995-2005. RESULTS: Positive results for malignancy were obtained in 24/58 patients (41.4%) by brush cytology and in 31/58 patients (53.4%) by forceps biopsy. The combination of both techniques brush cytology and forceps biopsy resulted only in a minor increase in diagnostic sensitivity to 60.3% (35/58 patients). In 20/58 patients (34.5%), diagnosis were obtained by both positive cytology and positive histology, in 11/58 (19%) by positive histology (negative cytology) and only 4/58 patients (6.9%) were confirmed by positive cytology (negative histology). CONCLUSION: Brush cytology and forceps biopsy have only limited sensitivity for the diagnosis of malignant hilar tumors. In our eyes, additional diagnostic techniques should be evaluated and should become routine in patients with negative cytological and histological findings. PMID:18286693

Benefit from NASA

NASA Image and Video Library

2004-04-15

Marshall inventors Seth Lawson and Stanley Smeltzer display a pair of obstetrical forceps they designed. The forceps, made from composite space-age materials, measure the force applied during instrument-assisted delivery. The new forceps will help medical students get a feel for instrument-assisted deliveries before entering practice.

Scissors stab wound to the cervical spinal cord at the craniocervical junction.

PubMed

Zhang, Xiao-Yong; Yang, Ying-Ming

2016-06-01

Stab wounds resulting in spinal cord injury of the craniocervical junction are rare. A scissors stab wound to the cervical spinal cord has been reported only once in the literature. This paper aimed to report a case of Brown-Séquard-plus syndrome in an 8-year-old boy secondary to a scissors stab wound at the craniocervical junction. Case report and review of the literature. Case report of an 8-year-old boy accidentally stabbed in the neck by scissors, which were thrown as a dart. The case study of an 8-year-old boy who was hospitalized because of a scissors stab wound at the craniocervical junction. The patient developed Brown-Séquard-plus syndrome on the left side of the body. Magnetic resonance imaging revealed a laceration of the spinal cord at the craniocervical junction with cerebrospinal fluid leakage. Careful cleansing and interrupted sutures of the wounds were performed to prevent cerebrospinal fluid leakage. Rehabilitation therapy was performed 2 days later. A follow-up examination revealed complete recovery of the neurologic deficit 8 months post-injury. Treatment of scissors stab wounds to the cervical spinal cord, whether conservative management or thorough surgical exploration, should be individualized based on history, examination, and imaging. As shown in this case report, despite conservative management, complete recovery, which was unexpected, was attributed to the initial mild laceration of the spinal cord and ipsilateral spinal cord functional compensation. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of Rotation on Perineal Lacerations in Forceps-Assisted Vaginal Deliveries

PubMed Central

Bradley, Megan S.; Kaminski, Robert J.; Streitman, David C.; Dunn, Shannon L.; Krans, Elizabeth E.

2013-01-01

Objective To determine the difference in the rates of severe perineal lacerations between forceps-assisted vaginal deliveries in the occiput-posterior (OP) position compared with forceps-assisted vaginal deliveries in which the fetal head was rotated to occiput anterior (OA) prior to delivery. Methods We studied a retrospective cohort of 148 women who had a forceps-assisted vaginal delivery from 2008–2011 at the University of Pittsburgh. Mild perineal lacerations were defined as first or second degree, and severe lacerations were defined as third or fourth degree. Chi-square and t tests were used for bivariate and logistic regression was used for multivariable analyses. P<.05 was considered statistically significant. Results Of 148 forceps-assisted deliveries, 81 delivered OA after either manual or forceps rotation, 10 delivered in the OP or occiput-transverse position after an unsuccessful rotation, and 57 delivered OP without attempted rotation. No significant differences were found between demographic, obstetric and neonatal characteristics of the groups. Overall, 86 (67.7%) women had mild lacerations and 41 (32.3%) had severe lacerations. A significantly greater rate of severe perineal lacerations were found in the OP nonrotated compared with the rotated group (43.4% compared with 24.3%; P=.02). In multivariable analyses, adjusted for age, race, insurance, body mass index, gestational age, parity, episiotomy and neonatal weight, forceps-assisted vaginal delivery in the OP position without rotation remained significantly more likely to be associated with severe lacerations (OR 3.67; 95% CI 1.42–9.47). Conclusion Forceps-assisted vaginal delivery after rotation of an OP position to an OA position is associated with less severe maternal perineal trauma than forceps-assisted delivery in the OP position. PMID:23743462

Effect of rotation on perineal lacerations in forceps-assisted vaginal deliveries.

PubMed

Bradley, Megan S; Kaminski, Robert J; Streitman, David C; Dunn, Shannon L; Krans, Elizabeth E

2013-07-01

To determine the difference in the rates of severe perineal lacerations between forceps-assisted vaginal deliveries in the occiput-posterior position compared with forceps-assisted vaginal deliveries in which the fetal head was rotated to occiput-anterior before delivery. We studied a retrospective cohort of 148 women who had a forceps-assisted vaginal delivery from 2008 to 2011 at the University of Pittsburgh. Mild perineal lacerations were defined as first or second degree, and severe lacerations were defined as third or fourth degree. χ and t tests were used for bivariate and logistic regression was used for multivariable analyses. P<.05 was considered statistically significant. Of 148 forceps-assisted deliveries, 81 delivered occiput-anterior after either manual or forceps rotation, 10 delivered in the occiput-posterior or occiput-transverse position after an unsuccessful rotation, and 57 delivered occiput-posterior without attempted rotation. No significant differences were found among demographic, obstetric, and neonatal characteristics of the groups. Overall, 86 (67.7%) women had mild lacerations and 41 (32.3%) had severe lacerations. A significantly greater rate of severe perineal lacerations was found in the occiput-posterior nonrotated compared with the rotated group (43.4% compared with 24.3%; P=.02). In multivariable analyses, adjusted for age, race, insurance, body mass index, gestational age, parity, episiotomy, and birth weight, forceps-assisted vaginal delivery in the occiput-posterior position without rotation remained significantly more likely to be associated with severe lacerations (odds ratio 3.67, 95% confidence interval 1.42-9.47). Forceps-assisted vaginal delivery after rotation of an occiput-posterior position to an occiput-anterior position is associated with less severe maternal perineal trauma than forceps-assisted delivery in the occiput-posterior position. II.

Multi-institutional Evaluation of Upper Urinary Tract Biopsy Using Backloaded Cup Biopsy Forceps, a Nitinol Basket, and Standard Cup Biopsy Forceps.

PubMed

Lama, Daniel J; Safiullah, Shoaib; Patel, Roshan M; Lee, Thomas K; Balani, Jyoti P; Zhang, Lishi; Okhunov, Zhamshid; Margulis, Vitaly; Savage, Stephen J; Uchio, Edward; Landman, Jaime

2018-04-06

To compare the performance of 3 contemporary ureteroscopic biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC). We retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup biopsy forceps, a nitinol basket, or 3F standard cup biopsy forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of biopsy-proven UTUC diagnosis, the biopsy grade was compared with both the grade and stage of the surgical specimen. Biopsy utilization varied among the 3 institutions (P <.0001). Significant variabilities in specimen size (P = .001), the presence of intact urothelium (P = .008), and crush artifact (P = .028) were found among the biopsy devices. The quality of specimens from backloaded cup forceps was rated similarly to the nitinol basket (P >.05) and was favored over standard cup forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant biopsy; however, the backloaded cup forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02). The backloaded cup forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup forceps. Ureteroscopic biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC. Copyright © 2018 Elsevier Inc. All rights reserved.

A pitfall during endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes.

PubMed

Krenke, Rafal; Korczynski, Piotr; Gorska, Katarzyna; Chazan, Ryszarda

2014-03-01

The high diagnostic yield and favorable safety profile of endobronchial ultrasound-guided transbronchial forceps biopsy of the mediastinal lymph nodes have been recently demonstrated. We report an unusual technical problem during endobronchial ultrasound-guided transbronchial forceps biopsy that could be a prerequisite for severe complications. A rupture of the steering band precluded closure of the forceps jaws opened in the subcarinal lymph node. A solution to the problem is presented, together with other procedure-related complications reported in the literature. The report emphasizes that a dysfunction of the forceps steering band can result in severe complications when it occurs during transbronchial sampling of mediastinal lesions. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Split-mouth comparison of physics forceps and extraction forceps in orthodontic extraction of upper premolars.

PubMed

Hariharan, Samyuktha; Narayanan, Vinod; Soh, Chen Loong

2014-12-01

We compared outcome variables (operative complications, inflammatory complications, and operating time) in patients being treated by orthodontic extraction of upper premolars with the Physics forceps or the universal extraction forceps. We organised a single blind, split-mouth clinical trial to compare the outcomes of the 2 groups (n=54 premolars). The Physics forceps group had lower mean (SD) visual analogue scores (VAS) for pain (0.59 (0.57)) on the first postoperative day than the other group (1.04 (0.85)) (p=0.03). There were no other significant differences between the 2 groups in any other variable studied. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

.... This type of device consists of the following: (1) An amniotome is an instrument used to rupture the... cerclage needle is a looplike instrument used to suture the cervix. (10) A hook-type contraceptive... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used...

Training on Kielland's forceps: A survey of trainees' opinions.

PubMed

Al Wattar, B H; Mahmud, A; Janjua, A; Parry-Smith, W; Ismail, K M

2017-04-01

We conducted a cross-sectional survey including specialist trainees in obstetrics and gynaecology in the Health Education West Midlands region, UK, to capture their views and assess training opportunities on the use of Kielland's forceps. Half of the trainees in the region completed the survey (87/172, 50%). Only 31% of our trainees worked in units that supported the training on these forceps (27/87, 31%). The majority reported that they did not get enough exposure to using Kielland's forceps (53/87, 60.9%). Only a minority (5.7%, 5/87) felt confident to perform a Kielland's rotational delivery independently. The majority (64.3%, 56/87) were keen to continue using Kielland's forceps in the future if competent. More than two-thirds (86.2%, 75/87) felt that simulation could aid their training. There was large enthusiasm for training on the safe use of Kielland's forceps among trainees in obstetrics and gynaecology in the West Midlands region. A national assessment of training resources is needed to better plan training recourses on this complex skill.

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

21 CFR 876.1075 - Gastroenterology-urology biopsy instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

... biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This... regulations. (b) Classification. (1) Class II (performance standards). (2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from...

"Scissors, Paper, Stone": Perceptual Foundations of Noun Classifier Systems.

ERIC Educational Resources Information Center

Erbaugh, Mary S.

While all languages use shape to classify unfamiliar objects, some languages as diverse as Mandarin, Thai, Japanese, Mohawk, and American Sign Language lexicalize these and other types of description as noun classifiers. Classification does not develop from a fixed set of features in the object, but is discourse-sensitive and invoked when it would…

Scissors mode of Gd nuclei studied from resonance neutron capture

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kroll, J.; Baramsai, B.; Becker, J. A.

2012-10-20

Spectra of {gamma} rays following the neutron capture at isolated resonances of stable Gd nuclei were measured. The objectives were to get new information on photon strength of {sup 153,155-159}Gd with emphasis on the role of the M1 scissors-mode vibration. An analysis of the data obtained clearly indicates that the scissors mode is coupled not only to the ground state, but also to all excited levels of the nuclei studied. The specificity of our approach ensures unbiasedness in estimating the sumed scissors-mode strength {Sigma}B(M1){up_arrow}, even for odd product nuclei, for which conventional nuclear resonance fluorescence measurements yield only limited information.more » Our analysis indicates that for these nuclei the sum {Sigma}B(M1){up_arrow} increases with A and for {sup 157,159}Gd it is significantly higher compared to {sup 156,158}Gd.« less

Surgical scissors extension adds the 7th axis of force feedback to the Freedom 6S.

PubMed

Powers, Marilyn J; Sinclair, Ian P W; Brouwer, Iman; Laroche, Denis

2007-01-01

A virtual reality surgical simulator ideally allows seamless transition between the real and virtual world. In that respect, all of a surgeon's motions and tools must be simulated. Until now researchers have been limited to using a pen-like tool in six degrees-of-freedom. This paper presents the addition of haptically enabled scissors to the end effector of a 6-DOF haptic device, the Freedom 6S. The scissors are capable of pinching a maximum torque of 460 mN.m with low inertia and low back-drive friction. The device is a balanced design so that the user feels like they are holding no more than actual scissors, although with some added inertia on the load end. The system is interchangeable between the 6-DOF and 7-DOF configurations to allow switching tools quickly.

Comparison between scissor and laser resections of intrauterine septa in hysteroscopy

NASA Astrophysics Data System (ADS)

Wilczak, Maciej; Wozniak, Jakub; Cwojdzinski, Marek; Sajdak, Stefan; Opala, Tomasz; Pisarski, Tadeusz

1996-03-01

The comparison between results of scissors- and Nd-YAG laser-resection of intrauterine septa in hysteroscopy was shown. In 12 patients the scissors-resection and in 11 women the laser- resection was done. In the group of patients after laser procedure 10 of them were pregnant and 9 delivered healthy children. One missed abortion was diagnosed in the twenty-first week of gestation. After scissors-resection 7 women became pregnant and 5 of them bore mature children. Two of those seven lost their gestation (spontaneous abortions in the nineteenth and twentieth weeks of pregnancy). In the authors' opinion hysteroscopy is a very useful method of diagnostics and therapy of intrauterine septa. The Nd-YAG laser-resection of intrauterine septa seems to be the method with the lowest number of complications. Fertility and parity highly improves after removal of the septa localized in the uterine cavity.

Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy.

PubMed

Kawai, Manabu; Tani, Masaji; Okada, Ken-ichi; Hirono, Seiko; Miyazawa, Motoki; Shimizu, Astusi; Kitahata, Yuji; Yamaue, Hiroki

2013-09-01

The appropriate surgical stump closure after distal pancreatectomy (DP) is still controversial. This study investigated the benefits and risks of stapler closure during DP. The risk factors of pancreatic fistulas were investigated in 122 DPs among 3 types of stump closure: hand-sewn suture (n = 32), bipolar scissors (n = 45), and stapler closure (n = 45). There was no significant difference in the incidence of pancreatic fistula between the 3 types of stump closure (hand-sewn suture [44%] vs bipolar scissors [37.7%] vs stapler closure [35.5%]). By using receiver operating characteristics curves, 12 mm was the best cutoff value of the thickness of the pancreas for pancreatic fistulas after DP using stapler closure. Three factors (ie, male sex, body mass index >25 kg/m(2), and stapler closure) were independent risk factors of pancreatic fistulas after DP with a pancreas thicker than 12 mm. A pancreas thicker than 12 mm significantly increased the incidence of pancreatic fistulas after DP using stapler closure. Copyright © 2013 Elsevier Inc. All rights reserved.

Forceps biopsy and suction catheter for sampling in pulmonary nodules and infiltrates.

PubMed

Peschke, Antje; Wiedemann, Bärbel; Höffken, Gert; Koschel, Dirk

2012-06-01

Transbronchial lung biopsy with forceps is a standard procedure in bronchoscopic tissue sampling. Suction catheter aspiration is another technique, but it is not widely known and almost no data exist regarding its diagnostic efficiency. 272 patients were included in a prospective and randomised study between February 2007 and October 2009. All were referred for bronchoscopic evaluation of pulmonary nodules/masses or infiltrates. We compared the diagnostic yield of forceps biopsy and suction catheter aspiration for a definite diagnosis and looked at whether such a diagnosis depends on the underlying pulmonary change. All patients underwent bronchoscopy with forceps biopsy and catheter aspiration. A definitive diagnosis was reached in a total of 183 (67.3%) patients, with catheter aspiration in 140 (51.5%) patients and with forceps biopsy in 136 (50.0%) patients. In 90 (33.1%) patients, a definite diagnosis could only be reached with the combination of both techniques. The diagnostic yield of forceps biopsy was better than catheter aspiration in infiltrates (p = 0.027), but was no different in nodules or masses (p = 0.09). Suction catheter aspiration is a useful technique of bronchoscopic tissue sampling. The combination of catheter aspiration and forceps biopsy results in a higher diagnostic yield than either method used alone.

[Transabdominal chorionic villus sampling using biopsy forceps or needle: pregnancy outcomes by technique used].

PubMed

Spallina, J; Anselem, O; Haddad, B; Touboul, C; Tsatsaris, V; Le Ray, C

2014-11-01

To compare pregnancy outcomes after transabdominal chorionic villus sampling using biopsy forceps or needle. Retrospective bicentric study including all women who had a transabdominal chorionic villus sampling between 2005 and 2009 (172 using biopsy forceps and 160 using needle). The primary endpoint was the rate of fetal loss, after excluding medical abortion due to the result of the biopsy. The secondary endpoint was the rate of premature rupture of the membrane. All cases were reviewed to try to determine the responsibility of the biopsy. The pregnancy outcomes were not different between the two groups: 4 (4.4%) fetal losses in the biopsy forceps group and 6 (7.4%) in the needle group (P=0.52). Only one case (1.2%) of fetal loss can be attributed to the biopsy, using a needle, and none (0%) following a forceps biospy (P=0.29). The rate of premature rupture of the membrane was comparable in the two groups. The pregnancy outcomes following chorionic villus sampling using a biopsy forceps or a needle seem comparable. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Zealots tame oscillations in the spatial rock-paper-scissors game

NASA Astrophysics Data System (ADS)

Szolnoki, Attila; Perc, Matjaž

2016-06-01

The rock-paper-scissors game is a paradigmatic model for biodiversity, with applications ranging from microbial populations to human societies. Research has shown, however, that mobility jeopardizes biodiversity by promoting the formation of spiral waves, especially if there is no conservation law in place for the total number of competing players. First, we show that even if such a conservation law applies, mobility still jeopardizes biodiversity in the spatial rock-paper-scissors game if only a small fraction of links of the square lattice is randomly rewired. Secondly, we show that zealots are very effective in taming the amplitude of oscillations that emerge due to mobility and/or interaction randomness, and this regardless of whether the later is quenched or annealed. While even a tiny fraction of zealots brings significant benefits, at 5% occupancy zealots practically destroy all oscillations regardless of the intensity of mobility, and regardless of the type and strength of randomness in the interaction structure. Interestingly, by annealed randomness the impact of zealots is qualitatively the same as by mobility, which highlights that fast diffusion does not necessarily destroy the coexistence of species, and that zealotry thus helps to recover the stable mean-field solution. Our results strengthen the important role of zealots in models of cyclic dominance, and they reveal fascinating evolutionary outcomes in structured populations that are a unique consequence of such uncompromising behavior.

News on the Scissors Mode

NASA Astrophysics Data System (ADS)

Pietralla, N.; Beller, J.; Beck, T.; Derya, V.; Löher, B.; Romig, C.; Savran, D.; Scheck, M.; Tornow, W.; Zweidinger, M.

2014-09-01

We report on our recent nuclear resonance fluorescence experiments on l52,l54,l56Gd. Decay branches of the scissors mode to intrinsic excitations are observed. They are interpreted as a new signature for a spherical-to-deformed nuclear shape phase transition.

Flexible RF filter using a nonuniform SCISSOR.

PubMed

Zhuang, Leimeng

2016-03-15

This work presents a flexible radiofrequency (RF) filter using an integrated microwave photonic circuit that comprises a nonuniform side-coupled integrated spaced sequence of resonators (N-SCISSOR). The filter passband can be reconfigured by varying the N-SCISSOR parameters. When employing a dual-parallel Mach-Zechnder modulator, the filter is also able to perform frequency down-conversion. In the experiment, various filter response shapes are shown, ranging from a flat-top band-pass filter to a total opposite high-rejection (>40  dB) notch filter, with a frequency coverage of greater than two octaves. The frequency down-conversion function is also demonstrated.

Stereoscopic Analysis of Silicone Breast Implant Shells Damaged by Surgical Instruments.

PubMed

Rapp, Derek A; Neaman, Keith C; Hammond, Dennis C

2015-07-01

Iatrogenic shell injury during the implantation and explantation of silicone gel breast implants may lead to eventual device failure. Identification of the patterns of injury caused by surgical instruments is important when attempting to characterize the cause of shell rupture. Understanding the true causes of device failure may help with its prevention. The purpose of this study was to microscopically characterize patterns of shell injury induced by various surgical instruments. Textured and smooth silicone gel implants were intentionally damaged with a variety of surgical instruments. Various scalpels and surgical scissors ranging in fineness were used to create full-thickness injuries in the implant shell. Optical microscopy and scanning electron microscopy were then used to image the injured area to determine patterns of injury. Full-thickness striations across the thickness of the shell could be seen with damage caused by scissors. The density of these striations correlated directly with the fineness of scissors used. No striations were seen with injuries caused by scalpels. Striations were only observed in injuries caused by scissors and suture needles. Striation density correlated with the coarseness of the cutting edge. No such striations were seen in shells damaged by a scalpel even when the angle of approach was changed. This difference can be of assistance in distinguishing between scissors versus scalpel injury of an implant shell.

[A case of malignant lymphoma successfully diagnosed using Sasada transbronchial angled biopsy forceps].

PubMed

Komori, Chika; Sasada, Shinji; Okamoto, Norio; Kawahara, Kunimitsu; Uehara, Nobuko; Shimada, Kazutaka; Kuhara, Hanako; Terada, Haruko; Tsujino, Kazuyuki; Matsunashi, Tatsuro; Minami, Toshiyuki; Suzuki, Hidekazu; Kobayashi, Masashi; Hirashima, Tomonori; Matsui, Kaoru; Kawase, Ichiro; Kusunoki, Yoko

2009-01-01

A 68-year-old man was referred to our hospital due to general fatigue, fever and weight loss. His chest radiograph showed a nodule (2.8 cm) in the right middle lobe. Computed tomography and positron emission tomography showed multiple metastases to the bone, liver and lymph nodes. The lung nodule was not accessible by standard transbronchial forceps. However, biopsy specimens obtained using Sasada Transbronchial Angled Biopsy Forceps (STAF) pathologically confirmed the diagnosis of malignant lymphoma. We report the case, and discuss the utility of STAF for lung lesions that are difficult to access with standard forceps.

Predictive factors suggesting an underestimation of gastric lesions initially diagnosed as adenomas by forceps biopsy.

PubMed

Ko, Sung Jun; Yang, Min A; Yun, So Hee; Park, Moon Sik; Han, Shang Hoon; Cho, Jin Woong

2016-03-01

The endoscopic forceps biopsy of gastric lesion may provide inadequate specimens for a correct diagnosis of the entire lesion. Therefore, a histologic discrepancy may exist between specimens obtained by forceps biopsy and by endoscopic resection. The aim of this study was to evaluate the endoscopic characteristics of an underestimation in gastric carcinomas initially diagnosed as adenomas by forceps biopsy. We retrospectively reviewed 431 lesions diagnosed as gastric adenomas by forceps biopsy and resected by endoscopic submucosal dissection (ESD) between January 2008 and December 2011. The endoscopic findings were reviewed for location, size, gross appearance, ulceration, and surface color. We compared these variables between the adenoma group and the carcinoma group, as defined by the post-resection pathological findings. The mean patient age was 65.63±9.30 years in the adenoma group and 64.75±10.30 years in the carcinoma group. The mean size of the lesion was 21.04±8.65 mm in the adenoma group and 22.06±7.46 mm in the carcinoma group. In the multivariate analysis, high-grade dysplasia from endoscopic forceps biopsy and red discoloration were significant variables associated with carcinoma in post-resection histology. Gastric adenomatous lesions with endoscopic characteristics of surface redness and high-grade dysplasia on forceps biopsy should be resected completely by ESD because of the high possibility of an underestimation after ESD.

Robotic Cholecystectomy Using the Newly Developed Korean Robotic Surgical System, Revo-i: A Preclinical Experiment in a Porcine Model.

PubMed

Kang, Chang Moo; Chong, Jae Uk; Lim, Jin Hong; Park, Dong Won; Park, Sung Jun; Gim, Suhyeon; Ye, Hye Jin; Kim, Se Hoon; Lee, Woo Jung

2017-09-01

One Korean company recently successfully produced a robotic surgical system prototype called Revo-i (MSR-5000). We, therefore, conducted a preclinical study for robotic cholecystectomy using Revo-i, and this is a report of the first case of robotic cholecystectomy performed using the Revo-i system in a preclinical porcine model. Revo-i consists of a surgeon console (MSRC-5000), operation cart (MSRO-5000) and vision cart (MSRV-5000), and a 40 kg-healthy female porcine was prepared for robotic cholecystectomy with general anesthesia. The primary end point was the safe completion of these procedures using Revo-i: The total operation time was 88 minutes. The dissection time was defined as the time from the initial dissection of the Calot area to the time to complete gallbladder detachment from the liver bed: The dissection time required 14 minutes. The surgical console time was 45 minutes. There was no gallbladder perforation or significant bleeding noted during the procedure. The porcine survived for two weeks postoperatively without any complications. Like the da Vinci surgical system, the Revo-i provides a three-dimensional operative view and allows for angulated instrument motion (forceps, needle-holders, clip-appliers, scissors, bipolar energy, and hook monopolar energy), facilitating an effective laparoscopic procedure. Our experience suggests that robotic cholecystectomy can be safely completed in a porcine model using Revo-i. © Copyright: Yonsei University College of Medicine 2017.

Laparoscopic partial nephrectomy for renal tumor: Nagoya experience.

PubMed

Yoshikawa, Yoko; Ono, Yoshinari; Hattori, Ryohei; Gotoh, Momokazu; Yoshino, Yasushi; Katsuno, Satoshi; Katoh, Masashi; Ohshima, Shinichi

2004-08-01

To clarify the indication for a vascular clamp during laparoscopic partial nephrectomy, the clinical results of 17 patients who underwent the procedure for small renal tumors were reviewed. Seventeen patients with renal tumors were enrolled in our laparoscopic partial nephrectomy program between October 1999 and November 2003. During laparoscopy, a vascular clamp was used to remove the tumor mass and suture the incised renal parenchyma and urinary collecting system in 8 patients who had less-than-1-cm-thick renal parenchyma between the mass and the renal sinus or calices. In the remaining 9 patients, who had 1-cm-or-more-thick renal parenchyma between the mass and sinus or calices, renal bleeding was controlled using ultrasonic scissors, gauze tampon, argon beam coagulator, and fibrin glue. Sixteen patients were successfully treated with laparoscopy; one required conversion to open surgery because of uncontrollable bleeding. The average operative time was 4.5 hours, and average estimated bleeding volume was 301 mL. In the 8 patients requiring vascular clamping by forceps, the average ischemic time was 25 minutes. In all patients, the tumor mass was completely removed with negative surgical margins, and renal function was preserved. Three patients had prolonged urinary leakage for a mean of 21 days. Laparoscopic partial nephrectomy offers many advantages, including surgery that is both nephron sparing and minimally invasive. A vascular clamp was indicated for patients with less-than-1-cm-thick renal parenchyma between the tumor mass and renal sinus or calices.

Calculus, Paper, Scissors

ERIC Educational Resources Information Center

Flores, Luis; Flores, Alfinio

2006-01-01

The idea of cutting out a curve while looking at the direction of cut of the scissors is used to explore concepts related to curves, tangents and derivatives, especially tangent line, concavity and points of inflection, curvature, and a curve as envelope of tangent lines. (Contains 6 figures.)

Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility

PubMed Central

2013-01-01

Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = −0.438 and −0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials. PMID:23688510

Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility.

PubMed

Servidoni, Maria F; Sousa, Marisa; Vinagre, Adriana M; Cardoso, Silvia R; Ribeiro, Maria A; Meirelles, Luciana R; de Carvalho, Rita B; Kunzelmann, Karl; Ribeiro, Antônio F; Ribeiro, José D; Amaral, Margarida D

2013-05-20

Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = -0.438 and -0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials.

Predictive factors for positive diagnosis of malignant biliary strictures by transpapillary brush cytology and forceps biopsy.

PubMed

Naitoh, Itaru; Nakazawa, Takahiro; Kato, Akihisa; Hayashi, Kazuki; Miyabe, Katsuyuki; Shimizu, Shuya; Kondo, Hiromu; Nishi, Yuji; Yoshida, Michihiro; Umemura, Shuichiro; Hori, Yasuki; Kuno, Toshiya; Takahashi, Satoru; Ohara, Hirotaka; Joh, Takashi

2016-01-01

The diagnostic yields of endoscopic transpapillary brush cytology and forceps biopsies for malignant biliary strictures (MBS) remain unclear and predictive factors for diagnosis have not been established. We aimed to clarify the diagnostic yields of both methods and the predictive factors We reviewed 241 patients with biliary strictures who underwent transpapillary brush cytology (n = 202) or forceps biopsy (n= 208) between 2004 and 2014 at a single academic center. The sensitivity of forceps biopsy for MBS was significantly higher than that of brush cytology [60.6% (97/160) vs 36.1% (57/158), P < 0.01). The sensitivity of forceps biopsy was significantly higher in diagnosing bile duct cancer than pancreatic cancer [78.8% (52/66) vs 42.4% (28/66), P < 0.01). Multivariate analysis revealed that serum total bilirubin (TB) level (T-Bil) ≥ 4 mg/dL [odds ratio (OR) 2.506, 95% confidence interval (CI): 1.139-5.495, P = 0.022) was an independent predictor for positive diagnosis by brush cytology, while bile duct cancer (OR 4.926, 95% CI 2.183-11.111, P < 0.001), stricture length ≥ 30 mm (OR 2.941, 95% CI 1.119-7.752, P = 0.029) and TB ≥ 4 mg/dL (OR 2.252, 95% CI 1.052-4.831, P = 0.037) were significant indicators of a positive diagnosis by forceps biopsy. Endoscopic transpapillary forceps biopsy shows higher sensitivity than that of brush cytology for MBS. Bile duct cancer, stricture length ≥ 30 mm and TB ≥ 4 mg/dL are good indicators of forceps biopsy. © 2016 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

The role of transbronchial cryobiopsy in lung transplantation.

PubMed

Montero, M Angeles; de Gracia, Javier; Culebras, Mario; Mugnier, Jacqueline; Álvarez, Antonio; Berastegui, Cristina; Ortiz-Villalón, Cristian

2018-05-19

Lung transplant monitoring is usually assessed by forceps transbronchial biopsies. These types of biopsies show limited reliability and high degree of variability due to insufficient material and compression artefact, which lead to misinterpretation and eventually mistreatment of the transplanted patients. The following study was undertaken to assess the diagnostic yield, histological quality and safety of cryobiopsy in comparison with conventional forceps biopsy for sampling lung tissue in transplant recipients. From January to December 2011, 81 consecutive transbronchial biopsies (41 forceps and 40 cryoprobe) were indicated in single or bilateral lung transplantation recipients with clinical acute or chronic lung injury. Lung samples obtained by cryoprobe were larger (8.5±6.5mm FB group vs 22.1±12.5 CB group; P < 0.0001) and had no crush artefacts (P = 0.002), allowed us to increase the diagnosis of acute (P = 0,0657) and chronic cellular rejection P = 0,0053). Transbronchial cryoprobe bronchoscopy allows harvesting of larger and more expanded lung tissue samples by increasing the diagnostic yield in the monitoring of the lung allograft by means of a safe procedure. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Molecular Detection of H. pylori Using Adherent Gastric Mucous to Biopsy Forceps.

PubMed

Matsumoto, Hiroshi; Shiotani, Akiko; Nishibayashi, Hiroyuki; Kamada, Tomoari; Kimura, Tomonari; Fujimura, Yoshinori; Nakato, Rui; Murao, Takahisa; Fujita, Minoru; Haruma, Ken

2016-12-01

We assessed whether adherent gastric mucous to biopsy forceps instead of biopsy samples was suitable for the diagnosis of H. pylori infection. We confirmed the PCR methods to improve the diagnosis of H. pylori infection and clarithromycin (CAM) susceptibility. Gastric mucous was obtained by gently scraping gastric mucosa using biopsy forceps in patients undergoing upper gastrointestinal (GI) endoscopy for PCR and rapid urease test (RUT). DNA was extracted from gastric mucous present within the gel of RUT. H. pylori status and CAM susceptibility were evaluated using H. pylori-specific PCR amplification for 23S rRNA using 4 different primer sets and 16S rRNA. H. pylori positive was defined as two of the three tests (serum antibody, histology, and RUT or PCR) were positive. CAM susceptibility was evaluated by point mutations (A 2142G and A 2143G of 23S rRNA). Samples taken from 494 subjects were evaluated: 300 H. pylori-positive patients and 194 negative patients. The results of PCR using DNA extracted from gastric mucous present within the RUT gel were consistent with those within water. The accuracy of 23S rRNA PCR for H. pylori detection using RUT samples was superior to the other tests. The frequency of CAM resistance was 38.9%, and eradication rate was 91.3% in the patients with wild-type and 47.0% in the patients with the mutant strains. Adherent gastric mucous to biopsy forceps in RUT gel can be used for molecular testing to confirm the diagnosis of H. pylori infection and for CAM susceptibility. © 2016 John Wiley & Sons Ltd.

Bleeding after tooth extraction in patients taking aspirin and clopidogrel (Plavix®) compared with healthy controls.

PubMed

Sadeghi-Ghahrody, Mohsen; Yousefi-Malekshah, Seyed Hamid; Karimi-Sari, Hamidreza; Yazdanpanah, Hamid; Rezaee-Zavareh, Mohammad Saeid; Yavarahmadi, Mohammadhosein

2016-06-01

The risk of perioperative bleeding is high in patients who take aspirin and clopidogrel after a percutaneous coronary intervention, and whether to stop the drugs is a matter of concern for dentists. The aim of this study was to answer the specific question: should aspirin and clopidogrel bisulphate (Plavix®) be discontinued during a conventional forceps extraction? We studied 64 patients during the first year after percutaneous insertion of coronary stents who were taking aspirin (ASA) 80mg and clopidogrel (Plavix(®)) 75mg, and 50 healthy patients who were to have a conventional forceps extraction at this polyclinic in 2013-2014 and acted as controls. Clinical details (underlying diseases; number of roots; type of tooth; type of haemostasis; and bleeding immediately, 30minutes, and 48hours after intervention) were compared. We evaluated 114 patients with the mean (range) age of 56 (43-76) years, and there were no significant differences in demographic data, underlying diseases, type of tooth, number of roots, and dose of anaesthetic between the groups. There were also no significant differences in the number of bleeds immediately and 30minutes after intervention (P=0.310 and 0.205). The time that the last dose of aspirin had been taken correlated with 30-minute haemostasis (20 compared with 12hours, p=0.037). During the 48hours after the intervention, there were no uncontrolled bleeds or emergency referrals. We conclude that using aspirin and Plavix® simultaneously has no considerable effect on the risk of bleeding in patients having conventional forceps extraction of a single tooth. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Chemical scissors cut phosphorene nanostructures

NASA Astrophysics Data System (ADS)

Peng, Xihong; Wei, Qun

2014-12-01

Phosphorene, a recently fabricated two-dimensional puckered honeycomb structure of phosphorus, showed promising properties for applications in nano-electronics. In this work, we report a chemical scissors effect on phosphorene, using first-principles method. It was found that chemical species, such as H, OH, F, and Cl, can act as scissors to cut phosphorene. Phosphorus nanochains and nanoribbons can be obtained. The scissors effect results from the strong bonding between the chemical species and phosphorus atoms. Other species such as O, S and Se fail to cut phosphorene nanostructures due to their weak bonding with phosphorus. The electronic structures of the produced P-chains reveal that the hydrogenated chain is an insulator while the pristine chain is a one-dimensional Dirac material, in which the charge carriers are massless fermions travelling at an effective speed of light ˜8 × 105 m s-1. The obtained zigzag phosphorene nanoribbons show either metallic or semiconducting behaviors, depending on the treatment of the edge phosphorus atoms.

Development of Tasks and Evaluation of a Prototype Forceps for NOTES

PubMed Central

Addis, Matthew; Aguirre, Milton; Haluck, Randy; Matthew, Abraham; Pauli, Eric; Gopal, Jegan

2012-01-01

Background and Objectives: Few standardized testing procedures exist for instruments intended for Natural Orifice Translumenal Endoscopic Surgery. These testing procedures are critical for evaluating surgical skills and surgical instruments to ensure sufficient quality. This need is widely recognized by endoscopic surgeons as a major hurdle for the advancement of Natural Orifice Translumenal Endoscopic Surgery. Methods: Beginning with tasks currently used to evaluate laparoscopic surgeons and instruments, new tasks were designed to evaluate endoscopic surgical forceps instruments. Results: Six tasks have been developed from existing tasks, adapted and modified for use with endoscopic instruments, or newly designed to test additional features of endoscopic forceps. The new tasks include the Fuzzy Ball Task, Cup Drop Task, Ring Around Task, Material Pull Task, Simulated Biopsy Task, and the Force Gauge Task. These tasks were then used to evaluate the performance of a new forceps instrument designed at Pennsylvania State University. Conclusions: The need for testing procedures for the advancement of Natural Orifice Translumenal Endoscopic Surgery has been addressed in this work. The developed tasks form a basis for not only testing new forceps instruments, but also for evaluating individual performance of surgical candidates with endoscopic forceps instruments. PMID:22906337

Main interior space facing south toward the ocean. Original scissor ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Main interior space facing south toward the ocean. Original scissor trusses and deck roof are visible at the top. Octagonal window with large picture windows face the ocean. - San Luis Yacht Club, Avila Pier, South of Front Street, Avila Beach, San Luis Obispo County, CA

The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries.

PubMed

Benavides, Lorena; Wu, Jennifer M; Hundley, Andrew F; Ivester, Thomas S; Visco, Anthony G

2005-05-01

A forceps-assisted vaginal delivery is a well-recognized risk factor for anal sphincter injury. Some studies have shown that occiput posterior (OP) fetal head position is also associated with an increased risk for third- or fourth-degree lacerations. The objective of this study was to assess whether OP position confers an incrementally increased risk for anal sphincter injury above that present with forceps deliveries. This was a retrospective cohort study of 588 singleton, cephalic, forceps-assisted vaginal deliveries performed at our institution between January 1996 and October 2003. Maternal demographics, labor and delivery characteristics, and neonatal factors were examined. Statistical analysis consisted of univariate statistics, Student t test, chi2, and logistic regression. The prevalence of occiput anterior (OA) and OP positions was 88.4% and 11.6%, respectively. The groups were similar in age, marital status, body mass index, use of epidural, frequency of inductions, episiotomies, and shoulder dystocias. The OA group had a higher frequency of rotational forceps (16.2% vs 5.9%, P = .03), greater birth weights (3304 +/- 526 g vs 3092 +/- 777 g, P = .004), and a larger percentage of white women (48.8% vs 34.3%, P = .04). Overall, 35% of forceps deliveries resulted in a third- or fourth-degree laceration. Anal sphincter injury occurred significantly more often in the OP group compared with the OA group (51.5% vs 32.9%, P = .003), giving an odds ratio of 2.2 (CI: 1.3-3.6). In a logistic regression model that controlled for occiput posterior position, maternal body mass index, race, length of second stage, episiotomy, birth weight, and rotational forceps, OP head position was 3.1 (CI: 1.6-6.2) times more likely to be associated with anal sphincter injury than OA head position. Forceps-assisted vaginal deliveries have been associated with a greater risk for anal sphincter injury. Within this population of forceps deliveries, an OP position further increases the risk of third- or fourth-degree lacerations when compared with an OA position.

Mola Scissors: An Exercise in Design.

ERIC Educational Resources Information Center

Carson, Janet

1982-01-01

Describes a design exercise for college education majors. Five paper scissor shapes are used to illustrate the role of balance, variation, repetition, and unity in design. After comparing their own designs to Indian molas, students explore how color and shape affect design by elaborating their work with oil crayons. (AM)

The birth of forceps.

PubMed

Sheikh, Sukhera; Ganesaratnam, Inithan; Jan, Haider

2013-07-01

Operative vaginal delivery has been described since the Middle Ages. During this time, however, labour would be sustained over several days and intrapartum death almost inevitable. In these circumstances, intervention involving the use of surgical instruments or even kitchen utensils would serve purely as an attempt to avoid maternal mortality. The establishment of forceps-assisted delivery as a means of avoiding both maternal and neonatal morbidity was initiated in the 16th century by the Chamberlen family and later developed over several centuries by leading obstetricians of the time including Simpson, Barnes and Keilland. The evolution of forceps is a fascinating story which is rich in history. Despite the development of Ventouse and the increasing use of Caesarean section for difficult delivery, forceps remain an integral part of obstetric practice. The striking resemblance of modern day forceps to the original instruments used by the Chamberlens is a testament to both the family's ingenuity and enterprise as well as the subsequent pioneering obstetricians who followed in their footsteps.

The birth of forceps

PubMed Central

Sheikh, Sukhera; Ganesaratnam, Inithan; Jan, Haider

2013-01-01

Operative vaginal delivery has been described since the Middle Ages. During this time, however, labour would be sustained over several days and intrapartum death almost inevitable. In these circumstances, intervention involving the use of surgical instruments or even kitchen utensils would serve purely as an attempt to avoid maternal mortality. The establishment of forceps-assisted delivery as a means of avoiding both maternal and neonatal morbidity was initiated in the 16th century by the Chamberlen family and later developed over several centuries by leading obstetricians of the time including Simpson, Barnes and Keilland. The evolution of forceps is a fascinating story which is rich in history. Despite the development of Ventouse and the increasing use of Caesarean section for difficult delivery, forceps remain an integral part of obstetric practice. The striking resemblance of modern day forceps to the original instruments used by the Chamberlens is a testament to both the family's ingenuity and enterprise as well as the subsequent pioneering obstetricians who followed in their footsteps. PMID:23885296

Radiology-guided forceps biopsy and airway stenting in severe airway stenosis.

PubMed

Li, Zong Ming; Wu, Gang; Han, Xin Wei; Ren, Ke Wei; Zhu, Ming

2014-01-01

We aimed to determine the feasibility, safety, and effectiveness of radiology-guided forceps biopsy and airway stenting in patients with severe airway stenosis. This study involved 28 patients with severe airway stenosis who underwent forceps biopsy between October 2006 and September 2011. Chest multislice computed tomography was used to determine the location and extent of stenosis. Sixteen patients had tracheal stenosis, two patients had stenosis of the tracheal carina, six patients had stenosis of the left main bronchus, and four patients had stenosis of the right main bronchus. Forceps biopsy and stenting of the stenosed area were performed under fluoroscopic guidance in digital subtraction angiography and the biopsy specimens were analyzed histopathologically. We contacted the patients via phone call and utilized a standardized questionnaire to determine their medical condition during a postoperative three-month follow-up. The technical success rate of radiology-guided forceps biopsy was 100%. Biopsy specimens were obtained in all patients. Dyspnea was relieved immediately after stent placement. No serious complications, such as tracheal hemorrhage or perforation, mediastinal emphysema, or asphyxia, occurred. Radiology-guided forceps biopsy and airway stenting can be used for the emergency treatment of severe airway stenosis. This method appears to be safe and effective, and it may be an alternative therapeutic option in patients who cannot tolerate fiberoptic bronchoscopy.

The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness.

PubMed

Yamashita, Yasunobu; Ueda, Kazuki; Kawaji, Yuki; Tamura, Takashi; Itonaga, Masahiro; Yoshida, Takeichi; Maeda, Hiroki; Magari, Hirohito; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Ichinose, Masao; Kato, Jun

2016-07-15

Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.

Ureteroscopic biopsy of upper tract urothelial carcinoma: comparison of basket and forceps.

PubMed

Kleinmann, Nir; Healy, Kelly A; Hubosky, Scott G; Margel, David; Bibbo, Marluce; Bagley, Demetrius H

2013-12-01

To compare two different biopsy devices for upper tract urothelial carcinoma (UTUC) and evaluate the pathologic result obtained by these devices. From January 2008 to December 2010, 414 ureteroscopies were performed and 504 biopsies were taken for evaluation of UTUC. Two biopsy devices were compared: 2.4F stainless steel flat wire basket and 3F cup biopsy forceps. The effect of the biopsy device on obtaining an adequate pathologic specimen was evaluated using univariate and multivariate binary logistic regression analysis. We also investigated whether tumor grade determination was affected by the biopsy device among patients with a diagnostic biopsy. Diagnosis was successful in 63% and 94% in the forceps and basket groups, respectively (P < 0.0001). Among biopsies with a definite diagnosis of UTUC, specific grade was determined in 80% and 93% in the forceps and basket groups, respectively (P = 0.033). In subgroup analysis of tumors larger than 10 mm in diameter, diagnosis was obtained in 80% and 94% in the forceps and basket groups, respectively (P = 0.037). Cytologic evaluation was found to increase diagnostic rates. The stainless steel flat wire basket was shown to be superior to the 3F cup biopsy forceps in terms of obtaining tissue diagnosis and providing specific grade.

Air suctioning during colon biopsy forceps removal reduces bacterial air contamination in the endoscopy suite.

PubMed

Vavricka, S R; Tutuian, R; Imhof, A; Wildi, S; Gubler, C; Fruehauf, H; Ruef, C; Schoepfer, A M; Fried, M

2010-09-01

Bacterial contamination of endoscopy suites is of concern; however studies evaluating bacterial aerosols are lacking. We aimed to determine the effectiveness of air suctioning during removal of biopsy forceps in reducing bacterial air contamination. This was a prospective single-blinded trial involving 50 patients who were undergoing elective nontherapeutic colonoscopy. During colonoscopy, endoscopists removed the biopsy forceps first without and then with suctioning following contact with the sigmoid mucosa. A total of 50 L of air was collected continuously for 30 seconds at 30-cm distance from the biopsy channel valve of the colonoscope, with time starting at forceps removal. Airborne bacteria were collected by an impactor air sampler (MAS-100). Standard Petri dishes with CNA blood agar were used to culture Gram-positive bacteria. Main outcome measure was the bacterial load in endoscopy room air. At the beginning and end of the daily colonoscopy program, the median (and interquartile [IQR] range) bioaerosol burden was 4 colony forming units (CFU)/m (3) (IQR 3 - 6) and 16 CFU/m (3) (IQR 13 - 18), respectively. Air suctioning during removal of the biopsy forceps reduced the bioaerosol burden from a median of 14 CFU/m (3) (IQR 11 - 29) to a median of 7 CFU/m (3) (IQR 4 - 16) ( P = 0.0001). Predominantly enterococci were identified on the agar plates. The bacterial aerosol burden during handling of biopsy forceps can be reduced by applying air suction while removing the forceps. This simple method may reduce transmission of infectious agents during gastrointestinal endoscopies. Copyright Georg Thieme Verlag KG Stuttgart . New York.

[Comparison of hot versus cold biopsy forceps in the diagnosis of endobronchial lesions].

