Atraumatic (pencil-point) versus conventional needles for lumbar puncture:a clinical practice guideline

Is the needle tip configuration important when performing a lumbar puncture for any indication? A systematic review published in the Lancet in December 2017 suggests that it is. The review found that using atraumatic (pencil-point) lumbar puncture needles instead of conventional lumbar puncture needles reduced the risk of post-dural-puncture headache and of return to hospital for additional pain control.1 This guideline recommendation aims to promptly and transparently translate this evidence to a clinical recommendation, following standards for GRADE methodology and trustworthy guidelines.2 The BMJ Rapid Recommendations panel makes a strong recommendation for the use of atraumatic needles for lumbar puncture in all patients regardless of age (adults and children) or indication instead of conventional needles.3 4 Box 1 shows the article and evidence linked to this Rapid Recommendation. The main infographic provides an overview of the absolute benefits and harms (although none were present here) of atraumatic needles. Table 1 below shows any evidence that has emerged since the publication of this guideline.publishedVersio

Experimental investigation and numerical simulation of plastic flow behavior during forward-backward-radial extrusion process

Finite element method was employed to investigate the effect of process parameters of plastic deformation behavior in Forward-Backward-Radial Extrusion (FBRE) process. The result of an axisymmetric model shows that the friction between die components and the sample has a substantial effect on the material flow behavior. Although strain heterogeneity index (SHI) slightly decreases with an increase in friction, large portion of the sample experiences significant strain heterogeneity. Increasing the friction factor also localizes the strain heterogeneity effect in the backward section, and spread the effect in the forward section. Decreasing the friction in the FBRE process can reduce the amount of the strain heterogeneity in the product while decreases the required punch force substantially. Furthermore, an increase in gap thickness increases the deformation in the area close to the lower punch at the expense of the area in the vicinity of the upper punch. The numerical simulation has a good agreement with the experimental results which confirms the accuracy of the proposed finite element model

Finite element analysis of plastic deformation in variable lead axisymmetric forward spiral extrusion

A modified axisymmetric forward spiral extrusion (AFSE) has been proposed recently to enhance the strain accumulation during the process. The new technique is called variable lead axisymmetric forward spiral extrusion (VLAFSE) that features a variable lead along the extrusion direction. To assess the effect of design modification on plastic deformation, a comprehensive study has been performed here using a 3D transient finite element (FE) model. The FE results established the shear deformation as the dominant mode of deformation which has been confirmed experimentally. The variable lead die extends strain accumulation in the radial and longitudinal directions over the entire grooved section of the die and eliminates the rigid body rotation which occurs in the case of a constant lead die, AFSE. A comparison of forming loads for VLAFSE and AFSE proved the advantages of the former design in the reduction of the forming load which is more pronounced under higher frictional coefficients. This finding proves that the efficiency of VLAFSE is higher than that of AFSE. Besides, the significant amount of accumulated shear strain in VLAFSE along with non-axisymmetric distribution of friction creates a surface feature in the processed sample called zipper effect that has been investigated. © 2012 Springer Science+Business Media New York

A study of plastic deformation during axisymmetric forward spiral extrusion and its subsequent mechanical property changes

Axisymmetric forward spiral extrusion (AFSE) accumulates large strains in its sample while extruding it through a die with engraved spiral grooves. A three-dimensional finite element model of AFSE has been developed using ABAQUS to investigate the deformation mode in detail, including the effect of groove geometry and the heterogeneity of plastic deformation. The numerical results demonstrated that the strain distribution in the AFSE sample cross section is linear in the radial direction within a concentric core while the distribution, outside the core, in the vicinity of the grooves is non-linear and non-axisymmetric. Mechanical properties and grain structure changes of the deformed sample were investigated. Improvements of mechanical properties in the processed samples can be attributed to the domination of the shear deformation mode in a plane normal to the extrusion axis and consequently the elongation of grains in the tangential directio

A kinematics study of variable lead axisymmetric forward spiral extrusion

Variable lead axi-symmetric forward spiral extrusion (VLAFSE) allows far more efficient strain accumulation than constant lead counterpart AFSE. It eliminates the rigid body rotation of the sample in an AFSE die which only causes frictional loss and has no contribution to the deformation. Based on a proposed velocity field, the kinematic formulation for VLAFSE is presented, utilized to predict strain components in the deformation zone and compared with experimental measurements. A simple closed form solution of the VLAFSE problem is presented which describes the flow of material inside the extrusion die. The results confirm that the effective strain of the process accumulates non-linearly in the both radial and extrusion directions

Changes of concave and convex rib-vertebral angle, angle difference and angle ratio in patients with right thoracic adolescent idiopathic scoliosis

The aim of this study is to describe the radiological changes in rib–vertebral angles (RVAs), rib–vertebral angle differences (RVADs), and rib–vertebral angle ratios (RVARas) in patients with untreated right thoracic adolescent idiopathic scoliosis and to compare with the normal subjects. The concave and convex RVA from T1 to T12, the RVADs and the RVARas were measured on AP digital radiographs of 44 female patients with right convex idiopathic scoliosis and 14 normal females. Patients were divided into three groups: normal subjects (group 1), scoliotic patients with Cobb’s angle equal or\30 (group 2) and scoliotic patients with Cobb’s angle over 30 (group 3). Overall values (mean ± SD) of the RVAs on the concave side were 90.5 ± 17 in group 1, 90.3 ± 15.8 in group 2 and 88.8 ± 15.4 in group 3. On the convex side, values were 90.0 ± 17.3 in group 1, 86.3 ± 13.7 in group 2 and 80.7 ± 14.4 in group 3. Overall values (mean ± SD) of the RVADs at all levels were 0.5 ± 0.7 in group 1, 4.0 ± 4.8 in group 2 and 8.0 ± 4.0 in group 3. The RVARa values (mean ± SD) at all levels was 1.008 ± 0.012 in group 1, 1.041 ± 0.061 in group 2 and 1.102 ± 0.151 in group 3. RVAD and RVARa values in the scoliotic segment were greater in patients with untreated scoliosis over 30 than in patients with an untreated deformity of\30 or normal subjects. A significant effect between groups was observed for the RVA, RVAD and RVARa variables. Measurement of RVA, RVAD and RVARa should not only be performed at and around the apex of a thoracic spinal deformity, but also extended to the whole thoracic spine