Robotic Bronchoscopy for the Diagnosis of Pulmonary Lesions

Pulmonary nodules (lesions <3 cm in size) are commonly identified on computed tomographic scans, but radiographic features alone are inadequate to reliably differentiate between benign and malignant etiologies. Therefore, tissue biopsy remains the standard approach to determine the appropriate treatment course for many patients with pulmonary nodules. Although percutaneous biopsy is highly accurate, it poses substantial risks of procedural complications, including pneumothorax and bleeding. Robotic bronchoscopy has recently been developed to overcome many of the limitations of previous navigational platforms. Here, we explore the currently available systems for robotic bronchoscopy-in particular, electromagnetic-navigation robotic-assisted bronchoscopy and shape-sensing robotic-assisted bronchoscopy.

A Systematic Review of Electromagnetic Treatments for Body Contouring

BACKGROUND

Energy-based treatments include ultrasound, lasers, cryolipolysis, and radiofrequency. The most recent energy treatment for noninvasive body contouring is electromagnetic treatments-a hot topic in plastic surgery today. A systematic review to assess efficacy and safety has not been published.

METHODS

An electronic search was performed using PubMed to identify the literature describing electromagnetic treatments. Measurements from imaging studies were tabulated and compared.

RESULTS

Fourteen clinical studies were evaluated. Two studies included simultaneous radiofrequency treatments. In 11 studies, the Emsculpt device was used; in 2 studies, the Emsculpt-Neo device was used. One study included a sham group of patients. The usual protocol was 4 treatments given over a 2-week period. No complications were reported. Eight studies included abdominal measurement data obtained using magnetic resonance imaging, computed tomography, or ultrasound. Photographic results were typically modest. Photographs showing more dramatic results also showed unexplained reductions in untreated areas.Measurement variances were high. The mean reduction in fat thickness was 5.5 mm. The mean increment in muscle thickness was 2.2 mm. The mean decrease in muscle separation was 2.9 mm (P = 0.19). Early posttreatment ultrasound images in 1 study showed an echolucent muscle layer, compared with a more echodense layer at the baseline, consistent with tissue swelling after exercise. Almost all studies were authored by medical advisors for the device manufacturer.

DISCUSSION

Measurement data show small reductions in fat thickness, occurring almost immediately after the treatments. Adipocyte removal without tissue swelling would be unique among energy-based treatments. Similarly, muscle hypertrophy is not known to occur acutely after exercise; muscle swelling likely accounts for an early increment in muscle thickness. Any improvement in the diastasis recti is likely fictitious.

CONCLUSIONS

Electromagnetic treatments, either administered alone or in combination with radiofrequency, are safe. However, the evidence for efficacy is tenuous. Measured treatment effects are very small (<5 mm). Conflict of interest and publication bias are major factors in studies evaluating energy-based alternatives. The evidence-based physician may not be satisfied that an equivocal treatment benefit justifies the time and expense for patients.

[Research on the Application of Electromagnetic Navigation Technology in Surgical Robots]

Due to the need to achieve precise operations during surgery, in order to prevent hand tremors and poor surgical field of view, more and more surgical robots are used in surgical operations combined with navigation technology to meet the requirements for surgical accuracy. Open surgery such as orthopaedics, joint replacement and neurosurgery on the market generally use optical navigation systems to guide robots to achieve precise positioning, but optical navigation systems cannot be used for operations in areas with small surgical space. Therefore, a robotic surgical system based on electromagnetic navigation technology that can be applied to the craniofacial area was proposed. By using this robot, the problems of difficult operation and low precision caused by the narrow craniofacial space can be solved. Key techniques and considerations are studied. The function of the developed prototype is verified through model tests. The test results show that the surgical robot under the electromagnetic navigation technology can achieve precise surgical operations improve the success rate of the doctor's surgery and reduce postoperative complications.

