Endoscopic innovations

Overall, Digestive Disease Week (DDW) 2013 was an excellent year for endoscopic innovation. For this section, the abstracts have been divided into new technologies and new techniques. The abstracts selected for review are ones that represent material that has a reasonable chance of affecting the practice of GI endoscopy

The Empire of Pan American Airways

This item was digitized by the Internet Archive. Thesis (M.B.A.)--Boston Universityhttps://archive.org/details/empireofpanameri00haw

A Multi-Purpose Modular Electronics Integration Node for Exploration Extravehicular Activity

As NASA works to develop an effective integrated portable life support system design for exploration Extravehicular activity (EVA), alternatives to the current system s electrical power and control architecture are needed to support new requirements for flexibility, maintainability, reliability, and reduced mass and volume. Experience with the current Extravehicular Mobility Unit (EMU) has demonstrated that the current architecture, based in a central power supply, monitoring and control unit, with dedicated analog wiring harness connections to active components in the system has a significant impact on system packaging and seriously constrains design flexibility in adapting to component obsolescence and changing system needs over time. An alternative architecture based in the use of a digital data bus offers possible wiring harness and system power savings, but risks significant penalties in component complexity and cost. A hybrid architecture that relies on a set of electronic and power interface nodes serving functional models within the Portable Life Support System (PLSS) is proposed to minimize both packaging and component level penalties. A common interface node hardware design can further reduce penalties by reducing the nonrecurring development costs, making miniaturization more practical, maximizing opportunities for maturation and reliability growth, providing enhanced fault tolerance, and providing stable design interfaces for system components and a central control. Adaptation to varying specific module requirements can be achieved with modest changes in firmware code within the module. A preliminary design effort has developed a common set of hardware interface requirements and functional capabilities for such a node based on anticipated modules comprising an exploration PLSS, and a prototype node has been designed assembled, programmed, and tested. One instance of such a node has been adapted to support testing the swingbed carbon dioxide and humidity control element in NASA s advanced PLSS 2.0 test article. This paper will describe the common interface node design concept, results of the prototype development and test effort, and plans for use in NASA PLSS 2.0 integrated tests

Rapid Cycle Amine (RCA) 3.0 System Development

The Rapid Cycle Amine (RCA) 3.0 system is currently under development by NASA, the Lyndon B. Johnson Space Center (JSC) in conjunction with United Technologies Corporation Aerospace Systems (UTAS). The RCA technology is a new carbon dioxide (CO2) and humidity removal system that has been baselined for the Advanced Extravehicular Mobility Unit (AEMU) Portable Life Support System. The evolution of the RCA development has progressed through several iterations of technology readiness levels including RCA 1.0, RCA 2.0, and RCA 3.0 test articles. The RCA is an advancement over currently technologies due to its unique regeneration capability. The RCA is capable of simultaneously removing CO2 and humidity from an influent air steam and subsequent regeneration when exposed to a vacuum source. The RCA technology uses two solid amine sorbent beds in an alternating fashion to adsorb CO2 and water (uptake mode) and desorb CO2 and water (regeneration mode) at the same time. The two beds operate in an efficient manner so that while one bed is in the uptake mode, the other is in the regeneration mode, thus continuously providing an on-service sorbent bed by which CO2 and humidity may be removed. The RCA 2.0 and 3.0 test articles were designed with a novel valve assembly which allows for switching between uptake and regeneration modes with only one moving part while minimizing gas volume losses to the vacuum source by means of an internal pressure equalization step during actuation. The RCA technology also is low power, small, and has performed extremely well in all development testing thus far. A final design was selected for the RCA 3.0, fabricated, assembled, and performance tested in 2014 with delivery to NASAJSC in January 2015. This paper will provide an overview on the RCA 3.0 system design and results of pre-delivery testing with references to the development of RCA 1.0 and RCA 2.0

Matching-adjusted indirect comparison of bleeding outcomes in severe haemophilia A: Comparing valoctocogene roxaparvovec gene therapy, emicizumab prophylaxis, and FVIII replacement prophylaxis