PubMed

Firoozbakhsh, Shahram; Seifirad, Soroush; Safavi, Enayat; Dinparast, Reza; Taslimi, Shervin; Derakhshandeilami, Gholamreza

2011-11-01

Traditionally cold biopsy forceps were used for endobronchial biopsy, and recently electrocautery (hot) bronchoscopy biopsy forceps are introduced. It is hypothesized that hot biopsy forceps may decrease procedure related bleeding and also may decrease the quality of obtained samples. Patients with different indications for endobronchial biopsy during fiberoptic bronchoscopy underwent three hot and three cold biopsies with a random fashion. All biopsies were obtained with a single biopsy forceps with and without the application of an electrocoagulation current, set on soft coagulation mode (40W). A four point scale was used for quantification of bleeding. A single pathologist blinded to the patients' history was requested to review all samples. A three point scale was used to assess electrocoagulation damage. A total of 240 biopsies were obtained from 40 patients. Frequency of positive concordance between the two methods was 85%. The degree of electrocoagulation damage of the samples was as follows: grade 1=52.5%, grade 2=32.5%, and grade 3=15%. The average bleeding score following hot biopsy was significantly lower compared to the cold biopsy (P=.006). The concordance between diagnostic yield of hot and cold biopsies was 85%. There was no significant difference between the diagnostic yields of two biopsy methods (P=.687). Hot biopsy forceps significantly decreased the procedure related bleeding. The quality of samples was not impaired significantly. Regarding low prevalence of bleeding following endobronchial biopsy, routine use of hot bronchoscopy forceps is not reasonable. However, familiarity of bronchoscopists with this method may improve bronchoscopy safety. Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.

Computer-assisted brush-biopsy analysis for the detection of dysplasia in a high-risk Barrett's esophagus surveillance population.

PubMed

Anandasabapathy, Sharmila; Sontag, Stephen; Graham, David Y; Frist, Stephen; Bratton, Joan; Harpaz, Noam; Waye, Jerome D

2011-03-01

Barrett's epithelial dysplasia, the direct precursor to esophageal adenocarcinoma, is often unapparent and frequently missed during surveillance of Barrett's esophagus with four-quadrant forceps biopsy protocol. To determine whether the detection of dysplasia is improved by adding computer-assisted brush biopsy (EndoCDx©) to four-quadrant biopsy protocol. Patients with a history of Barrett's esophagus with dysplasia scheduled for endoscopic surveillance were recruited from four academic medical centers. Patients underwent brush biopsy followed by four-quadrant biopsy every 1-2 cm. The results from brush and forceps biopsy were reviewed independently by pathologists blinded to the other's results. Among 151 patients enrolled (124 men, 27 women; mean age: 65), 117 (77.5%) had forceps and brush-biopsy specimens adequate for interpretation. The mean number of forceps biopsies was 11.9 (median 10, range 2-40) and brush biopsies was 2.0 (median 2, range 1-4). The overall yield of forceps alone was 25.2% (n = 38). Brush biopsy added an additional 16 positive cases increasing the yield of dysplasia detection by 42% (95% CI: 20.7-72.7). The number needed to test (NNT) to detect one additional case of dysplasia was 9.4 (95% CI: 6.4-17.7). There were no significant differences in results among different centers, between standard versus jumbo forceps, or between forceps biopsies taken every 1 cm versus every 2 cm. These data suggest that computer-assisted brush biopsy is a useful adjunct to standard endoscopic surveillance regimens for the identification of dysplasia in Barrett's esophagus.

Scissor Sorcery: Cutting Activities for the Early Childhood Curriculum.

ERIC Educational Resources Information Center

Carpenter, Sharan Bryant

This handbook, designed for use with preschool and elementary age children, provides instructions and instructional materials for the development of proficiency in cutting. Scissor cutting is a critically important activity for young children to practice because, along with coloring and pasting, it is used widely to foster the three R's as well as…

Local dispersal promotes biodiversity in a real-life game of rock-paper-scissors

NASA Astrophysics Data System (ADS)

Kerr, Benjamin; Riley, Margaret A.; Feldman, Marcus W.; Bohannan, Brendan J. M.

2002-07-01

One of the central aims of ecology is to identify mechanisms that maintain biodiversity. Numerous theoretical models have shown that competing species can coexist if ecological processes such as dispersal, movement, and interaction occur over small spatial scales. In particular, this may be the case for non-transitive communities, that is, those without strict competitive hierarchies. The classic non-transitive system involves a community of three competing species satisfying a relationship similar to the children's game rock-paper-scissors, where rock crushes scissors, scissors cuts paper, and paper covers rock. Such relationships have been demonstrated in several natural systems. Some models predict that local interaction and dispersal are sufficient to ensure coexistence of all three species in such a community, whereas diversity is lost when ecological processes occur over larger scales. Here, we test these predictions empirically using a non-transitive model community containing three populations of Escherichia coli. We find that diversity is rapidly lost in our experimental community when dispersal and interaction occur over relatively large spatial scales, whereas all populations coexist when ecological processes are localized.

Utility of blind forceps biopsy of the main carina and upper-lobe carina in patients with non-small cell lung cancer.

PubMed

Gunen, H; Kizkin, O; Tahaoglu, C; Aktas, O

2001-02-01

Preoperative detection of non-small cell lung cancer (NSCLC) metastasis to the main carina and upper-lobe carina can alter the operative approach, preclude further staging procedures, and save many patients from thoracotomy. This study assessed whether bronchoscopic forceps biopsy of the normal-appearing main carina and upper-lobe carina (blind biopsy) ipsilateral to the primary NSCLC lesion improved the accuracy of cancer staging and helped guide the management of these patients. A prospective study of 52 patients was carried out at the SSK Süreyyapasa Center for Chest Disease and Cardiothoracic Surgery. Over a 6-month period, we bronchoscopically evaluated 52 consecutive NSCLC patients who were radiologically classified as operable. At least five blind forceps biopsy specimens were obtained from the main carina and/or upper-lobe carina during each patient's initial fiberoptic bronchoscopic examination. Biopsy specimens were collected from the main carina and upper-lobe carina in 51 and 17 patients, respectively. Initially, all patients were staged and evaluated for operability in standard fashion, without histologic assessment of the blind biopsy specimens. We then restaged the disease and reassessed the patients' operability in light of the biopsy findings. Metastasis was histologically diagnosed in seven patients (13.7%) who underwent main carina biopsy and in four patients (23.5%) who underwent upper-lobe carina biopsy. Cancer-positive blind biopsy results changed the status of 25% (6 of 24) of patients from operable to inoperable, and changed the surgical approach in 11.1% (2 of 18) of patients who ultimately did undergo surgery. We found no statistical relationship between metastasis to either carina and tumor type, stage of disease, visibility of the tumor on fiberoptic bronchoscopy, primary tumor location, T status, or N status (p > 0.05). A blind forceps biopsy of the main carina and upper-lobe carina ipsilateral to the lesion site should be done routinely at initial bronchoscopic examination of all radiologically operable patients with suspected lung cancer. This type of screening can save a significant number of NSCLC patients from inappropriate or unnecessary thoracotomy and further staging procedures with their associated morbidity and risk.

21 CFR 874.4710 - Esophagoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... disease, or to remove foreign bodies from the esophagus. When inserted, the device extends from the area.... 874.4710 Section 874.4710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy...

21 CFR 874.4710 - Esophagoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... disease, or to remove foreign bodies from the esophagus. When inserted, the device extends from the area.... 874.4710 Section 874.4710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy...

21 CFR 874.4710 - Esophagoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... disease, or to remove foreign bodies from the esophagus. When inserted, the device extends from the area.... 874.4710 Section 874.4710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... generic type of device includes the flexible foreign body claw, flexible biopsy forceps, rigid biopsy...

Emergence of unusual coexistence states in cyclic game systems.

PubMed

Park, Junpyo; Do, Younghae; Jang, Bongsoo; Lai, Ying-Cheng

2017-08-07

Evolutionary games of cyclic competitions have been extensively studied to gain insights into one of the most fundamental phenomena in nature: biodiversity that seems to be excluded by the principle of natural selection. The Rock-Paper-Scissors (RPS) game of three species and its extensions [e.g., the Rock-Paper-Scissors-Lizard-Spock (RPSLS) game] are paradigmatic models in this field. In all previous studies, the intrinsic symmetry associated with cyclic competitions imposes a limitation on the resulting coexistence states, leading to only selective types of such states. We investigate the effect of nonuniform intraspecific competitions on coexistence and find that a wider spectrum of coexistence states can emerge and persist. This surprising finding is substantiated using three classes of cyclic game models through stability analysis, Monte Carlo simulations and continuous spatiotemporal dynamical evolution from partial differential equations. Our finding indicates that intraspecific competitions or alternative symmetry-breaking mechanisms can promote biodiversity to a broader extent than previously thought.

Space Food Package - Gemini-Titan (GT)-4 Flight - MSC

NASA Image and Video Library

1965-05-01

Food packages of beef and gravy fully reconstituted and ready to eat. An astronaut would squeeze food through opening at right side of package. Water gun is used to reconstitute dehydrated food. Scissors are used to open packages. This is the type of space food which will be used on the Gemini-Titan 4 spaceflight. MSC, Houston, TX *S65-24895 thru S65-24899

Force sensing micro-forceps with integrated fiber Bragg grating for vitreoretinal surgery

NASA Astrophysics Data System (ADS)

He, Xingchi; Balicki, Marcin A.; Kang, Jin U.; Gehlbach, Peter L.; Handa, James T.; Taylor, Russell H.; Iordachita, Iulian I.

2012-01-01

Vitreoretinal surgery is a technically demanding ophthalmologic discipline. One of the main technical challenges in vitreoretinal surgery is the lack of force sensing since the surgical maneuvers fall below the human sensory threshold. Previously, a 2-degree-of-freedom (DOF) force sensing instrument with a surgical pick was developed and tested. However, a more commonly used instrument for vitreoretinal surgery is the forceps, with which a surgeon can easily grasp and delaminate the scar tissue. We have designed, fabricated and calibrated a novel 20-gauge (Ga) microsurgical instrument with a 2-DOF force sensing forceps. Three fiber Bragg grating (FBG) sensors are integrated into the customized AlconTM forceps tip. The redundant sensor configuration provides good compensation for temperature-related drift. The calibration data show that the tool can provide a force resolution of 0.25 mN. In order to test the functionality and performance, the forceps was evaluated in inner shell membrane peeling experiments with chicken embryos as well as in in-vivo rabbit experiments. The instrument has demonstrated the capability of being applied in the clinical environment, with consistent force measurements. The force exerted in inner shell membrane peeling is from 6.07 to 34.65 mN. The development of the 2-DOF force sensing micro-forceps has shown that the fabrication process is feasible and reliable, and it can be used to develop a future 3-DOF force sensing tool.

The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness

PubMed Central

Yamashita, Yasunobu; Ueda, Kazuki; Kawaji, Yuki; Tamura, Takashi; Itonaga, Masahiro; Yoshida, Takeichi; Maeda, Hiroki; Magari, Hirohito; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Ichinose, Masao; Kato, Jun

2016-01-01

Background/Aims Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Methods Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. Results In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). Conclusions The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall. PMID:27021502

Superiority of the EF-120-00-3F biopsy forceps in the histopathological evaluation of upper urinary tract specimens.

PubMed

Kramer, Mario W; Abbas, Mahmoud; Kabbani, Mohammad; Imkamp, Florian; Nagele, Udo; Bach, Thorsten; Jutzi, Stephan; von Klot, Christoph; Becker, Jan; Merseburger, Axel S; Kuczyk, Markus A; Kreipe, Hans H; Herrmann, Thomas R

2014-08-01

The purpose of this study was to analyze the efficacy of two different biopsy forceps with respect to their functionality and quality for histological assessment of upper urinary tract biopsies. We compared flow rates, active deflection angle and histological quality of specimens taken from upper urinary tract biopsies of 40 consecutively treated patients between October 2011 and October 2012. Two different biopsy forceps [group A = 20 patients: "Piranha (®) " (Boston Scientific, Natick, USA) versus group B = 20 patients: "EF-120-00-3F" (Euromedical GmbH, Siegsdorf, GER)] were assessed. The specimens obtained with the "EF-120-00-3F" were superior in terms of tissue preservation such as intact urothelium/tissue fragmentation and the prevention of artifacts due to tissue compression (existence of artifacts/nucleus evaluation). Furthermore, due to superiority of tissue preservation, tissues obtained with the "EF-120-00-3F" showed better tissue orientation in the sense of anatomic evaluation of invasion and deep layer involvement. Irrigation flow rates did not differ significantly while deflection angle was more impaired with the "Piranha" biopsy forceps. No difference was observed with the handling of both biopsy forceps. We conclude that the "EF-120-00-3F" biopsy forceps represent a valuable modification of antegradely insertable instruments that qualifies for improved and correct staging as well as diagnosis of upper urinary specimens in comparison with standard biopsy forcipes.

Radiology-guided forceps biopsy and airway stenting in severe airway stenosis

PubMed Central

Li, Zong-Ming; Wu, Gang; Han, Xin-Wei; Ren, Ke-Wei; Zhu, Ming

2014-01-01

PURPOSE We aimed to determine the feasibility, safety, and effectiveness of radiology-guided forceps biopsy and airway stenting in patients with severe airway stenosis. MATERIALS AND METHODS This study involved 28 patients with severe airway stenosis who underwent forceps biopsy between October 2006 and September 2011. Chest multislice computed tomography was used to determine the location and extent of stenosis. Sixteen patients had tracheal stenosis, two patients had stenosis of the tracheal carina, six patients had stenosis of the left main bronchus, and four patients had stenosis of the right main bronchus. Forceps biopsy and stenting of the stenosed area were performed under fluoroscopic guidance in digital subtraction angiography and the biopsy specimens were analyzed histopathologically. We contacted the patients via phone call and utilized a standardized questionnaire to determine their medical condition during a postoperative three-month follow-up. RESULTS The technical success rate of radiology-guided forceps biopsy was 100%. Biopsy specimens were obtained in all patients. Dyspnea was relieved immediately after stent placement. No serious complications, such as tracheal hemorrhage or perforation, mediastinal emphysema, or asphyxia, occurred. CONCLUSION Radiology-guided forceps biopsy and airway stenting can be used for the emergency treatment of severe airway stenosis. This method appears to be safe and effective, and it may be an alternative therapeutic option in patients who cannot tolerate fiberoptic bronchoscopy. PMID:24808434

Upbend and M1 scissors mode in neutron-rich nuclei - consequences for r-process $$(n,\\gamma )$$ reaction rates

DOE Office of Scientific and Technical Information (OSTI.GOV)

Larsen, A. C.; Goriely, S.; Bernstein, L. A.

2015-01-01

An enhanced probability for low-energy γ-emission ( upbend, Eγ < 3 MeV) at high excitation energies has been observed for several light and medium-mass nuclei close to the valley of stability. Also the M1 scissors mode seen in deformed nuclei increases the γ-decay probability for low-energy γ-rays (E γ ≈ 2–3 MeV). These phenomena, if present in neutron-rich nuclei, have the potential to increase radiative neutron-capture rates relevant for the r-process. Furthermore, the experimental and theoretical status of the upbend is discussed, and preliminary calculations of (n,γ) reaction rates for neutron-rich, mid-mass nuclei including the scissors mode are shown.

A computer-based simulation of obstetric forceps placement.

PubMed

Lapeer, Rudy; Audinis, Vilius; Gerikhanov, Zelimkhan; Dupuis, Olivier

2014-01-01

Obstetric forceps are commonly used when the expulsion of the baby during childbirth fails to progress. When the two forceps blades are applied correctly, i.e. symmetrically, the inner surface of each blade maximises the area in contact with the fetal head. On the contrary, when the blades are applied asymmetrically, the contact areas between the inner surface of the blades and the fetal head are minimal and at distinct locations at the left and right sides of the fetal head. It is therefore assumed in the field of obstetrics that asymmetric application is bound to cause intra-cranial damage due to significantly higher shear forces and significant deformation of the fetal cranial bones as compared to symmetric application. In this paper we present the first of a series of studies to analyse the mechanical contact between head and forceps under different conditions using finite element analysis. We used high fidelity mesh models of a fetal skull and obstetric forceps. The fetal cranial material properties are known from previous studies. We observed significantly higher deformations and stresses for the asymmetric application of the blades as compared to symmetric placement.

21 CFR 874.4720 - Mediastinoscope and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, and flexible biopsy curette, but excludes the fiberoptic light source and carrier. (b...

21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but...

21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but...

21 CFR 874.4720 - Mediastinoscope and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, and flexible biopsy curette, but excludes the fiberoptic light source and carrier. (b...

21 CFR 874.4680 - Bronchoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... foreign body claw, bronchoscope tubing, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, flexible biopsy curette, and rigid bronchoscope aspirating tube, but...

21 CFR 874.4720 - Mediastinoscope and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biopsy brush, rigid biopsy forceps, and flexible biopsy curette, but excludes the fiberoptic light source and carrier. (b...

Evaluation of microsurgical tasks with OCT-guided and/or robot-assisted ophthalmic forceps

PubMed Central

Yu, Haoran; Shen, Jin-Hui; Shah, Rohan J.; Simaan, Nabil; Joos, Karen M.

2015-01-01

Real-time intraocular optical coherence tomography (OCT) visualization of tissues with surgical feedback can enhance retinal surgery. An intraocular 23-gauge B-mode forward-imaging co-planar OCT-forceps, coupling connectors and algorithms were developed to form a unique ophthalmic surgical robotic system. Approach to the surface of a phantom or goat retina by a manual or robotic-controlled forceps, with and without real-time OCT guidance, was performed. Efficiency of lifting phantom membranes was examined. Placing the co-planar OCT imaging probe internal to the surgical tool reduced instrument shadowing and permitted constant tracking. Robotic assistance together with real-time OCT feedback improved depth perception accuracy. The first-generation integrated OCT-forceps was capable of peeling membrane phantoms despite smooth tips. PMID:25780736

The "Hitch Stitch": An Effective Method of Preventing Migration in High Tracheal Stenosis.

PubMed

Mehta, Ravindra M; Singla, Abhinav; Shah, Aashish; Loknath, Chakravarthi

2017-01-01

The incidence of caudal stent migration in high tracheal stenting is 13-21% and is common with silicone stents. This can lead to major problems, including emergency repeat procedures. Several antimigration methods are described, but have limitations in terms of their success rate, availability, cost or ease of the procedure. We describe an innovative method of stent migration prevention using a simple percutaneous anchoring "hitch stitch", validated in a large series. After tracheal stent placement, an Ethilon suture was passed into the stent lumen through an 18-G needle. To take this suture back to the exterior to complete the stitch, a retrieval loop was passed through another 14-G percutaneous cannula inserted into the stent lumen. Bronchoscopically, using a forceps the first suture was pulled inside the loop, the loop was retracted, the suture was exteriorized, and the knot was completed and embedded subcutaneously. While removing the stent, an endoscopic scissor was used to cut the stitch to free the stent. A total of 42 "hitch stitches" were done in 29 patients over 5 years, predominantly for silicone stents. Indications for stenting included postintubation tracheal stenosis (83.3%), malignancy (11.9%) and tracheoesophageal fistula (4.8%, metal stents). The procedure was successful in 41/42 (97.6%) patients. Stitch removal was uncomplicated. This is the largest series of an external stent anchoring procedure as a migration prevention strategy in high tracheal stenting, applicable to both silicone and metal stents. Stent migration prevention using this "hitch stitch" is simple, safe and successful, without any complications during stent removal. © 2016 S. Karger AG, Basel.

Nonlinear Kerr enhancement of the Sagnac effect in a coherently coupled array of optical microresonators

NASA Astrophysics Data System (ADS)

Wang, Chao; Search, Christopher

2013-03-01

Optical gyroscopes based on the Sagnac effect are of great interest both theoretically and practically. Previously it has been suggested a nonlinear Kerr medium inserted into a ring resonator gyroscope can largely increase the rotation sensitivity due to an instability caused by the non-reciprocal self-phase and cross-phase modulations. Recently, coupled microresonator arrays such as Side-Coupled Integrated Spaced Sequence of Resonators (SCISSOR) and Coupled Resonator Optical Waveguides (CROW) have drawn interest as potential integrated gyroscopes due to the sensitivity enhancement resulting from distributed interference between resonators. Here we analyze a SCISSOR system, which consists of an array of microresonators evanescently coupled to two parallel bus waveguides in the presence of a strong intra-resonator Kerr nonlinearity. We show that the distributed interference in the waveguides combined with the nonlinearly enhanced Sagnac effect in the resonators can further improve the sensitivity compared with either a single resonator of equal footprint or SCISSOR without a Kerr nonlinearity. Numerical simulation shows that bistability in the SCISSOR occurs and the rotation sensitivity dIoutput/dω can go to infinity near the boundaries of the bistable region.

Resonances in odd-odd 182Ta

NASA Astrophysics Data System (ADS)

Brits, C. P.; Wiedeking, M.; Bello Garrote, F. L.; Bleuel, D. L.; Giacoppo, F.; Görgen, A.; Guttormsen, M.; Hadynska-Klek, K.; Hagen, T. W.; Ingeberg, V. W.; Kheswa, B. V.; Klintefjord, M.; Larsen, A. C.; Malatji, K. L.; Nyhus, H. T.; Papka, P.; Renstrøm, T.; Rose, S.; Sahin, E.; Siem, S.; Tveten, G. M.; Zeiser, F.

2017-09-01

Enhanced γ-decay on the tail of the giant electric dipole resonance, such as the scissors or pygmy resonances, can have significant impact on (n,γ) reaction rates. These rates are important input for modeling processes that take place in astrophysical environments and nuclear reactors. Recent results from the University of Oslo indicate the existence of a significant enhancement in the photon strength function for nuclei in the actinide region due to the scissors resonance. Further, the M1 strength distribution of the scissors resonances in rare earth nuclei has been studied extensively over the years. To investigate the evolution and persistence of the scissor resonance in other mass regions, an experiment was performed utilizing the NaI(Tl) γ-ray detector array (CACTUS) and silicon particle telescopes (SiRi) at the University of Oslo Cyclotron laboratory. Particle-γ coincidences from the 181Ta(d,p)182Ta and 181Ta(d,d')181Ta reactions were used to measure the nuclear level density and photon strength function of the well-deformed 181Ta and 182Ta systems, to investigate the existence of resonances below the neutron separation energy. Note to the reader: the title of this article has been corrected on September 19, 2017.

21 CFR 874.4760 - Nasopharyngoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier...

21 CFR 874.4760 - Nasopharyngoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier...

21 CFR 874.4760 - Nasopharyngoscope (flexible or rigid) and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., salpingoscope, flexible foreign body claw, flexible biopsy forceps, rigid biopsy curette, flexible biospy brush, rigid biopsy forceps and flexible biopsy curette, but excludes the fiberoptic light source and carrier...

Development of a puller-buncher for harvesting southern pines without taproot attached

Treesearch

Peter Koch; S.J. Coughran

1975-01-01

A harvester-buncher that mounts on the front of a wheeled skidder has been developed to pull entire pine trees from the ground like carrots. Two elements are central to its design. The first is a scissor-type grib equipped with a pair of sout horizontal knife blades that close at the groundline and bite several inches into the stem from oposite sides of the tre. The...

Development of a puller-buncher for harvesting southern pines with taproot attached

Treesearch

P. Koch; S.J. Coughran

1975-01-01

A harvester-buncher that mounts on the front of a wheeled skidder has been developed to pull entire pine trees from the ground like carrots. Two elements are central to its design. The first is a scissors-type grip equipped with a pair of stout horizontal knife blades that close at the groundline and bite several inches into the stem from opposite sides of the tree....

Nuclear scissors modes and hidden angular momenta

DOE Office of Scientific and Technical Information (OSTI.GOV)

Balbutsev, E. B., E-mail: balbuts@theor.jinr.ru; Molodtsova, I. V.; Schuck, P.

The coupled dynamics of low-lying modes and various giant resonances are studied with the help of the Wigner Function Moments method generalized to take into account spin degrees of freedom and pair correlations simultaneously. The method is based on Time-Dependent Hartree–Fock–Bogoliubov equations. The model of the harmonic oscillator including spin–orbit potential plus quadrupole–quadrupole and spin–spin interactions is considered. New low-lying spin-dependent modes are analyzed. Special attention is paid to the scissors modes. A new source of nuclear magnetism, connected with counter-rotation of spins up and down around the symmetry axis (hidden angular momenta), is discovered. Its inclusion into the theorymore » allows one to improve substantially the agreement with experimental data in the description of energies and transition probabilities of scissors modes.« less

Scissors Mode of Dipolar Quantum Droplets of Dysprosium Atoms

NASA Astrophysics Data System (ADS)

Ferrier-Barbut, Igor; Wenzel, Matthias; Böttcher, Fabian; Langen, Tim; Isoard, Mathieu; Stringari, Sandro; Pfau, Tilman

2018-04-01

We report on the observation of the scissors mode of a single dipolar quantum droplet. The existence of this mode is due to the breaking of the rotational symmetry by the dipole-dipole interaction, which is fixed along an external homogeneous magnetic field. By modulating the orientation of this magnetic field, we introduce a new spectroscopic technique for studying dipolar quantum droplets. This provides a precise probe for interactions in the system, allowing us to extract a background scattering length for 164Dy of 69 (4 )a0 . Our results establish an analogy between quantum droplets and atomic nuclei, where the existence of the scissors mode is also only due to internal interactions. They further open the possibility to explore physics beyond the available theoretical models for strongly dipolar quantum gases.

Scissors Mode of 162 Dy Studied from Resonance Neutron Capture

DOE PAGES

Baramsai, B.; Bečvář, F.; Bredeweg, T. A.; ...

2015-05-28

Multi-step cascade γ-ray spectra from the neutron capture at isolated resonances of 161Dy nucleus were measured at the LANSCE/DANCE time-of-flight facility in Los Alamos National Laboratory. The objectives of this experiment were to confirm and possibly extend the spin assignment of s-wave neutron resonances and get new information on photon strength functions with emphasis on the role of the M1 scissors mode vibration. The preliminary results show that the scissors mode plays a significant role in all transitions between accessible states of the studied nucleus. The photon strength functions describing well our data are compared to results from 3He-induced reactions,more » (n,γ) experiments on Gd isotopes, and (γ,γ’) reactions.« less

Retrieval of Tip-embedded Inferior Vena Cava Filters by Using the Endobronchial Forceps Technique: Experience at a Single Institution.

PubMed

Stavropoulos, S William; Ge, Benjamin H; Mondschein, Jeffrey I; Shlansky-Goldberg, Richard D; Sudheendra, Deepak; Trerotola, Scott O

2015-06-01

To evaluate the use of endobronchial forceps to retrieve tip-embedded inferior vena cava (IVC) filters. This institutional review board-approved, HIPAA-compliant retrospective study included 114 patients who presented with tip-embedded IVC filters for removal from January 2005 to April 2014. The included patients consisted of 77 women and 37 men with a mean age of 43 years (range, 18-79 years). Filters were identified as tip embedded by using rotational venography. Rigid bronchoscopy forceps were used to dissect the tip or hook of the filter from the wall of the IVC. The filter was then removed through the sheath by using the endobronchial forceps. Statistical analysis entailed calculating percentages, ranges, and means. The endobronchial forceps technique was used to successfully retrieve 109 of 114 (96%) tip-embedded IVC filters on an intention-to-treat basis. Five failures occurred in four patients in whom the technique was attempted but failed and one patient in whom retrieval was not attempted. Filters were in place for a mean of 465 days (range, 31-2976 days). The filters in this study included 10 Recovery, 33 G2, eight G2X, 11 Eclipse, one OptEase, six Option, 13 Günther Tulip, one ALN, and 31 Celect filters. Three minor complications and one major complication occurred, with no permanent sequelae. The endobronchial forceps technique can be safely used to remove tip-embedded IVC filters. © RSNA, 2014.

A randomized trial to determine the diagnostic accuracy of conventional vs. jumbo forceps biopsy of gastric epithelial neoplasias before endoscopic submucosal dissection; open-label study.

PubMed

Jeon, Hyo Keun; Ryu, Ho Yoel; Cho, Mee Yon; Kim, Hyun-Soo; Kim, Jae Woo; Park, Hong Jun; Kim, Moon Young; Baik, Soon Koo; Kwon, Sang Ok; Park, Su Yeon; Won, Sung Ho

2014-10-01

Larger biopsy specimens or increasing the number of biopsies may improve the diagnostic accuracy of gastric epithelial neoplasia (GEN). The aims of this study was to compare the diagnostic accuracies between conventional and jumbo forceps biopsy of GEN before endoscopic submucosal dissection (ESD) and to confirm that increasing the number of biopsies is useful for the diagnosis of GEN. The concordance rate between EFB and ESD specimens was not significantly different between the two groups [83.1 % (54/65) in JG vs. 79.1 % (53/67) in CG]. On multivariate analyses, two or four EFBs significantly increased the cumulating concordance rate [coefficients; twice: 5.1 (P = 0.01), four times: 5.9 (P = 0.02)]. But, the concordance rate was decreased in high grade dysplasia (coefficient -40.32, P = 0.006). One hundred and sixty GENs from 148 patients were randomized into two groups and finally 67 GENs in 61 patients and 65 GENs in 63 patients were allocated to the conventional group (CG) or jumbo group (JG), respectively. Four endoscopic forceps biopsy (EFB) specimens were obtained from each lesion with conventional (6.8 mm) forceps or jumbo (8 mm) forceps. The histological concordance rate between 4 EFB specimens and ESD specimens was investigated in the two groups. Before ESD, the diagnostic accuracy of GENs was significantly increased not by the use of jumbo forceps biopsy but by increasing the number of biopsies.

Are the low-lying isovector 1 + states scissors vibrations?

NASA Astrophysics Data System (ADS)

Faessler, A.

At the Technische Hochschule in Darmstadt the group of Richter and coworkers found in 1983/84 in deformed rare earth nuclei low-lying isovector 1 + states. Such states have been predicted in the generalized Bohr-Mottelson model and in the interacting boson model no. 2 (IBA2). In the generalized Bohr-Mottelson model one allows for proton and neutron quadrupole deformations separately. If one includes only static proton and neutron deformations the generalized Bohr-Mottelson model reduces to the two rotor model. It describes the excitation energy of these states in good agreement with the data but overestimates the magnetic dipole transition probabilities by a factor 5. In the interacting boson model (IBA2) where only the outermost nucleons participate in the excitation the magnetic dipole transition probability is only overestimated by a factor 2. The too large collectivity in both models results from the fact that they concentrate the whole strength of the scissors vibrations into one state. A microscopic description is needed to describe the spreading of the scissors strength over several states. For a microscopic determination of these scissors states one uses the Quasi-particle Random Phase Approximation (QRPA). But this approach has a serious difficulty. Since one rotates for the calculation the nucleus into the intrinsic system the state corresponding to the rotation of the whole nucleus is a spurious state. The usual procedure to remove this spuriosity is to use the Thouless theorem which says that a spurious state created by an operator which commutes with the total hamiltonian (here the total angular momentum, corresponding to a rotation of the whole system) produces the spurious state if applied to the ground state. It says further the energy of this spurious state lies at zero excitation energy (it is degenerate with the ground state) and is orthogonal to all physical states. Thus the usual approach is to vary the quadrupole-quadrupole force strength so that a state lies at zero excitation energy and to identify that with the spuríous state. This procedure assumes that a total angular momentum commutes with a total hamiltonian. But this is not the case since the total hamiltonian contains a deformed Saxon-Woods potential. Thus one has to take care explicitly that the spurious state is removed. This we do in our approach by introducing Lagrange multipliers for each excited states and requesting that these states are orthogonal to the spurious state which is explicitly constructed by applying the total angular momentum operator to the ground state. To reduce the number of free parameters in the hamiltonian we take the Saxon-Woods potential for the deformed nuclei from the literature (with minor adjustments) and determine the proton-proton, neutron-neutron and the proton-neutron quadrupole force constant by requesting that the hamiltonian commutes with the total angular momentum in the (QRPA) ground state. This yields equations fixing all three coupling constants for the quadrupole-quadrupole force allowing even for isospin symmetry violation. The spin-spin force is taken from the Reid soft core potential. A possible spin-quadrupole force has been taken from the work of Soloviev but it turns out that this is not important. The calculation shows that the strength of the scissors vibrations are spread over many states. The main 1 + state at around 3 MeV has an overlap of the order of 14 % of the scissors state. 50% of that state are spread over the physical states up to an excitation energy of 6 MeV. The rest is distributed over higher lying states. The expectation value of the many-body hamiltonian in the scissors vibrational state shows roughly an excitation energy of 7 MeV above the ground state. The results also support the experimental findings that these states are mainly orbital excitations. States are not very collective. Normally only a proton and neutron particle-hole pair are with a large amplitude participating in forming these states. But those protons and neutrons which are excited perform scissors type vibrations.

Transcutaneous pleural biopsy with a retrograde forceps: a novel approach.

PubMed

Wiewiorski, Martin; Hiebinger, Andreas; Hoechel, Sebastian; Müller-Gerbl, Magdalena; Barg, Alexej; Valderrabano, Victor; Hügle, Thomas

2016-01-01

Pleural biopsies are commonly performed to investigate the cause of exudative pleural effusion. Biopsy needles (e.g. Abrams needle, Cope needle) are traditionally used to perform the biopsy. However, certain complications such as pneumothorax and haemothorax have been described. We present a technique utilizing a novel retrograde forceps, which could improve the simplicity and lower the complication rate of performing closed pleural biopsies. A retrograde forceps (Retroforceps, Karl Storz, Tuttlingen, Germany) was used to perform 20 transcutaneous pleural biopsies in a cadaver thorax under thoracoscopical control. Video documentation of the procedure from outside and inside the thorax was performed. The surgeon performing the biopsy was blinded to the thoracoscopical view. After the removal of the forceps, it was checked whether biopsy material was retrieved. The video material was retrospectively used to confirm whether the biopsy was taken from the pleura parietalis. Biopsy material was retrieved in 19 out of 20 biopsy attempts. Video material confirmed that the biopsy was taken from the pleura parietalis in all cases. Using a retrograde biopsy forceps is a simple and practicable procedure suitable for clinical application. This technique could potentially reduce the incidence of pneumothorax.

Beyond Scissors and Glue: Staff Developers Guide Teachers in Piecing Together a Vertically Aligned Curriculum and in Creating a Method to Get This Job Done

ERIC Educational Resources Information Center

Phelps, Vickie

2005-01-01

Layers and layers of curricula stuffed into vinyl binders were the norm in this Texas district until teachers sat down with scissors and glue to create a vertically aligned curriculum. They then created standards-based lessons to support the curriculum and put them into a database readily accessible by all.

Obstetric attending physician characteristics and their impact on vacuum and forceps delivery rates: University of California at San Francisco experience from 1977 to 1999.

PubMed

Chang, Anne Lynn S; Noah, Melinda Scully; Laros, Russell K

2002-06-01

The objective of our study was to determine the impact of obstetric attending physician characteristics (eg, region of previous residency training, sex, year of graduation from residency) on the rates of vacuum and forceps delivery at our institution. The analysis was based on 19,897 vaginal deliveries that were performed by 171 attending physicians and 160 resident physicians between 1977 and 1999 at the University of California at San Francisco Medical Center. Z -tests and multivariate logistic regression were performed on a perinatal database that contained standard obstetric variables. Male attending physicians had a higher percentage of forceps deliveries compared with female attending physicians (11.1% vs 6.6%; P <.001); female attending physicians had a higher percentage of vacuum deliveries compared with male attending physicians (9.8% vs 5.1%; P <.001). However, multivariate regression analysis revealed that only the year in which the procedure was performed affected both the forceps and vacuum delivery rates (P <.041). The region of previous residency training of the attending physician affected the vacuum delivery rate (P <.0001) but not the forceps delivery rate (P >.06) in multivariate logistic regression analysis. Factors such as the sex of the obstetric attending physician, the sex of the resident, and the year of graduation from residency for the obstetric attending physician did not have a significant impact on the forceps or vacuum delivery rates (all P >.05). Our study is the first to report that the apparent gender differences in forceps and vacuum delivery rates among obstetric attending physicians was due to the year in which the procedure was performed and not due to sex per se. We also found that the region of previous residency training for the obstetric attending physician significantly influenced the vacuum delivery rate.

Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett's esophagus with high-grade dysplasia and early cancer.

PubMed

Thota, Prashanthi N; Sada, Alaa; Sanaka, Madhusudhan R; Jang, Sunguk; Lopez, Rocio; Goldblum, John R; Liu, Xiuli; Dumot, John A; Vargo, John; Zuccarro, Gregory

2017-03-01

Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor. This is a retrospective review of patients referred to endoscopic therapy of BE with HGD or early esophageal adenocarcinoma (EAC) who underwent EMR from 2006 to 2011. Age, race, sex, length of Barrett's segment, hiatal hernia size, number of endoscopies and biopsy results and EUS findings were abstracted. A total of 151 patients underwent EMR. In 50 % (75/151) of patients, EMR histology was consistent with endoscopic forceps biopsy findings. EMR resulted in change in diagnosis with upstaging in 21 % (32/151) and downstaging in 29 % (44/151). In patients with HGD on EMR, EUS staging was T0 in 74.1 % (23/31) but upstaged in 25.8 % (8/31). In patients with IMC on EMR, EUS findings were T1a in 23.6 % (9/38), upstaged in 18.4 % (7/38) and downstaged in 57.8 % (22/38). EUS accurately identified EMR histology in all submucosal cancers. Grade of differentiation was reported in 24 cancers on EMR histology. There was no correlation between grade and EUS staging. EUS is of limited utility in accurate staging of BE patients with HGD or early EAC. Endoscopic forceps biopsy correlated with EMR findings in only 50 % of patients. Irrespective of the endoscopic forceps biopsy results, all BE patients with visible lesions should be referred to EMR.

The improved oval forceps suture-guiding method for minimally invasive Achilles tendon repair.

PubMed

Liu, Yang; Lin, Lixiang; Lin, Chuanlu; Weng, Qihao; Hong, Jianjun

2018-06-01

To discuss the effect and advantage of the improved oval forceps suture-guiding method combined with anchor nail in the treatment of acute Achilles tendon rupture. A retrospective research was performed on 35 cases of acute Achilles tendon rupture treated with the improved oval forceps suture-guiding method from January 2013 to October 2016. Instead of the Achillon device, we perform the Achillon technique with the use of simple oval forceps, combined with absorbable anchor nail, percutaneously to repair the acute Achilles tendon rupture. All patients were followed up for at least 12 months (range, 12-19 months), and all the patients underwent successful repair of their acute Achilles tendon rupture using the improved oval forceps suture-guiding method without any major intra- or postoperative complications. All the patients returned to work with pre-injury levels of activity at a mean of 12.51 ± 0.76 weeks. Mean AOFAS ankle-hindfoot scores improved from 63.95 (range, 51-78) preoperatively to 98.59 (range, 91-100) at last follow-up. This was statistically significant difference (P < 0.001). Mean Achilles Tendon Total Rupture Score (ATRS) at final follow-up was 94.87 (range, 90-100). The improved oval forceps suture-guiding method could make the advantage of minimally invasive repair with less complications, reduced surgical time and similar functional outcomes compared with the traditional open surgery. In addition, our new technique could save the cost of surgery with the compare of the Achillon device. At the same time for the cases which the remote broken tendon ends were within 2 cm from the calcaneal nodules, because of the less tendon tissue was left in the remote side, traditional percutaneous methods are incapable to ensure the reconstruction strength. By using the anchor nail, the improved technique has better repair capacity and expands the operation indication of oval forceps method. Copyright © 2018 Elsevier Ltd. All rights reserved.

Spiraling patterns in evolutionary models inspired by bacterial games with cyclic dominance

NASA Astrophysics Data System (ADS)

Mobilia, Mauro

2015-03-01

Understanding the mechanisms allowing the maintenance of biodiversity is a central issue in biology. Evolutionary game theory, where the success of one species depends on what the others are doing, provides a promising framework to investigate this complex problem. Experiments on microbial populations have shown that cyclic local interactions promote species coexistence. In this context, rock-paper-scissors games - in which rock crushes scissors, scissors cut paper, and paper wraps rock - are often used to model the dynamics of populations in cyclic competition. After a brief survey of some inspiring experiments, I will discuss the subtle interplay between individuals' mobility and their local interactions in two-dimensional rock-paper-scissors systems. This leads to the loss of biodiversity above a certain mobility threshold, and to the formation of spiraling patterns below the critical mobility rate. I will then study a generic rock-paper-scissors metapopulation model formulated on a two-dimensional grid of patches. When these have a large carrying capacity, the model's dynamics is faithfully described in terms of the system's complex Ginzburg-Landau equation properly derived from a multiscale expansion. The properties of the ensuing complex Ginzburg-Landau equation are exploited to derive the system's phase diagram and to characterize the spatio-temporal properties of the spiraling patterns in each phase. This enables us to analyze the spiral waves stability, how these are influenced by linear and nonlinear diffusion, and to discuss phenomena such as far-field breakup. Presentation mainy based on joint work with B. Szczesny and A. M. Rucklidge. Fruitful earlier collaborations with E. Frey, Q. He, T. Reichenbach, and U. C. Täuber are also acknowledged. Work supported by the UK EPSRC (Grant No. EP/P505593/1).

Clonal selection prevents tragedy of the commons when neighbors compete in a rock-paper-scissors game

NASA Astrophysics Data System (ADS)

Juul, Jeppe; Sneppen, Kim; Mathiesen, Joachim

2012-06-01

The rock-paper-scissors game is a model example of the ongoing cyclic turnover typical of many ecosystems, ranging from the terrestrial and aquatic to the microbial. Here we explore the evolution of a rock-paper-scissors system where three species compete for space. The species are allowed to mutate and change the speed by which they invade one another. In the case when all species have similar mutation rates, we observe a perpetual arms race where no single species prevails. When only two species mutate, their aggressions increase indefinitely until the ecosystem collapses and only the nonmutating species survives. Finally we show that when only one species mutates, group selection removes individual predators with the fastest growth rates, causing the growth rate of the species to stabilize. We explain this group selection quantitatively.

Paper-cutting operations using scissors in Drury's law tasks.

PubMed

Yamanaka, Shota; Miyashita, Homei

2018-05-01

Human performance modeling is a core topic in ergonomics. In addition to deriving models, it is important to verify the kinds of tasks that can be modeled. Drury's law is promising for path tracking tasks such as navigating a path with pens or driving a car. We conducted an experiment based on the observation that paper-cutting tasks using scissors resemble such tasks. The results showed that cutting arc-like paths (1/4 of a circle) showed an excellent fit with Drury's law (R 2  > 0.98), whereas cutting linear paths showed a worse fit (R 2  > 0.87). Since linear paths yielded better fits when path amplitudes were divided (R 2  > 0.99 for all amplitudes), we discuss the characteristics of paper-cutting operations using scissors. Copyright © 2018 Elsevier Ltd. All rights reserved.

Scissor bite in a young patient treated with an orthodontic-orthopedic device. A case report.

PubMed

Favero, V; Sbricoli, L; Favero, L

2013-06-01

Scissor bite is a rare malocclusion that often leads to minor facial asymmetry. An orthodontic and orthopaedic correction is advisable in young patients to prevent subsequent temporomandibular diseases requesting maxillofacial intervention. In this case report a 8-year-old girl in mixed dentition with unilateral left scissor bite was treated with a modified Rapid Palatal Expander. To modify an overexpanded maxilla (width 39 mm measured between both upper first molars) the device was used to close rather than to expand, without need of patient compliance. Orthodontic correction was then completed with traditional bracketing. Results were tangible (width 36 mm) and remained stable even for at least 2 years after retention. This original device has proved to be useful in this kind of situations and can be easily applied to young patient to correct such malocclusions.

Endobronchial Forceps-Assisted and Excimer Laser-Assisted Inferior Vena Cava Filter Removal: The Data, Where We Are, and How It Is Done.

PubMed

Chen, James X; Montgomery, Jennifer; McLennan, Gordon; Stavropoulos, S William

2018-06-01

The recognition of inferior vena cava filter related complications has motivated increased attentiveness in clinical follow-up of patients with inferior vena cava filters and has led to development of multiple approaches for retrieving filters that are challenging or impossible to remove using conventional techniques. Endobronchial forceps and excimer lasers are tools for designed to aid in complex inferior vena cava filter removals. This article discusses endobronchial forceps-assisted and excimer laser-assisted inferior vena cava filter retrievals. Copyright © 2018 Elsevier Inc. All rights reserved.

Usefulness and safety of biliary percutaneous transluminal forceps biopsy (PTFB): our experience.

PubMed

Ierardi, Anna Maria; Mangini, Monica; Fontana, Federico; Floridi, Chiara; De Marchi, Giuseppe; Petrillo, Mario; Capasso, Raffaella; Chini, Claudio; Cocozza, Eugenio; Cuffari, Salvatore; Segato, Sergio; Rotondo, Antonio; Carrafiello, Gianpaolo

2014-03-01

To evaluate the usefulness and safety of percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction. Forty consecutive patients (21 men and 19 women; mean age, 71.9 years) underwent forceps biopsy through percutaneous transhepatic biliary access performed to drain bile. Lesions involved the common bile duct (n 8), common hepatic duct (n 18), hilum (n 6), ampullary segment of the common bile duct (n 8) and were biopsied with 7-F biopsy forceps. Final diagnosis was confirmed with pathologic findings at surgery, or clinical and radiologic follow-up. Twenty-one of 40 biopsies resulted in correct diagnosis of malignancy. Thirteen biopsy diagnosis were proved to be true-negative. There were six false-negative and no false-positive diagnoses. Sensitivity, specificity and accuracy in aspecific biliary obstructions were 85%, 100% and 88,7% respectively. Sensitivity of biopsy in malignancies was higher than in benign obstructions (100% vs 68,4%, CI = 95%). Sensitivity was lower in the hilum tract and in the common bile duct than in other sites (CI = 95%). No major complications related to biopsy procedures occurred. Percutaneous transluminal forceps biopsy is a safe procedure, easy to perform through a transhepatic biliary drainage tract, providing high accuracy in the diagnosis of malignant biliary obstructions.

A novel method of forceps biopsy improves the diagnosis of proximal biliary malignancies.

PubMed

Kulaksiz, Hasan; Strnad, Pavel; Römpp, Achim; von Figura, Guido; Barth, Thomas; Esposito, Irene; Schirmacher, Peter; Henne-Bruns, Doris; Adler, Guido; Stiehl, Adolf

2011-02-01

Tissue specimen collection represents a cornerstone in diagnosis of proximal biliary tract malignancies offering great specificity, but only limited sensitivity. To improve the tumor detection rate, we developed a new method of forceps biopsy and compared it prospectively with endoscopic transpapillary brush cytology. 43 patients with proximal biliary stenoses, which were suspect for malignancy, undergoing endoscopic retrograde cholangiography were prospectively recruited and subjected to both biopsy [using a double-balloon enteroscopy (DBE) forceps under a guidance of a pusher and guiding catheter with guidewire] and transpapillary brush cytology. The cytological/histological findings were compared with the final clinical diagnosis. 35 out of 43 patients had a malignant disease (33 cholangiocarcinomas, 1 hepatocellular carcinoma, 1 gallbladder carcinoma). The sensitivity of cytology and biopsy in these patients was 49 and 69%, respectively. The method with DBE forceps allowed a pinpoint biopsy of the biliary stenoses. Both methods had 100% specificity, and, when combined, 80% of malignant processes were detected. All patients with non-malignant conditions were correctly assigned by both methods. No clinically relevant complications were observed. The combination of forceps biopsy and transpapillary brush cytology is safe and offers superior detection rates compared to both methods alone, and therefore represents a promising approach in evaluation of proximal biliary tract processes.

E 2 decay strength of the M 1 scissors mode of 156Gd and its first excited rotational state

NASA Astrophysics Data System (ADS)

Beck, T.; Beller, J.; Pietralla, N.; Bhike, M.; Birkhan, J.; Derya, V.; Gayer, U.; Hennig, A.; Isaak, J.; Löher, B.; Ponomarev, V. Yu.; Richter, A.; Romig, C.; Savran, D.; Scheck, M.; Tornow, W.; Werner, V.; Zilges, A.; Zweidinger, M.