Excitation of Mechanical Resonances in the Stationary Ring of a Mechanical Seal by a Continuously Operated Electromagnetic Acoustic Transducer

Acoustic/ultrasonic testing is now a common method in the field of nondestructive testing for detecting material defects or monitoring ongoing mechanical changes in a structure during operation. In many applications, piezoelectric transducers are used to generate mechanical waves inside the specimen. Their actual operating frequency is highly dependent on the dimensions of the transducer. Larger dimensions of the piezoelectric transducer allow for a lower operating frequency. However, these dimensions limit the use of piezoelectric transducers in certain applications where the size of the transducer is restricted due to limited installation space and when low-frequency excitation is required. One application that places these requirements on the transducer is the monitoring of mechanical seals. Here, the transducer must be mounted on the stationary ring of the seal. In this paper, a continuously operated electromagnetic acoustic transducer (EMAT) is presented as an alternative to piezoelectric transducers as a transmitter. The advantage of a EMAT is that it meets the requirements of limited sensor size (sensor area < 10 × 6 mm) and can excite mechanical waves with frequencies below 10 kHz. A structural analysis of the stationary ring shows that the first two mechanical resonances occur around 4 and 5.5 kHz. An experimental study meterologically demonstrates the ability of the EMAT to excite these first two mechanical resonances of the ring. A comparative simulation agrees well with the measurement.

Evaluation of oxidative stress and genotoxicity of 900 MHz electromagnetic radiations using Trigonella foenum-graecum test system

Unprecedented growth in the communication sector and expanded usage of the number of wireless devices in the past few decades have resulted in a tremendous increase in emissions of non-ionizing electromagnetic radiations (EMRs) in the environment. The widespread EMRs have induced many significant changes in biological systems leading to oxidative stress as well as DNA damage. Considering this, the present study was planned to study the effects of EMRs at 900 MHz frequency with the power density of 10.0 dBm (0.01 W) at variable exposure periods (0.5 h, 1 h, 2 h, 4 h, and 8 h per day for 7 days) on percentage germination, morphological characteristics, protein content, lipid peroxidation in terms of malondialdehyde content (MDA), and antioxidant defense system of Trigonella foenum-graecum test system. The genotoxicity was also evaluated using similar conditions. It was observed that EMRs significantly decreased the germination percentage at an exposure time of 4 h and 8 h. Fresh weight and dry weight of root and shoot did not show significant variations, while the root and shoot length have shown significant variations for 4 h and 8 h exposure period. Further, EMRs enhanced MDA indicating lipid peroxidation. In response to exposure of EMRs, there was a significant up-regulation in the activities of enzymes such as ascorbate peroxidase (APX), superoxide dismutase (SOD), glutathione-S-transferase (GST), guaiacol peroxidase (POD), and glutathione reductase (GR) in the roots and shoots of Trigonella-foenum graecum. The genotoxicity study showed the induction of chromosomal aberrations in root tip cells of the Trigonella foenum-graecum test system. The present study revealed the induction of oxidative stress and genotoxicity of EMRs exposure in the test system.

Evaluation of Electromagnetic Navigational Bronchoscopy Using Tomosynthesis-Assisted Visualization, Intraprocedural Positional Correction and Continuous Guidance for Evaluation of Peripheral Pulmonary Nodules

BACKGROUND

Electromagnetic navigational bronchoscopy (ENB) has been shown to have variable diagnostic accuracy for the assessment of peripheral pulmonary nodules. This may be because of discrepancies between the preplanned computed tomography of chest target lesion location versus actual target location (computed tomography-to-body divergence), and the lack of a continuous navigational image. The ILLUMISITE (Medtronic, Minneapolis, MN) is a newly developed ENB platform that utilizes tomosynthesis, an imaging technology that can visualize the target location using fluoroscopy (F-ENB). This new system also allows for intraprocedural positional correction and continuous navigation guidance during sampling to overcome these limitations and improve diagnostic yield. We report our first experience in a single center, single proceduralist using this new technology.

METHODS

We conducted a retrospective, single center, single operator study reviewing 72 consecutive patients (78 nodules) over a 3-month period. We investigated the overall diagnostic yield and diagnostic yield by nodule location, size, and sedation type using this new F-ENB system.