INTRODUCTION: Head-to-head evaluation of valoctocogene roxaparvovec, the first gene therapy approved for haemophilia A, with emicizumab is not available. Therefore, phase 3 trial data were indirectly compared. AIM: To compare bleeding rates in trials evaluating 6 × 1013  vg/kg valoctocogene roxaparvovec (GENEr8-1; NCT03370913), 1.5 mg/kg emicizumab dosed every week (HAVEN 3; NCT02847637), and FVIII prophylaxis (270-902) in participants with severe haemophilia A (FVIII ≤1 IU/dL). METHODS: Valoctocogene roxaparvovec versus emicizumab and FVIII prophylaxis as used in 270-902 versus emicizumab cross-trial comparisons were performed using matching-adjusted indirect comparison (MAIC). Individual participant data from GENEr8-1 and 270-902 were weighted to equalise aggregate participant baseline characteristics from HAVEN 3. After MAIC weighting, annualised bleeding rates (ABR) and proportions of participants without bleeds were compared for treated bleeds, all bleeds, treated joint bleeds, and treated spontaneous bleeds. RESULTS: After MAIC weighting, ABR for all bleeds was statistically significantly lower with valoctocogene roxaparvovec than emicizumab (rate ratio [95% CI], .55 [.33-.93]). Additionally, significantly higher proportions of participants had no treated joint bleeds (odds ratio [95% CI], 2.75 [1.20-6.31]) and no treated bleeds (3.25 [1.53-6.90]) with valoctocogene roxaparvovec versus emicizumab. When compared with the mainly standard half-life FVIII prophylaxis regimens in 270-902, mean ABRs (except for all bleeds) were significantly lower, and significantly higher proportions reported 0 bleeds for all outcomes with emicizumab. CONCLUSION: Valoctocogene roxaparvovec provided generally lower bleeding rates and higher probability of no bleeds, including treated joint bleeds, than emicizumab. Emicizumab was more effective than FVIII prophylaxis regimens used in 270-902

Model for the interpretation of hyperspectral remote-sensing reflectance

Remote-sensing reflectance is easier to interpret for the open ocean than for coastal regions because the optical signals are highly coupled to the phytoplankton (e.g., chlorophyll) concentrations. For estuarine or coastal waters, variable terrigenous colored dissolved organic matter (CDOM), suspended sediments, and bottom reflectance, all factors that do not covary with the pigment concentration, confound data interpretation. In this research, remote-sensing reflectance models are suggested for coastal waters, to which contributions that are due to bottom reflectance, CDOM fluorescence, and water Raman scattering are included. Through the use of two parameters to model the combination of the backscattering coefficient and the Q factor, excellent agreement was achieved between the measured and modeled remote-sensing reflectance for waters from the West Florida Shelf to the Mississippi River plume. These waters cover a range of chlorophyll of 0.2–40 mg/m³ and gelbstoff absorption at 440 nm from 0.02–0.4 m⁻¹. Data with a spectral resolution of 10 nm or better, which is consistent with that provided by the airborne visible and infrared imaging spectrometer (AVIRIS) and spacecraft spectrometers, were used in the model evaluation

Biopsy depth after radiofrequency ablation of dysplastic Barrett's esophagus

After endoscopic radiofrequency ablation (RFA) of dysplastic Barrett's esophagus (BE), endoscopic biopsy samples are obtained to assess response to therapy. Whether these biopsies are of adequate depth to assess efficacy is unknown

EUS-derived criteria for distinguishing benign from malignant metastatic solid hepatic masses

Background Detection of hepatic metastases during EUS is an important component of tumor staging. Objective To describe our experience with EUS-guided FNA (EUS-FNA) of solid hepatic masses and derive and validate criteria to help distinguish between benign and malignant hepatic masses. Design Retrospective study, survey. Setting Single, tertiary-care referral center. Patients Medical records were reviewed for all patients undergoing EUS-FNA of solid hepatic masses over a 12-year period. Interventions EUS-FNA of solid hepatic masses. Main Outcome Measurements Masses were deemed benign or malignant according to predetermined criteria. EUS images from 200 patients were used to create derivation and validation cohorts of 100 cases each, matched by cytopathologic diagnosis. Ten expert endosonographers blindly rated 15 initial endosonographic features of each of the 100 images in the derivation cohort. These data were used to derive an EUS scoring system that was then validated by using the validation cohort by the expert endosonographer with the highest diagnostic accuracy. Results A total of 332 patients underwent EUS-FNA of a hepatic mass. Interobserver agreement regarding the initial endosonographic features among the expert endosonographers was fair to moderate, with a mean diagnostic accuracy of 73% (standard deviation 5.6). A scoring system incorporating 7 EUS features was developed to distinguish benign from malignant hepatic masses by using the derivation cohort with an area under the receiver operating curve (AUC) of 0.92; when applied to the validation cohort, performance was similar (AUC 0.86). The combined positive predictive value of both cohorts was 88%. Limitations Single center, retrospective, only one expert endosonographer deriving and validating the EUS criteria. Conclusion An EUS scoring system was developed that helps distinguish benign from malignant hepatic masses. Further study is required to determine the impact of these EUS criteria among endosonographers of all experience