Endoscopic removal of eroded adjustable gastric band: lessons learned after 5 years and 78 cases

Background: One of the complications of laparoscopic adjustable gastric banding is intragastric erosion, leading to a revisional procedure to remove the band. Our aim was to present the procedure and results of endoscopic band removal in a 5-year multicenter experience from the Gastro Obeso Center and Universidade de Sao Paulo, Sao Paulo, and Universidade Federal de Pernambuco, Recite, Brazil. Methods: From 2003 to 2008, 82 patients were diagnosed with band erosion. The clinical data concerning the endoscopic procedure were prospectively recorded and retrospectively reviewed. Results: The average preoperative body mass index was 43.2 kg/m(2) (range 34-50). At the diagnosis of intragastric erosion, the body mass index was 24-41 kg/m(2) (average 31.8). The erosion occurred an average of 16.3 months (range 6-36) postoperatively. The symptoms included pain in 25 (31%), port infection in 21 patients (27%), and weight regain in 20 (25%), and 12 patients (15%) were asymptomatic. Endoscopic removal was possible for 78 patients (95%). In 85% of patients, the band was removed in the first session, with an average duration of 55 minutes (range 25-150). Five cases of pneumoperitoneum occurred after the procedure. Of these, 3 were treated conservatively, 1 was treated by laparoscopy, and I was treated by abdominal puncture using the Veress needle. Conclusion: Endoscopic removal of eroded laparoscopic adjustable gastric banding is safe and effective. It can be used as a first choice procedure in clinical practice. (Surg Obes Relat Dis 2010; 6:423-428.) (C) 2010 American Society for Metabolic and Bariatric Surgery. All rights reserved.

A NEW ADJUSTABLE PINCH DESIGNED FOR PRODUCING CRUSH NERVE INJURIES IN THE SCIATIC NERVE OF RATS

Objective: A new adjustable pinch has been developed for producing a crush injury, with a previously known load of 5 kg, on a 5 mm-long segment of the nerve. Methods: Stainless steel was the material selected for building the pinch due its durability and possibility of sterilization with anti-septic substances, which are often corrosive. The crushing load of the pinch is adjustable by increasing or decreasing the tension of the spring by means of a screw used for calibration, which is performed by a load cell. Result: This pinch has been used in a few experimental investigations and was shown to be as efficient as both the universal testing machine and the dead weight machine, previously used. Conclusion: The developed pinch has the advantages of being portable and user-friendly. In addition, the pinch is cheap and allows for the standardization of the applied load.

Lightweight adjustable partition system: evaluation of resistance to horizontal loads and functional failure from impacts

This paper presents and discusses the results of the serviciability and use condition tests carried on an innovative solution for partitions, designated AdjustMembrane developed within a research project. The proposed system is a modular non-loadbearing wall, tensioned between the pavements and ceiling slabs, which are used as anchoring elements. It allows several advantages, related with the weight reduction to achieve a good sustainable performance, such as the reduction of construction costs, energy, and materials, and it is easy to recycle and to reuse, allowing self-construction. Apart from a general presentation of the partition technology, this paper presents and discusses the results of experimental tests carried out. From the results obtained, it is possible to conclude that the solution fulfils the requirements for this typology of wall in terms of resistance to horizontal loads induced by soft and hard body impacts.

In vivo testing of a novel adjustable glaucoma drainage device.

PURPOSE: We report on the in vivo testing of a novel noninvasively adjustable glaucoma drainage device (AGDD), which features an adjustable outflow resistance, and assess the safety and efficiency of this implant. METHODS: Under general anesthesia, the AGDD was implanted on seven white New Zealand rabbits for a duration of 4 months under a scleral flap in a way analogous to the Ex-PRESS device and set in an operationally closed position. The IOP was measured on a regular basis on the operated and control eyes using a rebound tonometer. Once a month the AGDD was adjusted noninvasively from its fully closed to its fully open position and the resulting pressure drop was measured. The contralateral eye was not operated and served as control. After euthanization, the eyes were collected for histology evaluation. RESULTS: The mean preoperative IOP was 11.1 ± 2.4 mm Hg. The IOP was significantly lower for the operated eye (6.8 ± 2 mm Hg) compared to the nonoperated eye (13.1 ± 1.6 mm Hg) during the first 8 days after surgery. When opening the AGDD from its fully closed to fully open position, the IOP dropped significantly from 11.2 ± 2.9 to 4.8 ± 0.9 mm Hg (P < 0.05). CONCLUSIONS: Implanting the AGDD is a safe and uncomplicated surgical procedure. The fluidic resistance was noninvasively adjustable during the postoperative period with the AGDD between its fully closed and fully open positions.