RESULTS

The overall diagnostic yield was 87% and pnemothoraces occurred in 2/78 procedures. We did not find any statistically significant difference when comparing pulmonary nodule location, size or sedation method utilized ( P =0.231, 0.338, and 0.112, respectively). Sixty-nine percent of the pulmonary nodules biopsied were 2 to 3 cm in size. The average distance corrected after tomosynthesis visualization was 15.4 mm (0.4 to 29.8 mm).

CONCLUSION

We report our initial experience with the ILLUMISITE system using fluoroscopic tomosynthesis-assisted visualization with continuous navigational guidance at our institution. This new technology allows the operator to correct for better target lesion alignment and real time positional correction and may improve diagnostic yields with minimal complications for evaluation of peripheral pulmonary nodules.

Target registration errors in navigation-assisted mandibular surgery according to the tracking methods and the type of markers: experiments using human dry mandibular bone

OBJECTIVES

This study was conducted to evaluate the accuracy of navigation process according to the type of tracking methods and registration markers. The target registration errors (TREs) were measured at seven anatomical landmarks of the mandible.

METHODS

Four different experiments were performed to obtain the TREs using two tracking methods, the optical tracker (Polaris) and the electromagnetic (EM) tracker (Aurora), and two types of registration markers, invasive and noninvasive markers. All comparisons of TREs were statistically analyzed using SPSS and Python-based statistical package.

RESULTS

The average TRE values obtained from the four experiments were as follows: (1) 0.85 mm (± 0.07) using invasive marker and Aurora, (2) 1.06 mm (± 0.12) using invasive marker and Polaris, (3) 1.43 mm (± 0.15) using noninvasive marker and Aurora, and (4) 1.57 mm (± 0.23) using noninvasive marker and Polaris. Comparisons between all the experimental results revealed statistically significant differences except for the type of tracking system. Although the comparison between the modality of the tracking system showed no significant differences, the EM-based approach consistently demonstrated better performances than the optical type in all comparisons.

CONCLUSIONS

This study demonstrates that irrespective of the tracking modality, using invasive marker is a better choice in terms of accuracy. When using noninvasive marker, it is important to consider the increased TREs. In this study, the noninvasive marker caused a maximum increment of TREs of 0.81 mm compared with the invasive marker. Furthermore, using an EM-based tracker with invasive marker may result in the best accuracy for navigation.

Design of double-notch UWB filter with upper stopband characteristics based on ACPW-DGS

In this manuscript, a compact (size only 9.8mm*9.8mm) Ultra Wide Band (UWB) bandpass filter with a new structure is proposed, which can be used in the UWB wireless communication band authorized by the FCC. The top plane is composed of a pair of back-to-back microstrip lines, and the ground plane structure is based on an asymmetric coplanar waveguide-defect ground structure (ACPW-DGS). UWB is formed by the vertical electromagnetic coupling of the top plane and the ground plane. On this basis, split ring resonator (SRR) and C type resonator (CTR) are utilized to place double notch bands. A novel third order nested C-type resonator (TONCTR) is obtained by performing CTR, which can further optimize the upper stopband while ensuring double notch bands. The filter can be used for filtering within the UWB system, and it can also avoid the amateur radio band (9.2 -10.3GHz) and the X-band satellite link band (9.6-12.3GHz) on UWB communication systems. Finally, the measured results from the fabricated prototype are basically consistent with the simulation results.

A single-coil-based method for electromagnetic interference reduction in point-of-care low field MRI systems

One of the main challenges for point-of-care (POC) MRI systems is electromagnetic interference (EMI), since such systems are intended for use outside conventional Faraday-shielded rooms. Many methods have been proposed based on EMI detection via sensors external to the MRI system, followed by different types of signal processing to reduce artifacts in the image. Although these methods can be very effective, they do increase the complexity of the overall system, and introduce more potential failure points for systems designed for challenging environments. In this work we introduce a new method that does not require external sensors, but rather uses the "MR-silent" mode of an RF coil to detect the EMI, followed by simple subtraction from the signal from the "MR-active" mode. This method can be performed post-acquisition if there are two receive channels available, or as demonstrated here can operate with a single-channel receive detection system with the addition of a simple passive 180° power splitter/combiner into the receive chain. Proof-of-concept in vivo results show that a reduction in the standard deviation of the EMI up to ∼ 97 % is possible, with average values ∼ 90 %.