2017-05-01

The E 2 /M 1 multipole mixing ratio δ1 →2 of the 1sc+→21+ γ -ray decay in 156Gd and hence the isovector E 2 transition rate of the scissors mode of a well-deformed rotational nucleus has been measured for the first time. It has been obtained from the angular distribution of an artificial quasimonochromatic linearly polarized γ -ray beam of energy 3.07(6) MeV scattered inelastically off an isotopically highly enriched 156Gd target. The data yield first direct support for the deformation dependence of effective proton and neutron quadrupole boson charges in the framework of algebraic nuclear models. First evidence for a low-lying Jπ=2+ member of the rotational band of states on top of the 1+ band head is obtained, too, indicating a significant signature splitting in the K =1 scissors mode rotational band.

Spatially sculpted laser scissors for study of DNA damage and repair

NASA Astrophysics Data System (ADS)

Stephens, Jared; Mohanty, Samarendra K.; Genc, Suzanne; Kong, Xiangduo; Yokomori, Kyoko; Berns, Michael W.

2009-09-01

We present a simple and efficient method for controlled linear induction of DNA damage in live cells. By passing a pulsed laser beam through a cylindrical lens prior to expansion, an elongated elliptical beam profile is created with the ability to expose controlled linear patterns while keeping the beam and the sample stationary. The length and orientation of the beam at the sample plane were reliably controlled by an adjustable aperture and rotation of the cylindrical lens, respectively. Localized immunostaining by the DNA double strand break (DSB) markers phosphorylated H2AX (γH2AX) and Nbs1 in the nuclei of HeLa cells exposed to the ``line scissors'' was shown via confocal imaging. The line scissors method proved more efficient than the scanning mirror and scanning stage methods at induction of DNA DSB damage with the added benefit of having a greater potential for high throughput applications.

Initial experience using the rigid forceps technique to remove wall-embedded IVC filters.

PubMed

Avery, Allan; Stephens, Maximilian; Redmond, Kendal; Harper, John

2015-06-01

Severely tilted and embedded inferior vena cava (IVC) filters remain the most challenging IVC filters to remove. Heavy endothelialisation over the filter hook can prevent engagement with standard snare and cone recovery techniques. The rigid forceps technique offers a way to dissect the endothelial cap and reliably retrieve severely tilted and embedded filters. By developing this technique, failed IVC retrieval rates can be significantly reduced and the optimum safety profile offered by temporary filters can be achieved. We present our initial experience with the rigid forceps technique described by Stavropoulos et al. for removing wall-embedded IVC filters. We retrospectively reviewed the medical imaging and patient records of all patients who underwent a rigid forceps filter removal over a 22-month period across two tertiary referral institutions. The rigid forceps technique had a success rate of 85% (11/13) for IVC filter removals. All filters in the series showed evidence of filter tilt and embedding of the filter hook into the IVC wall. Average filter tilt from the Z-axis was 19 degrees (range 8-56). Filters observed in the case study were either Bard G2X (n = 6) or Cook Celect (n = 7). Average filter dwell time was 421 days (range 47-1053). There were no major complications observed. The rigid forceps technique can be readily emulated and is a safe and effective technique to remove severely tilted and embedded IVC filters. The development of this technique across both institutions has increased the successful filter removal rate, with perceived benefits to the safety profile of our IVC filter programme. © 2015 The Royal Australian and New Zealand College of Radiologists.

Feasibility and accuracy of molecular testing in specimens obtained with small biopsy forceps: comparison with the results of surgical specimens.

PubMed

Oki, Masahide; Yatabe, Yasushi; Saka, Hideo; Kitagawa, Chiyoe; Kogure, Yoshihito; Ichihara, Shu; Moritani, Suzuko

2015-01-01

During bronchoscopy, small biopsy forceps are increasingly used for the diagnosis of peripheral pulmonary lesions. However, it is unclear whether the formalin-fixed paraffin-embedded specimens sampled with the small biopsy forceps are suitable for the determination of genotypes which become indispensable for the management decision regarding patients with non-small cell lung cancer. The aim of this study was to evaluate the feasibility and accuracy of molecular testing in the specimens obtained with 1.5-mm small biopsy forceps. We examined specimens in 91 patients, who were enrolled in our previous 3 studies on the usefulness of thin bronchoscopes and given a diagnosis of non-small cell lung cancer by bronchoscopy with the 1.5-mm biopsy forceps, and then underwent surgical resection. An experienced pathologist examined paraffin-embedded specimens obtained by bronchoscopic biopsy or surgical resection in a blind fashion on epidermal growth factor receptor (EGFR) mutations, anaplastic lymphoma kinase (ALK) rearrangements and KRAS mutations. Twenty-five (27%), 2 (2%) and 5 (5%) patients had an EGFR mutation, ALK rearrangement and KRAS mutation, respectively, based on the results in surgical specimens. EGFR, ALK and KRAS testing with bronchoscopic specimens was feasible in 82 (90%), 86 (95%) and 83 (91%) patients, respectively. If molecular testing was feasible, the accuracy of EGFR, ALK and KRAS testing with bronchoscopic specimens for the results with surgical specimens was 98, 100 and 98%, respectively. The results of molecular testing in the formalin-fixed paraffin-embedded specimens obtained with the small forceps, in which the genotype could be evaluated, correlated well with those in surgically resected specimens.

Safety and Feasibility of Pleural Cryobiopsy Compared to Forceps Biopsy During Semi-rigid Pleuroscopy.

PubMed

Pathak, Vikas; Shepherd, Ray W; Hussein, Ehab; Malhotra, Rajiv

2017-06-01

Pleural biopsy is often obtained in patients with undiagnosed exudative pleural effusion during pleuroscopy. Standard forceps have been traditionally used for the biopsy. Cryoprobes are being increasingly used for transbronchial lung biopsy as they obtain larger specimens and have less crush artifact. However, the safety and feasibility of cryoprobe biopsy compared to standard forceps for pleural biopsy has not been fully assessed. The objective of this study was to demonstrate the safety and feasibility of cryoprobe biopsy in the pleural space using semi-rigid pleuroscopy. Patients with idiopathic exudative pleural effusions underwent pleuroscopy. The procedure was done in the endoscopy suite with full barrier precautions and moderate sedation. Pleural biopsies were initially taken with a 2.0-mm saw-toothed forceps followed by a 2.4-mm cryoprobe (ERBECRYO, ERBE, US). The freeze time for each biopsy was 3 s. There were a total of ten patients, five males and five females. The mean age was 69 years (SD ± 11 years). The mean number of biopsies taken from the parietal pleura using forceps was 4.5 (SD ± 1.5) vs. 3.7 (SD ± 1.4) using cryoprobe. The mean cumulative tissue volume with forceps biopsy was 80 cu. mm; the mean cumulative tissue volume with cryobiopsy was 320 cu. mm, p = 0.007. The diagnostic yields were similar in both the groups. There was no increased incidence of bleeding, chest wall injury, or pain using cryoprobe in any of the patients. The use of cryoprobe for parietal pleural biopsy via semi-rigid pleuroscopy was feasible and safe in this small pilot study.

Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps?

PubMed Central

Panteris, Vasileios; Vezakis, Antonios; Triantafillidis, JK

2018-01-01

Standardized approach to polypectomy of diminutive colorectal polyps (DCPs) is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety. This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides well-intentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but non-negligible risk of advanced neoplasia and even cancer. Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps, their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention. Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted. PMID:29662295

[Analysis of the use of the Salinas forceps at the Gynecologic-Obstetric Hospital of Garza García, N.L. (Nuevo León)].

PubMed

de la Garza Quintanilla, C; González Salinas, M V; Celaya Juárez, J A

1995-09-01

Six hundred and thirteen cases of Salinas forceps application at Hospital de Ginecoobstetricia de Garza García, N.L. from November 1992 to April, 1993, were reviewed. The largest patients group, 20 to 29 years of age with 54.5%; primiparae were predominant with 55.9%, the largest amount of applications in term products, 80.8%; elective forceps with 72.5%; low application with 83.0%; medium 2.5%; episiotomy, medium, right lateral in all the cases; epidural block anesthesia in all the patients, and only one complication 0.1%; most frequent position variety OIA with 50%; and the smaller OIP with 2.6%; 96.3% of products weighted more than 2,500 g; and 87.1% with Apgar 8-9 at one minute. Maternal morbidity, 30.1%; fetal morbidity, 6.1%, with one case with facial paralysis (0.1%) by medium forceps. There were no maternal deaths; 3 antepartum fetal deaths; none postpartum.

[A case of polypoid bronchial neurofibroma originating from right B2b successfully treated by bronchoscopic snaring forceps and Nd-YAG laser therapy].

PubMed

Takiguchi, Y; Uchiyama, T; Sato, K; Tatsumi, K; Kimura, H; Nagao, K; Fujisawa, T; Ohwada, H; Hiroshima, K; Kuriyama, T

1993-12-01

A 34-year-old man with persistent cough was admitted to our hospital. Bronchoscopic examination revealed a polypoid tumor with smooth surface which almost completely obstructed the right main bronchus. The tumor was removed by transbronchial snaring forceps and histologically confirmed as neurofibroma. Residual tumor was excised by biopsy forceps and further endoscopic Nd-YAG laser vaporization was performed. This is the first case in our country in which bronchoscopic treatment was performed for bronchial neurofibroma. Bronchoscopic removal might be the preferred treatment in the present case, although long-term follow-up is also required.

Safe removal of upper esophageal coins by using Magill forceps: two centers' experience.

PubMed

Cetinkursun, Salih; Sayan, Ali; Demirbag, Suzi; Surer, Ilhami; Ozdemir, Tunc; Arikan, Ahmet

2006-01-01

Coin ingestion with subsequent esophageal coin impaction is common in children. Considerable debate surrounds the choice of technique for the removal of esophageal coins. This study demonstrates a minimally invasive technique for upper esophageal coin extraction. A retrospective review was conducted of 165 children who had upper esophageal coins extracted by using a Magill forceps. One hundred fifty-six coins (96.4%) were successfully removed without any complications. The average time taken to remove the coin was 33 seconds. Use of the Magill forceps technique minimizes instrumentation of the esophagus and is an easy, safe technique for removing coins from the upper end of the esophagus.

Probing the E2 properties of the scissors mode with real photons

NASA Astrophysics Data System (ADS)

Beck, Tobias; Pietralla, Norbert; Beller, Jacob; Derya, Vera; Löher, Bastian; Savran, Deniz; Tornow, Werner; Werner, Volker; Zilges, Andreas

2018-05-01

The E2/M1 multipole mixing ratio δ1→2 of the 1+ sc → 2+ 1 γ-ray transition of 156Gd and 164Dy has been measured using the linearly polarized photon beams of the HIγS facility. The employed method of photonscattering experiments in combination with polarized, quasi-monochromatic beams and a dedicated detector setup is highly sensitive to the electric quadrupole-decay properties of the scissors mode.

Students Learning Physics While Lifting Themselves: A Simple Analysis of a Scissors Jack

ERIC Educational Resources Information Center

Haugland, Ole Anton

2017-01-01

Every time I have to jack up my car, I am a bit surprised by how slowly the scissors jack works the higher I raise it, and close to maximum height I need very little force to turn the crank. This agrees well with the principle of simple machines. Since I have to jack up my car at least twice a year to change between winter tires and summer tires,…

Commissioning a hobby cutting device for radiochromic film preparation.

PubMed

Zolfaghari, Somayeh; Francis, Kirby E; Kairn, Tanya; Crowe, Scott B

2017-06-01

In addition to a high spatial resolution and well characterised dose response, one of the major advantages of radiochromic film as a dosimeter is that sheets of film can be cut into pieces suitable for use as calibration films, and for in vivo and phantom measurements. The cutting of film is typically done using scissors or a guillotine, and this process can be time-consuming, limited in precision, requires extensive handling and does not allow holes to be cut from the film without cutting from an existing edge. This study investigated the use of a Brother ScanNCut hobby cutting system for EBT3 film preparation. The optimal operating parameters (blade size, pressure, speed) that resulted in precise cuts with minimal delamination at cut edges were identified using test cutting patterns. These parameters were then used to cut a large film insert for a stereotactic head phantom for comparison against an insert cut with scissors. While the hobby cutting system caused a wider region of delamination at the film edge (1.8 mm) compared to scissors (1 mm), the hobby cutting system was found to be able to produce reproducible cuts more efficiently and more accurately than scissors. The use of the hobby cutting system is recommended for complex phantom inserts (containing sharp corners or holes for alignment rods) or in situations where large numbers of film pieces need to be prepared.

A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

PubMed

Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

2016-02-01

The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

Incidence and risk factors of severe lacerations during forceps delivery in a single teaching hospital where simulation training is held annually.

PubMed

Sano, Yasuko; Hirai, Chihiro; Makino, Shintaro; Li, Xianglan; Takeda, Jun; Itakura, Atsuo; Takeda, Satoru

2018-04-01

This study was conducted to evaluate the incidence of severe lacerations during forceps delivery and the risk factors associated with such delivery in a hospital where simulation training is held annually. The medical records of 857 women who underwent forceps delivery at term with singleton cephalic presentation from 2010 to 2015 were reviewed. The relationship between clinical characteristics and birth canal trauma was analyzed. Birth canal trauma included third and fourth degree perineal lacerations. Univariable and multivariable models of logistic regression were employed to estimate the raw odds ratio and were adjusted for cofactors with 95% confidence intervals. Statistical significance was defined as P < 0.05. The incidence of severe lacerations was 10.1%. Birth weight, fetal head station, the rate of malrotation and the number of extractions were higher in women with severe lacerations (P < 0.01), whereas the use of obstetric anesthesia was lower in women with such lacerations (P < 0.01). Neither the indication for forceps delivery nor the qualifications of the operator had any influence on the incidence of severe lacerations. The incidence of severe lacerations was relatively low. Risk factors for severe lacerations with forceps delivery were identified as birth weight, fetal head station, malrotation and the number of extractions. Obstetric anesthesia may protect against severe lacerations. © 2018 Japan Society of Obstetrics and Gynecology.

The value of forceps biopsy and core needle biopsy in prediction of pathologic complete remission in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy.

PubMed

Tang, Jing-Hua; An, Xin; Lin, Xi; Gao, Yuan-Hong; Liu, Guo-Chen; Kong, Ling-Heng; Pan, Zhi-Zhong; Ding, Pei-Rong

2015-10-20

Patients with pathological complete remission (pCR) after treated with neoadjuvant chemoradiotherapy (nCRT) have better long-term outcome and may receive conservative treatments in locally advanced rectal cancer (LARC). The study aimed to evaluate the value of forceps biopsy and core needle biopsy in prediction of pCR in LARC treated with nCRT. In total, 120 patients entered this study. Sixty-one consecutive patients received preoperative forceps biopsy during endoscopic examination. Ex vivo core needle biopsy was performed in resected specimens of another 43 consecutive patients. The accuracy for ex vivo core needle biopsy was significantly higher than forceps biopsy (76.7% vs. 36.1%; p < 0.001). The sensitivity for ex vivo core needle biopsy was significantly lower in good responder (TRG 3) than poor responder (TRG ≤ 2) (52.9% vs. 94.1%; p = 0.017). In vivo core needle biopsy was further performed in 16 patients with good response. Eleven patients had residual cancer cells in final resected specimens, among whom 4 (36.4%) patients were biopsy positive. In conclusion, routine forceps biopsy was of limited value in identifying pCR after nCRT. Although core needle biopsy might further identify a subset of patients with residual cancer cells, the accuracy was not substantially increased in good responders.

The value of forceps biopsy and core needle biopsy in prediction of pathologic complete remission in locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy

PubMed Central

Gao, Yuan-Hong; Liu, Guo-Chen; Kong, Ling-Heng; Pan, Zhi-Zhong; Ding, Pei-Rong

2015-01-01

Patients with pathological complete remission (pCR) after treated with neoadjuvant chemoradiotherapy (nCRT) have better long-term outcome and may receive conservative treatments in locally advanced rectal cancer (LARC). The study aimed to evaluate the value of forceps biopsy and core needle biopsy in prediction of pCR in LARC treated with nCRT. In total, 120patients entered this study. Sixty-one consecutive patients received preoperative forceps biopsy during endoscopic examination. Ex vivo core needle biopsy was performed in resected specimens of another 43 consecutive patients. The accuracy for ex vivo core needle biopsy was significantly higher than forceps biopsy (76.7% vs. 36.1%; p < 0.001). The sensitivity for ex vivo core needle biopsy was significantly lower in good responder (TRG 3) than poor responder (TRG ≤ 2) (52.9% vs. 94.1%; p = 0.017). In vivo core needle biopsy was further performed in 16 patients with good response. Eleven patients had residual cancer cells in final resected specimens, among whom 4 (36.4%) patients were biopsy positive. In conclusion, routine forceps biopsy was of limited value in identifying pCR after nCRT. Although core needle biopsy might further identify a subset of patients with residual cancer cells, the accuracy was not substantially increased in good responders. PMID:26416245

Removal of intraocular foreign body in anterior chamber angle with prism contact lens and 23-gauge foreign body forceps.

PubMed

Huang, Yan-Ming; Yan, Hua; Cai, Jin-Hong; Li, Hai-Bo

2017-01-01

To introduce a novel approach in removal of anterior chamber angle foreign body (ACFB) using a prism contact lens and 23-gauge foreign body forceps. Data of 42 eyes of 42 patients who had undergone removal of ACFB using a prism contact lens and 23-gauge foreign body forceps from January 2008 to October 2013 were collected and analyzed. Twenty eyes in group A received the conventional approach by using toothed forceps through corneal limbus incision, and 22 eyes in group B underwent the novel method through the opposite corneal limbus incision. The success rate of ACFB once removal was 75% (15/20) in group A, and 100% (22/22) in group B. The average operation time of group A was significantly longer compared with group B (34.9±9.88min vs 22.13±8.85min; P <0.05). The average size of corneal limbus incision in group A was significantly larger than that of group B (4.85±1.89 mm vs 3.95±1.17 mm; P <0.05). The corneal limbus incision suturing were conducted in all eyes in group A, and only 5 eyes in group B. Removal of ACFB using a prism contact lens and 23-gauge foreign body forceps is a safer, more effective, and convenient technique compared with the conventional approach.

Mechatronic design of haptic forceps for robotic surgery.

PubMed

Rizun, P; Gunn, D; Cox, B; Sutherland, G

2006-12-01

Haptic feedback increases operator performance and comfort during telerobotic manipulation. Feedback of grasping pressure is critical in many microsurgical tasks, yet no haptic interface for surgical tools is commercially available. Literature on the psychophysics of touch was reviewed to define the spectrum of human touch perception and the fidelity requirements of an ideal haptic interface. Mechanical design and control literature was reviewed to translate the psychophysical requirements to engineering specification. High-fidelity haptic forceps were then developed through an iterative process between engineering and surgery. The forceps are a modular device that integrate with a haptic hand controller to add force feedback for tool actuation in telerobotic or virtual surgery. Their overall length is 153 mm and their mass is 125 g. A contact-free voice coil actuator generates force feedback at frequencies up to 800 Hz. Maximum force output is 6 N (2N continuous) and the force resolution is 4 mN. The forceps employ a contact-free magnetic position sensor as well as micro-machined accelerometers to measure opening/closing acceleration. Position resolution is 0.6 microm with 1.3 microm RMS noise. The forceps can simulate stiffness greater than 20N/mm or impedances smaller than 15 g with no noticeable haptic artifacts or friction. As telerobotic surgery evolves, haptics will play an increasingly important role. Copyright 2006 John Wiley & Sons, Ltd.

M1 excitation in Sm isotopes and the proton-neutron sdg interacting boson model

NASA Astrophysics Data System (ADS)

Mizusaki, Takahiro; Otsuka, Takaharu; Sugita, Michiaki

1991-10-01

The magnetic-dipole scissors mode in spherical to deformed Sm isotopes is studied in terms of the proton-neutron sdg interacting boson model, providing a good agreement with recent experiment by Ziegler et al. The present calculation correctly reproduces the increase of M1 excitation strength in going from spherical to deformed nuclei. It is suggested that there may be 1+ states which do not correspond to the scissors mode but absorb certain M1 strength from the ground state.

Scissors Duct

NASA Image and Video Library

2007-06-26

Stennis Space Center engineers are preparing to conduct water tests on an updated version of the scissors duct component of the J-2X engine. Measuring about 2 feet long and about 8 inches in diameter, the duct on the J-2X predecessor, the J-2, connected its fuel turbo pumps to the flight vehicle's upper stage run tanks. According to NASA's J-2X project manager at SSC, Gary Benton, the water tests should establish the limits of the duct's ability to withstand vibration.

Mesoscopic interactions and species coexistence in evolutionary game dynamics of cyclic competitions.

PubMed

Cheng, Hongyan; Yao, Nan; Huang, Zi-Gang; Park, Junpyo; Do, Younghae; Lai, Ying-Cheng

2014-12-15

Evolutionary dynamical models for cyclic competitions of three species (e.g., rock, paper, and scissors, or RPS) provide a paradigm, at the microscopic level of individual interactions, to address many issues in coexistence and biodiversity. Real ecosystems often involve competitions among more than three species. By extending the RPS game model to five (rock-paper-scissors-lizard-Spock, or RPSLS) mobile species, we uncover a fundamental type of mesoscopic interactions among subgroups of species. In particular, competitions at the microscopic level lead to the emergence of various local groups in different regions of the space, each involving three species. It is the interactions among the groups that fundamentally determine how many species can coexist. In fact, as the mobility is increased from zero, two transitions can occur: one from a five- to a three-species coexistence state and another from the latter to a uniform, single-species state. We develop a mean-field theory to show that, in order to understand the first transition, group interactions at the mesoscopic scale must be taken into account. Our findings suggest, more broadly, the importance of mesoscopic interactions in coexistence of great many species.

Scalable, MEMS-enabled, vibrational tactile actuators for high resolution tactile displays

NASA Astrophysics Data System (ADS)

Xie, Xin; Zaitsev, Yuri; Velásquez-García, Luis Fernando; Teller, Seth J.; Livermore, Carol

2014-12-01

The design, fabrication, and characterization of a new type of tactile display for people with blindness or low vision is reported. Each tactile element comprises a piezoelectric extensional actuator that vibrates in plane, with a microfabricated scissor mechanism to convert the in-plane actuations into robust, higher-amplitude, out-of-plane (vertical) vibrations that are sensed with the finger pads. When the tactile elements are formed into a 2D array, information can be conveyed to the user by varying the pattern of vibrations in space and time. Analytical models and finite element analysis were used to design individual tactile elements, which were implemented with PZT actuators and both SU-8 and 3D-printed scissor amplifiers. The measured displacements of these 3 mm × 10 mm, MEMS-enabled tactile elements exceed 10 µm, in agreement with models, with measured forces exceeding 45 mN. The performance of the MEMS-enabled tactile elements is compared with the performance of larger, fully-macroscale tactile elements to demonstrate the scale dependence of the devices. The creation of a 28-element prototype is also reported, and the qualitative user experience with the individual tactile elements and displays is described.

Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population

PubMed Central

Ayala-Yáñez, Rodrigo; Bayona-Soriano, Paulette; Hernández-Jimenez, Arturo; Contreras-Rendón, Alejandra; Chabat-Manzanera, Paulina; Nevarez-Bernal, Roberto

2015-01-01

Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country's high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (p = 0.016), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (p = 0.016), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications. PMID:26380111

Comparison of Keyes Punch Biopsy Instrument with Cervical Punch Biopsy Forceps for Diagnosing Cervical Lesions.

PubMed

Tyagi, Natasha; Suneja, Amita; Mishra, Kiran; Jain, Sandhya; Vaid, Neelam Bala; Guleria, Kiran

2017-01-01

To assess the feasibility and efficacy of Keyes punch biopsy instrument (KP) in diagnosing cervical lesions and compare it with cervical punch biopsy forceps (CP). 75 women having satisfactory colposcopy with abnormal transformation zone were included and paired colposcopic directed biopsies were taken using KP followed by CP from the same target area. It was feasible in all cases to take cervical biopsy with KP after increasing its effective length. The volume of gross specimen obtained by KP was less than CP (0.076 ± 0.097 vs. 0.101 ± 0.156 cm3, p = 0.061), however on microscopic examination, mean length and mean depth of tissue in KP was greater than CP by 0.06 mm (p = 0.810) and 0.14 mm (p = 0.634) respectively. Exact agreement was found with the final surgical specimen in 42% of cases in both the biopsy forceps. KP is almost at par with CP for diagnosing preinvasive cervical lesions and is a useful adjunct to the existing armamentarium of biopsy forceps. © 2016 S. Karger AG, Basel.

Flexible cystoscopic bladder biopsies: a technique for outpatient evaluation of the lower urinary tract urothelium.

PubMed

Beaghler, M; Grasso, M

1994-11-01

Routine urothelial biopsies of the lower urinary tract are obtained using the cold cup biopsy technique. This procedure is most often performed in the surgical suite and requires rigid endoscopic access and the use of biopsy forceps and Bugbee electrodes to obtain tissue for histologic examination. A new single-step biopsy forceps has been used through the flexible cystoscope. Using a 16 F actively deflectable, flexible cystoscope and the 5.4 F Therma Jaw Hot Urologic Forceps, bladder biopsies were obtained in 27 patients for a variety of indications. This biopsy forceps allows simultaneous tissue sampling and electrocoagulation of the biopsy site, thus eliminating the need for exchange of instruments through the flexible cystoscope. Tissue samples are somewhat protected from thermal changes during coagulation through the use of a Faraday cage. Biopsies were frequently obtained in an outpatient setting, requiring only local topical anesthesia (2% lidocaine jelly). Carcinoma in situ, transitional cell carcinoma, acute and chronic inflammation, and normal bladder mucosa were differentiated histologically. Using this technique, lower urinary tract urothelial mapping can be performed safely in the office with minimal patient discomfort.

E2 decay strength of the M1 scissors mode of ^{156}Gd and its first excited rotational state.

PubMed

Beck, T; Beller, J; Pietralla, N; Bhike, M; Birkhan, J; Derya, V; Gayer, U; Hennig, A; Isaak, J; Löher, B; Ponomarev, V Yu; Richter, A; Romig, C; Savran, D; Scheck, M; Tornow, W; Werner, V; Zilges, A; Zweidinger, M

2017-05-26

The E2/M1 multipole mixing ratio δ_{1→2} of the 1_{sc}^{+}→2_{1}^{+} γ-ray decay in ^{156}Gd and hence the isovector E2 transition rate of the scissors mode of a well-deformed rotational nucleus has been measured for the first time. It has been obtained from the angular distribution of an artificial quasimonochromatic linearly polarized γ-ray beam of energy 3.07(6) MeV scattered inelastically off an isotopically highly enriched ^{156}Gd target. The data yield first direct support for the deformation dependence of effective proton and neutron quadrupole boson charges in the framework of algebraic nuclear models. First evidence for a low-lying J^{π}=2^{+} member of the rotational band of states on top of the 1^{+} band head is obtained, too, indicating a significant signature splitting in the K=1 scissors mode rotational band.

Characterization of spiraling patterns in spatial rock-paper-scissors games.

PubMed

Szczesny, Bartosz; Mobilia, Mauro; Rucklidge, Alastair M

2014-09-01

The spatiotemporal arrangement of interacting populations often influences the maintenance of species diversity and is a subject of intense research. Here, we study the spatiotemporal patterns arising from the cyclic competition between three species in two dimensions. Inspired by recent experiments, we consider a generic metapopulation model comprising "rock-paper-scissors" interactions via dominance removal and replacement, reproduction, mutations, pair exchange, and hopping of individuals. By combining analytical and numerical methods, we obtain the model's phase diagram near its Hopf bifurcation and quantitatively characterize the properties of the spiraling patterns arising in each phase. The phases characterizing the cyclic competition away from the Hopf bifurcation (at low mutation rate) are also investigated. Our analytical approach relies on the careful analysis of the properties of the complex Ginzburg-Landau equation derived through a controlled (perturbative) multiscale expansion around the model's Hopf bifurcation. Our results allow us to clarify when spatial "rock-paper-scissors" competition leads to stable spiral waves and under which circumstances they are influenced by nonlinear mobility.

Does vacuum delivery carry a higher risk of shoulder dystocia? Review and meta-analysis of the literature.

PubMed

Dall'Asta, Andrea; Ghi, Tullio; Pedrazzi, Giuseppe; Frusca, Tiziana

2016-09-01

Vacuum extractor has been increasingly used over the last decades and is acknowledged as a risk factor for shoulder dystocia (SD). In this meta-analysis we assess the actual risk of SD following a vacuum delivery compared to spontaneous vaginal delivery (SVD) and forceps. Systematic literature search (English literature only) on MEDLINE, EMBASE, ScienceDirect, the Cochrane library and ClinicalTrials.gov conducted up to May 2015. Key search terms included: Operative/Vacuum/Forceps delivery [Mesh] and shoulder dystocia and subheadings. 2 stage-process study selection. We included only studies where data concerning the occurrence of SD following operative vaginal delivery were reported as adjusted odds ratio (AOR) and no significant difference in confounding factors for SD was recorded. Included trials clustered according to the delivery mode (1) vacuum vs. SVD, (2) forceps vs. vacuum. Methodological quality of each study evaluated with the Newcastle-Ottawa System (NOS). 87 potentially relevant papers. After applying inclusion and exclusion criteria only 7 were selected for the meta-analysis. Vacuum delivery appeared associated with a higher risk of SD than SVD in both fixed and random model (OR 2.87 and 2.98 respectively). No difference in the rate of SD was found between vacuum and forceps (p>0.05). Vacuum extractor carries an increased risk of SD compared with spontaneous vaginal delivery whereas the occurrence of SD does not seem to vary following vacuum or forceps. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evolution of restraint in a structured rock–paper–scissors community

PubMed Central

Nahum, Joshua R.; Harding, Brittany N.; Kerr, Benjamin

2011-01-01

It is not immediately clear how costly behavior that benefits others evolves by natural selection. By saving on inherent costs, individuals that do not contribute socially have a selective advantage over altruists if both types receive equal benefits. Restrained consumption of a common resource is a form of altruism. The cost of this kind of prudent behavior is that restrained individuals give up resources to less-restrained individuals. The benefit of restraint is that better resource management may prolong the persistence of the group. One way to dodge the problem of defection is for altruists to interact disproportionately with other altruists. With limited dispersal, restrained individuals persist because of interaction with like types, whereas it is the unrestrained individuals that must face the negative long-term consequences of their rapacity. Here, we study the evolution of restraint in a community of three competitors exhibiting a nontransitive (rock–paper–scissors) relationship. The nontransitivity ensures a form of negative feedback, whereby improvement in growth of one competitor has the counterintuitive consequence of lowering the density of that improved player. This negative feedback generates detrimental long-term consequences for unrestrained growth. Using both computer simulations and evolution experiments with a nontransitive community of Escherichia coli, we find that restrained growth can evolve under conditions of limited dispersal in which negative feedback is present. This research, thus, highlights a set of ecological conditions sufficient for the evolution of one form of altruism. PMID:21690371

Evolution of restraint in a structured rock-paper-scissors community.

PubMed

Nahum, Joshua R; Harding, Brittany N; Kerr, Benjamin

2011-06-28

It is not immediately clear how costly behavior that benefits others evolves by natural selection. By saving on inherent costs, individuals that do not contribute socially have a selective advantage over altruists if both types receive equal benefits. Restrained consumption of a common resource is a form of altruism. The cost of this kind of prudent behavior is that restrained individuals give up resources to less-restrained individuals. The benefit of restraint is that better resource management may prolong the persistence of the group. One way to dodge the problem of defection is for altruists to interact disproportionately with other altruists. With limited dispersal, restrained individuals persist because of interaction with like types, whereas it is the unrestrained individuals that must face the negative long-term consequences of their rapacity. Here, we study the evolution of restraint in a community of three competitors exhibiting a nontransitive (rock-paper-scissors) relationship. The nontransitivity ensures a form of negative feedback, whereby improvement in growth of one competitor has the counterintuitive consequence of lowering the density of that improved player. This negative feedback generates detrimental long-term consequences for unrestrained growth. Using both computer simulations and evolution experiments with a nontransitive community of Escherichia coli, we find that restrained growth can evolve under conditions of limited dispersal in which negative feedback is present. This research, thus, highlights a set of ecological conditions sufficient for the evolution of one form of altruism.

Quadrupole decay strength of the M1 scissors mode

NASA Astrophysics Data System (ADS)

Beck, T.; Beller, J.; Derya, V.; Gayer, U.; Isaak, J.; Löher, B.; Mertes, L.; Pietralla, N.; Ries, P.; Romig, C.; Savran, D.; Scheck, M.; Tornow, W.; Weller, H. R.; Werner, V.; Zweidinger, M.

2015-10-01

The E2/M1 multipole mixing ratio δ1→2 of the 1sc +→21+ transition of Gd was determined using results from high-statistics photon scattering. This provides a possibility for a new approach on the search of Jsc + members of the rotational band built on the scissors mode. By application of Alaga's rule, which is justifiable as 156Gd is a well-deformed rotor with good K quantum number, a transition strength of B (E 2 ;2sc +→01+)=0.034 (13 ) W.u. is estimated.

Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis.

PubMed

M, Irfan; Yaroko, Ali Ango; S M, Najeb; Periasamy, Centilnathan

2013-04-01

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Feasibility of New Technology to Comprehensively Characterize Air Emissions from Full Scale Open Burning and Open Detonation

DTIC Science & Technology

2010-12-01

balloon and ATV winch system (right). 9 Figure 2-4. Scissor lift (left) and instrumentation on the scissor lift (right). 10 Figure 2-5. Concrete burn...indoor facility (#1376), bunkers, a gravel/sand detonation area for open detonation tests (~330 ft × 165 ft, ~100 m ×50 m) and a concrete burn pad... Concrete burn pad with six reusable sheet steel pans showing a burn of 100 lb (45.5 kg) of M1 propellant. 2.2.3.2 Open Detonation Based on several pre

Learning From Experience: Development of a Cognitive Task List to Perform a Safe and Successful Non-Rotational Forceps Delivery.

PubMed

Simpson, Andrea N; Gurau, David; Secter, Michael; Mocarski, Eva; Pittini, Richard; Snelgrove, John; Hodges, Ryan; Windrim, Rory; Higgins, Mary

2015-07-01

Increased rates of delivery by Caesarean section have resulted in a reduction in rates of instrumental deliveries. This has led to a new educational challenge for teaching and development of skills. In teaching trainees, there are subconscious tasks that the supervising staff may not review because they are automatic. This study aimed to create a new tool to meet this challenge: to identify the core steps required to perform a non-rotational forceps delivery safely and successfully. Labour and delivery nursing staff of three large teaching hospitals were asked to identify clinicians they considered to be particularly skilled in non-rotational forceps deliveries. Obstetricians who were identified consistently in this way were invited to participate in the study. After providing written consent, participants were then filmed performing a non-rotational forceps delivery on a model. Two clinicians reviewed all videos and documented verbal and non-verbal components of the assessment. Thematic analysis combined findings into an integrated summary. The initial summary was then circulated to all participants for their approval. Seventeen clinicians were identified and consented. Themes identified included the need for careful assessment of suitability for operative delivery, the role of the multidisciplinary team, the need for careful and appropriate communication with the parents, the technique of delivery itself, and postpartum care and documentation. In the core steps identified, the clinicians balanced respect for the "elegant technique" of non-rotational forceps deliveries with careful assessment and knowing when to stop if safety criteria were not met.

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures.

PubMed

Kitajima, Yasuhiro; Ohara, Hirotaka; Nakazawa, Takahiro; Ando, Tomoaki; Hayashi, Kazuki; Takada, Hiroki; Tanaka, Hajime; Ogawa, Kanto; Sano, Hitoshi; Togawa, Shozo; Naito, Itaru; Hirai, Masaaki; Ueno, Koichiro; Ban, Tessin; Miyabe, Katuyuki; Yamashita, Hiroaki; Yoshimura, Norihiro; Akita, Shinji; Gotoh, Kazuo; Joh, Takashi

2007-10-01

Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated. After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone. The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage. Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.

Composite redesign of obstetrical forceps

NASA Technical Reports Server (NTRS)

Lawson, Seth W.; Smeltzer, Stan S.

1994-01-01

Due to the increase in the number of children being born recently, medical technology has struggled to keep pace in certain areas. In these areas, particular needs have arisen to which the subject of this paper is directed. In the area of obstetrics, the forceps design and function has remained relatively unchanged for a number of years. In an effort to advance the technology, NASA Marshall Space Flight Center has been asked by the obstetrical community to help in a redesign of the obstetric forceps. Traditionally the forceps design has been of tubular stainless steel, constructed in two halves which interlock and hinge to provide the gripping force necessary to aid in the delivery of an infant. The stainless steel material was used to provide for ease of cleaning and sterilization. However, one of the drawbacks of the non-flexible steel design is that excessive force can be placed upon an infants head which could result in damage or injury to the infant. The redesign of this particular obstetric tool involves applying NASA's knowledge of advanced materials and state of the art instrumentation to create a tool which can be used freely throughout the obstetrics community without the fear of injury to an infant being delivered.

Emergency cricothyrotomy-a comparative study of different techniques in human cadavers.

PubMed

Schober, Patrick; Hegemann, Martina C; Schwarte, Lothar A; Loer, Stephan A; Noetges, Peter

2009-02-01

Emergency cricothyrotomy is the final lifesaving option in "cannot intubate-cannot ventilate" situations. Fast, efficient and safe management is indispensable to reestablish oxygenation, thus the quickest, most reliable and safest technique should be used. Several cricothyrotomy techniques exist, which can be grouped into two categories: anatomical-surgical and puncture. We studied success rate, tracheal tube insertion time and complications of different techniques, including a novel cricothyrotomy scissors technique in human cadavers. Sixty-three inexperienced health care providers were randomly assigned to apply either an anatomical-surgical technique (standard surgical technique, n=18; novel cricothyrotomy scissors technique, n=14) or a puncture technique (catheter-over-needle technique, n=17; wire-guided technique, n=14). Airway access was almost always successful with the anatomical-surgical techniques (success rate in standard surgical group 94%, scissors group 100%). In contrast, the success rate was smaller (p<0.05) with the puncture techniques (catheter-over-needle group 82%, wire-guided technique 71%). Tracheal tube insertion time was faster overall (p<0.05) with anatomical-surgical techniques (standard surgical 78s [54-135], novel cricothyrotomy scissors technique 60s [42-82]; median [IQR]) than with puncture techniques (catheter-over-needle technique 74s [48-145], wire-guided technique 135s [116-307]). We observed fewer complications with anatomical-surgical techniques than with puncture techniques (p<0.001). In inexperienced health care personnel, anatomical-surgical techniques showed a higher success rate, a faster tracheal tube insertion time and a lower complication rate compared with puncture techniques, suggesting that they may be the techniques of choice in emergencies.

A method for mass harvesting islets (Brockmann bodies) from teleost fish.

PubMed

Yang, H; Wright, J R

1995-01-01

In certain species of fish, the insulin-producing tissue is uniquely located in separate structures called Brockmann bodies (BBs). Tilapia BBs have been shown to be a simple and inexpensive source of islet cells for xenotransplantation research. Each donor tilapia contains roughly 12-15 BBs, measuring from 0.3 to 5.0 mm in maximum dimension, in a triangular region of adipose tissue bounded by the liver, stomach, and spleen/gallbladder. At present, the larger BBs (usually 2-4) are harvested by microdissecting these "BB regions" using jeweler's forceps and microvascular scissors while being visualized with the aid of a dissecting microscope. It is a simple but time-consuming task that would not be applicable for harvesting massive amounts of BB tissue for large animal studies. Therefore, we have developed an easier and more efficient method of harvesting BBs based on a standard enzymatic method for isolating human adipocytes. BB regions are harvested from donor fish and pooled into a 50 mL plastic tube containing collagenase Type II (3 mg/mL) in Hank's balanced salt solution (HBSS); the tube is then placed in a 37 degrees C waterbath/shaker for roughly 15 min. The exact length of the digestion interval is determined by visual inspection of the tube to determine whether the BBs have been liberated. The digestion is then stopped by adding excess cold HBSS. The adipocytes float while the BBs and residual connective tissue (i.e., a few blood vessels, nerves, and bile ducts) form a pellet. The pellet is washed several times in HBSS and then placed in a culture dish. The BBs are easily handpicked with a siliconized pipette. Based on functional data and DNA content, this new method roughly doubles or triples our yield of BB tissue per donor fish. To determine whether BBs harvested in this manner functioned in a manner similar to those harvested by microdissection, we performed a series of transplants using mass-harvested BBs. Long-term normoglycemia was achieved in streptozotocin-diabetic nude mice and mean graft survival time was not altered in streptozotocin-diabetic euthymic balb/c mice. However, the total weight of donor fish required per recipient was decreased by 50% in both strains.

Phase Transitions and Volunteering in Spatial Public Goods Games

NASA Astrophysics Data System (ADS)

Szabó, György; Hauert, Christoph

2002-08-01

We present a simple yet effective mechanism promoting cooperation under full anonymity by allowing for voluntary participation in public goods games. This natural extension leads to ``rock-scissors-paper''-type cyclic dominance of the three strategies, cooperate, defect, and loner. In spatial settings with players arranged on a regular lattice, this results in interesting dynamical properties and intriguing spatiotemporal patterns. In particular, variations of the value of the public good leads to transitions between one-, two-, and three-strategy states which either are in the class of directed percolation or show interesting analogies to Ising-type models. Although volunteering is incapable of stabilizing cooperation, it efficiently prevents successful spreading of selfish behavior.

Iatrogenic pneumomediastinum and subcutaneous emphysema as a complication of colonoscopy with cold forceps biopsy.

PubMed

Loughlin, Michael T; Duncan, Timothy J

2012-04-01

A 58-year-old woman underwent outpatient colonoscopy with multiple cold forceps biopsy for evaluation of a presumptive diagnosis of ulcerative colitis. Six hours following the procedure, she developed subcutaneous crepitus and presented to the emergency department, where chest X-ray revealed pneumomediastinum and subcutaneous emphysema. Our case discusses this unusual complication of colonoscopy and its diagnosis and management.

Maternal and neonatal morbidity in relation to the instrument used for mid-cavity rotational operative vaginal delivery: a prospective cohort study.

PubMed

Bahl, R; Van de Venne, M; Macleod, M; Strachan, B; Murphy, D J

2013-11-01

To compare the maternal and neonatal morbidity associated with alternative instruments used to perform a mid-cavity rotational delivery. A prospective cohort study. Two university teaching hospitals in Scotland and England. Three hundred and eighty-one nulliparous women who had a mid-cavity rotational operative vaginal delivery. A data collection sheet was completed by the research team following delivery. Postpartum haemorrhage, third- and fourth-degree perineal tears, low cord pH, neonatal trauma, and failed or sequential operative vaginal delivery. One hundred and sixty-three women (42.8%) underwent manual rotation followed by non-rotational forceps delivery, 73 (19.1%) had a rotational vacuum delivery, and 145 (38.1%) delivered with the assistance of rotational (Kielland) forceps. The rates of postpartum haemorrhage were similar when comparing manual rotation with rotational vacuum (adjusted OR 1.42, 95% CI 0.66-3.98), and when comparing manual rotation with Kielland forceps (adjusted OR 1.22, 95% CI 0.71-2.88). The results were comparable for third- and fourth-degree perineal tears (adjusted OR 0.85, 95% CI 0.13-1.89; adjusted OR 0.94, 95% CI 0.39-1.82), low cord pH (adjusted OR 1.76, 95% CI 0.44-6.91; adjusted OR 1.12, 95% CI 0.44-2.83), neonatal trauma (adjusted OR 0.50, 95% CI 0.16-1.55; adjusted OR 3.25, 95% CI 0.65-16.17), and admission to the neonatal intensive care unit (adjusted OR 1.47, 95% CI 0.45-4.81; adjusted OR 1.04, 95% CI 0.49-2.19). The sequential use of instruments was less likely with manual rotation and forceps than with rotational vacuum delivery (0.6 versus 36.9%, OR 0.01, 95% CI 0.002-0.090). Maternal and perinatal outcomes are comparable with Kielland forceps, vacuum extraction, and manual rotation, with few serious adverse outcomes. With appropriate training mid-cavity rotational delivery can be practiced safely, including the use of Kielland forceps. © 2013 RCOG.

An unusual intracranial metallic foreign bodies and panhypopituitarism.

PubMed

Lakouichmi, Mohammed; Baïzri, Hicham; Mouhsine, Abdelilah; Boukhira, Abderrahmane; Akhaddar, Ali

2014-01-01

A 49 years old man, with a history of aggression at the age of 18 years by a pair of scissors, who consulted for unilateral migraine headaches look straight. Paraclinical explorations concluded that trauma to anterior pituitary by a metallic foreign body from the right nostril to the sella, responsible for panhypopituitarism and sinusitis. The headaches are frequent causes of consultation, often treated symptomatically but rarely explored. The direct trauma to the pituitary gland, by a metallic foreign body, is exceptional. We report the case of neglected panhypopituitarism, discovered 31 years after injury with a pair of scissors.

An unusual intracranial metallic foreign bodies and panhypopituitarism

PubMed Central

Lakouichmi, Mohammed; Baïzri, Hicham; Mouhsine, Abdelilah; Boukhira, Abderrahmane; Akhaddar, Ali

2014-01-01

A 49 years old man, with a history of aggression at the age of 18 years by a pair of scissors, who consulted for unilateral migraine headaches look straight. Paraclinical explorations concluded that trauma to anterior pituitary by a metallic foreign body from the right nostril to the sella, responsible for panhypopituitarism and sinusitis. The headaches are frequent causes of consultation, often treated symptomatically but rarely explored. The direct trauma to the pituitary gland, by a metallic foreign body, is exceptional. We report the case of neglected panhypopituitarism, discovered 31 years after injury with a pair of scissors. PMID:25667695

How directional mobility affects coexistence in rock-paper-scissors models

NASA Astrophysics Data System (ADS)

Avelino, P. P.; Bazeia, D.; Losano, L.; Menezes, J.; de Oliveira, B. F.; Santos, M. A.

2018-03-01

This work deals with a system of three distinct species that changes in time under the presence of mobility, selection, and reproduction, as in the popular rock-paper-scissors game. The novelty of the current study is the modification of the mobility rule to the case of directional mobility, in which the species move following the direction associated to a larger (averaged) number density of selection targets in the surrounding neighborhood. Directional mobility can be used to simulate eyes that see or a nose that smells, and we show how it may contribute to reduce the probability of coexistence.

How directional mobility affects coexistence in rock-paper-scissors models.

PubMed

Avelino, P P; Bazeia, D; Losano, L; Menezes, J; de Oliveira, B F; Santos, M A

2018-03-01

This work deals with a system of three distinct species that changes in time under the presence of mobility, selection, and reproduction, as in the popular rock-paper-scissors game. The novelty of the current study is the modification of the mobility rule to the case of directional mobility, in which the species move following the direction associated to a larger (averaged) number density of selection targets in the surrounding neighborhood. Directional mobility can be used to simulate eyes that see or a nose that smells, and we show how it may contribute to reduce the probability of coexistence.