Is lean body mass decreased after obesity treatment by adjustable gastric banding?

BACKGROUND: There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size. METHODS: Body composition was assessed by dual-energy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7+/-8.4 years, BMI 36.4+/-5.9 kg/m2, mean+/-SD), and in 117 control women (age 44.5+/-7.5 years; BMI 36.7+/-5.5 kg/m2) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM). RESULTS: 1 year after LAGB, body weight loss (-23.7+/-11.6 kg, P<10(-6)) was mainly due to decreased fat mass (-21.2+/-11.2 kg, P<10(-6)), and total LBM was modestly, although significantly, decreased (-2.1+/-4.2 kg, P=0.01). Appendicular LBM (-0.7+/-2.7 kg) and total SMM (-0.9+/-3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM. CONCLUSIONS: Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.

Adjustable Suture Removal: Increasing Aqueous Flow in "Safe" Trabeculectomy.

Purpose: Aqueous flow through trabeculectomy blebs has been suggested to influence filtration bleb survival. We investigated the relationship between the requirement to increase aqueous flow via adjustable suture removal and surgical outcomes following "safe trabeculectomy" with mitomycin C (MMC). Methods: 62 consecutive eyes of 53 patients underwent fornix based trabeculectomy with adjustable sutures, intraoperative MMC and intensive postoperative steroids. Subconjunctival antimetabolite injections and bleb needlings were administered according to bleb vascularity and IOP trends. Main outcome measures were: success rates (definition: IOP≤21mmHg and 20% IOP reduction); number of antimetabolite injections; bleb needlings; number of of eyes recommencing glaucoma medications and complications. Results: Mean age was 70.4±16.0 years (mean± SD); mean preoperative IOP was 24.5±9.1 mmHg and decreased to 12.3±8.9mmHg postoperatively. Mean number of sutures was 2.6 ± 0.7. Eyes were divided into 2 groups in relation to the number of sutures removed. The number of subconjunctival MMC injections required for those requiring 2 suture removals was significantly greater than those requiring 1 suture removal (p<0.05) The number of needlings and 5FU injections also increased but did not reach significance (p=0.09 and p=0.34 respectively). Least-squared linear regression analysis showed the number of needlings required had a statistically significant (p=0.05) trend with respect to time elapsed between surgery and first suture removal. No other interventions had significant trends. Mean time between surgery and suture removal was: 4.2±9.2 weeks (suture #1) and 5.7±9.7 weeks (suture#2). Antiglaucoma medication was restarted in only 5 eyes. Postoperative complications were infrequent: Seidel (3.2%), peripheral choroidal effusions at any time (3.2%), and shallow anterior chamber (1.6%). Conclusion: Eyes requiring a greater number of suture removals required a significantly greater number of antifibrosis interventions. The time elapsed before suture removal was inversely related to the number of postoperative needlings, suggesting these eyes may have decreased aqueous production and therefore require aggressive post-operative management to prevent bleb failure.