Frameless neuronavigation-assisted brain biopsy with electromagnetic tracking: how I do it?

BACKGROUND

In recent years, thanks to several technological innovations, stereotactic cerebral biopsies have evolved from frame-based to frameless neuronavigation-assisted techniques.

METHODS

The authors provide herein a detailed step-by-step description of the technique, shedding light on surgical tips and how to avoid complications. The practical application of the technique is demonstrated with a high-quality video.

CONCLUSION

The neuronavigation-assisted brain biopsy with electromagnetic tracking is a "true frameless" procedure. It represents a simple, safe, and effective innovation for frameless biopsy of cerebral lesions. This technique is time efficient, offering a high degree of accuracy required for the establishment of a definitive diagnosis, enabling optimal further treatment, and thus improving patient outcome.

A Review of Emerging Electromagnetic-Acoustic Sensing Techniques for Healthcare Monitoring

Conventional electromagnetic (EM) sensing techniques such as radar and LiDAR are widely used for remote sensing, vehicle applications, weather monitoring, and clinical monitoring. Acoustic techniques such as sonar and ultrasound sensors are also used for consumer applications, such as ranging and in vivo medical/healthcare applications. It has been of long-term interest to doctors and clinical practitioners to realize continuous healthcare monitoring in hospitals and/or homes. Physiological and biopotential signals in real-time serve as important health indicators to predict and prevent serious illness. Emerging electromagnetic-acoustic (EMA) sensing techniques synergistically combine the merits of EM sensing with acoustic imaging to achieve comprehensive detection of physiological and biopotential signals. Further, EMA enables complementary fusion sensing for challenging healthcare settings, such as real-world long-term monitoring of treatment effects at home or in remote environments. This article reviews various examples of EMA sensing instruments, including implementation, performance, and application from the perspectives of circuits to systems. The novel and significant applications to healthcare are discussed. Three types of EMA sensors are presented: (1) Chip-based radar sensors for health status monitoring, (2) Thermo-acoustic sensing instruments for biomedical applications, and (3) Photoacoustic (PA) sensing and imaging systems, including dedicated reconstruction algorithms were reviewed from time-domain, frequency-domain, time-reversal, and model-based solutions. The future of EMA techniques for continuous healthcare with enhanced accuracy supported by artificial intelligence (AI) is also presented.

Low Cost Digital Implementation of Hybrid FitzHugh Nagumo-Morris Lecar Neuron Model Considering Electromagnetic Flux Coupling

Digital realization of neuron models, especially implementation on a field programmable gate array (FPGA), is one of the key objectives of neuromorphic research, because the effective hardware realization of the biological neural networks plays a crucial role in implementing the behaviors of the brain for future applications. In this paper, a hybrid FitzHugh Nagumo-Morris Lecar (FNML) neuron model with electromagnetic flux coupling is considered, and two multiplierless piecewise linear (PWL) models, which have similar behaviors to the biological neuron, are presented. A comparison between digital implementation results of the original FNML and PWL models illustrates that, the PWL1 model provides a 65% speed-up with an overall saving (in FPGA resources) of 66.2%, and the PWL2 model yields a 71% speed-up with an overall saving of 78.2%.

Electromagnetic Interference from Heated Gloves May Compromise Avalanche Transceiver Function

INTRODUCTION

Rapid location of avalanche victims by companions using avalanche transceivers is of utmost importance to prevent asphyxiation. The objective was to determine whether electromagnetic interference from heating elements in gloves worn by rescuers or victims can impair the receiving or transmitting function of avalanche beacons.

METHODS

Commercially available heated gloves from 3 different manufacturers were examined during a simulated search with 3 common brands of avalanche transceivers. Distance to target beacon at first signal detection and accuracy of direction to target, as indicated by the arrow from the direction indicator, were evaluated.

