Auricle shaping using 3D printing and autologous diced cartilage.

ObjectiveTo reconstruct the auricle using a porous, hollow, three-dimensional (3D)-printed mold and autologous diced cartilage mixed with platelet-rich plasma (PRP).MethodsMaterialise Magics v20.03 was used to design a 3D, porous, hollow auricle mold. Ten molds were printed by selective laser sintering with polyamide. Cartilage grafts were harvested from one ear of a New Zealand rabbit, and PRP was prepared using 10 mL of auricular blood from the same animal. Ear cartilage was diced into 0.5- to 2.0-mm pieces, weighed, mixed with PRP, and then placed inside the hollow mold. Composite grafts were then implanted into the backs of respective rabbits (n = 10) for 4 months. The shape and composition of the diced cartilage were assessed histologically, and biomechanical testing was used to determine stiffness.ResultsThe 3D-printed auricle molds were 0.6-mm thick and showed connectivity between the internal and external surfaces, with round pores of 0.1 to 0.3 cm. After 4 months, the diced cartilage pieces had fused into an auricular shape with high fidelity to the anthropotomy. The weight of the diced cartilage was 5.157 ± 0.230 g (P > 0.05, compared with preoperative). Histological staining showed high chondrocyte viability and the production of collagen II, glycosaminoglycans, and other cartilaginous matrix components. In unrestricted compression tests, auricle stiffness was 0.158 ± 0.187 N/mm, similar to that in humans.ConclusionAuricle grafts were constructed successfully through packing a 3D-printed, porous, hollow auricle mold with diced cartilage mixed with PRP. The auricle cartilage contained viable chondrocytes, appropriate extracellular matrix components, and good mechanical properties.Levels of evidenceNA. Laryngoscope, 129:2467-2474, 2019

AN INVESTIGATION OF MEDICAL DEVICE DESIGN AND PHYSICAL ERGONOMICS IN HEALTHCARE

Human factors and process engineering are becoming a prominent area of research and application for industrial engineering principles as healthcare providers seek to improve patient safety, quality the optimization of resources. Human factors engineering and ergonomics play a crucial role in the pursuit of operational excellence and patient safety in healthcare. These disciplines contain the tools required to develop instrumentation, technology and training that can improve the usability of medical technology and the quality of care that patients receive. Designing tasks, tools and processes for optimal human use can enhance performance, reduce errors and improve safety. This thesis encompasses three journal articles. The first paper addresses how physical ergonomics can be used to evaluate and improve skill acquisition in endotracheal intubation. Significant differences in muscle utilization and wrist postures were observed between experience levels and genders of clinicians. Differences in muscle utilization and wrist postures were found to be significantly related to instrument grasp characteristics, identifying potential ergonomic best practices. The second paper investigates the mechanical design of laparoendoscopic single-site (LESS) surgical ports from a human factors perspective. This study characterized the differences in resistance and range of motion afforded by each LESS port during simulated single-incision use. The resistance of each port varied significantly with respect to instrument positions. The final paper explored each LESS surgical port against standard laparoscopy by using a validated laparoscopic training task to assess the usability and performance of each device. Instrument mobility was restricted by the LESS ports, but it did not affect task performance significantly. While each device exhibited positive and negative human factors attributes for clinicians and patients, it was concluded that procedural factors rather than device familiarity should influence LESS port selection. Advisor: M. Susan Hallbec

Video-assisted versus macintosh direct laryngoscopy for intubation of obese patients: a meta-analysis of randomized controlled trials

INTRODUCTION: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the usefulness of video-assisted (VL) approaches with the Macintosh direct laryngoscope for endotracheal intubation of obese patients. MATERIAL AND METHODS: Studies were obtained via a systematic search of SCOPUS, Medline, Web of Science, CINAHL, and the Cochrane Central databases. The polled relative risks (RRs) odds ratios (ODs) or standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated with a random–effects model. Subgroup analyses were performed to evaluate the influence of VL types on the association. RESULTS: First intubation attempt success rate in VL and DL group varied and amounted to 94.7% vs 89.5% respectively (OR = 2.04; 95% CI: 1.21–3.42; p = 0.007) and overall intubation success rate was 99.0% vs 97.5% respectively (OR = 2.20; 95% CI: 0.45–10.67; p = 0.33). Intubation time which was 48.0 ± 37.7 for VL and 48.4 ± 37.5 seconds for DL (SMD = 0.14; 95% CI: –0.33–0.61; p = 0.56). Cormack-Lehane 1 or 2 grade during intubation using VL was observed in 95.9% of cases and was statistically significantly higher than in the case of direct laryngoscopy (79.6%; OR = 6.68; 95% CI: 3.32–13.42; p < 0.001). CONCLUSIONS: Our meta-analysis suggests that video-assisted intubation may be superior to conventional intubation in an obese patient population due to a higher first–attempt success rate, better glottis visibility, and a lower rate of intubation-related injuries. Keywords - video-laryngoscope, direct-laryngoscope, endotracheal intubation, obese, intubation attempt, intubation time, meta-analysi