Design of adjustable packaging line

Diplomityön tavoite oli tutkia, mitä toimintoja ja tekniikoita uusi, joustava kartonkipakkauslinja sisältää ja mitkä suuntaukset pakkausteollisuudessa tulevat olemaan tärkeitä tulevaisuudessa. Pakkauslinjan päätoimintoja tarkasteltiin nykyisten jatulevaisuuden tekniikoiden pohjalta. Erityisesti tarkasteltiin laser-sovellusten käytön mahdollisuutta pakkauslinjan eri osatoiminnoissa. Katsaus pakkausteollisuuden tulevaisuuden näkymiin luotiin kirjallisuuden ja aikaisempien tutkimusten pohjalta, minkä perusteella työssä oletetaan, että yksilölliset ja monitoimipakkaukset tulevat lisääntymään tulevaisuudessa. Eri tuotantoerien välillä olevat asetusajat tulee saada minimoitua, mutta millä keinoin joustavuus on saavutettavissa? Yksi ratkaisu pakkausten valmistamisessa on käyttää robottisolua, mikä on mahdollista luultavasti ainakin kuppimuotoisten pakkausten kohdalla. Muutenkin robotiikka on lisääntymässä pakkausteollisuudessa. Digitaalisten painotekniikoiden kehitys on mahdollistanut yksilölliset painatukset. Tulevaisuudessa painatus on mahdollista tehdä pakkauslinjan loppupäässä, jopa vasta täytön ja suljennan jälkeen. Laserleikkaus on jo nyt käytössä, mutta tulevaisuudessa myös saumaus ja perinteinen nuuttaus on mahdollista tehdä lasersovelluksia käyttäen. Kehittynyt, väyläpohjainen ohjausjärjestelmä on tulevaisuudessa välttämätön joustavassa pakkauslinjassa. Internetin välityksellä toimiva etäohjattu virheenkorjausdiagnostiikka tulee myös olemaan itsestäänselvyys tulevaisuudessa. Kustannussäästöjä voidaan saavuttaa käyttämälläpakkauslinjassa modulaarista rakennetta. Standardiosien ja standardiosajärjestelmien käyttäminen pienentää myös käyttö- ja huoltokustannuksia. Tärkeää on kuitenkin muistaa, ettei joustavuutta voida saavuttaa pelkästään yhtä ominaisuutta tai tekniikkaa hyödyntäen vaan monia menetelmiä yhdistäen. Suunniteltavan pakkauslinjan toiminta on myös hyvä varmistaa käyttäen apuna mallinnusta ja simulointia.

Calculation of Activity Coefficients of Uni-Univalent Electrolytes by Equations Containing No Adjustable Parameters in Aqueous Solutions at 298.15 K

Normally either the Güntelberg or Davies equation is used to predict activity coefficients of electrolytes in dilute solutions when no better equation is available. The validity of these equations and, additionally, of the parameter-free equations used in the Bates-Guggenheim convention and in the Pitzerformalism for activity coefficients were tested with experimentally determined activity coefficients of HCl, HBr, HI, LiCl, NaCl, KCl, RbCl, CsCl, NH4Cl, LiBr,NaBr and KBr in aqueous solutions at 298.15 K. The experimental activity coefficients of these electrolytes can be usually reproduced within experimental errorby means of a two-parameter equation of the Hückel type. The best Hückel equations were also determined for all electrolytes considered. The data used in the calculations of this study cover almost all reliable galvanic cell results available in the literature for the electrolytes considered. The results of the calculations reveal that the parameter-free activity coefficient equations can only beused for very dilute electrolyte solutions in thermodynamic studies.

Calculation of Activity Coefficients of Electrolytes of Other Charge Types than 1-1 by Equations Containing No Adjustable Parameters in Aqueous Solutions at 25 0C

Normally either the Güntelberg or Davies equation is used to predict activity coefficients of electrolytes in dilute solutions when no betterequation is available. The validity of these equations and, additionally, of the parameter-free equation used in the Bates-Guggenheim convention for activity coefficients were tested with experimentally determined activity coefficients of LaCl3, CaCl2, SrCl2 and BaCl2 in aqueous solutions at 298.15 K. The experimentalactivity coefficients of these electrolytes can be usually reproduced within experimental error by means of a two-parameter equation of the Hückel type. The best Hückel equations were also determined for all electrolytes considered. The data used in the calculations of this study cover almost all reliable galvanic cell results available in the literature for the electrolytes considered. The results of the calculations reveal that the parameter-free activity coefficient equations can only be used for very dilute electrolyte solutions in thermodynamic studies

SRR loaded waveguide band rejection filter with adjustable bandwidth

The use of a split-ring resonator (SRR)-loaded waveguide for the design of a band-rejection filter with adjustable bandwidth is reported. The width of the stopband can be adjusted by suitably positioning the SRR array in the waveguide. The rejection band can be made very narrow by placing the array at the electric-field minimum. The stopband attenuation depends on the number of unit cells in the array.