RESULTS

Preliminary tests showed that transmitting and receiving signals are degraded by electromagnetic interference caused by rectangular pulses emitted by activated heating elements. Field tests revealed significantly reduced distances of first signal detection when heated gloves were turned on near receiving avalanche transceivers (P<0.001; Wilcoxon signed-rank test). Decreased distance to target beacon ranged between 1.9 m (5%) and 41.5 m (94%) at first detection, depending on the avalanche transceiver used.

CONCLUSIONS

Avalanche transceivers are susceptible to electromagnetic interference from gloves with electric heating elements. We do not recommend using heated gloves when performing a transceiver search for avalanche victims because it can lead to a delay in rescue.

Nacre-Mimetic Hierarchical Architecture in Polyborosiloxane Composites for Synergistically Enhanced Impact Resistance and Ultra-Efficient Electromagnetic Interference Shielding

Pervasive mechanical impact is growing requirement for advanced high-performance protective materials, while the electromagnetic interference (EMI) confers severe risk to human health and equipment operation. Bioinspired structural composites achieving outstanding safeguards against a single threat have been developed, whereas the synergistic implementation of impact/EMI coupling protection remains a challenge. This work proposes the concept of nacre-mimetic hierarchical composite duplicating the "brick-and-mortar" arrangement, which consists of freeze-drying constructed chitosan/MXene lamellar architecture skeleton embedded in a shear stiffening polyborosiloxane matrix. The resulting composite effectively attenuates the impact force of 85.9%-92.8% with extraordinary energy dissipation capacity, in the coordinative manner of strain-rate enhancement, structural densification, lamella dislocation and crack propagation. Attributed to the alternate laminated structure promoting the reflection loss of electromagnetic waves, it demonstrates an ultraefficient EMI shielding effectiveness of 47.2-71.8 dB within extremely low MXene loadings of 1.1-1.3 wt %. Furthermore, it serves favorably in impact monitoring and wireless alarm systems and accomplishes performance optimization through the combination of multiple biomimetic strategies. In conclusion, this function-integrated structural composite is shown to be a competitive candidate for sophisticated environments by resisting impact damage and EMI hazards.

Optimization of multi-frequency electromagnetic surveying for investigating waste characteristics in an open dumpsite

Implications: Open dump mining (ODM) is now applied as a sustainable approach to combat improper waste disposal and reduce municipal solid waste (MSW) in the open dumpsite. To implement ODM for producing RDF, business developers must know the amount and composition of waste that can be converted into RDF before mining. This study used multi-frequency EM surveys with frequencies of 5,000, 11,000, and 15,000 Hz. This multi-frequency method effectively determined the waste composition and identified potential excavation points in the open dumpsite prior to ODM. This method can mitigate the limitations of traditional surveying, due to its improved mobility, lower time consumption, and reduced labor needs.

Touch-Programmable Metasurface for Various Electromagnetic Manipulations and Encryptions

Previous programmable metasurfaces integrated with diodes or varactors require external instructions for field programmable gate arrays (FPGAs), which usually rely on computer-inputs or pre-loaded algorithms. But the complicated external devices make the coding regulation process of the programmable metasurfaces cumbersome and difficult to use. To simplify the process and provide a new interaction manner, a touch-programmable metasurface (TPM) based on touch sensing modules is proposed to realize various electromagnetic (EM) manipulations and encryptions. By simply touching the meta-units of the TPM, the state of the diodes can be changed. Through the touch controls, the TPM can achieve independent and direct manipulations of meta-units and efficient inputs of coding patterns without using a FPGA or other control modules. Various coding patterns are demonstrated to achieve diverse scattering-field control and flexible near-field EM information encryptions, which verifies the feasibility of the TPM design. The presented TPM will have wide application prospects in imaging displays, wireless communications, and EM information encryptions.