Study on Patient Simulation Robots for Airway Management Training

制度:新 ; 報告番号:甲3417号 ; 学位の種類:博士(工学) ; 授与年月日:2011/7/28 ; 早大学位記番号:新574

Airway surgery for obstructive sleep apnea and partial upper airway obstruction during sleep

This study analyzed the feasibility and efficacy of surgical therapies in patients with sleep-disordered breathing ranging from partial upper airway obstruction during sleep to severe obstructive sleep apnea syndrome. The surgical procedures evaluated were tracheostomy, laser-assisted uvulopalatoplasty (LUPP) and uvulopalatopharyngoplasty (UPPP) with laser or ultrasound scalpel. Obstructive sleep apnea and partial upper airway obstruction during sleep were measured with the static charge-sensitive bed (SCSB) and pulse oximeter. The patients with severe obstructive sleep apnea syndrome were treated with tracheostomy. Palatal surgery was performed only if the upper airway narrowing occurred exclusively at the soft palate level in patients with partial upper airway obstruction during sleep. The ultrasound scalpel technique was compared to laser-assisted UPPP. The efficacy of LUPP to reduce partial upper airway obstruction during sleep was assessed and histology of uvulopalatal specimen was compared to body fat distributional parameters and sleep study findings. Tracheostomy was effective therapy in severe obstructive sleep apnea. Partial upper airway obstruction and arterial oxyhemoglobin desaturation index during sleep decreased significantly after LUPP. The minimal retropalatal airway dimension increased and soft palate collapsibility decreased at the level where the velopharyngeal obstruction had occurred before the surgery. Ultrasound scalpel did not offer any significant benefits over the laser-assisted technique, except fewer postoperative haemorrhage events. The loose connective tissue as a manifestation of edema was the only histological finding showing correlation with partial upper airway obstruction parameters of SCSB. Tracheostomy remains a life-saving therapy and also long-term option when adherence to CPAP fails in patients with obstructive sleep apnea syndrome. LUPP effectively reduces partial upper airway obstruction during sleep provided that obstruction at the other levels than the soft palate and uvula were preoperatively excluded. Technically the ultrasound scalpel or laser surgeries are equal. In patients with partial upper airway obstruction the loose connective tissue is more important than fat accumulation in the soft palate. This supports the hypothesis that edema is a primary trigger for aggravation of upper airway narrowing during sleep at the soft palate level and evolution towards partial or complete upper airway obstruction during sleep.Siirretty Doriast

Laringoscópio digital

Quatro páginas são dobráveisDocumento confidencial. Não pode ser disponibilizado para consultaTese de mestrado integrado. Engenharia Mecânica (Especialização Automação). Faculdade de Engenharia. Universidade do Porto. 201

Exercise-induced Laryngeal Obstruction: Protocol for a Randomized Controlled Treatment Trial

Background: Exercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young individuals, caused by paradoxical inspiratory adduction of laryngeal structures, and diagnosed by continuous visualization of the larynx during high-intensity exercise. Empirical data suggest that EILO consists of different subtypes, possibly requiring different therapeutic approaches. Currently applied treatments do not rest on randomized controlled trials, and international guidelines based on good evidence can therefore not be established. This study aims to provide evidence-based information on treatment schemes commonly applied in patients with EILO. Methods and Analysis: Consenting patients consecutively diagnosed with EILO at Haukeland University Hospital will be randomized into four non-invasive treatment arms, based on promising reports from non-randomized studies: (A) standardized information and breathing advice only (IBA), (B) IBA plus inspiratory muscle training, (C) IBA plus speech therapy, and (D) IBA plus inspiratory muscle training and speech therapy. Differential effects in predefined EILO subtypes will be addressed. Patients failing the non-invasive approach and otherwise qualifying for surgical treatment by current department policy will be considered for randomization into (E) standard or (F) minimally invasive laser supraglottoplasty or (G) no surgery. Power calculations are based on the main outcomes, laryngeal adduction during peak exercise, rated by a validated scoring system before and after the interventions. Ethics and Dissemination: The study will assess approaches to EILO treatments that despite widespread use, are insufficiently tested in structured, verifiable, randomized, controlled studies, and is therefore considered ethically sound. The study will provide knowledge listed as a priority in a recent statement issued by the European Respiratory Society, requested by clinicians and researchers engaged in this area, and relevant to 5–7% of young people. Dissemination will occur in peer-reviewed journals, at relevant media platforms and conferences, and by engaging with patient organizations and the healthcare bureaucracy.publishedVersio

Validity, discriminative ability, and reliability of the hearing‐related quality of life questionnaire for adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102684/1/lary24336.pd