Design of redundant drive joint with adjustable stiffness and damping mechanism to improve joint admittance

Improving admittance of robotic joints is the key issue for making rehabilitation robots safe. This paper describes a design of Redundant Drive Joint (RD-Joint) which allows greater flexibility in the design of robotic mechanisms. The design strategy of the RD-Joint employs a systematic approach which consists of 1) adopting a redundant joint mechanism with internal kinematical redundancy to reduce effective joint inertia, and 2) adopting an adjustable admittance mechanism with a novel Cross link Reduction Mechanism and mechanical springs and dampers as a passive second actuator. First, the basic concepts used to construct the redundant drive joint mechanism are explained, in particular the method that allows a reduction in effective inertia at the output joint. The basic structure of the RD-Joint is introduced based on the idea of reduced inertia along with a method to include effective stiffness and damping. Then, the basic design of the adjustable admittance mechanism is described. Finally, a prototype of RD-joint is described and its expected characteristics are discussed.

CP-OQAM-OFDM based SC-FDMA: adjustable user bandwidth and space-time coding

The discrete Fourier transmission spread OFDM DFTS-OFDM) based single-carrier frequency division multiple access (SC-FDMA) has been widely adopted due to its lower peak-to-average power ratio (PAPR) of transmit signals compared with OFDM. However, the offset modulation, which has lower PAPR than general modulation, cannot be directly applied into the existing SC-FDMA. When pulse-shaping filters are employed to further reduce the envelope fluctuation of transmit signals of SC-FDMA, the spectral efficiency degrades as well. In order to overcome such limitations of conventional SC-FDMA, this paper for the first time investigated cyclic prefixed OQAMOFDM (CP-OQAM-OFDM) based SC-FDMA transmission with adjustable user bandwidth and space-time coding. Firstly, we propose CP-OQAM-OFDM transmission with unequally-spaced subbands. We then apply it to SC-FDMA transmission and propose a SC-FDMA scheme with the following features: a) the transmit signal of each user is offset modulated single-carrier with frequency-domain pulse-shaping; b) the bandwidth of each user is adjustable; c) the spectral efficiency does not decrease with increasing roll-off factors. To combat both inter-symbolinterference and multiple access interference in frequencyselective fading channels, a joint linear minimum mean square error frequency domain equalization using a prior information with low complexity is developed. Subsequently, we construct space-time codes for the proposed SC-FDMA. Simulation results confirm the powerfulness of the proposed CP-OQAM-OFDM scheme (i.e., effective yet with low complexity).

Enhanced visualization of histological samples with an adjustable RGB contrast system with application for tissue used in photodynamic therapy

The analysis of histological sections has long been a valuable tool in the pathological studies. The interpretation of tissue conditions, however, relies directly on visual evaluation of tissue slides, which may be difficult to interpret because of poor contrast or poor color differentiation. The Chromatic Contrast Visualization System (CCV) combines an optical microscope with electronically controlled light-emitting diodes (LEDs) in order to generate adjustable intensities of RGB channels for sample illumination. While most image enhancement techniques rely on software post-processing of an image acquired under standard illumination conditions, CCV produces real-time variations in the color composition of the light source itself. The possibility of covering the entire RGB chromatic range, combined with the optical properties of the different tissues, allows for a substantial enhancement in image details. Traditional image acquisition methods do not exploit these visual enhancements which results in poorer visual distinction among tissue structures. Photodynamic therapy (PDT) procedures are of increasing interest in the treatment of several forms of cancer. This study uses histological slides of rat liver samples that were induced to necrosis after being exposed to PDT. Results show that visualization of tissue structures could be improved by changing colors and intensities of the microscope light source. PDT-necrosed tissue samples are better differentiated when illuminated with different color wavelengths, leading to an improved differentiation of cells in the necrosis area. Due to the potential benefits it can bring to interpretation and diagnosis, further research in this field could make CCV an attractive technique for medical applications.

Mice and larvae tracking using a particle filter with an auto-adjustable observation model

This paper proposes a novel way to combine different observation models in a particle filter framework. This, so called, auto-adjustable observation model, enhance the particle filter accuracy when the tracked objects overlap without infringing a great runtime penalty to the whole tracking system. The approach has been tested under two important real world situations related to animal behavior: mice and larvae tracking. The proposal was compared to some state-of-art approaches and the results show, under the datasets tested, that a good trade-off between accuracy and runtime can be achieved using an auto-adjustable observation model. (C) 2009 Elsevier B.V. All rights reserved.