Development and effect of a cognitive enhancement gymnastics program for elderly people with dementia

PubMed Central

Han, Yoon-Soo; Araki, Tatsuo; Lee, Pil-Young; Choi, Jung-Hyun; Kwon, In-Seon; Kwon, Ki-Nam; Kim, Ji-Youn

2016-01-01

The purpose of this study was to develop a cognitive enhancement gymnastics program for the elderly with dementia and to verify its effect. The study was conducted on 27 people with dementia being treated in a dementia day care center in Incheon city. No statistically significant differences were found in the measures Mini-Mental State Examination for Dementia Screening (MMSE-DS), Short Geriatric Depression Scale (SGDS), Seoul Activities of Daily Living (S-ADL), or rock-paper-scissors. However, the MMSE-DS and rock-paper-scissors showed improvement after 12 weeks. PMID:27656632

Development of a dual joystick-controlled laser trapping and cutting system for optical micromanipulation of chromosomes inside living cells.

PubMed

Harsono, Marcellinus S; Zhu, Qingyuan; Shi, Linda Z; Duquette, Michelle; Berns, Michael W

2013-02-01

A multi-joystick robotic laser microscope system used to control two optical traps (tweezers) and one laser scissors has been developed for subcellular organelle manipulation. The use of joysticks has provided a "user-friendly" method for both trapping and cutting of organelles such as chromosomes in live cells. This innovative design has enabled the clean severing of chromosome arms using the laser scissors as well as the ability to easily hold and pull the severed arm using the laser tweezers. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis.

PubMed

Esaki, Mitsuru; Suzuki, Sho; Hayashi, Yasuyo; Yokoyama, Azusa; Abe, Shuichi; Hosokawa, Taizo; Ogino, Haruei; Akiho, Hirotada; Ihara, Eikichi; Ogawa, Yoshihiro

2018-02-27

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using the Flush Knife BT. We conducted a retrospective review of the case records of 149 patients with early gastric cancer treated with ESD using the needle-type ESD knives between January 2012 and August 2016 at Kitakyushu Municipal Medical Center. Lesions treated with ESD using the Splash M-knife (ESD-M) and the Flush Knife BT (ESD-F) were compared. Multivariate analyses and propensity score matching were used to compensate for the differences in age, gender, underlying disease, antithrombotic drug use, lesion location, lesion position, macroscopic type, tumor size, presence of ulceration, operator level and types of electrosurgical unit used. The primary endpoint was the requirement to use hemostatic forceps in the two groups. The secondary endpoints of procedure time, en bloc and complete resection rates, and adverse events rates were evaluated for the two groups. There were 73 patients in the ESD-M group, and 76 patients in the ESD-F group. Propensity score matching analysis created 45 matched pairs. Adjusted comparisons between the two groups showed a significantly lower usage rate of hemostatic forceps in the ESD-M group than in the ESD-F group (6.7% vs 84.4%, p < 0.001). Treatment outcomes showed an en bloc resection rate of 100% in both groups; complete resection rate of 95.6% vs 100%, p = 0.49; median procedure time of 74.0 min vs 71.0 min, p = 0.90; post-procedure bleeding of 2.2% vs 2.2%, p = 1, in the ESD-M and ESD-F groups, respectively. There were no perforations in either group. ESD-M appeared to reduce the usage of hemostatic forceps during ESD for early gastric cancer without increasing the adverse effects. Thus, it may contribute to a reduction in the total ESD cost.

A pilot study of EUS-guided through-the-needle forceps biopsy (with video).

PubMed

Nakai, Yousuke; Isayama, Hiroyuki; Chang, Kenneth J; Yamamoto, Natsuyo; Mizuno, Suguru; Mohri, Dai; Kogure, Hirofumi; Matsubara, Saburo; Tada, Minoru; Koike, Kazuhiko

2016-07-01

In EUS-guided FNA (EUS-FNA), small-caliber needles are preferable for optimal cytologic yield, whereas large ones are preferable when histologic specimens are needed. Because of the rigidity and friction induced by its large caliber, however, technical limitation does exist in a 19-gauge FNA needle. Recent development of miniature biopsy forceps enables EUS-guided through-the-needle forceps biopsy (EUS-TTNFB). The aim of this study is to evaluate safety and efficacy of EUS-TTNFB. Eighteen sessions of EUS-TTNFB in 17 patients with solid lesions were performed by using a 0.75-mm biopsy forceps through a 19-gauge FNA needle. Technical feasibility, safety, and diagnostic yield of EUS-TTNFB were retrospectively studied. A total of 49 passes, a median of 3 passes per session, were performed, and the needle puncture, advancement and removal of the biopsy forceps, and subsequent EUS-FNA were technically successful in all patients. No adverse events were observed other than one case with hyperamylasemia without pancreatitis. Macroscopic histologic core by EUS-TTNFB was obtained at a rate of 71% per pass. The tissue acquisition rate by EUS-TTNFB alone was 67% per pass and 100% per session. When EUS-TTNFB and subsequent EUS-FNA were combined, the tissue acquisition rate was 94% per pass. The accuracy of combined EUS-TTNFB and EUS-FNA to diagnose malignancy was 88% per pass and 94% per session. With a single pass of EUS-TTNFB and EUS-FNA, the tissue acquisition rate was 89%, and the accuracy to diagnose malignancy was 83%. EUS-TTNFB was safe and technically feasible and provided additional tissue acquisition with a single puncture of a 19-gauge FNA needle. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Obliteration of symptomatic Schatzki rings with jumbo biopsy forceps (with video).

PubMed

Gonzalez, A; Sullivan, M F; Bonder, A; Allison, H V; Bonis, P A; Guelrud, M

2014-01-01

A Schatzki ring is a submucosal, fibrotic thickening located at the gastroesophageal junction. Endoscopic treatment traditionally involves disruption of the ring. Many approaches have been described including bougies, balloons, biopsies, and diathermic monopolar incision. While all of these approaches are effective in the short-term, recurrence is common. The objective of our study was to evaluate the feasibility of complete excision of the ring using jumbo cold biopsy forceps. Our main outcome measurements were the feasibility, safety, and efficacy of complete obliteration of Schatzki rings using jumbo cold biopsy forceps. We designed an observational study using a standard protocol for patient management and data collection using a university hospital as our setting. We followed 10 patients with dysphagia due to a Schatzki's ring, six of whom had previously undergone bougienage or balloon dilation. Five patients were on maintenance therapy with a proton pump inhibitor and one with an H2 blocker. Complete endoscopic obliteration of the Schatzki rings with a cold jumbo biopsy forceps was achieved in all 10 patients requiring a mean of 9.8 biopsies (range 8-12). Omeprazole (20 mg twice daily) was prescribed after the procedure. All 10 patients demonstrated improvement in dysphagia after treatment, which persisted during a mean follow-up time of 379 days (range 63-496 days). There were no serious complications. The limitations of our study include lack of a control group, a small sample size, and being a single-institution study. We concluded that complete Schatzki ring obliteration with jumbo cold biopsy forceps is a safe, feasible, and effective endoscopic treatment. © 2014 International Society for Diseases of the Esophagus.

Is Laser Assisted Capsulotomy better than standard CCC?

PubMed

Gavriș, Monica; Mateescu, Radu; Belicioiu, Roxana; Olteanu, Ioana

2017-01-01

Objectives: To compare the safety and intraoperative difficulties of two capsulorhexis techniques for white intumescent cataract: Femtolaser-assisted capsulorhexis and manual capsulorhexis performed in 2-3 stages, with the Utrata forceps. Materials and methods: A prospective comparative study that included 28 eyes divided into 2 equal groups in which capsulorhexis was performed by using the 2 methods. In the first group, the capsulorhexis was executed by using LenSx Femtolaser. In the second group, an Utrata forceps was used to perform a manual 2-3 steps capsulorhexis as follows: a small 2-3 mm capsulorhexis was performed after the staining of the anterior capsule with Trypan Blue along with a good pressurization with viscoelastic substance. The liquefied cortex was aspirated, followed by the enlargement of the capsulorhexis. In some cases, the enlargement was made after IOL implantation. Results: In the Femtolaser group, the capsule was completely detached in 13 cases and only in one case, the capsule had a few bridges which detached easily, without endangering the capsulorhexis integrity. Its size was 4,9 mm in all cases. In the group in which capsulorhexis was performed with the Utrata forceps in 2-3 stages, this was complete, circular and relatively well centered in all cases, but the size varied between 4,5 and 5,5 mm. Conclusions: Femtosecond laser-assisted capsulorhexis was round, well centered and of a desired size of 4,9 mm. The manual capsulorhexis with the Utrata forceps depends on the surgeon's skill and experience and requires a good local anesthesia, the coloring of the anterior capsule with Tripan Blue, using a large quantity of cohesive viscoelastic substances and sometimes using micro incision forceps for helpful maneuvers. The size and centering of the capsulorhexis are not always identical with the intended ones.

A study of the method of the video image presentation for the manipulation of forceps.

PubMed

Kono, Soichi; Sekioka, Toshiharu; Matsunaga, Katsuya; Shidoji, Kazunori; Matsuki, Yuji

2005-01-01

Recently, surgical operations have sometimes been tried under laparoscopic video images using teleoperation robots or forceps manipulators. Therefore, in this paper, forceps manipulation efficiencies were evaluated when images for manipulation had some transmission delay (Experiment 1), and when the convergence point of the stereoscopic video cameras was either fixed and variable (Experiment 2). The operators' tasks in these experiments were sewing tasks which simulated telesurgery under 3-dimensional scenography. As a result of experiment 1, the operation at a 200+/-100 ms delay was kept at almost the same accuracy as that without delay. As a result of experiment 2, work accuracy was improved by using the zooming lens function; however the working time became longer. These results seemed to show the relation of a trade-off between working time and working accuracy.

Outcome of forceps delivery in a teaching hospital: A 2 year experience

PubMed Central

John, Lopamudra B.; Nischintha, S.; Ghose, Seetesh

2014-01-01

Introduction: The art of forceps delivery though existing for centuries has earned a disreputation due to the possibility of poor maternal and fetal outcome. However, its safe use can reduce the rising cesarean section rates in the present times. This study is to see the outcome of its use in a teaching hospital over a 2 year period. Materials and Methods: In this retrospective observational study, 120 cases of forceps delivery were studied for maternal outcome such as injuries, postpartum hemorrhage, and fetal outcome such as Apgar score at birth, neonatal intensive care unit admissions, injury, and mortality. Results: The most common indication was fetal distress (47.5%). A total of 15 cases (12.5%) of maternal injuries occurred, with 2 uterine ruptures one of which was in a previous lower segment caesarean section case, 4 complete perineal tears and 9 minor cervical and vaginal lacerations. A total of 12 babies (10%) had poor Apgar scores who recovered after resuscitation and one out of them died, which was a case of multiple instrumentation. Conclusion: Forceps is a reasonable option for the obstetrician to reduce the caesarean section rates; however, extreme caution, proper expertise and judicial use of this instrument are required to prevent undue risk to mother and fetus. PMID:24678216

Elastic Scattering Spectroscopy for the Detection of Pre-Cancer and Early Cancer of the Breast

DTIC Science & Technology

2006-06-01

and it is not currently possible even to use biopsy forceps through the sheath alone. However, it is practical to pass an ESS probe through the...to accept our ESS probe, tiny biopsy forceps or brushes for cytological PAGE 53 PAGE 54 examination. We envisage being able to take...ductoscopy (where biopsy is not feasible) and detect aneuploidy, an important prognostic factor. These results justify further prospective studies

Accidental ingestion of BiTine ring and a note on inefficient ring separation forceps.

PubMed

Baghele, Om Nemichand; Baghele, Mangala Om

2011-01-01

Accidental ingestion of medium-to-large instruments is relatively uncommon during dental treatment but can be potentially dangerous. A case of BiTine ring ingestion is presented with a note on inefficient ring separation forceps. A 28-year-old male patient accidentally ingested the BiTine ring (2 cm diameter, 0.5 cm outward projections) while it was being applied to a distoproximal cavity in tooth # 19. The ring placement forceps were excessively flexible; bending of the beaks towards the ring combined with a poor no-slippage mechanism led to sudden disengagement of the ring and accelerated movement towards the pharynx. We followed the patient with bulk forming agents and radiographs. Fortunately the ring passed out without any complications. Checking equipment and methods is as important as taking precautions against any preventable medical emergency. It is the responsibility of the clinician to check, verify and then use any instrument/equipment.

Primary esophageal mucosa-associated lymphoid tissue lymphoma diagnosed by using stacked forceps biopsy.

PubMed

Lee, D S; Ahn, Y C; Eom, D W; Lee, S J

2016-10-01

Non-Hodgkin lymphoma involving the esophagus is very rare. Only a few cases have been reported in the English literature to date, and it accounts for less than 1% of all cases of gastrointestinal lymphoma. As this malignancy manifests as a submucosal tumor, pathological diagnosis by using a simple endoscopic biopsy alone is difficult. Therefore, surgical biopsy, endoscopic mucosal resection, and endoscopic ultrasound-guided fine-needle aspiration have been used in most cases. Herein, we report a case of esophageal mucosa-associated lymphoid tissue lymphoma in a 49-year-old man, which involved the use of a stacked forceps biopsy to obtain adequate samples for pathological analysis; the use of the stacked forceps biopsy method is unlike those used in previous cases. The patient received cyclophosphamide, vincristine, and prednisolone chemotherapy; he achieved a complete response. In addition, we review the literature relevant to this case. © 2015 International Society for Diseases of the Esophagus.

Evaluation of delivery options for second stage events

PubMed Central

Bailit, Jennifer L.; Grobman, William A.; Rice, Madeline Murguia; Wapner, Ronald J.; Reddy, Uma M.; Varner, Michael W.; Thorp, John M.; Caritis, Steve N.; Iams, Jay D.; Saade, George; Rouse, Dwight J.; Tolosa, Jorge E.

2015-01-01

Background Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery in the second stage versus cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean versus operative vaginal delivery. Objective Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps versus cesarean delivery) in patients needing second stage assistance at a fetal station of +2 or below. Study Design Secondary analysis of an observational obstetric cohort in 25 academically-affiliated U.S. hospitals over a three-year period. A subset of ≥37 weeks, non-anomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, non-reassuring fetal status, labor dystocia or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother’s, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third and fourth degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the three attempted modes of delivery. Odds ratios were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. Results 2531 women met inclusion criteria. Vacuum attempt was associated with the lowest frequency of the neonatal composite (4.2% vs. 6.1% vaginal forceps vs. 6.9% cesarean) and maternal complications (Postpartum infection 0.2% vs. 0.9% forceps vs. 5.3% cesarean, Postpartum hemmorhage 1.4% vs. 2.8% forceps vs. 3.8% cesarean), except for severe lacerations (19.1% vs. 33.8% forceps vs. 0% cesarean). When confounders were taken into account, both forceps (odds ratio 0.16, 95%CI 0.05-0.49) and vacuum (odds ratio 0.04, 95%CI 0.01-0.17) were associated with a significantly lower odds of Post partuminfection. The neonatal composite and Postpartum hemmorhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P=.04). Conclusion In patients needing second stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of Postpartum infection, but higher frequency of severe lacerations. PMID:26596236

The rock-paper-scissors game

NASA Astrophysics Data System (ADS)

Zhou, Hai-Jun

2016-04-01

Rock-Paper-Scissors (RPS), a game of cyclic dominance, is not merely a popular children's game but also a basic model system for studying decision-making in non-cooperative strategic interactions. Aimed at students of physics with no background in game theory, this paper introduces the concepts of Nash equilibrium and evolutionarily stable strategy, and reviews some recent theoretical and empirical efforts on the non-equilibrium properties of the iterated RPS, including collective cycling, conditional response patterns and microscopic mechanisms that facilitate cooperation. We also introduce several dynamical processes to illustrate the applications of RPS as a simplified model of species competition in ecological systems and price cycling in economic markets.

Cyclic dominance in evolutionary games: a review

PubMed Central

Szolnoki, Attila; Mobilia, Mauro; Jiang, Luo-Luo; Szczesny, Bartosz; Rucklidge, Alastair M.; Perc, Matjaž

2014-01-01

Rock is wrapped by paper, paper is cut by scissors and scissors are crushed by rock. This simple game is popular among children and adults to decide on trivial disputes that have no obvious winner, but cyclic dominance is also at the heart of predator–prey interactions, the mating strategy of side-blotched lizards, the overgrowth of marine sessile organisms and competition in microbial populations. Cyclical interactions also emerge spontaneously in evolutionary games entailing volunteering, reward, punishment, and in fact are common when the competing strategies are three or more, regardless of the particularities of the game. Here, we review recent advances on the rock–paper–scissors (RPS) and related evolutionary games, focusing, in particular, on pattern formation, the impact of mobility and the spontaneous emergence of cyclic dominance. We also review mean-field and zero-dimensional RPS models and the application of the complex Ginzburg–Landau equation, and we highlight the importance and usefulness of statistical physics for the successful study of large-scale ecological systems. Directions for future research, related, for example, to dynamical effects of coevolutionary rules and invasion reversals owing to multi-point interactions, are also outlined. PMID:25232048

Cyclic dominance in evolutionary games: a review.

PubMed

Szolnoki, Attila; Mobilia, Mauro; Jiang, Luo-Luo; Szczesny, Bartosz; Rucklidge, Alastair M; Perc, Matjaž

2014-11-06

Rock is wrapped by paper, paper is cut by scissors and scissors are crushed by rock. This simple game is popular among children and adults to decide on trivial disputes that have no obvious winner, but cyclic dominance is also at the heart of predator-prey interactions, the mating strategy of side-blotched lizards, the overgrowth of marine sessile organisms and competition in microbial populations. Cyclical interactions also emerge spontaneously in evolutionary games entailing volunteering, reward, punishment, and in fact are common when the competing strategies are three or more, regardless of the particularities of the game. Here, we review recent advances on the rock-paper-scissors (RPS) and related evolutionary games, focusing, in particular, on pattern formation, the impact of mobility and the spontaneous emergence of cyclic dominance. We also review mean-field and zero-dimensional RPS models and the application of the complex Ginzburg-Landau equation, and we highlight the importance and usefulness of statistical physics for the successful study of large-scale ecological systems. Directions for future research, related, for example, to dynamical effects of coevolutionary rules and invasion reversals owing to multi-point interactions, are also outlined. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

A new suturing instrument that allows the use of microsuture at laparoscopy.

PubMed

McComb, P F

1992-04-01

A surgeon at University Hospital-Shaughnessy Site in Vancouver, British Columbia in Canada has used a new suturing instrument that enters the peritoneal cavity to permit microsutures of size 6-0 or less and 75 cm in length during laparoscopy. Surgeons can use this instrument to perform female sterilizations as well as removal of the gall gladder and appendix and repair of the bowel, bladder, and ureteric injuries. As of April 1992, the suturing instrument was not yet commercially available. It consists of a partial hollow 30 cm x 2 mm (inside diameter) tube with the end that does not enter the peritoneal cavity being occluded. The suturing instrument enters the peritoneal cavity via a standard 5 mm deflection valved trocar sleeve with a 3 mm reduction sleeve or with a 3 mm inside diameter occlusive rubber washer instead of the standard 5 mm washer. The suture must have sufficient tensile strength and have low coefficients for static and for sliding surface frictions. Once the suture and needle are inside the body, forceps which have entered via another cannula detach them from the suturing instrument. A 3 mm laproscopic needle driver replaces the suturing instrument at this point. The surgeon guides the needle through the intended tissues and then withdrawn with the needle driver through the 5 mm sleeve. The surgeon ties the knot outside the body and slides it down the length of the suture to apply it to the tissue. He/she repeats this 1 more time. Scissors inserted through the other opening then cut the suture. Once mastered, this process takes only a few minutes to complete. In all 11 cases or restoration of uterine tube patency done by the surgeon in Vancouver using the new technique, tubal patency has not been hindered. 2 assessed sterilization reversals have been successful.

Instrumental delivery: clinical practice guidelines from the French College of Gynaecologists and Obstetricians.

PubMed

Vayssière, Christophe; Beucher, Gael; Dupuis, Olivier; Feraud, Olivia; Simon-Toulza, Caroline; Sentilhes, Loïc; Meunier, Emmanuelle; Parant, Olivier; Schmitz, Thomas; Riethmuller, Didier; Baud, Olivier; Galley-Raulin, Fabienne; Diemunsch, Pierre; Pierre, Fabrice; Schaal, Jean-Patrick; Fournié, Alain; Oury, Jean François

2011-11-01

Routine use of a partograph is associated with a reduction in the use of forceps, but is not associated with a reduction in the use of vacuum extraction (Level A). Early artificial rupture of the membranes, associated with oxytocin perfusion, does not reduce the number of operative vaginal deliveries (Level A), but does increase the rate of fetal heart rate abnormalities (Level B). Early correction of lack of progress in dilatation by oxytocin perfusion can reduce the number of operative vaginal deliveries (Level B). The use of low-concentration epidural infusions of bupivacaine potentiated by morphinomimetics reduces the number of operative interventions compared with larger doses (Level A). Placement of an epidural before 3-cm dilatation does not increase the number of operative vaginal deliveries (Level A). Posterior positions of the fetus result in more operative vaginal deliveries (Level B). Manual rotation of the fetus from a posterior position to an anterior position may reduce the number of operative deliveries (Level C). Walking during labour is not associated with a reduction in the number of operative vaginal deliveries (Level A). Continuous support of the parturient by a midwife or partner/family member during labour reduces the number of operative vaginal deliveries (Level A). Under epidural analgesia, delayed pushing (2h after full dilatation) reduces the number of difficult operative vaginal deliveries (Level A). Ultrasound is recommended if there is any clinical doubt about the presentation of the fetus (Level B). The available scientific data are insufficient to contra-indicate attempted midoperative delivery (professional consensus). The duration of the operative intervention is slightly shorter with forceps than with a vacuum extractor (Level C). Nonetheless, the urgency of operative delivery is not a reason to choose one instrument over another (professional consensus). The cup-shaped vacuum extractor seems to be the instrument of choice for operative deliveries of fetuses in a cephalic transverse position, and may also be preferred for fetuses in a posterior position (professional consensus). Vacuum extraction deliveries fail more often than forceps deliveries (Level B). Overall, immediate maternal complications are more common for forceps deliveries than vacuum extraction deliveries (Level B). Compared with forceps, operative vaginal delivery using a vacuum extractor appears to reduce the number of episiotomies (Level B), first- and second-degree perineal lesions, and damage to the anal sphincter (Level B). Among the long-term complications, the rate of urinary incontinence is similar following forceps, vacuum extraction and spontaneous vaginal deliveries (Level B). Anal incontinence is more common following forceps delivery (Level B). Persistent anal incontinence has a similar prevalence regardless of the mode of delivery (caesarean or vaginal, instrumental or non-instrumental), suggesting the involvement of other factors (Level B). Rates of immediate neonatal mortality and morbidity are similar for forceps and vacuum extraction deliveries (Level B). It appears that difficult instrumental delivery may lead to psychological sequelae that may result in a decision not to have more children (Level C). The rates of neonatal convulsions, intracranial haemorrhage and jaundice do not differ between forceps and vacuum extraction deliveries (Levels B and C). Rapid sequence induction with a Sellick manoeuvre (pressure to the cricoid cartilage) and tracheal intubation with a balloon catheter is recommended for any general anaesthesia (Level B). Training must ensure that obstetricians can identify indications and contra-indications, choose the appropriate instrument, use the instruments correctly, and know the principles of quality control applied to operative vaginal delivery. Nowadays, traditional training can be accompanied by simulations. Training should be individualized and extended for some students. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

DEFENSE HEALTH CARE: Access to Care for Beneficiaries Who Have Not Enrolled in TRICARE’s Managed Care Option

DTIC Science & Technology

2006-12-01

Higher than Medicare Reimbursement Rates CPT codea Procedure or service performed Ratio of TRICARE to Medicare reimbursement 20250 Biopsy ...59350 Hysterorrhaphy of ruptured uterus 1.205 59409 Vaginal delivery only (with or without episiotomy and/or forceps ) 1.184 59410 Vaginal delivery only...with or without episiotomy and/or forceps ); including postpartum car 1.156 59412 External cephalic version, with or without tocolysis 1.139 59414

Conventional forceps or hot biopsy: comparative study of two methods in diagnosis of endobronchial lesions.

PubMed

Jabbari, Hamidreza; Fakhri, Mohammad; Lotfaliani, Mojtaba; Kiani, Arda

2013-01-01

It is suggested that hot electrocoagulation-enabled forceps (hot biopsy) may reduce hemorrhage risk after the biopsy in endobronchial tumors. The main concern in this method is possible reduction of the specimen's quality. To compare the procedure related hemorrhage with hot biopsy and conventional forceps biopsy and the diagnostic quality of the obtained specimens with either technique. In this prospective study, assessment of the biopsy samples and quantity of hemorrhage were done in a blind fashion. At first, for each patient a definite clinical diagnosis was made based on pathologic examination of all available samples, clinical data, and imaging findings. Then, second pathologist reviewed all samples to evaluate the quality of the samples. A total of 36 patients with endobronchial lesions were included in this study. Definite diagnosis was made in 83% of the patients. Diagnostic yield of the two methods were not statistically different, while the mean hemorrhage grades of all hot biopsy protocols were significantly lower as compared to that of conventional biopsy (p=0.003, p<0.001 and p<0.001 for 10,20and40 voltages respectively). No significant difference was detected between the qualities of specimens obtained by hot biopsy methods in comparison with conventional biopsy (p>0.05 for all three voltages). Hot biopsy can be a valuable alternative to forceps biopsy in evaluating endobronchial lesions.

Use of disposable graduated biopsy forceps improves accuracy of polyp size measurements during endoscopy.

PubMed

Jin, Hei-Ying; Leng, Qiang

2015-01-14

To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps (DGBF). Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a polyp was noted, endoscopists determined the width of the polyp; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the polyp was measured using the vernier caliper. One hundred and thirty-three colorectal polyps from 119 patients were studied. The mean diameter, by post-polypectomy measurement, was 0.92 ± 0.69 cm; 83 were < 1 cm, 36 were between 1 and 2 cm, and 14 were > 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size (1.26 ± 0.30 vs 1.02 ± 0.11). The accuracy of polyp size estimation was low by visual assessment; however, it improved when the DGBF was used.

Computational modeling and prototyping of a pediatric airway management instrument.

PubMed

Gonzalez-Cota, Alan; Kruger, Grant H; Raghavan, Padmaja; Reynolds, Paul I

2010-09-01

Anterior retraction of the tongue is used to enhance upper airway patency during pediatric fiberoptic intubation. This can be achieved by the use of Magill forceps as a tongue retractor, but lingual grip can become unsteady and traumatic. Our objective was to modify this instrument using computer-aided engineering for the purpose of stable tongue retraction. We analyzed the geometry and mechanical properties of standard Magill forceps with a combination of analytical and empirical methods. This design was captured using computer-aided design techniques to obtain a 3-dimensional model allowing further geometric refinements and mathematical testing for rapid prototyping. On the basis of our experimental findings we adjusted the design constraints to optimize the device for tongue retraction. Stereolithography prototyping was used to create a partially functional plastic model to further assess the functional and ergonomic effectiveness of the design changes. To reduce pressure on the tongue by regular Magill forceps, we incorporated (1) a larger diameter tip for better lingual tissue pressure profile, (2) a ratchet to stabilize such pressure, and (3) a soft molded tip with roughened surface to improve grip. Computer-aided engineering can be used to redesign and prototype a popular instrument used in airway management. On a computational model, our modified Magill forceps demonstrated stable retraction forces, while maintaining the original geometry and versatility. Its application in humans and utility during pediatric fiberoptic intubation are yet to be studied.

The Development of Object Function and Manipulation Knowledge: Evidence from a Semantic Priming Study

PubMed Central

Collette, Cynthia; Bonnotte, Isabelle; Jacquemont, Charlotte; Kalénine, Solène; Bartolo, Angela

2016-01-01

Object semantics include object function and manipulation knowledge. Function knowledge refers to the goal attainable by using an object (e.g., the function of a key is to open or close a door) while manipulation knowledge refers to gestures one has to execute to use an object appropriately (e.g., a key is held between the thumb and the index, inserted into the door lock and then turned). To date, several studies have assessed function and manipulation knowledge in brain lesion patients as well as in healthy adult populations. In patients with left brain damage, a double dissociation between these two types of knowledge has been reported; on the other hand, behavioral studies in healthy adults show that function knowledge is processed faster than manipulation knowledge. Empirical evidence has shown that object interaction in children differs from that in adults, suggesting that the access to function and manipulation knowledge in children might also differ. To investigate the development of object function and manipulation knowledge, 51 typically developing 8-9-10 year-old children and 17 healthy young adults were tested on a naming task associated with a semantic priming paradigm (190-ms SOA; prime duration: 90 ms) in which a series of line drawings of manipulable objects were used. Target objects could be preceded by three priming contexts: related (e.g., knife-scissors for function; key-screwdriver for manipulation), unrelated but visually similar (e.g., glasses-scissors; baseball bat-screwdriver), and purely unrelated (e.g., die-scissors; tissue-screwdriver). Results showed a different developmental pattern of function and manipulation priming effects. Function priming effects were not present in children and emerged only in adults, with faster naming responses for targets preceded by objects sharing the same function. In contrast, manipulation priming effects were already present in 8-year-olds with faster naming responses for targets preceded by objects sharing the same manipulation and these decreased linearly between 8 and 10 years of age, 10-year-olds not differing from adults. Overall, results show that the access to object function and manipulation knowledge changes during development by favoring manipulation knowledge in childhood and function knowledge in adulthood. PMID:27602004

Oncocytic Type Intraductal Papillary Mucinous Neoplasm of the Pancreas with Unusually Low Mucin Production Mimicking Intraductal Tubulopapillary Neoplasm: A Report of a Case Diagnosed by a Preoperative Endoscopic Biopsy

PubMed Central

Yoshida, Yukinari; Endo, Takao; Tanaka, Eiichi; Kikuchi, Takefumi; Akino, Kimishige; Mita, Hiroaki; Adachi, Yasuyo; Nakamura, Masahiro; Adachi, Yasushi; Ishii, Yoshifumi; Matsumoto, Joe; Hirano, Satoshi; Nitta, Takeo; Mitsuhashi, Tomoko; Kato, Yasuo

2017-01-01

We herein report the case of a 78-year-old woman with an intraductal tumor with scant mucin production in a moderately dilated main pancreatic duct that resembled an intraductal tubulopapillary neoplasm (ITPN) on imaging. An endoscopic transpapillary forceps biopsy enabled an accurate preoperative diagnosis of the tumor as an oncocytic type intraductal papillary mucinous neoplasm (IPMN) of the pancreas microscopically showing papillary growth consisting of oncocytic cells with a typical mucin expression profile, although with few intraepithelial lumina containing mucin. This is the first case of an oncocytic type IPMN mimicking an ITPN that was able to be diagnosed preoperatively. PMID:29021473

Decidual tissue growth and regression in the guinea pig: regulation by uterine blood flow and relation to circulating progesterone concentrations.

PubMed

Garris, D R

1984-05-01

The role of uterine blood flow (UBF) in the modulation of experimentally induced decidua formation was assessed in mature guinea pigs. The response to endometrial trauma, as indexed by uterine weight changes, was dependent upon the type of stimulus used, with deciduogenic effectiveness as follows: saline = oil = knife scratch less than scissor cut. Both the knife scratch and scissor cut techniques induced elevations in UBF compared with control values. Neither uterine weight nor UBF increased when trauma was applied to unresponsive uteri, indicating that inflammation was not the cause of uterine hyperemia. Uterine weight increased from basal levels on the day of trauma (i.e. day 5 of the estrous cycle) to a maximal weight between days 10 and 12 posttrauma. Maximal growth of the induced decidua occurred under conditions of elevated UBF. Subsequently, UBF declined between days 10 and 15 posttrauma, preceding the associate resorption of the induced decidua. During the period of decidua growth, serum progesterone levels were elevated compared with those in control animals. These data indicate that experimentally induced decidua formation in the guinea pig is associated with uterine hyperemia and increased corpus luteum activity, both of which are necessary for proper endometrial differentiation. It is hypothesized that these events mimic the uterine hyperemia associated with blastocyst implanplantation and early placentation in this species.

Skin lesion removal

MedlinePlus

... benign; Cryosurgery - skin, benign; BCC - removal; Basal cell cancer - removal; Actinic keratosis - removal; Wart - removal; Squamous cell - removal; Mole - removal; Nevus - removal; Nevi - removal; Scissor ...

Nonlinear dynamics of the rock-paper-scissors game with mutations.

PubMed

Toupo, Danielle F P; Strogatz, Steven H

2015-05-01

We analyze the replicator-mutator equations for the rock-paper-scissors game. Various graph-theoretic patterns of mutation are considered, ranging from a single unidirectional mutation pathway between two of the species, to global bidirectional mutation among all the species. Our main result is that the coexistence state, in which all three species exist in equilibrium, can be destabilized by arbitrarily small mutation rates. After it loses stability, the coexistence state gives birth to a stable limit cycle solution created in a supercritical Hopf bifurcation. This attracting periodic solution exists for all the mutation patterns considered, and persists arbitrarily close to the limit of zero mutation rate and a zero-sum game.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ullmann, J. L.; Kawano, T.; Baramsai, B.

The cross section for neutron capture in the continuum region has been difficult to calculate accurately. Previous results for 238 U show that including an M 1 scissors-mode contribution to the photon strength function resulted in very good agreement between calculation and measurement. Our paper extends that analysis to 234 , 236 U by using γ -ray spectra measured with the Detector for Advanced Neutron Capture Experiments (DANCE) at the Los Alamos Neutron Science Center to constrain the photon strength function used to calculate the capture cross section. Calculations using a strong scissors-mode contribution reproduced the measured γ -ray spectramore » and were in excellent agreement with the reported cross sections for all three isotopes.« less

Negative outcomes evoke cyclic irrational decisions in Rock, Paper, Scissors.

PubMed

Dyson, Benjamin James; Wilbiks, Jonathan Michael Paul; Sandhu, Raj; Papanicolaou, Georgios; Lintag, Jaimie

2016-02-04

Rock, Paper, Scissors (RPS) represents a unique gaming space in which the predictions of human rational decision-making can be compared with actual performance. Playing a computerized opponent adopting a mixed-strategy equilibrium, participants revealed a non-significant tendency to over-select Rock. Further violations of rational decision-making were observed using an inter-trial analysis where participants were more likely to switch their item selection at trial n + 1 following a loss or draw at trial n, revealing the strategic vulnerability of individuals following the experience of negative rather than positive outcome. Unique switch strategies related to each of these trial n outcomes were also identified: after losing participants were more likely to 'downgrade' their item (e.g., Rock followed by Scissors) but after drawing participants were more likely to 'upgrade' their item (e.g., Rock followed by Paper). Further repetition analysis revealed that participants were more likely to continue their specific cyclic item change strategy into trial n + 2. The data reveal the strategic vulnerability of individuals following the experience of negative rather than positive outcome, the tensions between behavioural and cognitive influences on decision making, and underline the dangers of increased behavioural predictability in other recursive, non-cooperative environments such as economics and politics.

Automatic imitation in a strategic context: players of rock–paper–scissors imitate opponents' gestures†

PubMed Central

Cook, Richard; Bird, Geoffrey; Lünser, Gabriele; Huck, Steffen; Heyes, Cecilia

2012-01-01

A compelling body of evidence indicates that observing a task-irrelevant action makes the execution of that action more likely. However, it remains unclear whether this ‘automatic imitation’ effect is indeed automatic or whether the imitative action is voluntary. The present study tested the automaticity of automatic imitation by asking whether it occurs in a strategic context where it reduces payoffs. Participants were required to play rock–paper–scissors, with the aim of achieving as many wins as possible, while either one or both players were blindfolded. While the frequency of draws in the blind–blind condition was precisely that expected at chance, the frequency of draws in the blind–sighted condition was significantly elevated. Specifically, the execution of either a rock or scissors gesture by the blind player was predictive of an imitative response by the sighted player. That automatic imitation emerges in a context where imitation reduces payoffs accords with its ‘automatic’ description, and implies that these effects are more akin to involuntary than to voluntary actions. These data represent the first evidence of automatic imitation in a strategic context, and challenge the abstraction from physical aspects of social interaction typical in economic and game theory. PMID:21775334

A genetic approach to the rock-paper-scissors game.

PubMed

Barreto, Wendell P; Marquitti, Flavia M D; de Aguiar, Marcus A M

2017-05-21

Polymorphisms are usually associated with defenses and mating strategies, affecting the individual's fitness. Coexistence of different morphs is, therefore, not expected, since the fittest morph should outcompete the others. Nevertheless, coexistence is observed in many natural systems. For instance, males of the side-blotched lizards (Uta stansburiana) present three morphs with throat colors orange, yellow and blue, which are associated with mating strategies and territorial behavior. The three male morphs compete for females in a system that is well described by the rock-paper-scissors dynamics of game theory. Previous studies have modeled the lizards as hermaphroditic populations whose individual's behavior were determined only by their phenotypes. Here we consider an extension of this dynamical system where diploidy and sexual reproduction are explicitly taken into account. Similarly to the lizards we represent the genetic system by a single locus with three alleles, o, y, and b in a diploid chromosome with dominance of o over y and of y over b. We show that this genotypic description of the dynamics results in the same equilibrium phenotype frequencies as the phenotypic models, but affects the stability of the system, changing the parameter region where coexistence of the three morphs is possible in a rock-paper-scissors game. Copyright © 2017 Elsevier Ltd. All rights reserved.

The effect of high concentration potassium permanganate on protein contamination from metallic and synthetic rubber airway equipment.

PubMed

Laupu, W; Brimacombe, J

2007-08-01

We tested the hypothesis that supplementary cleaning using potassium permanganate 8 mg.l(-1) eliminates protein deposits from the reusable metallic and synthetic rubber airway equipment. Twenty Macintosh laryngoscope blades (surgical steel), 20 pairs of Magill's forceps (surgical steel) and 20 Guedel airways (synthetic rubber) were allocated to two groups for supplementary cleaning. In group A, the device was immersed in potassium permanganate 8 mg.l(-1). In group B (controls), the device was immersed in sterile water. The devices were then immersed in a protein staining solution, rinsed and the severity of staining was scored. In addition, the devices were inspected for tissue and then tested for occult blood. Protein contamination was lower in the potassium permanganate group for all devices (each device: p < 0.0001). There was no staining detected in the permanganate group. In the permanganate group, dried tissue was detected in the teeth of one pair of forceps, which was not detected following supplementary cleaning. Additionally, occult blood was detected on two pairs of forceps and a laryngoscope blade, which was not detected following supplementary cleaning. In the control group, no tissue was detected but one pair of forceps and two laryngoscope blades tested positive for occult blood before and after supplementary cleaning. We conclude that supplementary cleaning using potassium permanganate 8 mg.l(-1) eliminates protein deposits from re-usable metallic and synthetic rubber airway equipment.

Use of disposable graduated biopsy forceps improves accuracy of polyp size measurements during endoscopy

PubMed Central

Jin, Hei-Ying; Leng, Qiang

2015-01-01

AIM: To determine the accuracy of endoscopic polyp size measurements using disposable graduated biopsy forceps (DGBF). METHODS: Gradations accurate to 1 mm were assessed with the wire of disposable graduated biopsy forceps. When a polyp was noted, endoscopists determined the width of the polyp; then, the graduated biopsy forceps was inserted and the largest diameter of the tumor was measured. After excision, during surgery or endoscopy, the polyp was measured using the vernier caliper. RESULTS: One hundred and thirty-three colorectal polyps from 119 patients were studied. The mean diameter, by post-polypectomy measurement, was 0.92 ± 0.69 cm; 83 were < 1 cm, 36 were between 1 and 2 cm, and 14 were > 2 cm. The mean diameter, by visual estimation, was 1.15 ± 0.88 cm; compared to the actual size measured using vernier calipers, the difference was statistically significant. The mean diameter measured using the DGBF was 0.93 ± 0.68 cm; compared to the actual size measured using vernier calipers, this difference was not statistically significant. The ratio between the mean size estimated by visual estimation and the actual size was significantly different from that between the mean size estimated using the DGBF and the actual size (1.26 ± 0.30 vs 1.02 ± 0.11). CONCLUSION: The accuracy of polyp size estimation was low by visual assessment; however, it improved when the DGBF was used. PMID:25605986

A New Method for Endoscopic Sampling of Submucosal Tissue in the Gastrointestinal Tract: A Comparison of the Biopsy Forceps and a New Drill Instrument.

PubMed

Walther, Charles; Jeremiasen, Martin; Rissler, Pehr; Johansson, Jan L M; Larsson, Marie S; Walther, Bruno S C S

2016-12-01

Background Sampling of submucosal lesions in the gastrointestinal tract through a flexible endoscope is a well-recognized clinical problem. One technique often used is endoscopic ultrasound-guided fine-needle aspiration, but it does not provide solid tissue biopsies with preserved architecture for histopathological evaluation. To obtain solid tissue biopsies from submucosal lesions, we have constructed a new endoscopic biopsy tool and compared it in a crossover study with the standard double cupped forceps. Methods Ten patients with endoscopically verified submucosal lesions were sampled. The endoscopist selected the position for the biopsies and used the instrument selected by randomization. After a biopsy was harvested, the endoscopist chose the next site for a biopsy and again used the instrument picked by randomization. A total of 6 biopsies, 3 with the forceps and 3 with the drill instrument, were collected in every patient. Results The drill instrument resulted in larger total size biopsies (mm 2 ; Mann-Whitney U test, P = .048) and larger submucosal part (%) of the biopsies (Mann-Whitney U test, P = .003) than the forceps. Two patients were observed because of chest pain and suspicion of bleeding in 24 hours. No therapeutic measures were necessary to be taken. Conclusion The new drill instrument for flexible endoscopy can safely deliver submucosal tissue samples from submucosal lesions in the upper gastrointestinal tract. © The Author(s) 2016.

Different protocols for cryobiopsy versus forceps biopsy in diagnosis of patients with endobronchial tumors.

PubMed

Jabari, Hamidreza; Sami, Ramin; Fakhri, Mohammad; Kiani, Arda

2012-01-01

Forceps biopsy is the standard procedure to obtain specimens in endobronchial lesions. New studies have proposed flexible cryoprobe as an accepted alternative method for this technique. Although diagnostic use of the cryobiopsy is confirmed in few studies, there is paucity of data with regard to an optimum protocol for this method since one of the main considerations in cryobiopsy is the freezing time. To evaluate diagnostic yield and safety of endobronchial biopsies using the flexible cryoprobe. Moreover, different freezing times were assessed to propose an optimized protocol for this diagnostic modality. For each patient with a confirmed intrabronchial lesion, diagnostic o value of forceps biopsy, cryobiopsy in three seconds, cryobiopsy in five seconds and combined results of cryobiopsy in both timings were recorded. A total of 60 patients (39 males and 21 females; Mean age 56.7 +/- 13.3) were included. Specimens that were obtained by cryobiopsy in five seconds were significantly larger than those of forceps biopsy and cryobiopsy in three seconds (p < 0.001). We showed that the achieved diagnostic yields for all three methods were not statistically different (p > 0.05). Simultaneous usage of samples produced in both cryobiopsies can significantly improve the diagnostic yield (p = 0.02). Statistical analysis showed that there were no significant differences in case of bleeding frequency among the three sampling methods. This study confirmed safety and feasibility of cryobiopsy. Additionally, combination of sampling with two different cold induction timings would significantly increase sensitivity of this emerging technique..

Endobronchial ultrasound-guided lymph node biopsy with transbronchial needle forceps: a pilot study.

PubMed

Herth, F J F; Schuler, H; Gompelmann, D; Kahn, N; Gasparini, S; Ernst, A; Schuhmann, M; Eberhardt, R

2012-02-01

One limitation of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the size of the available needles, frequently yielding only cells for cytological examination. The aim of this pilot study was to evaluate the efficacy and safety of newly developed needle forceps to obtain tissue for the histological diagnosis of enlarged mediastinal lymph nodes. Patients with enlarged, positron emission tomography (PET)-positive lymph nodes were included. The transbronchial needle forceps (TBNF), a sampling instrument combining the characteristics of a needle (bevelled tip for penetrating through the bronchial wall) with forceps (two serrated jaws for grasping tissue) was used through the working channel of the EBUS-TBNA scope. Efficacy and safety was assessed. 50 patients (36 males and 14 females; mean age 51 yrs) with enlarged or PET-positive lymph nodes were included in this pilot study. In 48 (96%) patients penetration of the bronchial wall was possible and in 45 patients tissue for histological diagnosis was obtained. In three patients TBNF provided inadequate material. For patients in whom the material was adequate for a histological examination, a specific diagnosis was established in 43 (86%) out of 50 patients (nonsmall cell lung cancer: n=24; small cell lung cancer: n=7; sarcoidosis: n=4; Hodgkin's lymphoma: n=4; tuberculosis: n=2; and non-Hodgkin's lymphoma: n=2).No clinically significant procedure-related complications were encountered. This study demonstrated that EBUS-TBNF is a safe procedure and provides diagnostic histological specimens of mediastinal lymph nodes.

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

PubMed Central

Kono, Yoshiyasu; Takenaka, Ryuta; Kawahara, Yoshiro; Okada, Hiroyuki; Hori, Keisuke; Kawano, Seiji; Yamasaki, Yasushi; Takemoto, Koji; Miyake, Takayoshi; Fujiki, Shigeatsu; Yamamoto, Kazuhide

2014-01-01

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy. METHODS: A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection (ESD) between January 2011 and January 2012. AIM-chromoendoscopy (AIM-CE) was performed followed by ESD. AIM solution was sprinkled and images were recorded every 30 s for 3 min. Clinical characteristics such as tumor size (< 2 cm, ≥ 2 cm), surface color in white light endoscopy (WLE) (whitish, normochromic or reddish), macroscopic appearance (flat or elevated, depressed), and reddish change in AIM-CE were selected as valuables. RESULTS: En bloc resection was achieved in all 54 cases, with curative resection of fifty two lesions (96.3%). Twenty three lesions (42.6%) were diagnosed as well-differentiated adenocarcinoma and the remaining 31 lesions (57.4%) were gastric adenoma. All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer. The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE (vs tumor size ≥ 2 cm, P = 0.016, vs normochromic or reddish surface color, P = 0.046, vs depressed macroscopic type, P = 0.0030). On the other hand, no significant differences were found in the specificity and accuracy. In univariate analysis, normochromic or reddish surface color in WLE (OR = 3.7, 95%CI: 1.2-12, P = 0.022) and reddish change in AIM-CE (OR = 14, 95%CI: 3.8-70, P < 0.001) were significantly related to diagnosis of early gastric cancer (EGC). In multivariate analysis, only reddish change in AIM-CE (OR = 11, 95%CI: 2.3-66, P = 0.0022) was a significant factor associated with diagnosis of EGC. CONCLUSION: AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy. PMID:24803824

Students Learning Physics While Lifting Themselves: A Simple Analysis of a Scissors Jack

NASA Astrophysics Data System (ADS)

Haugland, Ole Anton

2017-02-01

Every time I have to jack up my car, I am a bit surprised by how slowly the scissors jack works the higher I raise it, and close to maximum height I need very little force to turn the crank. This agrees well with the principle of simple machines. Since I have to jack up my car at least twice a year to change between winter tires and summer tires, I thought it was time to take a closer look at the physics behind the process. And like most physics teachers, I am always looking for new ideas for my teaching. In this note I will present a few ideas on how a jack can be a topic in physics teaching.

Bacterial contaminants of bandage contact lenses used after laser subepithelial or photorefractive keratectomy.

PubMed

Liu, Xiaowei; Wang, Peng; Kao, Andrew A; Jiang, Yang; Li, Ying; Long, Qin

2012-07-01

To compare the locations and types of bacterial contamination of bandage disposable soft contact lenses after laser subepithelial keratectomy (LASEK) and photorefractive keratectomy (PRK). Bandage disposable soft contact lenses were collected with sterile forceps from 30 eyes of 15 consecutive patients treated with LASEK (LASEK group) and 30 eyes of 15 consecutive patients who underwent PRK (PRK group) to correct myopia. Immediately after collection, each lens was cut in two parts with sterile scissors and placed onto chocolate agar with one piece outer face down and the inner face down for the other piece. The lenses were analyzed for bacterial colonization and evaluated for the amount of growth on the inner face and outer face, respectively. The antibiotic susceptibility tests were performed for the isolates using disk diffusion. Five positive cultures (16.7%) were found in LASEK group: 4 appeared in the inner face of the lens and1 appeared in the outer face. In PRK group, 2 of the 30 contact lenses (6.67%) had positive cultures; both of them appeared in the outer face of the lens. The difference of positive culture rate in the two groups was not statistically significant (χ=1.46, P=0.228). When comparing the positive colonization rate in location, the positive culture rate in the inner face of LASEK group was statistically significantly higher than that of PRK group (13.3% vs. 0%, χ=4.29, P=0.038); however, no clinical finding of infection was noted. In both groups, methicillin-sensitive coagulase-negative staphylococci (MSSCoN) were the most common isolate. Besides MSSCoN, the growth of methicillin-resistant coagulase-negative staphylococci, Corynebacterium, and Micrococcus were also present in this study. All the microorganisms were sensitive to tobramycin, which was used in conjunction with dexamethasone to treat the cases. Previous literature reports that the risk of infectious keratitis after LASEK or PRK is relatively low. However, within this study, the rate of positive cultures was relatively higher in LASEK group (16.7%) compared with that of PRK group (6.67%), especially in the inner face of the lens. The reason may be related to the procedure of keeping the epithelial flap in place, which could develop a local environment suitable for bacterial colonization and potential infection. Coagulase-negative staphylococci, a major element of the natural conjunctival flora, remain a major potentially infectious agent after LASEK and PRK.

Discrepancy between endoscopic forceps biopsy and endoscopic resection in gastric epithelial neoplasia.

PubMed

Lim, Hyun; Jung, Hwoon-Yong; Park, Young Soo; Na, Hee Kyong; Ahn, Ji Yong; Choi, Ji Young; Lee, Jeong Hoon; Kim, Mi-Young; Choi, Kwi-Sook; Kim, Do Hoon; Choi, Kee Don; Song, Ho June; Lee, Gin Hyug; Kim, Jin-Ho

2014-04-01

Endoscopic forceps biopsy (EFB) is a major diagnostic procedure for gastric epithelial neoplasia (GEN). However, discrepancy between the result of EFB and endoscopic resection (ER) is not uncommon. Thus, there is controversy over whether specimens obtained by EFB are optimal for diagnosis of GEN. We investigated the discrepancy between EFB and ER in the diagnosis of GEN. A total of 1,850 GEN cases were histologically diagnosed with EFB, including 954 low-grade dysplasias (LGDs), 315 high-grade dysplasias (HGDs), and 581 carcinomas. Following diagnosis with EFB, all patients were treated with ER. We retrospectively reviewed the pathologic findings and patient characteristics and analyzed predictors for the discrepancy between the two procedures (largest diameter, number of biopsy fragments, number of biopsy fragments/largest diameter, location, macroscopic type, color, surface unevenness, and erosion). The overall discrepancy rate between EFB and ER was 31.7 % (587/1,850). Among the discordant group, 440 (23.9 %) cases showed a higher grade of disease after ER; 229 of the 954 LGDs (24.0 %) were diagnosed as HGD or carcinoma, 166 of the 315 HGDs (52.7 %) as carcinoma, and 45 of the 581 differentiated carcinomas (7.7 %) as undifferentiated carcinoma. In the LGD group with EFB, the largest diameter (≥1.8 cm; P < 0.001), surface unevenness (P = 0.014), and depressed macroscopic type (P < 0.001) were factors associated with discrepancy. In the carcinoma group with EFB, flat macroscopic type (P = 0.043) was the only significant factor. In the HGD group with EFB, there were no significant factors for discrepancy. EFB can be insufficient for diagnosing GENs, and ER can be considered not only as treatment but also as a diagnostic modality in GEN. It is especially pertinent to all cases of HGD regardless of their endoscopic features and to cases of LGDs with the largest lesion diameter ≥1.8 cm, surface unevenness, or a depressed macroscopic type.

Comparison of post-tonsillectomy pain with two different types of bipolar forceps: low temperature quantum molecular resonance device versus high temperature conventional electrocautery.

PubMed

Chang, Hyun; Hah, J Hun

2012-06-01

The low temperature device did not show any advantages over the conventional high temperature electrocautery in terms of the postoperative pain, operation time, and complications in pediatric tonsillectomy. To compare post-tonsillectomy pain following the use of two different instruments with the same bipolar forceps techniques: low temperature quantum molecular resonance (QMR) device versus conventional high temperature electrocautery. Pediatric patients admitted from July 2008 through January 2009 were included. The participants underwent bilateral tonsillectomy; one side by the QMR device and the other by the bipolar electrocautery. The sides for each instrument were counterbalanced by the order of presentation. The postoperative pain was measured using the faces pain rating scale. In all, 33 patients with a mean age of 7.6 years were enrolled. The postoperative pain, operation time, and complications in 33 sides dissected by the electrocautery and 33 sides by the QMR device were compared. The average operation times with each device were not statistically different. The mean ratings of the perception of pain related to each instrument were not different on operation day and postoperative day 1, day 4, and day 7 (p = 0.133, 0.057, 0.625, and 1.0, respectively). There was no postoperative complication in any of the patients.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Patel, Prashant, E-mail: p.patel@bham.ac.uk; Rangarajan, Balaji; Mangat, Kamarjit, E-mail: kamarjit.mangat@uhb.nhs.uk, E-mail: kamarjit.mangat@nhs.net

PurposeVarious methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.Materials and MethodsFifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing themore » stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.ResultsWe report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.ConclusionWe propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.« less

The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

PubMed

Obiero, Walter; Young, Marisa R; Bailey, Robert C

2013-01-01

Male circumcision (MC) reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC) method. The PrePex male circumcision (PMC) method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method. Data were obtained from the Nyanza Reproductive Health Society (NRHS), an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars. Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively. The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency.

Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis.

PubMed

Ganganah, Oormila; Guo, Shu Liang; Chiniah, Manu; Li, Yi Shi

2016-07-01

Forceps biopsy (FB) is the most commonly used diagnostic tool for lung pathologies. FB is associated with a high diagnostic failure rate. Cryobiopsy (CB) is a novel technique providing a larger specimen size, few artefacts, more alveolar parts and superior diagnostic yield. CB, however, has drawbacks such as higher bleeding and pneumothorax rate. We conducted a meta-analysis to investigate the specimen area, diagnostic rate and bleeding severity in CB versus FB in interstitial lung diseases (ILDs) and lung tumours. A systematic literature search of PUBMED, BIOSIS PREVIEW and OVID databases was conducted using specific search terms. Eligible studies including RCTs and non-RCTs comparing cryobiopsy/cryotransbronchial biopsy (CB/CTBB) and forceps biopsy/forceps transbronchial biopsy (FB/FTBB) for specimen area, diagnostic rate and bleeding rate in ILDs and lung tumours were analysed. Two reviewers independently extracted data and evaluated the quality of the studies. Eight studies involving 916 patients were analysed. Specimen area (mm(2) ) was significantly larger in CB/CTBB than FB/FTBB (standard mean difference = 1.21, 95% confidence interval (0.94, 1.48), P < 0.00001). The diagnostic rate was significantly higher in CB/CTBB than FB/FTBB (Risk ratio 1.36, 95% confidence interval (1.16, 1.59), P = 0.0002). Three studies compared the bleeding severity with only one showing significantly more bleeding in CB. Cryobiopsy/cryotransbronchial shows superiority to FB/FTBB for specimen area and diagnostic rate. CB/CTBB has better efficacy over FB/FTBB. © 2016 Asian Pacific Society of Respirology.

Is endoscopic forceps biopsy enough for a definitive diagnosis of gastric epithelial neoplasia?

PubMed

Lee, Chang Kyun; Chung, Il-Kwun; Lee, Suck-Ho; Kim, Sang Pil; Lee, Sae Hwan; Lee, Tae Hoon; Kim, Hong-Soo; Park, Sang-Heum; Kim, Sun-Joo; Lee, Ji-Hye; Cho, Hyun Deuk; Oh, Mee-Hye

2010-09-01

Endoscopic forceps biopsy (EFB) as the primary histological diagnosis of gastric epithelial neoplasia (GEN) is debated in the era of endoscopic resection (ER). Our aim was to investigate the diagnostic reliability of EFB in patients with GEN compared with ER specimens as the reference standard for the final diagnosis in a large consecutive series. This was a cross-sectional retrospective study at a tertiary-referral center. A total of 354 consecutive patients with 397 GENs underwent ER (endoscopic mucosal resection or endoscopic submucosal dissection). Discrepancy rates between the histological results from EFB and ER specimens were assessed. Discrepancies that could affect patient outcome or clinical care were considered major. The overall histological discrepancy rate between EFB and ER specimens was 44.5% (95% confidence interval [CI], 39.7-49.5%) among the enrolled patients. The overall discrepancy rate was significantly higher in the intraepithelial neoplasia (IEN) group than in the carcinoma group (49.8% vs 25.6%, P < 0.001). The major discrepancy rate was also significantly higher in the IEN group than in the carcinoma group (36.6% vs 7.0%, P < 0.001). In subgroup analysis of the IEN group, a major histological discrepancy rate of 33.6% (70/208) for low-grade and 42.7% (44/103) for high-grade IEN was found, respectively. Endoscopic forceps biopsy was insufficient for a definitive diagnosis and therapeutic planning in patients with GEN. ER should be considered as not only definitive treatment but also a procedure for a precise histological diagnosis for lesions initially assessed as GEN by forceps biopsy specimens.

[The randomized controlled trial of the treatment for clavicular fracture by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation].

PubMed

Bi, Hong-zheng; Yang, Mao-qing; Tan, Yuan-chao; Fu, Song

2008-07-01

To study the curative effect and safety of rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation in treating clavicular fracture. All 201 cases of clavicular fractures were randomly divided into treatment group (101 cases) and control group (100 cases). The treatment group was treated by rotatory manual reduction with forceps holder and retrograde percutaneous pinning transfixation. The control group was treated by open reduction and internal fixation with Kirschner pin. All cases were followed up for 4 to 21 months (mean 10.6 months). SPSS was used to analyze clinic healing time of fracture and shoulder-joint function in both two groups. After operation, 101 cases of treatment group achieved union of fracture and the clinical healing time was 28 to 49 days (mean 34.5+/-2.7 days). In control group,there were 4 cases with nonunion of fracture,the other 96 cases were union,the clinical healing time was 36 to 92 days (mean 55.3+/-4.8 days). The excellent and good rate of shoulder-joint function was 100% in treatment group and 83% in control group. By t-test and chi2-test, there was significant difference between the two groups in curative effect (P<0.05). Rotatory manual reduction with forceps holder and retrograde pinning transfixation can be used in various kinds of clavicular shaft fracture, with many virtues such as easy operation, reliable fixation, short union time of fracture, good functional recovery of shoulder-joint and no incision scar affecting appearance.

SMART micro-scissors with dual motors and OCT sensors (Conference Presentation)

NASA Astrophysics Data System (ADS)

Yeo, Chaebeom; Jang, Seonjin; Park, Hyun-cheol; Gehlbach, Peter L.; Song, Cheol

2017-02-01

Various end-effectors of microsurgical instruments have been developed and studied. Also, many approaches to stabilize the tool-tip using robotics have been studied such as the steady hand robot system, Micron, and SMART system. In our previous study, the horizontal SMART micro-scissors with a common path swept source OCT distance and one linear piezoelectric (PZT) motor was demonstrated as a microsurgical system. Because the outer needle is connected with a mechanical handle and moved to engage the tool tip manually, the tool tip position is instantaneously changed during the engaging. The undesirable motion can make unexpected tissue damages and low surgical accuracy. In this study, we suggest a prototype horizontal SMART micro-scissors which has dual OCT sensors and two motors to improve the tremor cancellation. Dual OCT sensors provide two distance information. Front OCT sensor detects a distance from the sample surface to the tool tip. Rear OCT sensors gives current PZT motor movement, acting like a motor encoder. The PZT motor can compensate the hand tremor with a feedback loop control. The manual engaging of tool tip in previous SMART system is replaced by electrical engaging using a squiggle motor. Compared with previous study, this study showed better performance in the hand tremor reduction. From the result, the SMART with automatic engaging may become increasingly valuable in microsurgical instruments.

Clinical evaluation of laryngeal sensation in horses.

PubMed

Gaughan, E M; Hackett, R P; Ducharme, N G; Rakestraw, P C

1990-01-01

Sensory innervation of the larynx was examined by tactile stimulation with a blunt biopsy forceps passed through a flexible videoendoscope. Twenty horses with no evidence of laryngeal motor deficit were stimulated on 10 sites by touch with the forceps. Unilateral neurectomies of the internal branch of the left cranial laryngeal nerve were performed on 5 other horses. These horses were stimulated by touch on the same sites preoperatively and up to 1 week postoperatively. In all 25 horses the motor response of the larynx was recorded on videotape and evaluated by 2 observers blind as to treatment and time of evaluation. Normal horses responded to touch by adduction of both arytenoid cartilages, swallowing or both. This response was not altered by sedation with xylazine hydrochloride. Left cranial laryngeal neurectomized horses failed to respond to tactile stimulation of the left side, while adduction of both cartilages, swallowing or both was observed following stimulation on the right side. Laryngeal stimulation by touch with a biopsy forceps was accurate in identifying horses with complete deficits of the internal branch of the cranial laryngeal nerve.

21 CFR 888.4540 - Orthopedic manual surgical instrument.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b) Classification...

21 CFR 888.4540 - Orthopedic manual surgical instrument.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b) Classification...

21 CFR 888.4540 - Orthopedic manual surgical instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b) Classification...

21 CFR 888.4540 - Orthopedic manual surgical instrument.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b) Classification...

21 CFR 888.4540 - Orthopedic manual surgical instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., femoral neck punch, socket pusher, reamer, rongeur, scissors, screwdriver, bone skid, staple driver, bone screw starter, surgical stripper, tamp, bone tap, trephine, wire twister, and wrench. (b) Classification...

Hydrogen bonds in betaine-acid (1:1) crystals revealed by Raman and 13C chemical shift tensors

NASA Astrophysics Data System (ADS)

Ilczyszyn, Marek; Ilczyszyn, Maria M.

2017-06-01

H-bonds of five betaine-acid (1:1) crystals are considered by analysis of tensors based on the Raman scissoring mode and 13C chemical shift of the betaine -CO1O2- carboxylate group. The leading structural factor in these systems is the strongest H-bond linking the betaine and the acidic moieties, (O1⋯H-O)com. The Raman and NMR tensors are strongly related to its character and to the R(O1⋯O)com distance. Very high molecular polarizability variation due to the scissoring vibration was found for the betaine-selenious acid crystal. The probable reason is modest network of H-bonds in this case and relatively high proton polarizability of these bonds.

Constraining the calculation of U 234 , 236 , 238 ( n , γ ) cross sections with measurements of the γ -ray spectra at the DANCE facility

DOE PAGES

Ullmann, J. L.; Kawano, T.; Baramsai, B.; ...

2017-08-31

The cross section for neutron capture in the continuum region has been difficult to calculate accurately. Previous results for 238 U show that including an M 1 scissors-mode contribution to the photon strength function resulted in very good agreement between calculation and measurement. Our paper extends that analysis to 234 , 236 U by using γ -ray spectra measured with the Detector for Advanced Neutron Capture Experiments (DANCE) at the Los Alamos Neutron Science Center to constrain the photon strength function used to calculate the capture cross section. Calculations using a strong scissors-mode contribution reproduced the measured γ -ray spectramore » and were in excellent agreement with the reported cross sections for all three isotopes.« less

Forced oral opening for cadavers with rigor mortis: two approaches for the myotomy on the temporal muscles.

PubMed

Nakayama, Y; Aoki, Y; Niitsu, H; Saigusa, K

2001-04-15

Forensic dentistry plays an essential role in personal identification procedures. An adequate interincisal space of cadavers with rigor mortis is required to obtain detailed dental findings. We have developed intraoral and two directional approaches, for myotomy of the temporal muscles. The intraoral approach, in which the temporalis was dissected with scissors inserted via an intraoral incision, was adopted for elderly cadavers, females and emaciated or exhausted bodies, and had a merit of no incision on the face. The two directional approach, in which myotomy was performed with thread-wire saw from behind and with scissors via the intraoral incision, was designed for male muscular youths. Both approaches were effective to obtain a desired degree of an interincisal opening without facial damage.

Constraining the calculation of 234,236,238U (n ,γ ) cross sections with measurements of the γ -ray spectra at the DANCE facility

NASA Astrophysics Data System (ADS)

Ullmann, J. L.; Kawano, T.; Baramsai, B.; Bredeweg, T. A.; Couture, A.; Haight, R. C.; Jandel, M.; O'Donnell, J. M.; Rundberg, R. S.; Vieira, D. J.; Wilhelmy, J. B.; Krtička, M.; Becker, J. A.; Chyzh, A.; Wu, C. Y.; Mitchell, G. E.

2017-08-01

The cross section for neutron capture in the continuum region has been difficult to calculate accurately. Previous results for 238U show that including an M 1 scissors-mode contribution to the photon strength function resulted in very good agreement between calculation and measurement. This paper extends that analysis to U,236234 by using γ -ray spectra measured with the Detector for Advanced Neutron Capture Experiments (DANCE) at the Los Alamos Neutron Science Center to constrain the photon strength function used to calculate the capture cross section. Calculations using a strong scissors-mode contribution reproduced the measured γ -ray spectra and were in excellent agreement with the reported cross sections for all three isotopes.

Improving a scissor-action couch for conformal arc radiotherapy and radiosurgery.

PubMed

Li, Kaile; Yu, Cedric X; Ma, Lijun

2004-01-01

We have developed a method to improve the setup accuracy of a Varian Clinac 6/100 couch for delivering conformal arc therapy using a tertiary micro multileaf collimator (MLC) system. Several immobilization devices have been developed to improve the mechanical stability and isocenter alignment of the couch: turn-knob harnesses, double-track alignment plates, and a drop-in rod that attaches the couch to the concrete floor. These add-on components minimize the intercomponent motion of the couch's scissor elevator, which allows consistent treatment setup. The accuracy of our isocenter couch alignment is an improvement over the above devices, within 1 mm of their accuracy. The couch has been used with over 15 patients and with over 50 modulated conformal arc treatment deliveries at our institution.

White Matter Abnormalities in Autism and Unaffected Siblings.

PubMed

Jou, Roger J; Reed, Hannah E; Kaiser, Martha D; Voos, Avery C; Volkmar, Fred R; Pelphrey, Kevin A

2016-01-01

This study was conducted to identify a potential neuroendophenotype for autism using diffusion tensor imaging. Whole-brain, voxel-based analysis of fractional anisotropy was conducted in 50 children: 19 with autism, 20 unaffected siblings, and 11 controls. Relative to controls, participants with autism exhibited bilateral reductions in fractional anisotropy across association, commissure, and projection fibers. The most severely affected tracts included the uncinate fasciculus, forceps minor, and inferior fronto-occipital fasciculus. Unaffected siblings also exhibited reductions in fractional anisotropy, albeit less severe with fewer affected tracts, sparing the uncinate fasciculus and forceps minor. These results suggest the presence of a neuroendophenotype for autism.

Evaluation of delivery options for second-stage events.

PubMed

Bailit, Jennifer L; Grobman, William A; Rice, Madeline Murguia; Wapner, Ronald J; Reddy, Uma M; Varner, Michael W; Thorp, John M; Caritis, Steve N; Iams, Jay D; Saade, George; Rouse, Dwight J; Tolosa, Jorge E

2016-05-01

Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery vs cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose. Thus, the appropriate clinical comparison is cesarean vs operative vaginal delivery. Our objective was to compare outcomes by the first attempted operative delivery (vacuum, forceps vs cesarean delivery) in patients needing second-stage assistance at a fetal station of +2 or below. We conducted secondary analysis of an observational obstetric cohort in 25 academically affiliated US hospitals over a 3-year period. A subset of ≥37 weeks, nonanomalous, vertex, singletons, with no prior vaginal delivery who reached a station of +2 or below and underwent an attempt at an operative delivery were included. Indications included for operative delivery were: failure to descend, nonreassuring fetal status, labor dystocia, or maternal exhaustion. The primary outcomes included a composite neonatal outcome (death, fracture, length of stay ≥3 days beyond mother's, low Apgar, subgaleal hemorrhage, ventilator support, hypoxic encephalopathy, brachial plexus injury, facial nerve palsy) and individual maternal outcomes (postpartum hemorrhage, third- and fourth-degree tears [severe lacerations], and postpartum infection). Outcomes were examined by the 3 attempted modes of delivery. Odds ratios (OR) were calculated for primary outcomes adjusting for confounders. Final mode of delivery was quantified. In all, 2531 women met inclusion criteria. No difference in the neonatal composite outcome was observed between groups. Vacuum attempt was associated with the lowest frequency of maternal complications (postpartum infection 0.2% vs 0.9% forceps vs 5.3% cesarean, postpartum hemorrhage 1.4% vs 2.8% forceps vs 3.8% cesarean), except for severe lacerations (19.1% vs 33.8% forceps vs 0% cesarean). When confounders were taken into account, both forceps (OR, 0.16; 95% confidence interval, 0.05-0.49) and vacuum (OR, 0.04; 95% confidence interval, 0.01-0.17) were associated with a significantly lower odds of postpartum infection. The neonatal composite and postpartum hemorrhage were not significantly different between modes of attempted delivery. Cesarean occurred in 6.4% and 4.4% of attempted vacuum and forceps groups (P = .04). In patients needing second-stage delivery assistance with a station of +2 or below, attempted operative vaginal delivery was associated with a lower frequency of postpartum infection, but higher frequency of severe lacerations. Copyright © 2016 Elsevier Inc. All rights reserved.

Self adhesive dressing pouch for the protection of catheters.

PubMed

de la Cruz Martínez, Maria Teresa; Hernández, María José

2002-01-01

This paper is about a new model of dressing, used for the protection of all types of temporary and permanent catheters. Those who developed this dressing realised the practical difficulties during the placement and removal of traditional dressings, used in haemodialysis units. They also realised that it this was unpleasant for the patients, and there was a risk to the catheters when removing the dressings because of the use of scissors and other cutting instruments. This new dressing solves these previously mentioned problems and at the same time contributes to the comfort of the patients. The model has been registered as a standard using model, and therefore it is protected by law and its copyright (Intellectual Property).

Skylab

NASA Image and Video Library

1972-05-01

This is a close-up photograph of the Orbital Workshop (OWS) trash disposal airlock located on the floor of the lower level of the OWS. It provided a means of passing trash from the pressurized habitable area into the unpressurized waste tank. The crewman opened a valve which brought the airlock to the same pressure as that within the workshop. He then opened the lid, placed the bagged trash inside, closed the lid and locked it. By turning the valve handle, he reduced the pressure within the airlock until it reached the vacuum of the waste tank. The crewman then operated an ejector handle that caused a scissors-type mechanism to push the bagged trash from the airlock into the tank.

Cuts and puncture wounds

MedlinePlus

... pointed object such as a nail, knife, or sharp tooth. Symptoms Symptoms include: Bleeding Problems with function ... the last 10 years. Prevention Keep knives, scissors, sharp objects, firearms, and fragile items out of the ...

Intra-patient comparison of parietal pleural biopsies by rigid forceps, flexible forceps and cryoprobe obtained during medical thoracoscopy: a prospective series of 80 cases with pleural effusion.

PubMed

Wurps, H; Schönfeld, N; Bauer, T T; Bock, M; Duve, C; Sauer, R; Mairinger, T; Griff, S

2016-07-07

There is only few data available on the use of cryotechnique during medical thoracoscopy. Medical thoracoscopy was performed in consecutive patients with pleural effusion. Prospectively, biopsies were taken by rigid forceps, flexible forceps and cryoprobe. Specimen size, depth and diagnostic yield were compared. 80 Patients were included. 408 biopsies were taken (205 rigid biopsies, 104 flexible biopsies, 99 cryobiopsies). Mean surface area of rigid biopsies was 22.6 ± 20.4 mm(2) (flexible biopsies: 7.1 ± 9.3 mm(2), cryobiopsies: 14.4 ± 12.8 mm(2)). Rigid biopsies were significantly larger than cryobiopsies (p < 0.001) and flexible biopsies (p < 0.001), crybiopsies were significantly larger than flexible biopsies (p < 0.01). A deep biopsy containing fatty tissue was harvested in 63 % of rigid biopsies (cryobiopsy: 49.5 % flexible biopsy: 39.5 %). In 79/80 cases (98.7 % 95 % CI cannot be calculated) a diagnosis was obtained by rigid biopsy (cryobiopsy: 73/80 cases (91.3 % 95 % CI 86.0 - 96.5 %), flexible biopsy: 74/80 cases (92.5 % 95 % CI 88.6 - 97.4 %)). Diagnostic yield achieved with cryobiopsies was inferior to the yield of rigid biopsies (Difference: 12.7 %), but non-inferior to flexible biopsies (Difference: 6.5 %). Cryobiopsies in medical thoracoscopy are safe with high diagnostic yield, non-inferior to flexible biopsies with increased tissue quantity and quality. Cryotechnique can develop an important role in medical thoracoscopy in the near future when rigid thoracoscopy is not available.

Impact of Strategically Located White Matter Hyperintensities on Cognition in Memory Clinic Patients with Small Vessel Disease.

PubMed

Biesbroek, J Matthijs; Weaver, Nick A; Hilal, Saima; Kuijf, Hugo J; Ikram, Mohammad Kamran; Xu, Xin; Tan, Boon Yeow; Venketasubramanian, Narayanaswamy; Postma, Albert; Biessels, Geert Jan; Chen, Christopher P L H

2016-01-01

Studies on the impact of small vessel disease (SVD) on cognition generally focus on white matter hyperintensity (WMH) volume. The extent to which WMH location relates to cognitive performance has received less attention, but is likely to be functionally important. We examined the relation between WMH location and cognition in a memory clinic cohort of patients with sporadic SVD. A total of 167 patients with SVD were recruited from memory clinics. Assumption-free region of interest-based analyses based on major white matter tracts and voxel-wise analyses were used to determine the association between WMH location and executive functioning, visuomotor speed and memory. Region of interest-based analyses showed that WMHs located particularly within the anterior thalamic radiation and forceps minor were inversely associated with both executive functioning and visuomotor speed, independent of total WMH volume. Memory was significantly associated with WMH volume in the forceps minor, independent of total WMH volume. An independent assumption-free voxel-wise analysis identified strategic voxels in these same tracts. Region of interest-based analyses showed that WMH volume within the anterior thalamic radiation explained 6.8% of variance in executive functioning, compared to 3.9% for total WMH volume; WMH volume within the forceps minor explained 4.6% of variance in visuomotor speed and 4.2% of variance in memory, compared to 1.8% and 1.3% respectively for total WMH volume. Our findings identify the anterior thalamic radiation and forceps minor as strategic white matter tracts in which WMHs are most strongly associated with cognitive impairment in memory clinic patients with SVD. WMH volumes in individual tracts explained more variance in cognition than total WMH burden, emphasizing the importance of lesion location when addressing the functional consequences of WMHs.

Transbronchial needle aspiration cytology (TBNA) in endobronchial lesions: a valuable technique during bronchoscopy in diagnosing lung cancer and it will decrease repeat bronchoscopy.

PubMed

Shital, Patil; Rujuta, Ayachit; Sanjay, Mundkar

2014-05-01

Lung cancer is the leading cause of cancer deaths around the world. Globally, lung cancer is the largest contributor to new cancer diagnosis and to death from cancer. Various conventional diagnostic techniques (CDTs) such as endobronchial forcep biopsy (FB), bronchial washing (BW) and bronchial brushing (BB), and transbronchial needle aspiration cytology (TBNA) are employed during fiber-optic bronchoscopy. This is a prospective study conducted between June 2012 and September 2013 at Bronchoscopy unit of MIMSR Medical College Latur, India, to find the role of TBNA in exophytic endobronchial lesions in confirming the diagnosis of lung cancer and to find additive yield over other techniques such as BB, BW and FB, and included 150 patients on the basis of clinical and radiological features of malignancy. In exophytic endobronchial lesions, predominant endoscopic findings were cauliflower, polypoidal-like or nodular or multinodular endobronchial growth. TBNA, FB, BB and BW were performed in all the cases during FOB. Histopathological and cytological examinations of specimens were performed at Pathology department. The statistical analysis was done using chi-square test. Total 150 patients, between age group 24-80 years, mean age was 57.93 years, male population constitutes 86.17 % of total. 76.14 % cases were smoker of them 61.87 % cases having history of >40 pack years. Commoner symptoms were cough (91.33 %), hemoptysis (54.00 %) and chest pain (46.66 %), and mass lesion (40.66 %), hilar opacity (31.33 %) and collapse segmental/lobar (29.33 %) were commoner radiological abnormalities. Yield of TBNA, CDT and TBNA plus CDT in exophytic lesions is 60.66, 79.33 and 84.66 %, respectively, in diagnosis of lung malignancies (P < 0.001). Sensitivity of forcep biopsy and TBNA in diagnosing lung malignancy was 88.18 and 71.65 %, respectively (P < 0.01). FOB-related hypoxemia documented in two cases and minor bleeding in six cases. Other complications such as significant bleeding, pneumothorax and death were not seen. Minor bleeding was seen with forcep biopsy mainly in 4.0 % cases. TBNA has decreased repeat procedure, decreases cost for diagnosis. IHC on TBNA specimens had increased histological-type confirmation. Transbronchial needle aspiration is a beneficial, safe and minimally invasive bronchoscopic technique with insignificant side effect in the diagnosis bronchogenic carcinoma. TBNA considered safe, especially when fleshy vascular endobronchial growth is present and risk of bleeding is high with forcep biopsy. Inadequate tissue sampling due to the presence of necrosis, blood clot over the lesion and formation of crush artifacts by FB makes TBNA valuable in these lesions. TBNA will definitely decrease need for repeat bronchoscopy.

Virts on MDDK

NASA Image and Video Library

2010-02-15

S130-E-008276 (15 Feb. 2010) --- NASA astronaut Terry Virts, STS-130 pilot, is pictured near food packages and scissors floating freely on the middeck of space shuttle Endeavour while docked with the International Space Station.

Cycle frequency in standard Rock-Paper-Scissors games: Evidence from experimental economics

NASA Astrophysics Data System (ADS)

Xu, Bin; Zhou, Hai-Jun; Wang, Zhijian

2013-10-01

The Rock-Paper-Scissors (RPS) game is a widely used model system in game theory. Evolutionary game theory predicts the existence of persistent cycles in the evolutionary trajectories of the RPS game, but experimental evidence has remained to be rather weak. In this work, we performed laboratory experiments on the RPS game and analyzed the social-state evolutionary trajectories of twelve populations of N=6 players. We found strong evidence supporting the existence of persistent cycles. The mean cycling frequency was measured to be 0.029±0.009 period per experimental round. Our experimental observations can be quantitatively explained by a simple non-equilibrium model, namely the discrete-time logit dynamical process with a noise parameter. Our work therefore favors the evolutionary game theory over the classical game theory for describing the dynamical behavior of the RPS game.

Apex predator and the cyclic competition in a rock-paper-scissors game of three species

NASA Astrophysics Data System (ADS)

Souza-Filho, C. A.; Bazeia, D.; Ramos, J. G. G. S.

2017-06-01

This work deals with the effects of an apex predator on the cyclic competition among three distinct species that follow the rules of the rock-paper-scissors game. The investigation develops standard stochastic simulations but is motivated by a procedure which is explained in the work. We add the apex predator as the fourth species in a system that contains three species that evolve following the standard rules of migration, reproduction, and predation, and study how the system evolves in this new environment, in comparison with the case in the absence of the apex predator. The results show that the apex predator engenders the tendency to spread uniformly in the lattice, contributing to destroy the spiral patterns, keeping biodiversity but diminishing the average size of the clusters of the species that compete cyclically.

Active depth-guiding handheld micro-forceps for membranectomy based on CP-SSOCT

NASA Astrophysics Data System (ADS)

Cheon, Gyeong Woo; Lee, Phillip; Gonenc, Berk; Gehlbach, Peter L.; Kang, Jin U.

2016-03-01

In this study, we demonstrate a handheld motion-compensated micro-forceps system using common-path swept source optical coherence tomography with highly accurate depth-targeting and depth-locking for Epiretinal Membrane Peeling. Two motors and a touch sensor were used to separate the two independent motions: motion compensation and tool-tip manipulation. A smart motion monitoring and guiding algorithm was devised for precise and intuitive freehand control. Ex-vivo bovine eye experiments were performed to evaluate accuracy in a bovine retina retinal membrane peeling model. The evaluation demonstrates system capabilities of 40 um accuracy when peeling the epithelial layer of bovine retina.

Pre-operative intra-articular deep tissue sampling with novel retrograde forceps improves the diagnostics in periprosthetic joint infection.

PubMed

Wimmer, Matthias D; Ploeger, Milena M; Friedrich, Max J; Hügle, Thomas; Gravius, Sascha; Randau, Thomas M

2017-07-01

Histopathological tissue analysis is a key parameter within the diagnostic algorithm for suspected periprosthetic joint infections (PJIs), conventionally acquired in open surgery. In 2014, Hügle and co-workers introduced novel retrograde forceps for retrograde synovial biopsy with simultaneous fluid aspiration of the knee joint. We hypothesised that tissue samples acquired by retrograde synovial biopsy are equal to intra-operatively acquired deep representative tissue samples regarding bacterial detection and differentiation of periprosthetic infectious membranes. Thirty patients (male n = 15, 50%; female n = 15, 50%) with 30 suspected PJIs in painful total hip arthroplasties (THAs) were included in this prospective, controlled, non-blinded trial. The results were compared with intra-operatively obtained representative deep tissue samples. In summary, 27 out of 30 patients were diagnosed correctly as infected (17/17) or non-infected (10/13). The sensitivity to predict a PJI using the Retroforce® sampling forceps in addition to standard diagnostics was 85%, the specificity 100%. Retrograde synovial biopsy is a new and rapid diagnostic procedure under local anaesthesia in patients with painful THAs with similar histological results compared to deep tissue sampling.

Trial of a novel endoscopic tattooing biopsy forceps on animal model

PubMed Central

Si, Jian-Min; Sun, Lei-Min; Fan, Yu-Jing; Wang, Liang-Jing

2005-01-01

AIM: To tattoo gastric mucosa with a novel medical device which could be used to monitor and follow-up gastric mucosal lesions. METHODS: Combining endoscopic biopsy with sclerotherapy injection, we designed a new device that could perform biopsy and injection simultaneously. We performed endoscopies on a pig by using a novel endoscope tattoo biopsy forceps for 15 mo. At the same time, we used two-step method combining sclerotherapy injection needle with endoscopic biopsy. The acuity, inflammation and duration of endoscopy were compared between two methods. RESULTS: Compared with the old two-step method, although the inflammation induced by our new device was similar, the duration of procedure was markedly decreased and the acuity of tattooing was better than the old two-step method. All characteristics of the novel device complied with national safety guidelines. Follow-up gastroscopy after 15 mo showed the stained site with injection of 1:100 0.5 mL of India ink was still markedly visible with little inflammatory reaction. CONCLUSION: Endoscopic tattooing biopsy forceps can be widely used in monitoring precancerous lesions. Its safety and effectiveness has been established in animals. PMID:15793881

Monopolar soft-mode coagulation using hemostatic forceps for peptic ulcer bleeding.

PubMed

Yamasaki, Yasushi; Takenaka, Ryuta; Nunoue, Tomokazu; Kono, Yoshiyasu; Takemoto, Koji; Taira, Akihiko; Tsugeno, Hirofumi; Fujiki, Shigeatsu

2014-01-01

Upper gastrointestinal hemorrhage from bleeding peptic ulcer is sometimes difficult to treat by conventional endoscopic methods. Recently, monopolar electrocoagulation using a soft-coagulation system and hemostatic forceps (soft coagulation) has been used to prevent bleeding during endoscopic submucosal dissection. The aim of this study was to assess the safety and efficacy of soft coagulation in the treatment of bleeding peptic ulcer. A total of 39 patients with peptic ulcers were treated using soft coagulation at our hospital between January 2005 and March 2010. Emergency treatment employed an ERBE soft-mode coagulation system using hemostatic forceps. Second-look endoscopy was performed to evaluate the efficacy of prior therapy. Initial hemostasis was defined as accomplished by soft coagulation, with or without other endoscopic therapy prior to soft coagulation. The rate of initial hemostasis, rebleeding, and ultimate hemostasis were retrospectively analyzed. The study subjects were 31 men and 8 women with a mean age of 68.3±13.7 years, with 29 gastric ulcers and 10 duodenal ulcers. Initial hemostasis was achieved in 37 patients (95%). During follow-up, bleeding recurred in two patients, who were retreated with soft coagulation. The monopolar soft coagulation is feasible and safe for treating bleeding peptic ulcers.

Antibiotic prophylaxis for operative vaginal delivery.

PubMed

Liabsuetrakul, T; Choobun, T; Peeyananjarassri, K; Islam, M

2004-01-01

Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics are prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum and/or forceps deliveries. We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003) and MEDLINE (1966 to November 2003). All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. Four reviewers assessed trial eligibility and methodological quality. Two reviewers extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all reviewers. We assessed methodological quality of the included trial using the standard Cochrane criteria and the CONSORT statement of randomised controlled trials. We calculated the relative risks using a fixed effect model and all the reviewers interpreted and discussed the results. One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the relative risk reduction was 93% (relative risks 0.07; 95% confidence interval (CI) 0.00 to 1.21). There was no difference in the length of hospital stay between the two groups (weighted mean difference 0.09 days; 95% CI -0.23 to 0.41). The data were too few and of insufficient quality to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.

Post-thyroidectomy complications. The role of the device: bipolar vs ultrasonic device: Collection of data from 1,846 consecutive patients undergoing thyroidectomy.

PubMed

De Palma, Maurizio; Rosato, Ludovico; Zingone, Fabiana; Orlando, Giulio; Antonino, Antonio; Vitale, Mario; Puzziello, Alessandro

2016-07-01

Specific complications after thyroid surgery, such as recurrent laryngeal nerve injury (RLN) or hypoparathyroidism, are feared because they may give rise to a lifelong disability for the patient. The aim of this study was to evaluate the possible association between the types of device used (bipolar vs ultrasound-based harmonic scalpel defined Harmonic Focus) and major postoperative complications. During a 1-year period, between October 2010 and October 2011, Italian Endocrine Surgery Units affiliated with the Italian Endocrine Surgery Units Association collected data on all consecutive patients older than 18 years who had undergone primary total thyroidectomy, near total thyroidectomy, and completion thyroidectomy. The data were included in a dataset, listing demographic variables, details on the surgical procedure, and 2 major complications of the thyroid surgery: postoperative RLN palsy/hypomobility and hypocalcemia. Our population comprised 1,846 subjects (78.6% women, median age 52 years). Six hundred four (32.7%) subjects underwent thyroidectomy by bipolar forceps and 1,242 (67.3%) by ultrasonic device. The risk of hypocalcemia in subjects undergoing thyroidectomy by ultrasonic device was similar to those undergoing thyroidectomy by bipolar after adjusting for sex, type of thyroidectomy, and central lymphadenectomy (odds ratio .94, 95% confidence interval .76 to 1.17). Subjects who underwent thyroidectomy by ultrasonic device had a lower risk of RLN paralysis compared with those undergoing thyroidectomy by bipolar forceps also after adjusting for central lymphadenectomy (odds ratio .39, 95% confidence interval .2 to .7). This multicenter study acknowledges the value of the ultrasonic device as a protective factor only for RLN palsy, confirming nodal dissection as a risk factor for postoperative hypocalcemia and vocal folds disorders. Copyright © 2015 Elsevier Inc. All rights reserved.

Risk Factors for Birth Canal Lacerations in Primiparous Women

PubMed Central

Mikolajczyk, Rafael T.; Zhang, Jun; Troendle, James; Chan, Linda

2013-01-01

Lacerations of the birth canal are common side effects of vaginal birth. They are potentially preventable. Although serious long-term consequences have been identified for severe perineal lacerations, less attention has been paid to lacerations in other locations and how the risk factors vary for different lacerations. We analyzed a dataset including 1009 primiparous women with singleton pregnancies and vaginal deliveries, and we examined risk factors for third- and fourth-degree perineal lacerations and periurethral, vaginal, and labial lacerations using logistic regression analysis. Large fetal size (≥ 3500 g) substantially increased the risk of perineal (odd ratio [OR], 3.8; 95% confidence interval [CI], 1.8 to 7.9) and periurethral (OR, 2.3; 95% CI, 1.0 to 5.0) lacerations but not other types of lacerations. Episiotomy had no impact on perineal lacerations (OR 0.9) but had very strong protective effects for other lacerations (OR 0.1). Prolonged second stage of labor (>120 minutes) increased the risk of perineal and vaginal lacerations but reduced the risk for periurethral lacerations. Instrumental deliveries were significant risk factors for third- and fourth-degree perineal lacerations, with by far the strongest effect for low forceps (OR 25.0 versus <3 for outlet forceps, outlet vacuum, and low vacuum). We concluded that separating different birth canal lacerations is critical in identifying risk factors and potential preventive strategies. PMID:18509884

Risk factors for birth canal lacerations in primiparous women.

PubMed

Mikolajczyk, Rafael T; Zhang, Jun; Troendle, James; Chan, Linda

2008-05-01

Lacerations of the birth canal are common side effects of vaginal birth. They are potentially preventable. Although serious long-term consequences have been identified for severe perineal lacerations, less attention has been paid to lacerations in other locations and how the risk factors vary for different lacerations. We analyzed a dataset including 1009 primiparous women with singleton pregnancies and vaginal deliveries, and we examined risk factors for third- and fourth-degree perineal lacerations and periurethral, vaginal, and labial lacerations using logistic regression analysis. Large fetal size (> or = 3500 g) substantially increased the risk of perineal (odd ratio [OR], 3.8; 95% confidence interval [CI], 1.8 to 7.9) and periurethral (OR, 2.3; 95% CI, 1.0 to 5.0) lacerations but not other types of lacerations. Episiotomy had no impact on perineal lacerations (OR 0.9) but had very strong protective effects for other lacerations (OR 0.1). Prolonged second stage of labor (> 120 minutes) increased the risk of perineal and vaginal lacerations but reduced the risk for periurethral lacerations. Instrumental deliveries were significant risk factors for third- and fourth-degree perineal lacerations, with by far the strongest effect for low forceps (OR 25.0 versus < 3 for outlet forceps, outlet vacuum, and low vacuum). We concluded that separating different birth canal lacerations is critical in identifying risk factors and potential preventive strategies.

Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial.

PubMed

Holloran-Schwartz, M Brigid; Gavard, Jeffrey A; Martin, Jared C; Blaskiewicz, Robert J; Yeung, Patrick P

2016-01-01

To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. A randomized controlled trial (Canadian Task Force Classification I). An academic hospital. Forty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. Each patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Start time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (-4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). A single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Food packages for use on the Gemini 4 flight

NASA Technical Reports Server (NTRS)

1965-01-01

Food packages for use on the Gemini 4 flight. Packages include beef and gravy, peaches, strawberry cereal cubes and beef sandwiches. Water gun is used to reconstitute dehydrated food. Scissors are used to open the packages.

Heterogeneous network promotes species coexistence: metapopulation model for rock-paper-scissors game.

PubMed

Nagatani, Takashi; Ichinose, Genki; Tainaka, Kei-Ichi

2018-05-04

Understanding mechanisms of biodiversity has been a central question in ecology. The coexistence of three species in rock-paper-scissors (RPS) systems are discussed by many authors; however, the relation between coexistence and network structure is rarely discussed. Here we present a metapopulation model for RPS game. The total population is assumed to consist of three subpopulations (nodes). Each individual migrates by random walk; the destination of migration is randomly determined. From reaction-migration equations, we obtain the population dynamics. It is found that the dynamic highly depends on network structures. When a network is homogeneous, the dynamics are neutrally stable: each node has a periodic solution, and the oscillations synchronize in all nodes. However, when a network is heterogeneous, the dynamics approach stable focus and all nodes reach equilibriums with different densities. Hence, the heterogeneity of the network promotes biodiversity.

A portable fracture toughness tester for biological materials

NASA Astrophysics Data System (ADS)

Darvell, B. W.; Lee, P. K. D.; Yuen, T. D. B.; Lucas, P. W.

1996-06-01

A portable mechanical tester is described which is both lightweight and cheap to produce. The machine is simple and convenient to operate and requires only a minimum of personnel training. It can be used to measure the fundamental mechanical properties of pliant solids, particularly toughness (in the sense of `work of fracture') using either scissors or wedge tests. This is achieved through a novel hardware integration technique. The circuits are described. The use of the machine does not require a chart recorder but it can be linked to a personal computer, either to show force - displacement relationships or for data storage. The design allows the use of any relatively `soft' mechanical test, i.e. tests in which the deformability of the frame of the machine and its load cell do not introduce significant errors into the results. Examples of its use in measuring the toughness of biomaterials by scissors (paper, wood) and wedges (mung bean starch gels) are given.

Mining machine with adjustable jib

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hart, D.

1987-05-26

A mining machine is described having a pair of crawler tracks, a means for individually driving each of the crawler tracks, a frame mounted on the crawler tracks, an elongated jib carrying a sprocket at each end, an endless cutting chain supported on the sprockets, cutters and loading flights mounted on the endless cutting chain, and means on the frame supporting the elongated jib. The means support the elongated jib consisting of a bridge on the frame, at least one scissors linkage pivotally mounted on the bridge, and arm having a first end attached to the scissors linkage, a frontmore » plate mounted on the second end of the arm and means adjustably mounting the elongated jib on the front plate. The means adjustably mount the elongated jib on the front plate including a first means for rotating the elongated jib between a vertical position and a horizontal position.« less

Teleporting photonic qudits using multimode quantum scissors.

PubMed

Goyal, Sandeep K; Konrad, Thomas

2013-12-19

Teleportation plays an important role in the communication of quantum information between the nodes of a quantum network and is viewed as an essential ingredient for long-distance Quantum Cryptography. We describe a method to teleport the quantum information carried by a photon in a superposition of a number d of light modes (a "qudit") by the help of d additional photons based on transcription. A qudit encoded into a single excitation of d light modes (in our case Laguerre-Gauss modes which carry orbital angular momentum) is transcribed to d single-rail photonic qubits, which are spatially separated. Each single-rail qubit consists of a superposition of vacuum and a single photon in each one of the modes. After successful teleportation of each of the d single-rail qubits by means of "quantum scissors" they are converted back into a qudit carried by a single photon which completes the teleportation scheme.

Spatial pattern dynamics due to the fitness gradient flux in evolutionary games.

PubMed

deForest, Russ; Belmonte, Andrew

2013-06-01

We introduce a nondiffusive spatial coupling term into the replicator equation of evolutionary game theory. The spatial flux is based on motion due to local gradients in the relative fitness of each strategy, providing a game-dependent alternative to diffusive coupling. We study numerically the development of patterns in one dimension (1D) for two-strategy games including the coordination game and the prisoner's dilemma, and in two dimensions (2D) for the rock-paper-scissors game. In 1D we observe modified traveling wave solutions in the presence of diffusion, and asymptotic attracting states under a frozen-strategy assumption without diffusion. In 2D we observe spiral formation and breakup in the frozen-strategy rock-paper-scissors game without diffusion. A change of variables appropriate to replicator dynamics is shown to correctly capture the 1D asymptotic steady state via a nonlinear diffusion equation.

Limit cycles and the benefits of a short memory in rock-paper-scissors games.

PubMed

Burridge, James

2015-10-01

When playing games in groups, it is an advantage for individuals to have accurate statistical information on the strategies of their opponents. Such information may be obtained by remembering previous interactions. We consider a rock-paper-scissors game in which agents are able to recall their last m interactions, used to estimate the behavior of their opponents. At critical memory length, a Hopf bifurcation leads to the formation of stable limit cycles. In a mixed population, agents with longer memories have an advantage, provided the system has a stable fixed point, and there is some asymmetry in the payoffs of the pure strategies. However, at a critical concentration of long memory agents, the appearance of limit cycles destroys their advantage. By introducing population dynamics that favors successful agents, we show that the system evolves toward the bifurcation point.

Teleporting photonic qudits using multimode quantum scissors

NASA Astrophysics Data System (ADS)

Goyal, Sandeep K.; Konrad, Thomas

2013-12-01

Teleportation plays an important role in the communication of quantum information between the nodes of a quantum network and is viewed as an essential ingredient for long-distance Quantum Cryptography. We describe a method to teleport the quantum information carried by a photon in a superposition of a number d of light modes (a ``qudit'') by the help of d additional photons based on transcription. A qudit encoded into a single excitation of d light modes (in our case Laguerre-Gauss modes which carry orbital angular momentum) is transcribed to d single-rail photonic qubits, which are spatially separated. Each single-rail qubit consists of a superposition of vacuum and a single photon in each one of the modes. After successful teleportation of each of the d single-rail qubits by means of ``quantum scissors'' they are converted back into a qudit carried by a single photon which completes the teleportation scheme.

Limit cycles and the benefits of a short memory in rock-paper-scissors games

NASA Astrophysics Data System (ADS)

Burridge, James

2015-10-01

When playing games in groups, it is an advantage for individuals to have accurate statistical information on the strategies of their opponents. Such information may be obtained by remembering previous interactions. We consider a rock-paper-scissors game in which agents are able to recall their last m interactions, used to estimate the behavior of their opponents. At critical memory length, a Hopf bifurcation leads to the formation of stable limit cycles. In a mixed population, agents with longer memories have an advantage, provided the system has a stable fixed point, and there is some asymmetry in the payoffs of the pure strategies. However, at a critical concentration of long memory agents, the appearance of limit cycles destroys their advantage. By introducing population dynamics that favors successful agents, we show that the system evolves toward the bifurcation point.

Correction of a mutilated dentition with mini-implants as anchorage.

PubMed

Hyun, Jae-Man; Kim, Tae-Woo

2010-11-01

The patient was an adolescent boy, aged 15.6 years, with a mutilated dentition. He had extrusion of the maxillary left first molar because of loss of the mandibular first molar and lingual tilting and rotation of the mandibular second molars. Both left and right second molars were in scissors-bite that was more severe on the left side. By using mini-implants and a TPA with hooks, a 3-mm intrusion was successfully made on the maxillary left first molar. This provided room for mesial movement of the mandibular left second molar. The second molar was protracted into the space of the missing first molar, and the mandibular left third molar was positioned in place of the second molar. The second molars scissors-bite was corrected. Active treatment took 45 months, and the treatment result remained stable 2 years after debonding. Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Spatial pattern dynamics due to the fitness gradient flux in evolutionary games

NASA Astrophysics Data System (ADS)

deForest, Russ; Belmonte, Andrew

2013-06-01

We introduce a nondiffusive spatial coupling term into the replicator equation of evolutionary game theory. The spatial flux is based on motion due to local gradients in the relative fitness of each strategy, providing a game-dependent alternative to diffusive coupling. We study numerically the development of patterns in one dimension (1D) for two-strategy games including the coordination game and the prisoner's dilemma, and in two dimensions (2D) for the rock-paper-scissors game. In 1D we observe modified traveling wave solutions in the presence of diffusion, and asymptotic attracting states under a frozen-strategy assumption without diffusion. In 2D we observe spiral formation and breakup in the frozen-strategy rock-paper-scissors game without diffusion. A change of variables appropriate to replicator dynamics is shown to correctly capture the 1D asymptotic steady state via a nonlinear diffusion equation.

Hamming distance and mobility behavior in generalized rock-paper-scissors models

NASA Astrophysics Data System (ADS)

Bazeia, D.; Menezes, J.; de Oliveira, B. F.; Ramos, J. G. G. S.

2017-09-01

This work reports on two related investigations of stochastic simulations which are widely used to study biodiversity and other related issues. We first deal with the behavior of the Hamming distance under the increase of the number of species and the size of the lattice, and then investigate how the mobility of the species contributes to jeopardize biodiversity. The investigations are based on the standard rules of reproduction, mobility and predation or competition, which are described by specific rules, guided by generalization of the rock-paper-scissors game, valid in the case of three species. The results on the Hamming distance indicate that it engenders universal behavior, independently of the number of species and the size of the square lattice. The results on the mobility confirm the prediction that it may destroy diversity, if it is increased to higher and higher values.

Food mechanical properties and dietary ecology.

PubMed

Berthaume, Michael A

2016-01-01

Interdisciplinary research has benefitted the fields of anthropology and engineering for decades: a classic example being the application of material science to the field of feeding biomechanics. However, after decades of research, discordances have developed in how mechanical properties are defined, measured, calculated, and used due to disharmonies between and within fields. This is highlighted by "toughness," or energy release rate, the comparison of incomparable tests (i.e., the scissors and wedge tests), and the comparison of incomparable metrics (i.e., the stress and displacement-limited indices). Furthermore, while material scientists report on a myriad of mechanical properties, it is common for feeding biomechanics studies to report on just one (energy release rate) or two (energy release rate and Young's modulus), which may or may not be the most appropriate for understanding feeding mechanics. Here, I review portions of materials science important to feeding biomechanists, discussing some of the basic assumptions, tests, and measurements. Next, I provide an overview of what is mechanically important during feeding, and discuss the application of mechanical property tests to feeding biomechanics. I also explain how 1) toughness measures gathered with the scissors, wedge, razor, and/or punch and die tests on non-linearly elastic brittle materials are not mechanical properties, 2) scissors and wedge tests are not comparable and 3) the stress and displacement-limited indices are not comparable. Finally, I discuss what data gathered thus far can be best used for, and discuss the future of the field, urging researchers to challenge underlying assumptions in currently used methods to gain a better understanding between primate masticatory morphology and diet. © 2016 Wiley Periodicals, Inc.

78 FR 36239 - Notice of Inventory Completion: Wayne State University Gordon L. Grosscup Museum of Anthropology...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... human remains reportedly included a pair of scissors, a hand blown bottle, a scalpel, six silver... with several pieces of animal bone. No known individuals were identified. No associated funerary...

Erythromycin and Benzoyl Peroxide Topical

MedlinePlus

... on to step 5. If your medication comes in small pouches, use scissors or your fingers to tear off the top at the notched tab. Do not open the pouch with your teeth. Squeeze the contents of the pouch onto your ...

Trends in major modifiable risk factors for severe perineal trauma, 1996-2006.

PubMed

Kudish, Bela; Sokol, Robert J; Kruger, Michael

2008-08-01

To examine what effect the major modifiable risk factors for severe perineal trauma have had on the rates of this trauma over time. A retrospective observational cohort study of singleton vaginal deliveries taken from a perinatal database for the period 1996 through 2006. A total of 46,239 singleton vertex vaginal deliveries met the inclusion criteria. Major risk factors for severe perineal trauma were increased maternal age (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.1-1.5), non-African American ethnicity (OR 1.5, 95% CI 1.3-1.7), nulliparity (OR 4.8, 95% CI 4.11-5.6), fetal birth weight (OR 2.2, 95% CI 1.9-2.4), forceps (OR 8.3, 95% CI 5.4-10.8), vacuum (OR 2.9, 95% CI 1.9-4.4), and midline episiotomy (OR 5.7, 95% CI 5.0-6.4). Evaluation of the changes in rates of these factors over the study period revealed that the decline in the rates of episiotomy and the use of forceps accounted for a reduction in severe lacerations of more than 50%. Reduction of severe perineal trauma by restricted use of the 2 modifiable clinical variables, episiotomy and forceps, is evident over time.

Trends in major modifiable risk factors for severe perineal trauma, 1996–2006

PubMed Central

Kudish, Bela; Sokol, Robert J.; Kruger, Michael

2009-01-01

Objective To examine what effect the major modifiable risk factors for severe perineal trauma have had on the rates of this trauma over time. Methods A retrospective observational cohort study of singleton vaginal deliveries taken from a perinatal database for the period 1996 through 2006. Results A total of 46 239 singleton vertex vaginal deliveries met the inclusion criteria. Major risk factors for severe perineal trauma were increased maternal age (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.1–1.5), non–African American ethnicity (OR 1.5, 95% CI 1.3–1.7), nulliparity (OR 4.8, 95% CI 4.11–5.6), fetal birth weight (OR 2.2, 95% CI 1.9–2.4), forceps (OR 8.3, 95% CI 5.4–10.8), vacuum (OR 2.9, 95% CI 1.9–4.4), and midline episiotomy (OR 5.7, 95% CI 5.0–6.4). Evaluation of the changes in rates of these factors over the study period revealed that decline in the rates of episiotomy and use of forceps accounted for a reduction in severe lacerations of more than 50%. Conclusion Reduction of severe perineal trauma by restricted use of the 2 modifiable clinical variables, episiotomy and forceps, is evident over time. PMID:18420204

Biopsy forceps is inadequate for the resection of diminutive polyps.

PubMed

Efthymiou, M; Taylor, A C; Desmond, P V; Allen, P B; Chen, R Y

2011-04-01

Cold biopsy forceps polypectomy (CBP) is often used for the removal of diminutive polyps. The efficacy of the technique has not been thoroughly assessed. The aim of this study was to prospectively assess the efficacy of CBP for removing diminutive polyps. This was a prospective study from St Vincent's Hospital, a tertiary referral hospital in Melbourne, Australia. A total of 143 patients were screened and 52 patients with ≥ 1 diminutive polyps were enrolled. CBP was used to resect diminutive polyps until no polyp tissue was visible. The polyp base was then resected using endoscopic mucosal resection (EMR) with a 1 - 2-mm margin. The CBP and EMR samples were compared to assess completeness of the resection. Overall 39 % (21 / 54) of diminutive polyps were completely resected using CBP. After binary logistic regression analysis, polyp histology was found to be predictive of resection, with complete resection of 62 % (13 / 21) for adenomas and 24 % (8 / 33) for hyperplastic polyps (odds ratio 5.1; P = 0.008). The size and number of bites taken with the forceps were not predictive of complete response. Within the limitations of a modest sample size, CBP appears to be inadequate treatment for the removal of diminutive polyps. © Georg Thieme Verlag KG Stuttgart · New York.

Retrospective study: The diagnostic accuracy of conventional forceps biopsy of gastric epithelial compared to endoscopic submucosal dissection (STROBE compliant).

PubMed

Lu, Chao; Lv, Xueyou; Lin, Yiming; Li, Dejian; Chen, Lihua; Ji, Feng; Li, Youming; Yu, Chaohui

2016-07-01

Conventional forceps biopsy (CFB) is the most popular way to screen for gastric epithelial neoplasia (GEN) and adenocarcinoma of gastric epithelium. The aim of this study was to compare the diagnostic accuracy between conventional forceps biopsy and endoscopic submucosal dissection (ESD).Four hundred forty-four patients who finally undertook ESD in our hospital were enrolled from Jan 1, 2009 to Sep 1, 2015. We retrospectively assessed the characteristics of pathological results of CFB and ESD.The concordance rate between CFB and ESD specimens was 68.92% (306/444). Men showed a lower concordance rate (63.61% vs 79.33%; P = 0.001) and concordance patients were younger (P = 0.048). In multivariate analysis, men significantly had a lower concordance rate (coefficient -0.730, P = 0.002) and a higher rate of pathological upgrade (coefficient -0.648, P = 0.015). Locations of CFB did not influence the concordance rate statistically.The concordance rate was relatively high in our hospital. According to our analysis, old men plus gastric fundus or antrum of CFB were strongly suggested to perform ESD if precancerous lesions were found. And young women with low-grade intraepithelial neoplasia could select regular follow-up.

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

21 CFR 884.1720 - Gynecologic laparoscope and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... accessory instruments include: the lens cleaning brush, biopsy brush, clip applier (without clips...), retractor, mechanical (noninflatable), snare, stylet, forceps, dissector, mechanical (noninflatable...

Anal incontinence after childbirth

PubMed Central

Eason, Erica; Labrecque, Michel; Marcoux, Sylvie; Mondor, Myrto

2002-01-01

Background Incontinence of stool and flatus are frequent complications of childbirth. We examined the prevalence and possible causes of these adverse outcomes in a large cohort of women. Methods We studied 949 pregnant women who gave birth in 5 hospitals in 1995/96 in the province of Quebec. These women, participants in a randomized controlled trial of prenatal perineal massage, completed a self-administered questionnaire 3 months after giving birth. Results Three months after delivery 29 women (3.1%) reported incontinence of stool, and 242 (25.5%) had involuntary escape of flatus. Incontinence of stool was more frequent among women who delivered vaginally and had third- or fourth-degree perineal tears than among those who delivered vaginally and had no anal sphincter tears (7.8% v. 2.9%). Forceps delivery (adjusted risk ratio [RR] 1.45, 95% confidence interval [CI] 1.01–2.08) and anal sphincter tears (adjusted RR 2.09, 95% CI 1.40–3.13) were independent risk factors for incontinence of flatus or stool or both. Anal sphincter injury was strongly and independently associated with first vaginal birth (RR 39.2, 95% CI 5.4–282.5), median episiotomy (adjusted RR 9.6, 95% CI 3.2–28.5), forceps delivery (adjusted RR 12.3, 95% CI 3.0–50.4) and vacuum-assisted delivery (adjusted RR 7.4, 95% CI 1.9–28.5) but not with birth weight (adjusted RR for birth weight 4000 g or more: 1.4, 95% CI 0.6–3.0) or length of the second stage of labour (adjusted RR for second stage 1.5 hours or longer compared with less than 0.5 hours: 1.2, 95% CI 0.5–2.7). Interpretation Anal incontinence is associated with forceps delivery and anal sphincter laceration. Anal sphincter laceration is strongly predicted by first vaginal birth, median episiotomy, and forceps or vacuum delivery but not by birth weight or length of the second stage of labour. PMID:11868640

Anal incontinence after childbirth.

PubMed

Eason, Erica; Labrecque, Michel; Marcoux, Sylvie; Mondor, Myrto

2002-02-05

Incontinence of stool and flatus are frequent complications of childbirth. We examined the prevalence and possible causes of these adverse outcomes in a large cohort of women. We studied 949 pregnant women who gave birth in 5 hospitals in 1995/96 in the province of Quebec. These women, participants in a randomized controlled trial of prenatal perineal massage, completed a self-administered questionnaire 3 months after giving birth. Three months after delivery 29 women (3.1%) reported incontinence of stool, and 242 (25.5%) had involuntary escape of flatus. Incontinence of stool was more frequent among women who delivered vaginally and had third- or fourth-degree perineal tears than among those who delivered vaginally and had no anal sphincter tears (7.8% v. 2.9%). Forceps delivery (adjusted risk ratio [RR] 1.45, 95% confidence interval [CI] 1.01-2.08) and anal sphincter tears (adjusted RR 2.09, 95% CI 1.40-3.13) were independent risk factors for incontinence of flatus or stool or both. Anal sphincter injury was strongly and independently associated with first vaginal birth (RR 39.2, 95% CI 5.4-282.5), median episiotomy (adjusted RR 9.6, 95% CI 3.2-28.5), forceps delivery (adjusted RR 12.3, 95% CI 3.0-50.4) and vacuum-assisted delivery (adjusted RR 7.4, 95% CI 1.9-28.5) but not with birth weight (adjusted RR for nirth weight 4000 g or more: 1.4, 95% CI 0.6-3.0) or length of the second stage of labour (adjusted RR for second stage 1.5 hours or longer compared with less than 0.5 hours: 1.2, 95% CI 0.5-2.7). Anal incontinence is associated with forceps delivery and anal sphincter laceration. Anal sphincter laceration is strongly predicted by first vaginal birth, median episiotomy, and forceps or vacuum delivery but not by birth weight or length of the second stage of labour.

Impact of Strategically Located White Matter Hyperintensities on Cognition in Memory Clinic Patients with Small Vessel Disease

PubMed Central

Hilal, Saima; Kuijf, Hugo J.; Ikram, Mohammad Kamran; Xu, Xin; Tan, Boon Yeow; Venketasubramanian, Narayanaswamy; Postma, Albert; Biessels, Geert Jan; Chen, Christopher P. L. H.

2016-01-01

Background and Purpose Studies on the impact of small vessel disease (SVD) on cognition generally focus on white matter hyperintensity (WMH) volume. The extent to which WMH location relates to cognitive performance has received less attention, but is likely to be functionally important. We examined the relation between WMH location and cognition in a memory clinic cohort of patients with sporadic SVD. Methods A total of 167 patients with SVD were recruited from memory clinics. Assumption-free region of interest-based analyses based on major white matter tracts and voxel-wise analyses were used to determine the association between WMH location and executive functioning, visuomotor speed and memory. Results Region of interest-based analyses showed that WMHs located particularly within the anterior thalamic radiation and forceps minor were inversely associated with both executive functioning and visuomotor speed, independent of total WMH volume. Memory was significantly associated with WMH volume in the forceps minor, independent of total WMH volume. An independent assumption-free voxel-wise analysis identified strategic voxels in these same tracts. Region of interest-based analyses showed that WMH volume within the anterior thalamic radiation explained 6.8% of variance in executive functioning, compared to 3.9% for total WMH volume; WMH volume within the forceps minor explained 4.6% of variance in visuomotor speed and 4.2% of variance in memory, compared to 1.8% and 1.3% respectively for total WMH volume. Conclusions Our findings identify the anterior thalamic radiation and forceps minor as strategic white matter tracts in which WMHs are most strongly associated with cognitive impairment in memory clinic patients with SVD. WMH volumes in individual tracts explained more variance in cognition than total WMH burden, emphasizing the importance of lesion location when addressing the functional consequences of WMHs. PMID:27824925

Ultrasound-guided instrumental removal of the retained placenta after vaginal delivery.

PubMed

Rosenstein, Melissa G; Vargas, Juan E; Drey, Eleanor A

2014-08-01

The standard treatment for retained placenta is manual extraction, in which a hand is introduced inside the uterus to cleave a plane between the placenta and the uterine wall. For women without an epidural, the procedure is extremely uncomfortable and may require additional measures such as intravenous narcotics or regional anesthesia. Although ultrasound-guided instrumental removal of the placenta is standard practice as part of second-trimester abortion by dilation and evacuation and may be done at many institutions, especially after failed manual extraction, it has not yet been described in the literature as a technique following vaginal birth. Our experience with this technique is that it causes less discomfort to the patient than a traditional manual extraction, because the instrument entering the uterus is much narrower than a hand. With the patient in dorsal lithotomy, we locate the cervix and stabilize it either with fingers or a ring forceps on the anterior lip. We introduce Bierer ovum forceps into the uterus under direct ultrasound guidance. The Bierer forceps are preferred because of their long length, large head, and serrated teeth that allow for a firm, secure grip on the placenta. We grasp the placental tissue with the forceps and apply slow, gentle traction in short strokes, regrasping increasingly more distal areas of placenta as necessary to tease out the placenta. After 1-2 minutes, the placenta separates and can be pulled out of the uterus, usually intact. Our experience suggests that this technique is a well-tolerated option for women without an epidural who have a retained placenta. Further study is needed to quantify the amount of discomfort and anesthesia that can be avoided with this technique, as well as whether there is any change in the frequency of infectious complications or the necessity of postremoval curettage. Copyright © 2014 Mosby, Inc. All rights reserved.

[Value of liquid-based cytology of brushing specimens obtained via fiberoptic bronchoscopy for the diagnosis of lung cancer].

PubMed

Zhao, Huan; Guo, Huiqin; Zhang, Chuanxin; Zhao, Linlin; Cao, Jian; Pan, Qinjing

2015-06-01

To investigate the value of the liquid-based cytology (LBC) of brushing specimens obtained via fiberoptic bronchoscopy for clinical diagnosis of lung cancer. We retrospectively analyzed the LBC cases in our hospital from January 2011 to May 2012, and evaluate its role in the diagnosis of lung cancer. The clinical data of a total of 4 380 cases were reviewed and 3 763 of them had histopathological or clinical follow-up results (including 3 306 lung cancer cases and 457 benign lesion cases). The sensitivity, specificity, and accuracy of LBC diagnosis for lung cancer were 72.4% (2 392/3 306), 99.3% (454/457) and 75.6% (2 846/3 763), respectively. Of the 1 992 lung cancer cases diagnosed by brushing LBC, 528 cases (26.5%) were failed to take forceps biopsy and 113 cases (5.7%) showed negative forceps biopsy results. The accurate rate of subtyping of LBC for non-small cell carcinoma and small cell carcinoma was 99.0% (1 487/1 502) (P < 0.001). Take the resection histopathology as gold standard, the accurate rates of subtyping squamous cell carcinoma, adenocarcinoma and small cell carcinoma by LBC were 95.6% (351/367), 95.6% (351/367) and 100% (367/367), respectively, (P < 0.001). The accurate rates of subtyping of squamous cell carcinoma, adenocarcinoma and small cell carcinoma by forceps biopsy were 97.0% (293/302), 97.4% (294/302) and 99.7% (301/302), respectively, (Kappa = 0.895, P < 0.001). There was no significant difference in subtyping respectively between forceps biopsy and brushing LBC (P > 0.05). Fiberoptic bronchoscopic brushing liquid-based cytology can significantly improve the detection rate of lung cancer, and have a high specificity and accurate rate of subtyping. It is an effective tool for the diagnosis and subtyping of lung cancer.

Antibiotic prophylaxis for operative vaginal delivery.

PubMed

Liabsuetrakul, Tippawan; Choobun, Thanapan; Peeyananjarassri, Krantarat; Islam, Q Monir

2014-10-13

Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014). All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. For this update, we assessed methodological quality of the one included trial using the standard Cochrane criteria and the GRADE approach. We calculated the risk ratio (RR) and mean difference (MD) using a fixed-effect model and all the review authors interpreted and discussed the results. One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. This trial identified only two out of the nine outcomes specified in this review. It reported seven women with endomyometritis in the group given no antibiotic and none in prophylactic antibiotic group. This difference did not reach statistical significance, but the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41). Overall, the risk of bias was judged as low. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay. The data were too few to make any recommendations for practice. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.

Mission Specialist (MS) Lenoir cuts Pilot Overmyer's hair on middeck

NASA Technical Reports Server (NTRS)

1982-01-01

Mission Specialist (MS) Lenoir, using hairbrush and scissors, cuts Pilot Overmyer's hair and trims his sideburns in front of forward middeck lockers. Personal hygiene kit (open), towels, and field sequential (FS) crew cabin camera are attached to lockers.

The Hooey Machine.

ERIC Educational Resources Information Center

Scarnati, James T.; Tice, Craig J.

1992-01-01

Describes how students can make and use Hooey Machines to learn how mechanical energy can be transferred from one object to another within a system. The Hooey Machine is made using a pencil, eight thumbtacks, one pushpin, tape, scissors, graph paper, and a plastic lid. (PR)

Wakata haircut in the Service Module (SM)

NASA Image and Video Library

2009-04-04

ISS018-E-044607 (4 April 2009) --- Japan Aerospace Exploration Agency (JAXA) astronaut Koichi Wakata, Expedition 18/19 flight engineer, returns scissors and hair clippers to their storage bag after trimming his hair in the Zarya module of the International Space Station.

Scale-free memory model for multiagent reinforcement learning. Mean field approximation and rock-paper-scissors dynamics

NASA Astrophysics Data System (ADS)

Lubashevsky, I.; Kanemoto, S.

2010-07-01

A continuous time model for multiagent systems governed by reinforcement learning with scale-free memory is developed. The agents are assumed to act independently of one another in optimizing their choice of possible actions via trial-and-error search. To gain awareness about the action value the agents accumulate in their memory the rewards obtained from taking a specific action at each moment of time. The contribution of the rewards in the past to the agent current perception of action value is described by an integral operator with a power-law kernel. Finally a fractional differential equation governing the system dynamics is obtained. The agents are considered to interact with one another implicitly via the reward of one agent depending on the choice of the other agents. The pairwise interaction model is adopted to describe this effect. As a specific example of systems with non-transitive interactions, a two agent and three agent systems of the rock-paper-scissors type are analyzed in detail, including the stability analysis and numerical simulation. Scale-free memory is demonstrated to cause complex dynamics of the systems at hand. In particular, it is shown that there can be simultaneously two modes of the system instability undergoing subcritical and supercritical bifurcation, with the latter one exhibiting anomalous oscillations with the amplitude and period growing with time. Besides, the instability onset via this supercritical mode may be regarded as “altruism self-organization”. For the three agent system the instability dynamics is found to be rather irregular and can be composed of alternate fragments of oscillations different in their properties.

Forceps Delivery

MedlinePlus

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All the wrong places: an unusual case of foreign body ingestion and inhalation.

PubMed

Tammana, V S; Valluru, N; Sanderson, A

2012-09-01

Intentional ingestion of foreign bodies is common in psychiatric patients and prison inmates. Timing of endoscopy for ingested foreign bodies varies and depends on the type and location of the foreign body in the gastrointestinal tract. We present the case of a 26-year-old man who was brought from a correctional facility after confessing to have swallowed a few shower curtain hooks. Abdominal X-ray done in the emergency room revealed multiple foreign bodies in the stomach. An upper endoscopy was done in the emergency room with the use of an overtube. The first metal piece was caught by a snare and removed with the endoscope. All other foreign bodies which were present on the abdominal X-ray could not be visualized initially as there was retained food in the stomach. After multiple attempts, four other foreign bodies were found and each one was caught by the forceps and then the scope was removed with the forceps holding the foreign body. There was an additional foreign body in the right mainstem bronchus. The patient had coughed up the foreign body and swallowed it into the gastrointestinal tract. A computed tomography scan of chest and abdomen was done for evaluation, which showed the foreign body in the cecum. To our knowledge, this is the first case report of a patient intentionally transferring a foreign body from one organ system to another. Colonoscopy was done and the foreign body was removed rectally with a snare without any complications.

Real-time surgery simulation of intracranial aneurysm clipping with patient-specific geometries and haptic feedback

NASA Astrophysics Data System (ADS)

Fenz, Wolfgang; Dirnberger, Johannes

2015-03-01

Providing suitable training for aspiring neurosurgeons is becoming more and more problematic. The increasing popularity of the endovascular treatment of intracranial aneurysms leads to a lack of simple surgical situations for clipping operations, leaving mainly the complex cases, which present even experienced surgeons with a challenge. To alleviate this situation, we have developed a training simulator with haptic interaction allowing trainees to practice virtual clipping surgeries on real patient-specific vessel geometries. By using specialized finite element (FEM) algorithms (fast finite element method, matrix condensation) combined with GPU acceleration, we can achieve the necessary frame rate for smooth real-time interaction with the detailed models needed for a realistic simulation of the vessel wall deformation caused by the clamping with surgical clips. Vessel wall geometries for typical training scenarios were obtained from 3D-reconstructed medical image data, while for the instruments (clipping forceps, various types of clips, suction tubes) we use models provided by manufacturer Aesculap AG. Collisions between vessel and instruments have to be continuously detected and transformed into corresponding boundary conditions and feedback forces, calculated using a contact plane method. After a training, the achieved result can be assessed based on various criteria, including a simulation of the residual blood flow into the aneurysm. Rigid models of the surgical access and surrounding brain tissue, plus coupling a real forceps to the haptic input device further increase the realism of the simulation.

Usefulness of a Flexible Port for Natural Orifice Transluminal Endoscopic Surgery by the Transrectal and Transvaginal Routes

PubMed Central

Ohdaira, Takeshi; Ikeda, Keiichi; Tajiri, Hisao; Yasuda, Yoshikazu; Hashizume, Makoto

2010-01-01

We developed a flexible port for NOTES which allows the use of conventional forceps for laparoscope-assisted surgery without change. The port is not affected by the location of the through hole in the gastrointestinal tract or vagina which elicits a problem in conventional NOTES, and its length can be adjusted during surgery by cutting the port itself. The port is made of polymer resin with a low friction coefficient. Furthermore, the port walls have a square wave structure which contributes to (1) the prevention of devices, for example, endoscope, from getting stuck at the time of insertion and retrieval, (2) the prevention of port slippage in the surgical opening for port insertion, (3) the prevention of unexpected port removal, (4) the prevention of port bore deformation, and (5) the improvement of port flexibility in the longitudinal direction. We validated the insertion and retrieval capacities of commercially available forceps for laparoscope-assisted surgery and power devices. Furthermore, we used the flexible port to conduct cholecystectomy and partial gastrectomy. We could confirm that the selection of the flexible port diameter according to the device type allowed the smooth insertion and retrieval of the device and that the port produced no air leakage. We affirmed that it is possible to conduct surgery by the cross or parallel method similarly to single port surgery. We considered that the flexible port has a potential of becoming a revolutionary port in NOTES. PMID:20508827

Tissue welding forceps usage in superficial parotidectomy: a clinical assessment.

PubMed

Michel, Randall G; Tsau, Kang; Weinstock, Bernard I

2008-01-01

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

[Surgical methods for delivery in modern obstetrics and their influence on maternal and infant health].

PubMed

Kokhanevych, Ie V; Mitsoda, R M; Konoplianko, T V; Konoplianko, V V

2000-03-01

The article addresses issues of comparative characterization of deliveries involving surgery and impact thereof on the health of the mother and her child. Risk factors are identified that the mother and her child run in sectio cesarea, in application of obstetrical forceps, and in vacuum-extraction of the fetus. Cesarean section was found out to be the most acceptable mode of delivery in origination of organic and functional nervous system involvement in children but the most ill-chosen and unpropitious one in the mother, especially so in those groups at risk for bleeding, septic complications, and genital endometriosis. Among those surgical methods of delivery being the least traumatic to the mother are obstetrical forceps and vacuum-extraction of the fetus.

Mission Specialist (MS) Lenoir cuts Pilot Overmyer's hair on middeck

NASA Technical Reports Server (NTRS)

1982-01-01

Mission Specialist (MS) Lenoir, using hairbrush and scissors, cuts Pilot Overmyer's hair and trims his sideburns in front of forward middeck lockers. Personal hygiene kit (open), towels, meal tray assemblies, and field sequential (FS) crew cabincamera are attached to lockers.

Wakata haircut in the Service Module (SM)

NASA Image and Video Library

2009-04-04

ISS018-E-044602 (4 April 2009) --- Japan Aerospace Exploration Agency (JAXA) astronaut Koichi Wakata, Expedition 18/19 flight engineer, trims his hair in the Zarya module of the International Space Station, using scissors and a vacuum device to garner freshly cut hair.

Fourier decomposition of payoff matrix for symmetric three-strategy games.

PubMed

Szabó, György; Bodó, Kinga S; Allen, Benjamin; Nowak, Martin A

2014-10-01

In spatial evolutionary games the payoff matrices are used to describe pair interactions among neighboring players located on a lattice. Now we introduce a way how the payoff matrices can be built up as a sum of payoff components reflecting basic symmetries. For the two-strategy games this decomposition reproduces interactions characteristic to the Ising model. For the three-strategy symmetric games the Fourier components can be classified into four types representing games with self-dependent and cross-dependent payoffs, variants of three-strategy coordinations, and the rock-scissors-paper (RSP) game. In the absence of the RSP component the game is a potential game. The resultant potential matrix has been evaluated. The general features of these systems are analyzed when the game is expressed by the linear combinations of these components.

Scissors Modes and Spin Excitations in Light Nuclei Including ΔN=2 Excitations: Behaviour of 8Be and 10Be

NASA Astrophysics Data System (ADS)

Fayache, M. S.; Sharma, S. Shelley; Zamick, L.

1996-10-01

Shell model calculations are performed for magnetic dipole excitations in8Be and10Be, first with a quadrupole-quadrupole interaction (Q·Q) and then with a realistic interaction. The calculations are performed both in a 0pspace and in a large space which includes all 2ℏωexcitations. In the 0pwithQ·Qwe have an analytic expression for the energies of all states. In this limit we find that in10Be theL=1S=0 scissors mode with isospinT=1 is degenerate with that ofT=2. By projection from an intrinsic state we can obtain simple expressions forB(M1) to the scissors modes in8Be and10Be. We plot cumulative sums for energy-weighted isovector orbital transitions fromJ=0+ground states to the 1+excited states. These have the structure of a low-energy plateau and a steep rise to a high-energy plateau. The relative magnitudes of these plateaux are discussed. By comparing8Be and10Be we find that contrary to the behaviour in heavy deformed nuclei,B(M1)orbitalis not proportional toB(E2). On the other hand, a sum rule which relatesB(M1) to the difference (B(E2)isoscalar-B(E2)isovector) succeeds in describing the difference in behaviours in the two nuclei. The results forQ·Qand the realistic interactions are compared, as are the results in the 0pspace and the large (0p+2ℏω) space. The Wigner supermultiplet scheme is a very useful guide in analyzing the shell model results.

Four classes of interactions for evolutionary games.

PubMed

Szabó, György; Bodó, Kinga S; Allen, Benjamin; Nowak, Martin A

2015-08-01

The symmetric four-strategy games are decomposed into a linear combination of 16 basis games represented by orthogonal matrices. Among these basis games four classes can be distinguished as it is already found for the three-strategy games. The games with self-dependent (cross-dependent) payoffs are characterized by matrices consisting of uniform rows (columns). Six of 16 basis games describe coordination-type interactions among the strategy pairs and three basis games span the parameter space of the cyclic components that are analogous to the rock-paper-scissors games. In the absence of cyclic components the game is a potential game and the potential matrix is evaluated. The main features of the four classes of games are discussed separately and we illustrate some characteristic strategy distributions on a square lattice in the low noise limit if logit rule controls the strategy evolution. Analysis of the general properties indicates similar types of interactions at larger number of strategies for the symmetric matrix games.

Evolutionary games on graphs

NASA Astrophysics Data System (ADS)

Szabó, György; Fáth, Gábor

2007-07-01

Game theory is one of the key paradigms behind many scientific disciplines from biology to behavioral sciences to economics. In its evolutionary form and especially when the interacting agents are linked in a specific social network the underlying solution concepts and methods are very similar to those applied in non-equilibrium statistical physics. This review gives a tutorial-type overview of the field for physicists. The first four sections introduce the necessary background in classical and evolutionary game theory from the basic definitions to the most important results. The fifth section surveys the topological complications implied by non-mean-field-type social network structures in general. The next three sections discuss in detail the dynamic behavior of three prominent classes of models: the Prisoner's Dilemma, the Rock-Scissors-Paper game, and Competing Associations. The major theme of the review is in what sense and how the graph structure of interactions can modify and enrich the picture of long term behavioral patterns emerging in evolutionary games.

Boxing Up a Mini Herd: Art Put to Pasture.

ERIC Educational Resources Information Center

Zimmerman, Midge

2002-01-01

Presents an art project for high school students that was inspired by the 1999 "Cows on Parade" exhibition in Chicago (Illinois). Explains that students used old Gateway computer boxes to create their own cows using the box, scissors, and a hot-glue gun. (CMK)

Endoductal tissue sampling of biliary strictures through endoscopic retrograde cholangiopan creatography (ERCP).

PubMed

Pugliese, V; Antonelli, G; Vincenti, M; Gatteschi, B

1997-01-01

Pathological proof of malignant in biliary strictures is useful in the preoperative setting as it helps define therapeutic planning and prognosis, and reduces the length of the subsequent surgical intervention. However, it is difficult to obtain. The aim of this study was to evaluate the yield of histological and cytological examination of endobiliary samples obtained during endoscopic retrograde cholangiopancreatography (ERCP). Endobiliary forceps biopsy and brush cytology were performed during ERCP examination in 52 consecutive patients, 36 with malignant and 16 with benign strictures. Histology and cytology turned out to have the same sensitivity (53%). The gain in sensitivity achieved by combining the two techniques was limited, reaching a value of 61%. The specificity, however, was 100% for both methods. Most of the few complications observed were due to sphincterotomy and subsided spontaneously or with medical treatment. However, one patient experienced a serous complication and chose to be treated by surgical intervention. The complication was caused by forceps biopsy. This study shows that 1) sampling of biliary strictures during ERCP is the primary approach to tissue diagnosis; 2) brush cytology alone is sufficient in clinical practice; 3) forceps biopsy must always be used to sample intra-ampullary strictures but should be considered as a secondary step to sample strictures located more proximally, in the bile ducta, if previous cytology was negative.

INTERNAL LIMITING MEMBRANE PEELING-DEPENDENT RETINAL STRUCTURAL CHANGES AFTER VITRECTOMY IN RHEGMATOGENOUS RETINAL DETACHMENT.

PubMed

Hisatomi, Toshio; Tachibana, Takashi; Notomi, Shoji; Koyanagi, Yoshito; Murakami, Yusuke; Takeda, Atsunobu; Ikeda, Yasuhiro; Yoshida, Shigeo; Enaida, Hiroshi; Murata, Toshinori; Sakamoto, Taiji; Sonoda, Koh-Hei; Ishibashi, Tatsuro

2018-03-01

To examine retinal changes after vitrectomy with internal limiting membrane (ILM) peeling, we used 3-dimensional optical coherence tomography (3D-OCT) in rhegmatogenous retinal detachment cases. The 68 eyes from 67 patients with rhegmatogenous retinal detachment were studied, including 35 detached macula cases (51%) and 33 attached macula cases. Internal limiting membrane peeling was performed with fine forceps after brilliant blue G staining. The 3D-OCT images were obtained with volume-rendering technologies from cross-sectional OCT images. The 3D-OCT detected 45 eyes (66%) with ILM peeling-dependent retinal changes, including dissociated optic nerve fiber layer appearance, dimple sign, temporal macular thinning, ILM peeling area thinning, or forceps-related retinal thinning. The ILM peeled area was detectable in only 9 eyes with 3D-OCT, whereas it was undetectable in other 59 eyes. The dissociated optic nerve fiber layer appearance was detected in 8 of the total cases (12%), and dimple signs were observed in 14 cases (21%). Forceps-related thinning was also noted in eight cases (24%) of attached macula cases and in four cases (11%) of detached macula cases. No postoperative macular pucker was noted in the observational period. The 3D-OCT clearly revealed spatial and time-dependent retinal changes after ILM peeling. The changes occurred in 2 months and remained thereafter.

Antibiotic-mediated antagonism leads to a bacterial game of rock-paper-scissors in vivo

NASA Astrophysics Data System (ADS)

Kirkup, Benjamin C.; Riley, Margaret A.

2004-03-01

Colicins are narrow-spectrum antibiotics produced by and active against Escherichia coli and its close relatives. Colicin-producing strains cannot coexist with sensitive or resistant strains in a well-mixed culture, yet all three phenotypes are recovered in natural populations. Recent in vitro results conclude that strain diversity can be promoted by colicin production in a spatially structured, non-transitive interaction, as in the classic non-transitive model rock-paper-scissors (RPS). In the colicin version of the RPS model, strains that produce colicins (C) kill sensitive (S) strains, which outcompete resistant (R) strains, which outcompete C strains. Pairwise in vitro competitions between these three strains are resolved in a predictable order (C beats S, S beats R, and R beats C), but the complete system of three strains presents the opportunity for dynamic equilibrium. Here we provide conclusive evidence of an in vivo antagonistic role for colicins and show that colicins (and potentially other bacteriocins) may promote, rather than eliminate, microbial diversity in the environment.

Genome editing: the road of CRISPR/Cas9 from bench to clinic

PubMed Central

Eid, Ayman; Mahfouz, Magdy M

2016-01-01

Molecular scissors engineered for site-specific modification of the genome hold great promise for effective functional analyses of genes, genomes and epigenomes and could improve our understanding of the molecular underpinnings of disease states and facilitate novel therapeutic applications. Several platforms for molecular scissors that enable targeted genome engineering have been developed, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) and, most recently, clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated-9 (Cas9). The CRISPR/Cas9 system's simplicity, facile engineering and amenability to multiplexing make it the system of choice for many applications. CRISPR/Cas9 has been used to generate disease models to study genetic diseases. Improvements are urgently needed for various aspects of the CRISPR/Cas9 system, including the system's precision, delivery and control over the outcome of the repair process. Here, we discuss the current status of genome engineering and its implications for the future of biological research and gene therapy. PMID:27741224

The rock-paper-scissors game and the evolution of alternative male strategies

NASA Astrophysics Data System (ADS)

Sinervo, B.; Lively, C. M.

1996-03-01

MANY species exhibit colour polymorphisms associated with alternative male reproductive strategies, including territorial males and 'sneaker males' that behave and look like females1-3. The prevalence of multiple morphs is a challenge to evolutionary theory because a single strategy should prevail unless morphs have exactly equal fitness4,5 or a fitness advantage when rare6,7. We report here the application of an evolutionary stable strategy model to a three-morph mating system in the side-blotched lizard. Using parameter estimates from field data, the model predicted oscillations in morph frequency, and the frequencies of the three male morphs were found to oscillate over a six-year period in the field. The fitnesses of each morph relative to other morphs were non-transitive in that each morph could invade another morph when rare, but was itself invadable by another morph when common. Concordance between frequency-dependent selection and the among-year changes in morph fitnesses suggest that male interactions drive a dynamic 'rock-paper-scissors' game7.

Four-state rock-paper-scissors games in constrained Newman-Watts networks.

PubMed

Zhang, Guo-Yong; Chen, Yong; Qi, Wei-Kai; Qing, Shao-Meng

2009-06-01

We study the cyclic dominance of three species in two-dimensional constrained Newman-Watts networks with a four-state variant of the rock-paper-scissors game. By limiting the maximal connection distance Rmax in Newman-Watts networks with the long-range connection probability p , we depict more realistically the stochastic interactions among species within ecosystems. When we fix mobility and vary the value of p or Rmax, the Monte Carlo simulations show that the spiral waves grow in size, and the system becomes unstable and biodiversity is lost with increasing p or Rmax. These results are similar to recent results of Reichenbach et al. [Nature (London) 448, 1046 (2007)], in which they increase the mobility only without including long-range interactions. We compared extinctions with or without long-range connections and computed spatial correlation functions and correlation length. We conclude that long-range connections could improve the mobility of species, drastically changing their crossover to extinction and making the system more unstable.

Genome editing: the road of CRISPR/Cas9 from bench to clinic.

PubMed

Eid, Ayman; Mahfouz, Magdy M

2016-10-14

Molecular scissors engineered for site-specific modification of the genome hold great promise for effective functional analyses of genes, genomes and epigenomes and could improve our understanding of the molecular underpinnings of disease states and facilitate novel therapeutic applications. Several platforms for molecular scissors that enable targeted genome engineering have been developed, including zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs) and, most recently, clustered regularly interspaced palindromic repeats (CRISPR)/CRISPR-associated-9 (Cas9). The CRISPR/Cas9 system's simplicity, facile engineering and amenability to multiplexing make it the system of choice for many applications. CRISPR/Cas9 has been used to generate disease models to study genetic diseases. Improvements are urgently needed for various aspects of the CRISPR/Cas9 system, including the system's precision, delivery and control over the outcome of the repair process. Here, we discuss the current status of genome engineering and its implications for the future of biological research and gene therapy.

Preventing perineal trauma during childbirth: a systematic review.

PubMed

Eason, E; Labrecque, M; Wells, G; Feldman, P

2000-03-01

To review systematically techniques proposed to prevent perineal trauma during childbirth and meta-analyze the evidence of their efficacy from randomized controlled trials. MEDLINE (1966-1999), the Cochrane Library (1999 Issue 1), and the Cochrane Collaboration: Pregnancy and Childbirth Database (1995); and reference lists from articles identified. Search terms included childbirth or pregnancy or delivery, and perineum, episiotomy, perineal massage, obstetric forceps, vacuum extraction, labor stage-second. No language or study-type constraints were imposed. Randomized controlled trials (RCTs) of interventions affecting perineal trauma were reviewed. If no RCTs were available, nonrandomized research designs such as cohort studies were included. Studies were selected by examination of titles and abstracts of more than 1,500 articles, followed by analysis of the methods sections of studies that appeared to be RCTs. INTEGRATION AND RESULTS: Eligible studies used random or quasirandom allocation of an intervention of interest and reported perineal outcomes. Further exclusions were based on failure to report results by intention to treat, or incomplete or internally inconsistent reporting of perineal outcomes. Final selection of studies and data extraction was by consensus of the first two authors. Data from trials that evaluated similar interventions were combined using a random effects model to determine weighted estimate of risk difference and number needed to treat. Effects of sensitivity analysis and quality scoring were examined. Results indicated good evidence that avoiding episiotomy decreased perineal trauma (absolute risk difference -0.23, 95% confidence interval [CI] -0.35, -0.11). In nulliparas, perineal massage during the weeks before giving birth also protected against perineal trauma (risk difference -0.08, CI -0.12, -0.04). Vacuum extraction (risk difference -0.06, CI -0.10, -0.02) and spontaneous birth (-0.11, 95% CI -0.18, -0.04) caused less anal sphincter trauma than forceps delivery. The mother's position during the second stage has little influence on perineal trauma (supported upright versus recumbent: risk difference 0.02, 95% CI -0.05, 0.09). Factors shown to increase perineal integrity include avoiding episiotomy, spontaneous or vacuum-assisted rather than forceps birth, and in nulliparas, perineal massage during the weeks before childbirth. Second-stage position has little effect. Further information on techniques to protect the perineum during spontaneous delivery is sorely needed.

Incidence of and risk factors for perineal trauma: a prospective observational study

PubMed Central

2013-01-01

Background Our aim was to describe the range of perineal trauma in women with a singleton vaginal birth and estimate the effect of maternal and obstetric characteristics on the incidence of perineal tears. Methods We conducted a prospective observational study on all women with a planned singleton vaginal delivery between May and September 2006 in one obstetric unit, three freestanding midwifery-led units and home settings in South East England. Data on maternal and obstetric characteristics were collected prospectively and analysed using univariable and multivariable logistic regression. The outcome measures were incidence of perineal trauma, type of perineal trauma and whether it was sutured or not. Results The proportion of women with an intact perineum at delivery was 9.6% (125/1,302) in nulliparae, and 31.2% (453/1,452) in multiparae, with a higher incidence in the community (freestanding midwifery-led units and home settings). Multivariable analysis showed multiparity (OR 0.52; 95% CI: 0.30–0.90) was associated with reduced odds of obstetric anal sphincter injuries (OASIS), whilst forceps (OR 4.43; 95% CI: 2.02–9.71), longer duration of second stage of labour (OR 1.49; 95% CI: 1.13–1.98), and heavier birthweight (OR 1.001; 95% CI: 1.001–1.001), were associated with increased odds. Adjusted ORs for spontaneous perineal truama were: multiparity (OR 0.42; 95% CI: 0.32–0.56); hospital delivery (OR 1.48; 95% CI: 1.01–2.17); forceps delivery (OR 2.61; 95% CI: 1.22–5.56); longer duration of second stage labour (OR 1.45; 95% CI: 1.28–1.63); and heavier birthweight (OR 1.001; 95% CI: 1.000–1.001). Conclusions This large prospective study found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool, digital perineal stretching in the second stage, hands off delivery technique, or maternal birth position with incidence of OASIS or spontaneous perineal trauma. We also found a low overall incidence of OASIS, and fewer second degree tears were sutured in the community than in the hospital settings. This study confirms previous findings of overall high incidence of perineal trauma following vaginal delivery, and a strong association between forceps delivery and perineal trauma. PMID:23497085

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

21 CFR 876.4730 - Manual gastroenterology-urology surgical instrument and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... forceps cover, biopsy tray without biopsy instruments, line clamp, nonpowered rectal probe, nonelectrical..., gastro-urology probe and director, nonself-retaining retractor, laparotomy rings, nonelectrical snare...

A New Surgical Approach for the Treatment of Conjunctivochalasis: Reduction of the Conjunctival Fold with Bipolar Electrocautery Forceps

PubMed Central

Arenas, Eduardo; Muñoz, Diana

2016-01-01

Aim. To report a new surgical technique for the treatment of conjunctivochalasis. Methods. A new surgical technique in which specially designed bipolar electrocautery forceps facilitate the complete reduction of the conjunctival folds without creating lesions near the corneoscleral limbus was designed. A retrospective revision of the medical records of patients treated with this technique between the years 2011 and 2013 was made, and eighteen eyes of sixteen patients with conjunctivochalasis treated with this new technique were included. Results. All the eyes treated showed a significant improvement with no evidence of scar lesions after a mean follow-up time of 10 months. Conclusions. The surgical technique presented here could be a good alternative for the management of conjunctivochalasis. PMID:27200408

[Surgical renal biopsies: technique, effectiveness and complications].

PubMed

Pinsach Elías, L; Blasco Casares, F J; Ibarz Servió, L; Valero Milián, J; Areal Calama, J; Bucar Terrades, S; Saladié Roig, J M

1991-01-01

Retrospective study made on 140 renal surgical biopsies (RSB) performed throughout the past 4 years in our Unit. The technique's effectiveness and morbidity are emphasized and the surgical technique and type of anaesthesia described. The sample obtained was enough to perform an essay in 100% cases, and a diagnosis was reached in 98.5%. Thirty-nine patients (27.8%) presented complications, 13 (9.2%) of which were directly related to the surgical technique. No case required blood transfusion and no deaths were reported. The type of anaesthesia used was: local plus sedation in 104 (74.2%) cases, rachianaesthesia in 10 (7.1%) and general in 26 (18.5%). The same approach was used in all patients: minimal subcostal lumbotomy, using Wilde's forceps to obtain the samples. It is believed that RSB is a highly effective, low mortality procedure, easy and quick to perform, and suitable for selected patients.

Antibiotic prophylaxis for operative vaginal delivery.

PubMed

Liabsuetrakul, Tippawan; Choobun, Thanapan; Peeyananjarassri, Krantarat; Islam, Q Monir

2017-08-05

Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear. To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both. We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies. All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment. Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach. One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay. One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.

Forceps delivery is associated with increased risk of pelvic organ prolapse and muscle trauma: a cross-sectional study 16-24 years after first delivery.

PubMed

Volløyhaug, I; Mørkved, S; Salvesen, Ø; Salvesen, K Å

2015-10-01

To study possible associations between mode of delivery and pelvic organ prolapse (POP) and pelvic floor muscle trauma 16-24 years after first delivery and, in particular, to identify differences between forceps and vacuum delivery. This was a cross-sectional study including 608 women who delivered their first child in 1990-1997 and were examined with POP quantification (POP-Q) and pelvic floor ultrasound in 2013-2014. Outcome measures were POP ≥ Stage 2 or previous prolapse surgery, levator avulsion and levator hiatal area on Valsalva. Univariable and multivariable logistic regression analyses and ANCOVA were applied to identify outcome variables associated with mode of delivery. Comparing forceps to vacuum delivery, the adjusted odds ratios (aOR) were 1.72 (95% CI, 1.06-2.79; P = 0.03) for POP ≥ Stage 2 or previous prolapse surgery and 4.16 (95% CI, 2.28-7.59; P < 0.01) for levator avulsion. Hiatal area on Valsalva was larger, with adjusted mean difference (aMD) of 4.75 cm(2) (95% CI, 2.46-7.03; P < 0.01). Comparing forceps with normal vaginal delivery, the adjusted odds ratio (aOR) was 1.74 (95% CI, 1.12-2.68; P = 0.01) for POP ≥ Stage 2 or surgery and 4.35 (95% CI, 2.56-7.40; P < 0.01) for levator avulsion; hiatal area on Valsalva was larger, with an aMD of 3.84 cm(2) (95% CI, 1.78-5.90; P < 0.01). Comparing Cesarean delivery with normal vaginal delivery, aOR was 0.06 (95% CI, 0.02-0.14; P < 0.01) for POP ≥ Stage 2 or surgery and crude OR was 0.00 (95% CI, 0.00-0.30; P < 0.01) for levator avulsion; hiatal area on Valsalva was smaller, with an aMD of -8.35 cm(2) (95% CI, -10.87 to -5.84; P < 0.01). No differences were found between vacuum and normal vaginal delivery. We found that mode of delivery was associated with POP and pelvic floor muscle trauma in women from a general population, 16-24 years after their first delivery. Forceps was associated with significantly more POP, levator avulsion and larger hiatal areas than were vacuum and normal vaginal deliveries. There were no statistically significant differences between vacuum and normal vaginal deliveries. Cesarean delivery was associated with significantly less POP and pelvic floor muscle trauma than were normal or operative vaginal delivery. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Effectiveness of diffusion tensor imaging in differentiating early-stage subcortical ischemic vascular disease, Alzheimer's disease and normal ageing.

PubMed

Tu, Min-Chien; Lo, Chung-Ping; Huang, Ching-Feng; Hsu, Yen-Hsuan; Huang, Wen-Hui; Deng, Jie Fu; Lee, Yung-Chuan

2017-01-01

To describe and compare diffusion tensor imaging (DTI) parameters between patients with subcortical ischemic vascular disease (SIVD) and Alzheimer's disease (AD) diagnosed using structuralized neuropsychiatric assessments, and investigate potential neuronal substrates related to cognitive performance. Thirty-five patients with SIVD, 40 patients with AD, and 33 cognitively normal control (NC) subjects matched by age and education level were consecutively recruited and underwent cognitive function assessments and DTI examinations. Comparisons among these three subgroups with regards to cognitive performance and DTI parameters including fractional anisotropy (FA) and mean diffusivity (MD) values were performed. Partial correlation analysis after controlling for age and education was used to evaluate associations between cognitive performance and DTI parameters. With regards to cognitive performance, the patients with SIVD had lower total scores in frontal assessment battery (FAB) compared to those with AD (p < 0.05) in the context of comparable Mini-Mental Status Examination and Cognitive Abilities Screening Instrument scores. With regards to DTI parameters, there were more regions of significant differences in FA among these three subgroups compared with MD. Compared with NC group, the patients with SIVD had significant global reductions in FA (p < 0.001 ~ 0.05), while significant reductions in FA among the patients with AD were regionally confined within the left superior longitudinal fasciculus, genu and splenium of the corpus callosum, and bilateral forceps major, and the anterior thalamic radiation, uncinate fasciculus, and cingulum of the left side (p < 0.01 ~ 0.05). Analysis of FA values within the left forceps major, left anterior thalamic radiation, and genu of the corpus callosum revealed a 71.8% overall correct classification (p < 0.001) with sensitivity of 69.4%, specificity of 73.8%, positive predictive value of 69.4%, and negative predictive value of 73.8% in discriminating patients with SIVD from those with AD. In combined analysis of the patients with SIVD and AD (n = 75), the total FAB score was positively correlated with FA within the bilateral forceps minor, genu of the corpus callosum, left forceps major, left uncinate fasciculus, and right inferior longitudinal fasciculus (p = 0.001 ~ 0.038), and inversely correlated with MD within the right superior longitudinal fasciculus, genu and body of the corpus callosum, bilateral forceps minor, right uncinate fasciculus, and right inferior longitudinal fasciculus (p = 0.003 ~ 0.040). Our findings suggest the effectiveness of DTI measurements in distinguishing patients with early-stage AD from those with SIVD, with discernible changes in spatial distribution and magnitude of significance of the DTI parameters. Strategic FA assessments provided the most robust discriminative power to differentiate SIVD from AD, and FAB may serve as an additional cognitive marker. We also identified the neuronal substrates responsible for FAB performance.

Intravenous Remifentanil Analgaesia for an Obstetric Patient with Type I Neurofibromatosis and a Factor V Leiden Mutation

PubMed Central

Gálvez, José L.; Errando, Carlos L.; Serrano, Silvia; Martín-Ayuso, Marga; Valverde-Mantecón, José M.

2017-01-01

Type I neurofibromatosis is characterised by altered skin pigmentation and the growth of benign tumours, particularly along the peripheral nerves and central nervous system. We report a 36-year-old primigravida woman in labour who was admitted to the obstetric suite of the Hospital Sant Joan de Déu, Barcelona, Spain, in 2007 with hypothyroidism, type I neurofibromatosis and a factor V Leiden mutation. Due to a lack of cranial and spinal imaging data, an epidural was not indicated; instead, continuous intravenous remifentanil analgaesia was administered. The remifentanil infusion was self-titrated by the patient using a visual analogue scale, with the dosage ranging from 0.01 to 0.25 μg/kg/minute. Due to rotational dystocia, Kjelland-type forceps were used during the delivery. After birth, the infant was found to have Apgar scores of 9 and 10, with no maternal or neonatal adverse effects observed. Although still controversial, remifentanil may be a successful alternative for analgaesia in similar cases; however, the specific risks and benefits for each patient should be considered prior to administration. PMID:29372092

Ultraviolet radiation as disinfection for fish surgical tools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Walker, Ricardo W.; Markillie, Lye Meng; Colotelo, Alison HA

Telemetry is frequently used to examine the behavior of fish, and the transmitters used are normally surgically implanted into the coelomic cavity of fish. Implantation requires the use of surgical tools such as scalpels, forceps, needle holders, and sutures. When fish are implanted consecutively, as in large telemetry studies, it is common for surgical tools to be sterilized or, at minimum, disinfected between each use so that pathogens that may be present are not spread among fish. To determine the efficacy for this application, ultraviolet (UV) radiation was used to disinfect surgical tools exposed to one of four aquatic organismsmore » that typically lead to negative health issues for salmonids. These organisms included Aeromonas salmonicida, Flavobacterium psychrophilum, Renibacterium salmoninarum, and Saprolegnia parasitica, causative agents of furunculosis, coldwater disease, bacterial kidney disease, and saprolegniasis (water mold), respectively. Four experiments were conducted to address the question of UV efficacy. In the first experiment, forceps were exposed to the three bacteria at three varying concentrations. After exposure to the bacterial culture, tools were placed into a mobile Millipore UV sterilization apparatus. The tools were then exposed for three different time periods – 2, 5, or 15 min. UV radiation exposures at all durations were effective at killing all three bacteria on forceps at the highest bacteria concentrations. In the second experiment, stab scalpels, sutures, and needle holders were exposed to A. salmonicida using the same methodology as used in Experiment 1. UV radiation exposure at 5 and 15 min was effective at killing A. salmonicida on stab scalpels and sutures but not needle holders. In the third experiment, S. parasitica, a water mold, was tested using an agar plate method and forceps-pinch method. UV radiation was effective at killing the water mold at all three exposure durations. Collectively, this study shows that UV radiation appears to provide a quick alternative disinfection technique to chemical disinfectants (e.g., ethanol) for some surgical tools. However, we do not recommend using this method for tools such as needle holders having overlapping parts or other structures that cannot be exposed directly to UV radiation« less

Revolutionizing (robot-assisted) laparoscopic gamma tracing using a drop-in gamma probe technology

PubMed Central

van Oosterom, Matthias N; Simon, Hervé; Mengus, Laurent; Welling, Mick M; van der Poel, Henk G; van den Berg, Nynke S; van Leeuwen, Fijs WB

2016-01-01

In complex (robot-assisted) laparoscopic radioguided surgery procedures, or when low activity lesions are located nearby a high activity background, the limited maneuverability of a laparoscopic gamma probe (LGP; 4 degrees of freedom (DOF)) may hinder lesion identification. We investigated a drop-in gamma probe (DIGP) technology to be inserted via a trocar, after which the laparoscopic surgical tool at hand can pick it up and maneuver it. Phantom experiments showed that distinguishing a low objective from a high background source (1:100 ratio) was only possible with the detector faced >90° from the high background source. Signal-low-objective-to-background ratios of 3.77, 2.01 and 1.84 were found for detector angles of 90°, 135° and 180°, respectively, whereas detector angles of 0° and 45° were unable to distinguish the sources. This underlines the critical role probe positioning plays. We then focused on engineering of the gripping part for optimal DIGP pick-up with a conventional laparoscopic forceps (4 DOF) or a robotic forceps (6 DOF). DIGPs with 0°, 45°, 90°, and 135° -grip orientations were designed, and their maneuverability- and scanning direction were evaluated and compared to a conventional LGP. The maneuverability- and scanning direction of the DIGP was found highest when using the robotic forceps, with the largest effective scanning direction range obtained with the 90° -grip design (0-180° versus 0-111°, 0-140°, and 37-180° for 0°, 45° and 135° -grip designs, respectively). For the laparoscopic forceps, the scan direction directly translated from the angle of the grip design with the advantage that the 135° -gripped DIGP could be faced backwards (not possible with the conventional LGP). In the ex vivo clinical setup, the surgeon rated DIGP pick-up most convenient for the 45°-grip design. Concluding, the DIGP technology was successfully introduced. Optimization of the grip design and grasping angle of the DIGP increased its utility for (robot-assisted) laparoscopic gamma tracing. PMID:27069762

Pigeons ("Columba Livia") Approach Nash Equilibrium in Experimental Matching Pennies Competitions

ERIC Educational Resources Information Center

Sanabria, Federico; Thrailkill, Eric

2009-01-01

The game of Matching Pennies (MP), a simplified version of the more popular Rock, Papers, Scissors, schematically represents competitions between organisms with incentives to predict each other's behavior. Optimal performance in iterated MP competitions involves the production of random choice patterns and the detection of nonrandomness in the…

NAVS Alternatives Set the Standard for Humane Education.

ERIC Educational Resources Information Center

Petty, Linda

1997-01-01

Describes some alternatives to dissection offered to teachers through the National Anti-Vivisection Society (NAVS) and other sources. These include models, CD-ROMs, and software that enable students to click on scalpels, scissors, and other instruments to cut through videotaped specimens. Also details the Dissection Hotline and the Dissection…

14 CFR 125.207 - Emergency equipment requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Administrator: Contents Quantity Adhesive bandage compressors, 1 in 16 Antiseptic swabs 20 Ammonia inhalants 10 Bandage compressors, 4 in 8 Triangular bandage compressors, 40 in 5 Arm splint, noninflatable 1 Leg splint, noninflatable 1 Roller bandage, 4 in 4 Adhesive tape, 1-in standard roll 2 Bandage scissors 1 Protective latex...

14 CFR 125.207 - Emergency equipment requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Administrator: Contents Quantity Adhesive bandage compressors, 1 in 16 Antiseptic swabs 20 Ammonia inhalants 10 Bandage compressors, 4 in 8 Triangular bandage compressors, 40 in 5 Arm splint, noninflatable 1 Leg splint, noninflatable 1 Roller bandage, 4 in 4 Adhesive tape, 1-in standard roll 2 Bandage scissors 1 Protective latex...

14 CFR 125.207 - Emergency equipment requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Administrator: Contents Quantity Adhesive bandage compressors, 1 in 16 Antiseptic swabs 20 Ammonia inhalants 10 Bandage compressors, 4 in 8 Triangular bandage compressors, 40 in 5 Arm splint, noninflatable 1 Leg splint, noninflatable 1 Roller bandage, 4 in 4 Adhesive tape, 1-in standard roll 2 Bandage scissors 1 Protective latex...

14 CFR 125.207 - Emergency equipment requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Administrator: Contents Quantity Adhesive bandage compressors, 1 in 16 Antiseptic swabs 20 Ammonia inhalants 10 Bandage compressors, 4 in 8 Triangular bandage compressors, 40 in 5 Arm splint, noninflatable 1 Leg splint, noninflatable 1 Roller bandage, 4 in 4 Adhesive tape, 1-in standard roll 2 Bandage scissors 1 Protective latex...

Science | AAAS

Science.gov Websites

be caused by haywire immune system eating brain connections CRISPR Stopping CRISPR's genome-editing scissors from snipping out of control CRISPR patent hearing produces no clear winner, only 'soft signals ' Did a Swedish researcher eat the first CRISPR meal ever served? Top articles in Careers dollars in a

University of Minnesota Duluth Engineering Design Challenge

DTIC Science & Technology

2015-03-23

on overall weight, size, lifting capacity, and ease of transporting. Many initial designs were considered including fire hose lift bags, hydraulic...Many initial designs were considered including fire hose lift bags, hydraulic lifts, a scissor lift, a spring loaded pawl tri-pod, and a pulley lift...26 Fire Hose

Melvin on FD during Expedition 16/STS-122 Joint Operations

NASA Image and Video Library

2008-02-10

S122-E-007587 (10 Feb. 2008) --- Astronaut Leland Melvin, STS-122 mission specialist, witnesses microgravity in action on the aft flight deck of Space Shuttle Atlantis while docked with the International Space Station. A package of food, scissors and a spoon float freely near Melvin.

Interview: Fenton Johnson.

ERIC Educational Resources Information Center

Creadick, Anna

1995-01-01

Fenton Johnson, an award-winning writer living in San Francisco, reflects on growing up in a large Catholic family in Appalachian Kentucky and the stigma associated with being gay. His latest novel, "Scissors, Papers, Rock," relates the story of a young man leaving the gay urban culture of San Francisco to return to the straight rural…

Rocks, Paper, Scissors: Best Practices in Peer Mentoring

ERIC Educational Resources Information Center

Bowden, Shelly Hudson

2014-01-01

In this article, Shelly Hudson Bowden, a kindergarten teacher for 14 years, offers her observations of peer-to-peer mentoring relationships among her kindergarten students that they formed and maintained. These mentoring relationships supported students' learning as they mentored one another in both "social" and "academic"…

Managing the Student Press: Consider Carefully before You Unsheath the Censor's Scissors.

ERIC Educational Resources Information Center

Sendor, Benjamin

1988-01-01

The United States Supreme Court's decision in "Hazelwood School District v. Kuhlmeier" gives school officials sweeping power over school-sponsored publications and other curricular and extracurricular activities. To avoid charges of squelching student expression, school boards should make sure that policies limit censorship to legitimate…

Linear electro-optic effect in semiconductors: Ab initio description of the electronic contribution

NASA Astrophysics Data System (ADS)

Prussel, Lucie; Véniard, Valérie

2018-05-01

We propose an ab initio framework to derive the electronic part of the second-order susceptibility tensor for the electro-optic effect in bulk semiconductors. We find a general expression for χ(2 ) evaluated within time-dependent density-functional theory, including explicitly the band-gap corrections at the level of the scissors approximation. Excitonic effects are accounted for, on the basis of a simple scalar approximation. We apply our formalism to the computation of the electro-optic susceptibilities for several semiconductors, such as GaAs, GaN, and SiC. Taking into account the ionic contribution according to the Faust-Henry coefficient, we obtain a good agreement with experimental results. Finally, using different types of strain to break centrosymmetry, we show that high electro-optic coefficients can be obtained in bulk silicon for a large range of frequencies.

Effects of electronic and lattice polarization on the band structure of delafossite transparent conductive oxides.

PubMed

Vidal, Julien; Trani, Fabio; Bruneval, Fabien; Marques, Miguel A L; Botti, Silvana

2010-04-02

We use hybrid functionals and restricted self-consistent GW, state-of-the-art theoretical approaches for quasiparticle band structures, to study the electronic states of delafossite Cu(Al,In)O2, the first p-type and bipolar transparent conductive oxides. We show that a self-consistent GW approximation gives remarkably wider band gaps than all the other approaches used so far. Accounting for polaronic effects in the GW scheme we recover a very nice agreement with experiments. Furthermore, the modifications with respect to the Kohn-Sham bands are strongly k dependent, which makes questionable the common practice of using a scissor operator. Finally, our results support the view that the low energy structures found in optical experiments, and initially attributed to an indirect transition, are due to intrinsic defects in the samples.

Robotic single-site pelvic lymphadenectomy.

PubMed

Tateo, Saverio; Nozza, Arrigo; Del Pezzo, Chiara; Mereu, Liliana

2014-09-01

To examine the feasibility of performing pelvic lymphadenectomy with robotic single site approach. Recent papers described the feasibility of robotic-single site hysterectomy [1-3] for benign and malign pathologies but only with the development of new single site 5mm instruments as the bipolar forceps, robotic single site platform can be safely utilized also for lymphadenectomy. A 65 year-old, multiparous patient with a body mass index of 22.5 and diagnosed with well differentiated adenocarcinoma of the endometrium underwent a robotic single-site peritoneal washing, total hysterectomy, bilateral adnexectomy and pelvic lymphadenectomy. The procedure was performed using the da Vinci Si Surgical System (Intuitive Surgical, Sunnyvale, CA) through a single 2,5 cm umbilical incision, with a multi-channel system and two single site robotic 5mm instruments. A 3-dimensional, HD 8.5mm endoscope and a 5mm accessory instrument were also utilized. Type I lymphonodes dissection for external iliac and obturator regions was performed [4]. Total operative time was 210 min; incision, trocar placement and docking time occurring in 12 min. Total console time was 183 min, estimated blood loss was 50 ml, no intra-operative or post-operative complications occurred. Hospital discharge occurred on post operative day 2 and total number of lymphnodes removed was 33. Difficulties in term of instrument's clashing and awkward motions have been encountered. Robotic single-site pelvic lymphadenectomy using bipolar forceps and monopolar hook is feasible. New developments are needed to improve surgical ergonomics and additional studies should be performed to explore possible benefits of this procedure. Copyright © 2014 Elsevier Inc. All rights reserved.

21 CFR 876.5540 - Blood access device and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... is part of an artificial kidney system for the treatment of patients with renal failure or toxemic... dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor...

21 CFR 876.5540 - Blood access device and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... is part of an artificial kidney system for the treatment of patients with renal failure or toxemic... dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor...

21 CFR 876.5540 - Blood access device and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... is part of an artificial kidney system for the treatment of patients with renal failure or toxemic... dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor...

21 CFR 876.5540 - Blood access device and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... is part of an artificial kidney system for the treatment of patients with renal failure or toxemic... dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor...

21 CFR 876.5540 - Blood access device and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... is part of an artificial kidney system for the treatment of patients with renal failure or toxemic... dilator, disconnect forceps, shunt guard, crimp plier, tube plier, crimp ring, joint ring, fistula adaptor...

Comparison of outcomes between operative vaginal deliveries and spontaneous vaginal deliveries in southeast Nigeria.

PubMed

Lawani, Lucky O; Anozie, Okechukwu B; Ezeonu, Paul O; Iyoke, Chukwuemeka A

2014-06-01

To evaluate the incidence of, indications for, and outcome of operative vaginal deliveries compared with spontaneous vaginal deliveries in southeast Nigeria. A retrospective cohort study was conducted involving cases of operative vaginal delivery performed at Ebonyi State University Teaching Hospital over a 10-year period. Data on the procedures were abstracted from the operation notes of the medical records of parturients. An incidence of 4.7% (n = 461) was recorded. The most common indications for vacuum and forceps delivery were prolonged second stage of labor (44.9%) and poor maternal effort (27.8%). The only indication for destructive operation was intrauterine fetal death (3.7%). The risk ratio (RR) for hemorrhage/vulvar hematoma was 1.14 (95% confidence interval [CI], 0.53-2.48) for vacuum-assisted delivery and 5.49 (95% CI, 0.82-36.64) for forceps delivery. The RR for genital laceration was 1.21 (95% CI, 0.44-3.30) for vacuum-assisted delivery and 9.41 (95% CI, 1.33-66.65) for forceps delivery. The risk of fetal scalp bruises and caput succedaneum was higher for operative vaginal delivery than for spontaneous vaginal delivery, with no significant difference in maternal morbidity. The perinatal mortality rate was 0.9 per 1000 live births. Operative vaginal delivery by experienced healthcare providers is associated with good obstetric outcomes with minimal risk. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Retrieval of large Occlutech Figula Flex septal defect occluders using a commercially available bioptome: proof of concept.

PubMed

Georgiev, Stanimir; Tanase, Daniel; Genz, Thomas; Ewert, Peter; Naumann, Susanne; Pozza, Robert Dalla; Eicken, Andreas

2018-07-01

This study aimed to develop a method for retrieval of the new meshed nitinol atrial septal defect occluders - Ceraflex and Occlutech. The newly developed atrial septal defect occluders have potential benefits considering implantation, but concerns regarding their removal in case of embolisation have been raised. Over 21 years, 1449 patients underwent interventional atrial septal defect occlusion in our institution. We reviewed the cases of embolisation of the device, developed a strategy for device removal, and tested it on the benchside and in animal tests. In 11 patients (0.8%), the intended atrial septal defect occlusion was complicated by an embolisation of the device. In contrast to the Amplatzer septal occluders, retrieval of Occlutech devices larger than 16 mm with snare techniques was impossible. In benchside tests, this was confirmed and a new method for removal of large meshed devices was developed. This involved the commercially available Maslanka® biopsy forceps. The feasibility of this technique in vivo was tested in a pig model. During animal tests, using the Maslanka biopsy forceps it was possible to interventionally retrieve embolised Ceraflex and Occlutech devices of different sizes - 10, 16, 30, and 40 mm - into a 12-F sheath. It was impossible to retrieve Occlutech and Ceraflex devices larger than 16 mm into a large sheath in vivo and during benchside tests. However, this was feasible on the bench and in vivo using the Maslanka biopsy forceps even with the largest available devices.

Membrane Peeling-Induced Retinal Alterations on Intraoperative OCT in Vitreomacular Interface Disorders From the PIONEER Study.

PubMed

Ehlers, Justis P; Han, Jaehong; Petkovsek, Daniel; Kaiser, Peter K; Singh, Rishi P; Srivastava, Sunil K

2015-11-01

To assess retinal architectural alterations that occur following membrane peeling procedures and the impact of peel technique on these alterations utilizing intraoperative optical coherence tomography (iOCT). This is a subanalysis of the prospective PIONEER iOCT study of eyes undergoing a membrane peeling for a vitreomacular interface (VMI) disorder. Intraoperative scanning was performed with a microscope-mounted OCT system. Macroarchitectural alterations (e.g., full-thickness retinal elevations) and microarchitectural alterations (e.g., relative layer thickness alterations) were analyzed. Video/iOCT correlation was performed to identify instrument-tissue manipulations resulting in macroarchitectural alterations. One hundred sixty-three eyes were included in the macroarchitectural analysis. Instrumentation utilized for membrane peeling included forceps alone for 73 eyes (45%), combined diamond-dusted membrane scraper (DDMS) and forceps for 87 eyes (53%), and other techniques in three eyes (2%). Focal retinal elevations were identified in 45 of 163 eyes (28%). Video/iOCT correlation identified 69% of alterations involved forceps compared to 26% due to DDMS. Sixteen percent of retinal alterations persisted 1 month following surgery. The microarchitectural analysis included 134 eyes. Immediately following membrane peeling, there was a significant increase in the ellipsoid zone to retinal pigment epithelium height (+20%, P < 0.00001) and the cone outer segment tips to retinal pigment epithelium height (+18%, P < 0.00001). Significant subclinical retinal architectural changes occur during membrane peeling for VMI conditions. Differences in surgical instruments may impact these architectural alterations.

A Second Life for CDs

ERIC Educational Resources Information Center

Snoderly, Kathleen

2011-01-01

Cutting a few CDs apart with scissors, the author found that the process created somewhat brittle shards. As a result, she started to paint a few with acrylic, finding to her amazement that the paint gave the CDs a leathery, more manageable texture. Upon further experimentation, she found that if the CDs are painted somewhat translucently in…

SUBVERISON: Uruguayan Armed Forces Summary of Subversive Movement in Latin America. Part I

DTIC Science & Technology

1977-08-12

nication" ("Problemas y Perspectivas de la Comunicacion de Masas"), Buenos Aires, TROQUEL. 935 ARGENTINA. Leonard C. Lewin, "Undesirable Peace...and the Scissors. The Means of Social Communication in Argentina" ("La Red y La Tijera. Los Medios de Comunicacion Social en la Argentina

Losers in the 'Rock-Paper-Scissors' game: The role of non-hierarchical competition and chaos as biodiversity sustaining agents in aquatic systems

EPA Science Inventory

Processes occurring within small areas (patch-scale) that influence species richness and spatial heterogeneity of larger areas (landscape-scale) have long been an interest of ecologists. This research focused on the role of patch-scale deterministic chaos arising in phytoplankton...

Five Easy Principles to Make Math Moments Count

ERIC Educational Resources Information Center

Cutler, Carrie S.

2011-01-01

Preschool children are learning so many skills--how to cut with scissors, zip zippers, recognize the alphabet and their names, and share toys with others. A strong academic curriculum also requires that children learn more about math (National Council of Teachers of Mathematics [NCTM], 2000). By following the five easy principles outlined here,…

Volunteering leads to rock-paper-scissors dynamics in a public goods game

NASA Astrophysics Data System (ADS)

Semmann, Dirk; Krambeck, Hans-Jürgen; Milinski, Manfred

2003-09-01

Collective efforts are a trademark of both insect and human societies. They are achieved through relatedness in the former and unknown mechanisms in the latter. The problem of achieving cooperation among non-kin has been described as the `tragedy of the commons', prophesying the inescapable collapse of many human enterprises. In public goods experiments, initial cooperation usually drops quickly to almost zero. It can be maintained by the opportunity to punish defectors or the need to maintain good reputation. Both schemes require that defectors are identified. Theorists propose that a simple but effective mechanism operates under full anonymity. With optional participation in the public goods game, `loners' (players who do not join the group), defectors and cooperators will coexist through rock-paper-scissors dynamics. Here we show experimentally that volunteering generates these dynamics in public goods games and that manipulating initial conditions can produce each predicted direction. If, by manipulating displayed decisions, it is pretended that defectors have the highest frequency, loners soon become most frequent, as do cooperators after loners and defectors after cooperators. On average, cooperation is perpetuated at a substantial level.

Concurrent performance in a three-alternative choice situation: response allocation in a Rock/Paper/Scissors game.

PubMed

Kangas, Brian D; Berry, Meredith S; Cassidy, Rachel N; Dallery, Jesse; Vaidya, Manish; Hackenberg, Timothy D

2009-10-01

Adult human subjects engaged in a simulated Rock/Paper/Scissors game against a computer opponent. The computer opponent's responses were determined by programmed probabilities that differed across 10 blocks of 100 trials each. Response allocation in Experiment 1 was well described by a modified version of the generalized matching equation, with undermatching observed in all subjects. To assess the effects of instructions on response allocation, accurate probability-related information on how the computer was programmed to respond was provided to subjects in Experiment 2. Five of 6 subjects played the counter response of the computer's dominant programmed response near-exclusively (e.g., subjects played paper almost exclusively if the probability of rock was high), resulting in minor overmatching, and higher reinforcement rates relative to Experiment 1. On the whole, the study shows that the generalized matching law provides a good description of complex human choice in a gaming context, and illustrates a promising set of laboratory methods and analytic techniques that capture important features of human choice outside the laboratory.

Oscillatory dynamics in rock-paper-scissors games with mutations.

PubMed

Mobilia, Mauro

2010-05-07

We study the oscillatory dynamics in the generic three-species rock-paper-scissors games with mutations. In the mean-field limit, different behaviors are found: (a) for high mutation rate, there is a stable interior fixed point with coexistence of all species; (b) for low mutation rates, there is a region of the parameter space characterized by a limit cycle resulting from a Hopf bifurcation; (c) in the absence of mutations, there is a region where heteroclinic cycles yield oscillations of large amplitude (not robust against noise). After a discussion on the main properties of the mean-field dynamics, we investigate the stochastic version of the model within an individual-based formulation. Demographic fluctuations are therefore naturally accounted and their effects are studied using a diffusion theory complemented by numerical simulations. It is thus shown that persistent erratic oscillations (quasi-cycles) of large amplitude emerge from a noise-induced resonance phenomenon. We also analytically and numerically compute the average escape time necessary to reach a (quasi-)cycle on which the system oscillates at a given amplitude. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Social cycling and conditional responses in the Rock-Paper-Scissors game

PubMed Central

Wang, Zhijian; Xu, Bin; Zhou, Hai-Jun

2014-01-01

How humans make decisions in non-cooperative strategic interactions is a big question. For the fundamental Rock-Paper-Scissors (RPS) model game system, classic Nash equilibrium (NE) theory predicts that players randomize completely their action choices to avoid being exploited, while evolutionary game theory of bounded rationality in general predicts persistent cyclic motions, especially in finite populations. However as empirical studies have been relatively sparse, it is still a controversial issue as to which theoretical framework is more appropriate to describe decision-making of human subjects. Here we observe population-level persistent cyclic motions in a laboratory experiment of the discrete-time iterated RPS game under the traditional random pairwise-matching protocol. This collective behavior contradicts with the NE theory but is quantitatively explained, without any adjustable parameter, by a microscopic model of win-lose-tie conditional response. Theoretical calculations suggest that if all players adopt the same optimized conditional response strategy, their accumulated payoff will be much higher than the reference value of the NE mixed strategy. Our work demonstrates the feasibility of understanding human competition behaviors from the angle of non-equilibrium statistical physics. PMID:25060115

21 CFR 876.4300 - Endoscopic electrosurgical unit and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Endoscopic electrosurgical unit and accessories. (a) Identification. An endoscopic electrosurgical unit and... device includes the electrosurgical generator, patient plate, electric biopsy forceps, electrode, flexible snare, electrosurgical alarm system, electrosurgical power supply unit, electrical clamp, self...

Prevention of childbirth injuries to the pelvic floor.

PubMed

Heit, M; Mudd, K; Culligan, P

2001-08-01

The majority of childbirth injuries to the pelvic floor occur after the first vaginal delivery. Cesarean sections performed after the onset of labor may not protect the pelvic floor. Elective cesarean section is the only true primary prevention strategy for childbirth injuries to the pelvic floor. Alternative primary prevention strategies include elective cesarean section for women with nonmodifiable risks for childbirth injuries to the pelvic floor, antepartum pelvic floor exercises, or intrapartum pudendal nerve monitoring. Secondary prevention strategies must focus on modifying obstetric practices that predispose women to pelvic floor injury. These factors are best delineated for anal incontinence and include restrictive use of episiotomy, mediolateral episiotomy when necessary, spontaneous over forceps-assisted vaginal delivery, vacuum extraction over forceps delivery, and antepartum perineal massage. Finally, tertiary prevention strategies should address the mode of delivery made for women with childbirth injuries to the pelvic floor who desire future fertility.

INTRAOCULAR LENS SCAFFOLD TO PREVENT INTRAOCULAR FOREIGN BODY SLIPPAGE.

PubMed

Agarwal, Amar; Ashok Kumar, Dhivya; Agarwal, Athiya

2017-01-01

To report the application of intraocular lens (IOL) scaffold technique in intraocular foreign body (IOFB) removal. Patient with IOFB in posterior segment is included. The IOFB is retrieved from the posterior segment (pars plana vitrectomy and exteriorization of the IOFB from the retinal surface using an intravitreal forceps via the posterior capsulotomy) and placed on the iris. A three-piece posterior chamber IOL is placed in the sulcus via the clear corneal incision. IOFB is then removed from the anterior chamber over the IOL by forceps. Metallic IOFB of 4 mm × 3 mm has been retrieved by IOL scaffold technique after rescuing it from the posterior segment. There has been no drop or slip of IOFB in the vitreous during removal. Posterior chamber IOL served as scaffold during IOFB removal from anterior chamber. The IOL scaffold maneuver has shown to prevent slippage by acting as a barrier between the IOFB and the vitreous.

Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position.

PubMed

Hirsch, E; Elue, R; Wagner, A; Nelson, K; Silver, R K; Zhou, Y; Adams, M G

2014-12-01

To identify risk factors for severe (third/fourth degree) perineal laceration with operative vaginal delivery (OVD, forceps or vacuum). Case-control study comparing singleton OVDs with or without severe laceration (n=138). In multivariable analyses, severe perineal laceration was associated with occiput posterior (OP) position at delivery, vaginal nulliparity, use of forceps, longer period pushing in the second stage and lower gestational age, but not birth weight, labor induction or episiotomy. Among 29 OP patients at full dilation, 9/13 (69%) attempted rotations to occiput anterior (OA) were successful, and 14/16 (88%) patients in whom rotation was not attempted remained OP at delivery. Successful rotation from OP to OA was associated with fewer severe lacerations than no attempt or unsuccessful rotation (22 vs 75%, P=0.01). Severe perineal laceration during OVD is associated with OP position at delivery and is reduced threefold in patients successfully rotated from OP to OA.

[Intramedullary nailing in diaphyseal clavicle fractures using minimally invasive percutaneous reduction].

PubMed

Müller, M; Freude, T; Stöckle, U; Kraus, T M

2017-02-01

Closed reduction and intramedullary nailing is common in diaphyseal clavicle fractures. The aim of this report is to demonstrate a surgical method with minimally invasive percutaneous reduction in cases where closed reduction fails. The procedure is associated with good cosmetic results. Percutaneous reduction using two reduction forceps enables intramedullary nailing without an open procedure. Open, multifragmented or non-dislocated fractures, oblique fractures due to postoperative dislocation or shortening risk, fracture having potential to become compound fractures, neurovascular complications, pseudoarthroses. The patient is in beach-chair position. After an incision, the nail is entered from medial, two reduction forceps are mounted percutaneously at the lateral and medial fragment. After reduction the nail is pushed forward into the lateral fragment. Thereby, the fracture hematoma is not disturbed for the most part. Early functional rehabilitation with maximal abduction and anteversion of 90° for 6 weeks. Anatomic reduction can be achieved with mild cosmetic impairment.

White Matter Changes and Confrontation Naming in Retired Aging National Football League Athletes.

PubMed

Strain, Jeremy F; Didehbani, Nyaz; Spence, Jeffrey; Conover, Heather; Bartz, Elizabeth K; Mansinghani, Sethesh; Jeroudi, Myrtle K; Rao, Neena K; Fields, Lindy M; Kraut, Michael A; Cullum, C Munro; Hart, John; Womack, Kyle B

2017-01-15

Using diffusion tensor imaging (DTI), we assessed the relationship of white matter integrity and performance on the Boston Naming Test (BNT) in a group of retired professional football players and a control group. We examined correlations between fractional anisotropy (FA) and mean diffusivity (MD) with BNT T-scores in an unbiased voxelwise analysis processed with tract-based spatial statistics (TBSS). We also analyzed the DTI data by grouping voxels together as white matter tracts and testing each tract's association with BNT T-scores. Significant voxelwise correlations between FA and BNT performance were only seen in the retired football players (p < 0.02). Two tracts had mean FA values that significantly correlated with BNT performance: forceps minor and forceps major. White matter integrity is important for distributed cognitive processes, and disruption correlates with diminished performance in athletes exposed to concussive and subconcussive brain injuries, but not in controls without such exposure.

Single-Incision Laparoscopic Cholecystectomy after Endoscopic Nasogallbladder Drainage: A Case Report

PubMed Central

Igami, Tsuyoshi; Ebata, Tomoki; Yokoyama, Yukihiro; Sugawara, Gen; Mizuno, Takashi; Yamaguchi, Junpei; Nagino, Masato

2015-01-01

Objective To report a single-incision laparoscopic cholecystectomy (SILC) for a patient with cholecystitis that required endoscopic nasogallbladder drainage (ENGBD). Clinical Presentation and Intervention A 75-year-old man was diagnosed with moderate acute cholecystitis and underwent antiplatelet therapy for a history of brain infarction. An ENGBD was performed as an initial treatment for his cholecystitis. After recovery from the cholecystitis, a SILC was performed using a SILS Port with an additional forceps. Because neither Rouviere's sulcus nor Calot's triangle could be identified with a favorable laparoscopic view, the fundus-first procedure was selected. The patient's postoperative course was uneventful, and he was discharged from the hospital on day 3 after surgery. Conclusion In this case of a patient who had cholecystitis that required ENGBD, a SILC was successful performed using a combination of SILS Port with additional forceps and fundus-first procedure. PMID:26022235

Evolution and stability of altruist strategies in microbial games

NASA Astrophysics Data System (ADS)

Adami, Christoph; Schossau, Jory; Hintze, Arend

2012-01-01

When microbes compete for limited resources, they often engage in chemical warfare using bacterial toxins. This competition can be understood in terms of evolutionary game theory (EGT). We study the predictions of EGT for the bacterial “suicide bomber” game in terms of the phase portraits of population dynamics, for parameter combinations that cover all interesting games for two-players, and seven of the 38 possible phase portraits of the three-player game. We compare these predictions to simulations of these competitions in finite well-mixed populations, but also allowing for probabilistic rather than pure strategies, as well as Darwinian adaptation over tens of thousands of generations. We find that Darwinian evolution of probabilistic strategies stabilizes games of the rock-paper-scissors type that emerge for parameters describing realistic bacterial populations, and point to ways in which the population fixed point can be selected by changing those parameters.

A ferromagnetic surgical system reduces phrenic nerve injury in redo congenital cardiac surgery.

PubMed

Shinkawa, Takeshi; Holloway, Jessica; Tang, Xinyu; Gossett, Jeffrey M; Imamura, Michiaki

2017-05-01

A ferromagnetic surgical system (FMwand®) is a new type of dissection device expected to reduce the risk of adjacent tissue damage. We reviewed 426 congenital cardiac operations with cardiopulmonary bypass through redo sternotomy to assess if this device prevented phrenic nerve injury. The ferromagnetic surgical system was used in 203 operations (47.7%) with regular electrocautery and scissors. The preoperative and operative details were similar between the operations with or without the ferromagnetic surgical system. The incidence of phrenic nerve injury was significantly lower with the ferromagnetic surgical system (0% vs 2.7%, P = 0.031). A logistic regression model showed that the use of the ferromagnetic surgical system was significantly associated with reduced odds of phrenic nerve injury (P < 0.001). © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

A new video laryngo-pharyngoscope with shape-holding coiled tube and surgical forceps: a preliminary study.

PubMed

Tamura, Koichi; Kim, Masanobu; Abe, Koji; Toda, Naoki; Jinouchi, Osamu; Kalubi, Bukasa; Takeda, Noriaki

2009-12-01

We developed a new video laryngo-pharyngoscope with a shape-holding coiled tube and examined its effectiveness in some patients. The video laryngo-pharyngoscope is designed to inspect the pharynx and larynx transorally and to perform surgical manipulations. The scope consists of a coiled tube, a grip with trigger connected to the forceps and a CCD Camera with a battery. The stainless coiled tube of the scope is flexible but shape-holding, so that its shape can be changed by hand with the characteristic that the new orientation remains invariable during both inspection and operation in the pharynx and larynx. After a local anesthesia, the operator holds the scope in one hand and pulls the patient's tongue by the other hand. The operator then inserted the scope transorally while monitoring video images that were wirelessly transferred to the display to ensure that the forceps has reached the area of interest and treated lesions successfully. Using the scope, we successfully examined the upper airway lesions and removed foreign bodies from the pharynx and performed both resection of a benign tumor and taking a biopsy of a malignant tumor from the pharynx and larynx. But, we could hardly remove vocal fold polyps because of the structural limitation of the scope. We demonstrated that the new video laryngo-pharyngoscope can be used safely and successfully in the inspection and removal of lesions in the oropharynx and supraglottic area of the larynx and will be a useful tool for minimally invasive office-based surgery.

[Study on accuracy of endoscopic polyp size measurement by disposable graduated biopsy forceps].

PubMed

Liu, Ping; Zhang, Xiu; Lin, Hui-ping; Jin, Hei-jing; Leng, Qiang; Zhang, Jin-hao; Zhang, Yang; Yao, Hang; Wu, Kun-lan

2013-12-01

To study the accuracy of endoscopic polyp size measurement by disposable graduated biopsy forceps (DGBF). Accurate gradation of 1 mm was made in the wire of disposable graduated biopsy forceps, which was used to measure the size of tumors under endoscopy. Fifty-eight polyps from 43 patients underwent endoscopy in our department from May to June 2013 were enrolled. Size of polyp was measured and compared among DGBF, routine estimation and direct measurement after resection. The accuracy of polyp size measurement was investigated by four colonoscopists who had finished at least 2000 procedures of colonoscopy. The mean diameter of post-polypectomy measurement was (1.02±0.84) cm. Diameter was less than 1 cm in 36 polyps, 1 to 2 cm in 15, and over 2 cm in 7. The mean diameter of visual estimation was (1.29±1.07) cm, and the difference was significant as compared with actual size (P=0.000). The mean diameter measured by DGBF was (1.02±0.82) cm, and the difference was not significant as compared with actual size (P=0.775). The ratio of visual estimation to actual size was 1.29±0.31, and DGBF estimation to actual size was 1.02±0.11 with significant difference (P=0.000). The accurate rate of DGBF in estimating polyp size was 77.6% (45/58), which was obviously higher as compared to visual estimation [19.0% (11/58), P=0.000]. The accuracy of DGBF as a scale in the estimation of poly size increases as compared to visual estimation.

Successful endoscopic removal of a rare, large impacted pancreatic duct stone using grasping forceps: A case report with video.

PubMed

Liu, Qin; Wang, Yiping; Zeng, Hongze; Hu, Bing

2018-04-01

As a main complication of chronic pancreatitis (CP), pancreatic duct stones (PDSs) are often associated with ductal obstruction resulting in increasing intraductal and parenchymal pressure and long-lasting pain. There are many methods for removing PDSs. However, for large stones, it is technically difficult to remove them entirely by endoscopic retrograde cholangiopancreatography (ERCP). A 57-year-old man presented with a chief complaint of severe epigastric pain radiating to his back 3 or 4 times annually for 2 years. The abdominal computed tomography scan revealed dilation of the proximal pancreatic duct with an irregular high-density calcification shadow located at the head of the pancreas. A pancreatic stent was placed initially by ERCP to relieve epigastric pain and alleviate symptom. Repeated ERCP was subsequently performed 2 months later to extract the impacted large pancreatic stone. By using grasping forceps, the huge coralloid stone (272 × 0 mm) was successfully extracted in an en bloc manner. Then, a 7-French × 5 cm plastic pancreatic stent was placed for 2 weeks. The patient was free of any pancreatic pain during the 2-year follow-up. Generally, for large or impacted pancreatic stones, endoscopic removal is technically difficult to achieve. Pancreatic stenting can be an effective method of alleviating abdominal pain and facilitating subsequent endoscopic lithoextraction. Extraction of large stones with grasping forceps can be an alternative approach instead of extracorporeal shock wave lithotripsy or surgery when stones are impacted at the papilla's orifice and partially protruding into the duodenal lumen.

No Scissors Allowed

ERIC Educational Resources Information Center

Bates, Janet

2012-01-01

Once, in the author's continual quest for unique and varied art projects, she was inspired by a colorful Kleenex[R] box which was covered with faces in a variety of sizes, ages, shapes and colors. What a fun idea to have her class create their own portraits using only construction paper, glue and one's fingers. As she shared an examplar rip-art…

Paper, Scissors, Rock: Aspects of the Intertwined Histories of Pedagogy and Model-Making

ERIC Educational Resources Information Center

Insley, Jane

2017-01-01

Investigating the stories behind the makers of 3D models of crystals has proved unexpectedly unstraightforward. Drawing on actor-network theory (ANT), this article investigates the references behind a set of models of mineralogical crystals made of pasteboard held by National Museums Scotland (NMS), to uncover the history and tradition of such…

Compact, Low-Power, and High-Speed Graphene-Based Integrated Photonic Modulator Technology

DTIC Science & Technology

2017-11-02

which we want to transfer graphene, we cut the graphene-on- Copper foil into appropriate pieces using sharp razor blades or scissors. We then follow a...rinsed under running DI water for 5 minutes. Patterns on HSQ are then transferred to alumina in a Plasma-Therm ICP system using the recipe which was

The Use of Tools by Children with Hemophilia.

ERIC Educational Resources Information Center

Markova, I.; And Others

1984-01-01

Eight mothers with their 3.1- to 5.7-year-old hemophiliac children and eight control mothers with their nonhemophiliac children were videotaped while playing two games without tools and three additional games involving use of a knife, a pair of scissors, and a wooden hammer. Mothers of hemophiliac children did not correct their children when they…

Demonstration of the Principles of Restriction Endonuclease Cleavage Reactions Using Thermostable Bfl I from "Anoxybacillus Flavithermus"

ERIC Educational Resources Information Center

Sharma, Prince; D'Souza, David R.; Bhandari, Deepali; Parashar, Vijay; Capalash, Neena

2003-01-01

Restriction enzymes are basic tools in recombinant DNA technology. To shape the molecular biology experiments, the students must know how to work with these molecular scissors. Here, we describe an integrated set of experiments, introduced in the "Advances in Molecular Biology and Biotechnology" postgraduate course, which covers the important…

Rockin' around the Rock Cycle

ERIC Educational Resources Information Center

Frack, Susan; Blanchard, Scott Alan

2005-01-01

In this activity students will simulate how sedimentary rocks can be changed into metamorphic rocks by intense pressure. The materials needed are two small pieces of white bread, one piece of wheat bread, and one piece of a dark bread (such as pumpernickel or dark rye) per student, two pieces of waxed paper, scissors, a ruler, and heavy books.…

Microsurgical Versus Conventional Skin Closure in the Laboratory Rat (Rattus norvegicus)

DTIC Science & Technology

microscope using 6/0 monocryl. Wound strength was measured using a published method. A harvested incision was suspended with forceps and water was slowly...evaluated histologically using published methods to examine vascularization, fibroblast proliferation, inflammation and epithelialization. Results

A SHORT HISTORY CSISRS - AT THE CUTTING EDGE OF NUCLEAR DATA INFORMATION STORAGE AND RETRIEVAL SYSTEMS AND ITS RELATIONSHIP TO CINDA, EXFOR AND ENDF.

DOE Office of Scientific and Technical Information (OSTI.GOV)

HOLDEN, N.E.

A short history of CSISRS, pronounced ''scissors'' and standing for the Cross Section Information Storage and Retrieval System, is given. The relationship of CSISRS to CINDA, to the neutron nuclear data four-centers, to EXFOR and to ENDF, the evaluated neutron nuclear data file, is briefly explained.

Magnetic dipole excitations of 50Cr

NASA Astrophysics Data System (ADS)

Pai, H.; Beck, T.; Beller, J.; Beyer, R.; Bhike, M.; Derya, V.; Gayer, U.; Isaak, J.; Krishichayan, Kvasil, J.; Löher, B.; Nesterenko, V. O.; Pietralla, N.; Martínez-Pinedo, G.; Mertes, L.; Ponomarev, V. Yu.; Reinhard, P.-G.; Repko, A.; Ries, P. C.; Romig, C.; Savran, D.; Schwengner, R.; Tornow, W.; Werner, V.; Wilhelmy, J.; Zilges, A.; Zweidinger, M.

2016-01-01

The low-lying M 1 strength of the open-shell nucleus 50Cr has been studied with the method of nuclear resonance fluorescence up to 9.7 MeV using bremsstrahlung at the superconducting Darmstadt linear electron accelerator S-DALINAC and Compton backscattered photons at the High Intensity γ -ray Source (HI γ S ) facility between 6 and 9.7 MeV of the initial photon energy. Fifteen 1+ states have been observed between 3.6 and 9.7 MeV. Following our analysis the lowest 1+ state at 3.6 MeV can be considered as an isovector orbital mode with some spin admixture. The obtained results generally match the estimations and trends typical for the scissors-like mode. Detailed calculations within the Skyrme quasiparticle random-phase-approximation method and the large-scale shell model justify our conclusions. The calculated distributions of the orbital current for the lowest 1+-state suggest the schematic view of Lipparini and Stringari (isovector rotation-like oscillations inside the rigid surface) rather than the scissors-like picture of Lo Iudice and Palumbo. The spin M 1 resonance is shown to be mainly generated by spin-flip transitions between the orbitals of the f p shell.

Stochastic Evolution Dynamic of the Rock-Scissors-Paper Game Based on a Quasi Birth and Death Process

NASA Astrophysics Data System (ADS)

Yu, Qian; Fang, Debin; Zhang, Xiaoling; Jin, Chen; Ren, Qiyu

2016-06-01

Stochasticity plays an important role in the evolutionary dynamic of cyclic dominance within a finite population. To investigate the stochastic evolution process of the behaviour of bounded rational individuals, we model the Rock-Scissors-Paper (RSP) game as a finite, state dependent Quasi Birth and Death (QBD) process. We assume that bounded rational players can adjust their strategies by imitating the successful strategy according to the payoffs of the last round of the game, and then analyse the limiting distribution of the QBD process for the game stochastic evolutionary dynamic. The numerical experiments results are exhibited as pseudo colour ternary heat maps. Comparisons of these diagrams shows that the convergence property of long run equilibrium of the RSP game in populations depends on population size and the parameter of the payoff matrix and noise factor. The long run equilibrium is asymptotically stable, neutrally stable and unstable respectively according to the normalised parameters in the payoff matrix. Moreover, the results show that the distribution probability becomes more concentrated with a larger population size. This indicates that increasing the population size also increases the convergence speed of the stochastic evolution process while simultaneously reducing the influence of the noise factor.

Teaching: the Wave Mechanics of McLeods' Stringy Electron, Explicit Nucleons, and Through-the-Earth Projections of Constellations' Stick Figures

NASA Astrophysics Data System (ADS)

McLeod, Roger David; McLeod, David Matthew

2012-02-01

This shows how Hooke's law, for electron, proton and neutron, 2D and 3D, strings, builds electromagnetic string-waves, extending, and pleasing, Schr"odinger. These are composed of spirally linked, parallel, north-pole oriented, neutrino and antineutrino strings, stable by magnetic repulsions. Their Dumbo Proton is antineutrino-scissor cut, and compressed in the vicinity of a neutron star, where electrostatic marriage occurs with a neutrino-scissor cut, and compressed, electron, so a Mickey Neutron emerges. Strings predict: electron charge is - 1/3 e, Dumbo P is 25 % longer than Mickey N, and Hooke says relaxing springs fuel three, separate, non-eternal, inflations, after Big Bangs. Gravity is strings, longitudinally linked. Einstein says Herman Grid's black diagonals prove human vision reads its information from algebraically-signed electromagnetic field distributions, (diffraction) patterns, easily known by ray-tracing, not requiring difficult Spatial Fourier Transformation. High-schoolers understand its application to Wave Mechanics, agreeing that positive-numbered probabilities do not enter, to possibly displease God. Detected stick-figure forms of constellations: like Phoenix, Leo, Canis Major, and especially Orion, fool some observers into false beliefs in things like UFHumanoids, or Kokopelli, Pele and Pamola!

Six years follow-up of a penis replantation in a child.

PubMed

de Lagausie, Pascal; Jehanno, Pascal

2008-03-01

Total amputation of the penis is very rare in a child. This article presents a case of a traumatic penile amputation at the base of the perineum, with scissors, in a 4-year-old child. Six hours after the aggression, the penis was replanted. Three weeks after the intervention, except for skin necrosis, the results were excellent. Six years afterward, this child has done very well from pediatric, psychological, urological, and plastic surgery points of view. Sensibility and erections are present and normal. Longer follow-ups particularly during puberty are necessary. Total amputation of the penis is a very rare accident in a child. Partial lesions are more common, particularly during circumcision. As in adult cases, replantation of the penis in a child needs a clean section by scissors or a knife, a correct conservation of the penis (in ice but without direct contact), and a short period between the lesion and the surgical procedure. All these conditions explain that very few cases are reported in the literature. We present a case of amputation of the penis in a 4-year-old child, with good results 6 years afterward.

Traffic jams induce dynamical phase transition in spatial rock-paper-scissors game

NASA Astrophysics Data System (ADS)

Nagatani, Takashi; Ichinose, Genki; Tainaka, Kei-ichi

2018-02-01

Spatial and temporal behaviors of the rock-paper-scissors (RPS) game is key to understanding not only biodiversity but also a variety of cyclic systems. It has been demonstrated that, in the stochastic cellular automaton of RPS game, three species cannot survive on one-dimensional (1-d) lattice; only a single species survives. Previous studies have shown that three species are able to coexist if the migration of species is considered. However, their definitions of migration are the swapping of two species or the random walk of species, which rarely occurs in nature. Here, we investigate the effect of migration by using the 1-d lattice traffic model in which species can move rightward if the site ahead is empty. Computer simulations reveal that three species can survive at the same time within the wide range of parameter values. At low densities, all species can coexist. In contrast, the extinction of two species occurs if the density exceeds the critical limit of the jamming transition. This dynamical phase transition between the coexistence and single (non-coexistence) phase clearly separates due to the self-organized pattern: condensation and rarefaction in the stripe-pattern of three species.

Old scissors to industrial automation: the impact of technologic evolution on worker's health.

PubMed

Teodoroski, Rita de Cassia Clark; Koppe, Vanessa Mazzocchi; Merino, Eugênio Andrés Díaz

2012-01-01

To cut a fabric, the professional performs different jobs and among them stands out the cut. The scissors has been the instrument most used for this activity. Over the years, technology has been conquering its space in the textile industry. However, despite the industrial automation able to offer subsidies to answer employment market demands, without appropriate orientation, the worker is exposed to the risks inherent at the job. Ergonomics is a science that search to promote the comfort and well being in consonance with efficacy. Its goals are properly well defined and clearly guide the actions aimed at transforming the working conditions. This study aimed to analyze the activity of cut tissues with a machine by a seamstress and the implications on their body posture. The methodology used was the observation technique and application of the Protocol RULA, where the result obtained was the level 3 and score 5, confirming that "investigations and changes are required soon". Conclude that using the machine to tissue cut should be encouraged, but in conjunction with orientations for improving posture while handling it. It seeks to prevent dysfunction of the musculoskeletal system that prevents employees from performing their work tasks efficiently and productively.

An experimental investigation of evolutionary dynamics in the Rock-Paper-Scissors game.

PubMed

Hoffman, Moshe; Suetens, Sigrid; Gneezy, Uri; Nowak, Martin A

2015-03-06

Game theory describes social behaviors in humans and other biological organisms. By far, the most powerful tool available to game theorists is the concept of a Nash Equilibrium (NE), which is motivated by perfect rationality. NE specifies a strategy for everyone, such that no one would benefit by deviating unilaterally from his/her strategy. Another powerful tool available to game theorists are evolutionary dynamics (ED). Motivated by evolutionary and learning processes, ED specify changes in strategies over time in a population, such that more successful strategies typically become more frequent. A simple game that illustrates interesting ED is the generalized Rock-Paper-Scissors (RPS) game. The RPS game extends the children's game to situations where winning or losing can matter more or less relative to tying. Here we investigate experimentally three RPS games, where the NE is always to randomize with equal probability, but the evolutionary stability of this strategy changes. Consistent with the prediction of ED we find that aggregate behavior is far away from NE when it is evolutionarily unstable. Our findings add to the growing literature that demonstrates the predictive validity of ED in large-scale incentivized laboratory experiments with human subjects.

Stochastic Evolution Dynamic of the Rock-Scissors-Paper Game Based on a Quasi Birth and Death Process.

PubMed

Yu, Qian; Fang, Debin; Zhang, Xiaoling; Jin, Chen; Ren, Qiyu

2016-06-27

Stochasticity plays an important role in the evolutionary dynamic of cyclic dominance within a finite population. To investigate the stochastic evolution process of the behaviour of bounded rational individuals, we model the Rock-Scissors-Paper (RSP) game as a finite, state dependent Quasi Birth and Death (QBD) process. We assume that bounded rational players can adjust their strategies by imitating the successful strategy according to the payoffs of the last round of the game, and then analyse the limiting distribution of the QBD process for the game stochastic evolutionary dynamic. The numerical experiments results are exhibited as pseudo colour ternary heat maps. Comparisons of these diagrams shows that the convergence property of long run equilibrium of the RSP game in populations depends on population size and the parameter of the payoff matrix and noise factor. The long run equilibrium is asymptotically stable, neutrally stable and unstable respectively according to the normalised parameters in the payoff matrix. Moreover, the results show that the distribution probability becomes more concentrated with a larger population size. This indicates that increasing the population size also increases the convergence speed of the stochastic evolution process while simultaneously reducing the influence of the noise factor.

(CaO)nIrO2 (n = 1, 2, 4) family: Chemical scissors effects of CaO on structural characteristics correlated to physical properties. Ab initio study

NASA Astrophysics Data System (ADS)

Matar, Samir F.; Etourneau, Jean

2017-11-01

Based on crystal chemistry analysis within Ca-Ir-O ternary, the generic (CaO)nIrO2 formula leading to CaIrO3 for n = 1, Ca2IrO4 for n = 2 and Ca4IrO6 for n = 4 actual chemical compounds show significant structural changes regarding the spatial arrangement of IrO6 octahedra whereby increasing amounts of CaO act as 'chemical scissor' decreasing the dimensionality of stacking octahedra from 3D (IrO2) to 0D (Ca4IrO6). This is accompanied by changes in the electronic structure investigated within density functional theory. Such changes are particularly exhibited by linear increase of Ir density of states at the Fermi level revealing increasing localization of d states with crystal field effects. Eventually only for Ca4IrO6 a magnetic instability occurs in non magnetic configuration. Spin polarized calculations lead to development of small magnitude but finite magnetization on Ir with M 0.50 μB totally polarized along minority spin channel ↓.

Corrosion protection of reusable surgical instruments.

PubMed

Shah, Sadiq; Bernardo, Mildred

2002-01-01

To understand the corrosion properties of surgical scissors, 416 stainless steel disks and custom electrodes were used as simulated surfaces under various conditions. These simulated surfaces were exposed to tap water and 400-ppm synthetic hard water as Ca2CO3 under different conditions. The samples were evaluated by various techniques for corrosion potential and the impact of environmental conditions on the integrity of the passive film. The electrodes were used to monitor the corrosion behavior by potentiodynamic polarization technique in water both in the presence and absence of a cleaning product. The surface topography of the 416 stainless steel disks was characterized by visual observations and scanning electron microscopy (SEM), and the surface chemistry of the passive film on the surface of the scissors was characterized by x-ray photoelectron spectroscopy (XPS). The results suggest that surgical instruments made from 416 stainless steel are not susceptible to uniform corrosion; however, they do undergo localized corrosion. The use of suitable cleaning products can offer protection against localized corrosion during the cleaning step. More importantly, the use of potentiodynamic polarization techniques allowed for a quick and convenient approach to evaluate the corrosion properties of surgical instruments under a variety of simulated-use environmental conditions.

Effect of hand hygiene and glove use on cleanliness of reusable surgical instruments.

PubMed

Costa, D M; Lopes, L K O; Tipple, A F V; Castillo, R B; Hu, H; Deva, A K; Vickery, K

2017-12-01

During functionality testing and packaging of reusable surgical instruments (RSI) for sterilization, instruments are frequently touched. There is a lack of standards relating to hand hygiene frequency and use of gloves in the sterilizing service unit packing area. To determine the effect of hand hygiene and glove use on maintenance of RSI cleanliness. Following manual and automated cleaning, Halsted-mosquito forceps were assessed for adenosine triphosphate (ATP), protein and microbial contamination after handling with gloved and ungloved but washed hands using an ATP surface swab test, bicinchoninic acid assay, and standard culture plate/broth, respectively. Gram's stain was used to classify the isolates. RSI contamination was assessed immediately following and 1, 2, and 4 h after washing hands. Packing instruments with hands that had been unwashed for 2 or 4 h resulted in a significant increase in contaminating ATP when compared with all other treatment groups (P < 0.05). There was a significant correlation between the time since washing hands, the amount of ATP (r = 0.93; P ≤ 0.001), and the microbial load (r = 0.83; P ≤ 0.001) contaminating the forceps, where the longer the time the hands remained unwashed the higher the contamination. Significantly more contaminating protein was found on forceps handled with ungloved hands that had not been washed for 2 or 4 h (P < 0.001). Critical RSI inspection, assembling, lubricating and packing should be performed using either gloves or within 1 h of washing hands. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Pelvic Floor Disorders After Childbirth: Effect of Episiotomy, Perineal Laceration, and Operative Birth

PubMed Central

Handa, Victoria L.; Blomquist, Joan L.; McDermott, Kelly C.; Friedman, Sarah; Muñoz, Alvaro

2011-01-01

Objective To investigate whether episiotomy, perineal laceration, and operative delivery are associated with pelvic floor disorders after vaginal childbirth. Methods This is a planned analysis of data for a cohort study of pelvic floor disorders. Participants who had experienced at least one vaginal birth were recruited 5–10 years after delivery of their first child. Obstetric exposures were classified by review of hospital records. At enrollment, pelvic floor outcomes, including stress incontinence, overactive bladder, anal incontinence, and prolapse symptoms were assessed with a validated questionnaire. Pelvic organ support was assessed using the Pelvic Organ Prolapse Quantification system. Logistic regression analysis was used to estimate the relative odds of each pelvic floor disorder by obstetric history, adjusting for relevant confounders. Results Of 449 participants, 71 (16%) had stress incontinence, 45 (10%) had overactive bladder, 56 (12%) had anal incontinence, 19 (4%) had prolapse symptoms and 64 (14%) had prolapse to or beyond the hymen on examination. Forceps delivery increased the odds of each pelvic floor disorder considered, especially overactive bladder (odds ratio 2.92, 95% confidence interval 1.44, 5.93) and prolapse (odds ratio 1.95, 95% confidence interval 1.03, 3.70). Episiotomy was not associated with any of these pelvic floor disorders. In contrast, women with a history of more than one spontaneous perineal laceration were significantly more likely to have prolapse to or beyond the hymen (odds ratio 2.34, 95% confidence interval 1.13, 4.86). Our multivariable results suggest that one additional woman would develop prolapse for every 8 women who experienced at least one forceps birth (versus delivering all her children by spontaneous vaginal birth). Conclusion Forceps deliveries and perineal lacerations, but not episiotomies, were associated with pelvic floor disorders 5–10 years after a first delivery. PMID:22227639

Comparison of efficacy, safety, and cost-effectiveness of in-office cup forcep biopsies versus operating room biopsies for laryngopharyngeal tumors.

PubMed

Naidu, Harini; Noordzij, J Pieter; Samim, Arang; Jalisi, Scharukh; Grillone, Gregory A

2012-09-01

To compare the diagnostic yield, safety, and cost of biopsies of laryngopharyngeal tumor performed in an office setting with those performed in the operating room (OR) under general anesthesia. This was a retrospective review of patients' records at Boston Medical Center from 2006 to 2008. In-office biopsies were performed using flexible digital videolaryngoscopy with cup forcep biopsies taken via the working channel in patients in whom cancer was strongly suspected. Patients whose in-office biopsies were nondiagnostic or suspected to be falsely negative were taken to the OR for biopsy under general anesthesia and served as the control group. Twelve patients fit the selection criteria and had in-office biopsies attempted. One patient could not tolerate the in-office biopsy. Seven of the 11 in-office biopsies performed were diagnostic for squamous cell carcinoma. The average cost (facility and professional otolaryngology charges) for an in-office biopsy was $2053.91. Five of these patients required further biopsy in the OR at an average cost (charges for surgeon, OR, anesthesia, and recovery room) of $9024.47. There were no significant complications reported for any of the procedures. In patients with strongly suspected laryngopharyngeal cancer, in-office cup forcep biopsies were 64% diagnostic. When compared with the OR, in-office cup biopsies of laryngopharyngeal tumor are safe and considerably more cost-effective. Although 36% of patients required operative biopsies, the cost would have been considerably higher in this cohort if all patients had gone to the OR for biopsies. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Operative vaginal delivery and invasive procedures in pregnancy among women living with HIV.

PubMed

Peters, Helen; Francis, Kate; Harding, Kate; Tookey, Pat A; Thorne, Claire

2017-03-01

To describe the use and outcomes of operative delivery and invasive procedures in pregnancy amongst women living with HIV. The National Study of HIV in Pregnancy and Childhood (NSHPC) is a comprehensive population-based surveillance study in the UK and Ireland. The NSHPC has collected data on operative delivery since 2008, and invasive procedures in pregnancy (amniocentesis, cordocentesis, chorionic villus sampling) from 2012. Descriptive analyses were conducted on 278 pregnancies expected to deliver from 1 January 2008 with outcome reported to the NSHPC by 31 March 2016. Among 9372 pregnancies in 2008-2016, there were 9072 livebirths with 251 operative deliveries and 27 invasive procedures in pregnancy reported. Information was available for 3023/3490 vaginal deliveries, and use of forceps or vacuum reported in 251deliveries (8.2%), increasing over calendar time to almost 10% by 2014-16. Forceps were used twice as often as vacuum delivery, and forceps use increased over time. One infant delivered operatively is known to have acquired HIV. From 2012 there were 4063 pregnancies resulting in 3952 livebirths, 83 terminations and 28 stillbirths. 2163/4063 had information on use (or not) of invasive procedures in pregnancy. Amniocentesis was reported in 25/2163 pregnancies, there was one report of chorionic villus sampling and one of cordocentesis. There were no reported transmissions following invasive procedures in pregnancy. This is the largest study to date to report on operative delivery in women living with HIV on combined antiretroviral therapy (cART), and provides an up-to-date picture of invasive procedures during pregnancy in this group. Findings from this comprehensive national study are reassuring but numbers are currently low; on-going monitoring is crucial as obstetric care of women with HIV becomes normalised. Copyright © 2017 Elsevier B.V. All rights reserved.

[Surgical excision and botulinum toxin A injection for vocal process granuloma].

PubMed

Ma, Lijing; Xiao, Yang; Ye, Jingying; Yang, Qingwen; Wang, Jun

2015-01-01

To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma. 28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes. All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%. Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.

Kinematics of Faulting and Structural Evolution of Neogene Supra-detachment Basins on the Menderes Metamorphic Core Complex, Western Anatolia

NASA Astrophysics Data System (ADS)

Dilek, Y.; Oner, Z.; Davis, E. A.

2007-12-01

The Menderes metamorphic massif (MM) in western Anatolia is a classic core complex with exhumed high-grade crustal rocks intruded by granodioritic plutons and overlain by syn-extensional sedimentary rocks. Timing and the mechanism(s) of the initial exhumation of the MM are controversial, and different hypotheses exist in the literature. Major structural grabens (i.e. Alasehir, Buyuk Menderes) within the MM that are bounded by high-angle and seismically active faults are late-stage brittle structures, which characterize the block-faulting phase in the extensional history of the core complex and are filled with Quaternary sediments. On the southern shoulder of the Alasehir graben high-grade metamorphic rocks of the MM are overlain by the Miocene and younger sedimentary rocks above a N-dipping detachment surface. The nearly 100-m-thick cataclastic shear zone beneath this surface contain S-C fabrics, microfaults, Riedel shears, mica-fish structures and shear bands, all consistently indicating top-to-the North shearing. Granodioritic plutons crosscutting the MM and the detachment surface are exposed within this cataclastic zone, displaying extensional ductile and brittle structures. The oldest sedimentary rocks onlapping the cataclastic shear zone of the MM here are the Middle Miocene lacustrine shale and limestone units, unconformably overlain by the Upper Miocene fluvial and alluvial fan deposits. Extensive development of these alluvial fan deposits by the Late Miocene indicates the onset of range-front faulting in the MM by this time, causing a surge of coarse clastic deposition along the northern edge of the core complex. The continued exhumation and uplift of the MM provided the necessary relief and detrital material for the Plio-Pleistocene fluvial systems in the Alasehir supradetachment basin (ASDB). A combination of rotational normal faulting and scissor faulting in the extending ASDB affected the depositional patterns and drainage systems, and produced local unconformities within the basinal stratigraphy. High-angle, oblique-slip scissor faults crosscutting the MM rocks, the detachment surface and the basinal strata offset them for more than few 100 meters and the fault blocks locally show different structural architecture and metamorphic grades, suggesting differential uplift along these scissor faults. This fault kinematics and the distribution of range-parallel and range-perpendicular faults strongly controlled the shape and depth of the accommodation space within the ASDB. At a more regional scale scissor faulting across the MM seems to have controlled the foci of Plio-Pleistocene point-source volcanism in the Aegean extensional province (e.g. Kula area). There are no major interruptions in the syn-extensional depositional history of the ASDB, ruling out the pulsed-extension models suggesting a period of contractional deformation in the late Cenozoic evolution of the MM. The onset of exhumation and extensional tectonics in the MM and western Anatolia was a result of thermal weakening of the orogenic crust, following a widespread episode of post-collisional magmatism in the broader Aegean region during the Eocene through Miocene.

Safe Tissue Manipulation in Retinal Microsurgery via Motorized Instruments with Force Sensing.

PubMed

Gonenc, Berk; Gehlbach, Peter; Taylor, Russell H; Iordachita, Iulian

2017-01-01

Retinal microsurgery involves careful manipulation of delicate tissues by applying very small amount of forces most of which lie below the tactile sensory threshold of the surgeons. Membrane peeling is a common task in this domain, where application of excessive peeling forces can easily lead to serious complications, hence needs to be avoided. To quantify tool-tissue interaction forces during retinal microsurgery, various force-sensing tools were developed based on fiber Bragg grating sensors, yet the most beneficial way of using the acquired force information is currently unknown. In this study, using a motorized force-sensing micro-forceps tool, we develop an assistive method that enhances safety during membrane peeling by automatically opening the forceps and releasing the tissue based on the detected peeling forces. Through peeling experiments using bandages, we demonstrate that our method can effectively maintain the peeling force at a safe level even in case of non-homogeneous adhesion properties of the membrane.

Air Saturation Dive 4 - 8 February 1980, CEDD Test Number 1-80.

DTIC Science & Technology

1980-09-01

heart rate. Blood pressure measurements will be recorded. A finger-prick blood sample will be required from each subject for microhematocrit...manoeuvres on command from the surface. Termination Criteria. With the exception of the finger-prick blood sample for microhematocrit determination, all...each experimental period. 3. Scissors, alligator clips - 4 clips/subject. 4. Metric steel tape measure. 5. Impedance cardiography connecting cables - I

Treatment of Neuropathic Pain after SCI with a Catalytic Oxidoreductant

DTIC Science & Technology

2015-10-01

opening the scissor. The thoracic aorta was visualized and a small aneurysm clip was placed on the aorta at the level of T8 to induce ischemic injury...into aorta via left ventricle and a small cut was made on right atrium. The vasculature was 6 | P a g e     briefly rinsed with 60 mL saline by

Hair cuttime on ISS

NASA Image and Video Library

2015-03-22

Caption: ISS043E044174 (03/22/2015) --- Its haircut time onboard the International Space Station as Expedition 43 Commander and NASA astronaut Terry Virts handles the scissors while ESA (European Space Agency) astronaut Samantha Cristoforetti holds the vacuum to immediately pull the fine hair strands into the safe container so they don't float away into the station. Hair trims are a regular occurrence during an astronaut's six month tour.

Pile et Face: Avec du papier, des images, de la colle...et des ciseaux (Heads and Tails: With Paper, Pictures, Glue...and Scissors).

ERIC Educational Resources Information Center

Vever, Daniel

1991-01-01

A kit using the concept of puzzles as a focus for developing self-correcting instructional materials for French language teaching is described. The kit, designed for teachers and including 47 ideas organized by theme, contains matrices and cards for a variety of exercises at various levels and suggestions for their use. (MSE)

Optimization of Quantitative Proteomics Using 2-Dimensional Difference Gel Electrophoresis to Characterize Molecular Mechanisms of Chemical Warfare Nerve Agent Exposure in the Rat Brain

DTIC Science & Technology

2010-11-01

minced finely with scissors, and transferred to a pre-cooled hand-held glass dounce homogenizer. The pestle was passed through the dounce until the...Nakajima, Sarin experiences in Japan : acute toxicity and long-term effects. Journal of the Neurological Sciences, 2006. 249(1): p. 76-85. 9. Shih, T.-M

76 FR 58038 - Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian Affairs...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... iron handle, 1 iron handle fragment, 1 iron bowl fragment, 2 iron keys, 1 iron hinge, 1 iron gun hammer, 2 iron gun pieces, 1 fish hook, 12 nails, 1 iron ring, 1 coffee mill, 1 possible iron file, 1 large iron tack, 4 iron rods, 3 unidentified iron fragments, 1 metal tube, 1 scissors fragment, 1 finial...

Buns, Scissors and Strawberry Laces--A Model of Science Education?

ERIC Educational Resources Information Center

Walsh, Ed; Edwards, Rebecca

2009-01-01

Models are included in the science National Curriculum because modelling is a key tool for scientists and an integral part of how science works. Modelling is explicitly referred to in the Programmes of Study for Science at Key Stage 3 and 4 (age 11-16) and in Assessing Pupil's Progress (APP). Pupils need to learn how to use models because they are…

Intraocular foreign-body hazard during vitrectomy.

PubMed

Bovino, J A; Marcus, D F

1982-03-01

We noted two instances of forceps-induced fragmentation of the bar used for scleral plug storage during vitreous surgery. The silicone bar material was adherent to the plug in both cases. Because this represents a significant intraocular foreign body hazard, the scleral plug should be carefully inspected before insertion.

Dynamics of prebiotic RNA reproduction illuminated by chemical game theory

PubMed Central

Yeates, Jessica A. M.; Hilbe, Christian; Zwick, Martin; Nowak, Martin A.; Lehman, Niles

2016-01-01

Many origins-of-life scenarios depict a situation in which there are common and potentially scarce resources needed by molecules that compete for survival and reproduction. The dynamics of RNA assembly in a complex mixture of sequences is a frequency-dependent process and mimics such scenarios. By synthesizing Azoarcus ribozyme genotypes that differ in their single-nucleotide interactions with other genotypes, we can create molecules that interact among each other to reproduce. Pairwise interplays between RNAs involve both cooperation and selfishness, quantifiable in a 2 × 2 payoff matrix. We show that a simple model of differential equations based on chemical kinetics accurately predicts the outcomes of these molecular competitions using simple rate inputs into these matrices. In some cases, we find that mixtures of different RNAs reproduce much better than each RNA type alone, reflecting a molecular form of reciprocal cooperation. We also demonstrate that three RNA genotypes can stably coexist in a rock–paper–scissors analog. Our experiments suggest a new type of evolutionary game dynamics, called prelife game dynamics or chemical game dynamics. These operate without template-directed replication, illustrating how small networks of RNAs could have developed and evolved in an RNA world. PMID:27091972

Dynamics of prebiotic RNA reproduction illuminated by chemical game theory.

PubMed

Yeates, Jessica A M; Hilbe, Christian; Zwick, Martin; Nowak, Martin A; Lehman, Niles

2016-05-03

Many origins-of-life scenarios depict a situation in which there are common and potentially scarce resources needed by molecules that compete for survival and reproduction. The dynamics of RNA assembly in a complex mixture of sequences is a frequency-dependent process and mimics such scenarios. By synthesizing Azoarcus ribozyme genotypes that differ in their single-nucleotide interactions with other genotypes, we can create molecules that interact among each other to reproduce. Pairwise interplays between RNAs involve both cooperation and selfishness, quantifiable in a 2 × 2 payoff matrix. We show that a simple model of differential equations based on chemical kinetics accurately predicts the outcomes of these molecular competitions using simple rate inputs into these matrices. In some cases, we find that mixtures of different RNAs reproduce much better than each RNA type alone, reflecting a molecular form of reciprocal cooperation. We also demonstrate that three RNA genotypes can stably coexist in a rock-paper-scissors analog. Our experiments suggest a new type of evolutionary game dynamics, called prelife game dynamics or chemical game dynamics. These operate without template-directed replication, illustrating how small networks of RNAs could have developed and evolved in an RNA world.

THE EVOLUTION OF RESTRAINT IN BACTERIAL BIOFILMS UNDER NONTRANSITIVE COMPETITION

PubMed Central

Prado, Federico; Kerr, Benjamin

2009-01-01

Theoretical and empirical evidence indicates that competing species can coexist if dispersal, migration, and competitive interactions occur over relatively small spatial scales. In particular, spatial structure appears to be critical to certain communities with nontransitive competition. A typical nontransitive system involves three competing species that satisfy a relationship similar to the children’s game of rock–paper–scissors. Although the ecological dynamics of nontransitive systems in spatially structured communities have received some attention, fewer studies have incorporated evolutionary change. Here we investigate evolution within toxic bacterial biofilms using an agent-based simulation that represents a nontransitive community containing three populations of Escherichia coli. In structured, nontransitive communities, strains evolve that do not maximize their competitive ability: They do not reduce their probability of death to a minimum or increase their toxicity to a maximum. That is, types evolve that exercise restraint. We show that nontransitivity and spatial structure (in the form of localized interactions) are both necessary for the evolution of restraint in these biofilms. PMID:18039324

The evolution of restraint in bacterial biofilms under nontransitive competition.

PubMed

Prado, Federico; Kerr, Benjamin

2008-03-01

Theoretical and empirical evidence indicates that competing species can coexist if dispersal, migration, and competitive interactions occur over relatively small spatial scales. In particular, spatial structure appears to be critical to certain communities with nontransitive competition. A typical nontransitive system involves three competing species that satisfy a relationship similar to the children's game of rock-paper-scissors. Although the ecological dynamics of nontransitive systems in spatially structured communities have received some attention, fewer studies have incorporated evolutionary change. Here we investigate evolution within toxic bacterial biofilms using an agent-based simulation that represents a nontransitive community containing three populations of Escherichia coli. In structured, nontransitive communities, strains evolve that do not maximize their competitive ability: They do not reduce their probability of death to a minimum or increase their toxicity to a maximum. That is, types evolve that exercise restraint. We show that nontransitivity and spatial structure (in the form of localized interactions) are both necessary for the evolution of restraint in these biofilms.

Phase diagrams for the spatial public goods game with pool punishment

NASA Astrophysics Data System (ADS)

Szolnoki, Attila; Szabó, György; Perc, Matjaž

2011-03-01

The efficiency of institutionalized punishment is studied by evaluating the stationary states in the spatial public goods game comprising unconditional defectors, cooperators, and cooperating pool punishers as the three competing strategies. Fines and costs of pool punishment are considered as the two main parameters determining the stationary distributions of strategies on the square lattice. Each player collects a payoff from five five-person public goods games, and the evolution of strategies is subsequently governed by imitation based on pairwise comparisons at a low level of noise. The impact of pool punishment on the evolution of cooperation in structured populations is significantly different from that reported previously for peer punishment. Representative phase diagrams reveal remarkably rich behavior, depending also on the value of the synergy factor that characterizes the efficiency of investments payed into the common pool. Besides traditional single- and two-strategy stationary states, a rock-paper-scissors type of cyclic dominance can emerge in strikingly different ways.

76 FR 53324 - Airworthiness Directives; Agusta S.p.A. Model A109A, A109A II, A109C, and A109K2 Helicopters

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... Airworthiness Directives; Agusta S.p.A. Model A109A, A109A II, A109C, and A109K2 Helicopters AGENCY: Federal... helicopters. That EAD currently requires inspecting the main rotor scissor fitting assembly to determine if... helicopter. DATES: Effective September 12, 2011. The incorporation by reference of certain publications...

Use of graph algorithms in the processing and analysis of images with focus on the biomedical data.

PubMed

Zdimalova, M; Roznovjak, R; Weismann, P; El Falougy, H; Kubikova, E

2017-01-01

Image segmentation is a known problem in the field of image processing. A great number of methods based on different approaches to this issue was created. One of these approaches utilizes the findings of the graph theory. Our work focuses on segmentation using shortest paths in a graph. Specifically, we deal with methods of "Intelligent Scissors," which use Dijkstra's algorithm to find the shortest paths. We created a new software in Microsoft Visual Studio 2013 integrated development environment Visual C++ in the language C++/CLI. We created a format application with a graphical users development environment for system Windows, with using the platform .Net (version 4.5). The program was used for handling and processing the original medical data. The major disadvantage of the method of "Intelligent Scissors" is the computational time length of Dijkstra's algorithm. However, after the implementation of a more efficient priority queue, this problem could be alleviated. The main advantage of this method we see in training that enables to adapt to a particular kind of edge, which we need to segment. The user involvement has a significant influence on the process of segmentation, which enormously aids to achieve high-quality results (Fig. 7, Ref. 13).

For AAPT: Teaching the Wave Mechanics of McLeods' Stringy Electron, Explicit Nucleons, and Through-the-Earth Projections of Constellations' Stick Figures

NASA Astrophysics Data System (ADS)

McLeod, David Matthew

2011-11-01

McLeods' NEF11#22 submission is from their same-title INVITED presentation at Frontiers in Optics 2011, San Jose, CA. It shows how Hooke's law for electron, proton and neutron strings build electromagnetic waves from strings. These are composed of spirally linked, parallel, north-pole oriented, neutrino and antineutrino strings, stable because of magnetic repulsions. Their Dumbo Proton is antineutrino-scissor cut, and compressed in the vicinity of a neutron star, where electrostatic marriage occurs with a neutrino-scissor cut, and compressed, electron, so a Mickey Neutron emerges. Strings then predict electron charge is -- 1/3 e, Dumbo P is 25 % longer than Mickey N, and Hooke says relaxing springs fuel three separate inflations after each Big Bang oscillation. Gravity can be strings longitudinally linked. Einstein says Herman Grid's black diagonals prove human vision reads its information from algebraically-signed electromagnetic field diffraction patterns known by ray-tracing, not difficult Spatial Fourier Transformation. High-schoolers understand its application to Wave Mechanics, and agree that positive-numbered probabilities do not enter to possibly displease God. Stick figure constellations detected, like Phoenix, Leo, Canis Major, and especially Orion, fool some observers into false beliefs in things like UFHumanoids, or Kokopelli, Pele and Pamola!

Acute optic nerve sheath fenestration in humans using the free electron laser (FEL): a case report

NASA Astrophysics Data System (ADS)

Joos, Karen M.; Mawn, Louise A.; Shen, Jin-Hui; Jansen, E. Duco; Casagrande, Vivien A.

2002-06-01

Our previous studies using rabbits and monkeys showed that the Amide II wavelength (6.45 micrometers ) produced by the FEL could efficiently produce an optic nerve sheath fenestration with minimal damage. In order to determine if the technology safely could be applied to human surgery, we used 2 blind human eyes during enucleation to compare the results of producing fenestrations with the FEL or a scissors. FDA and Vanderbilt IRB approvals, and individual patient consents were obtained. The FEL energy was transmitted to a human operating room. After disinsertion of the medial rectus muscle, an optic nerve sheath fenestration (2 mm diameter) was made with either the FEL (6.45 micrometers , 325 micrometers spot size, 30 Hz, 3 mJ) through a hollow waveguide surgical probe or with a scissors. The enucleation was then completed. The optic nerve was dissected from the globe and fixed. Specimens were examined histologically. Dural incisions were effective with both methods. FEL energy at 6.45 micrometers can be transmitted to an operating room and delivered to human ocular tissue through a hollow waveguide surgical probe. This FEL wavelength can produce an optic nerve sheath fenestration without acute direct damage to the nerve in this case report.

Behavioural and neural modulation of win-stay but not lose-shift strategies as a function of outcome value in Rock, Paper, Scissors.

PubMed

Forder, Lewis; Dyson, Benjamin James

2016-09-23

Competitive environments in which individuals compete for mutually-exclusive outcomes require rational decision making in order to maximize gains but often result in poor quality heuristics. Reasons for the greater reliance on lose-shift relative to win-stay behaviour shown in previous studies were explored using the game of Rock, Paper, Scissors and by manipulating the value of winning and losing. Decision-making following a loss was characterized as relatively fast and relatively inflexible both in terms of the failure to modulate the magnitude of lose-shift strategy and the lack of significant neural modulation. In contrast, decision-making following a win was characterized as relatively slow and relatively flexible both in terms of a behavioural increase in the magnitude of win-stay strategy and a neural modulation of feedback-related negativity (FRN) and stimulus-preceding negativity (SPN) following outcome value modulation. The win-stay/lose-shift heuristic appears not to be a unified mechanism, with the former relying on System 2 processes and the latter relying on System 1 processes. Our ability to play rationally appears more likely when the outcome is positive and when the value of wins are low, highlighting how vulnerable we can be when trying to succeed during competition.

Competitive intransitivity, population interaction structure, and strategy coexistence.

PubMed

Laird, Robert A; Schamp, Brandon S

2015-01-21

Intransitive competition occurs when competing strategies cannot be listed in a hierarchy, but rather form loops-as in the game rock-paper-scissors. Due to its cyclic competitive replacement, competitive intransitivity promotes strategy coexistence, both in rock-paper-scissors and in higher-richness communities. Previous work has shown that this intransitivity-mediated coexistence is strongly influenced by spatially explicit interactions, compared to when populations are well mixed. Here, we extend and broaden this line of research and examine the impact on coexistence of intransitive competition taking place on a continuum of small-world networks linking spatial lattices and regular random graphs. We use simulations to show that the positive effect of competitive intransitivity on strategy coexistence holds when competition occurs on networks toward the spatial end of the continuum. However, in networks that are sufficiently disordered, increasingly violent fluctuations in strategy frequencies can lead to extinctions and the prevalence of monocultures. We further show that the degree of disorder that leads to the transition between these two regimes is positively dependent on population size; indeed for very large populations, intransitivity-mediated strategy coexistence may even be possible in regular graphs with completely random connections. Our results emphasize the importance of interaction structure in determining strategy dynamics and diversity. Copyright © 2014 Elsevier Ltd. All rights reserved.

21 CFR 872.6300 - Rubber dam and accessories.

Code of Federal Regulations, 2012 CFR

2012-04-01

... center intended to isolate a tooth from fluids in the mouth during dental procedures, such as filling a... center. The device includes the rubber dam, rubber dam clamp, rubber dam frame, and forceps for a rubber... sexually transmitted diseases through oral sex; those devices are classified as condoms in § 884.5300 of...

21 CFR 872.6300 - Rubber dam and accessories.

Code of Federal Regulations, 2011 CFR

2011-04-01

... center intended to isolate a tooth from fluids in the mouth during dental procedures, such as filling a... center. The device includes the rubber dam, rubber dam clamp, rubber dam frame, and forceps for a rubber... sexually transmitted diseases through oral sex; those devices are classified as condoms in § 884.5300 of...

21 CFR 872.6300 - Rubber dam and accessories.

Code of Federal Regulations, 2014 CFR

2014-04-01

... center intended to isolate a tooth from fluids in the mouth during dental procedures, such as filling a... center. The device includes the rubber dam, rubber dam clamp, rubber dam frame, and forceps for a rubber... sexually transmitted diseases through oral sex; those devices are classified as condoms in § 884.5300 of...

21 CFR 872.6300 - Rubber dam and accessories.

Code of Federal Regulations, 2010 CFR

2010-04-01

... center intended to isolate a tooth from fluids in the mouth during dental procedures, such as filling a... center. The device includes the rubber dam, rubber dam clamp, rubber dam frame, and forceps for a rubber... sexually transmitted diseases through oral sex; those devices are classified as condoms in § 884.5300 of...

21 CFR 872.6300 - Rubber dam and accessories.

Code of Federal Regulations, 2013 CFR

2013-04-01

... center intended to isolate a tooth from fluids in the mouth during dental procedures, such as filling a... center. The device includes the rubber dam, rubber dam clamp, rubber dam frame, and forceps for a rubber... sexually transmitted diseases through oral sex; those devices are classified as condoms in § 884.5300 of...

Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

PubMed

Reychler, H; Mahy, P

2011-01-01

Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

Intravesical markers for delineation of target volume during external focal irradiation of bladder carcinomas.

PubMed

Hulshof, Maarten C C M; van Andel, George; Bel, Arjen; Gangel, Pieter; van de Kamer, Jeroen B

2007-07-01

A clip forceps was developed which can insert markers at the border of a bladder tumour through a rigid cystoscope. This technique proved to be simple and safe and is of help for delineation of the target volume during CT simulation for focal boost irradiation of bladder cancer.

Perigynium removal and cold, moist stratification improve germination of Carex nebrascensis (Nebraska sedge)

Treesearch

J. Chris Hoag; R. Kasten Dumroese; Michael E. Sellers

2001-01-01

For 2 populations of Nebraska sedge (Carex nebrascensis Dewey [Cyperaceae]), removal of the perigynium, the saclike structure around mature achenes, either with forceps or sandpaper, provided sufficient scarification to significantly increase total germination about 50% compared with that of nonscarified achenes. We also found that a combination of...

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2014 CFR

2014-04-01

... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used... and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to... used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal...

21 CFR 884.4530 - Obstetric-gynecologic specialized manual instrument.

Code of Federal Regulations, 2013 CFR

2013-04-01

... cervix or vagina. (14) A gynecological biopsy forceps is an instrument with two blades and handles used... and hold the cervix or fundus. (16) An internal pelvimeter is an instrument used within the vagina to... used to expose the interior of the vagina. (18) A fiberoptic nonmetal vaginal speculum is a nonmetal...