Exploring multiple electrical layers overlying coal seams using the transient electromagnetic method

The transient electromagnetic method (TEM) is widely applied in coal hydrogeological exploration owing to its sensitivity to low-resistivity bodies. However, when a coal seam is buried deep, particularly if there are multiple electrical layers in the vertical direction of the overlying stratum, the results of the calculation using the late-channel empirical formula of the TEM may no longer reflect the actual situation. In this study, we evaluated the principle of the one-dimensional (1D) Occam algorithm and the steps for performing an inversion. We proposed various two-, three-, and four-layer electrical models for inversion using the 1D Occam algorithm. Our results are consistent with the electrical distribution of the models, thus indicating the effectiveness of the algorithm. A test project of large-depth transient electromagnetic exploration in the Datong Coalfield in Shanxi, China, was selected for experimental verification. The 1D Occam inversion was used to successfully identify various electrical strata overlying the coal seam.

Electromagnetic absorption enhancing mechanisms by modified biochar derived from Enteromorpha prolifera: a combined experimental and simulation study

Although the rapid advances of wireless technologies and electronic devices largely improve the quality of life, electromagnetic (EM) pollution increases the risk of exposure to EM radiation. Developing high-efficiency absorbers with a rational structure and wideband characteristics is of great significance to eliminate radiation pollution. Herein, Enteromorpha prolifera derived biochar which would provide a suitable surface and multiple polarizations has been prepared as the supporter to anchor nanoparticles. In addition, theoretical simulation results further confirm that radar wave scattering could be largely inhibited after coating with absorbing materials. As a result, the hybrid absorbers achieve remarkable EM absorption properties attributed to the synergistic magnetic-dielectric loss. Elaborate compositional and structural characterization studies indicate that the absorber has a large specific area and numerous polarization centers, which would make full use of waste biomass as light weight and broadband high-performance EM absorption materials.

Fast Design Optimization and Comparative Analysis for Linear Permanent Magnet Motor with Magnet Skew, Auxiliary Tooth and Overhang Structure

This paper presents a fast design optimization using an effective characteristic analysis for linear permanent magnet motors (LPMMs) with techniques for improving motor performance such as using an auxiliary tooth, permanent magnet (PM) skew, and overhang structures. These techniques have different effects on the characteristics of the LPMM depending on the combinations of each other, resulting in complexity in the design optimization process. In particular, the three-dimensional (3-D) effect of the PM skew and overhang structure takes a lot of time to be analyzed. To deal with this problem, an effective magnetic field analysis method and a novel optimization algorithm are proposed. Preferentially, the field reconstruction method is used for a fast and accurate evaluation of the magnetic field of the LPMM. In the proposed magnetic field analysis method, the change of magnetic field distribution due to the addition of an auxiliary tooth is predicted, and the 3-D magnetic field effect of PM skew and overhang structure is considered. By reducing the computational burden in the magnetic field analysis, the electromagnetic characteristics of LPMMs can be calculated quickly, such as detent force, end force, thrust force, and back-EMF. The effect of the auxiliary tooth and overhang structure on the optimal PM skew length is investigated with comparative study results. Subsequently, the proposed optimization algorithm has the advantage of reducing time cost by providing multimodal optimization and robustness evaluation of local peaks at the same time. The proposed method is verified via comparison with finite element analysis and experimental results.

Electromagnetic-guided versus endoscopic-guided postpyloric placement of nasoenteral feeding tubes

BACKGROUND

For people who are malnourished and unable to consume food by mouth, nasoenteral feeding tubes are commonly used for the administration of liquid food and drugs. Postpyloric placement is when the tip of the feeding tube is placed beyond the pylorus, in the small intestine.  Endoscopic-guided placement of postpyloric feeding tubes is the most common approach. Usually, an endoscopist and two or more medical professionals perform this procedure using a guidewire technique. The position of the tube is then confirmed with fluoroscopy or radiography, which requires moving people undergoing the procedure to the radiology department. Alternatively, electromagnetic-guided placement of postpyloric nasoenteral feeding tubes can be performed by a single trained nurse, at the bedside and with less equipment than endoscopic-guided placement. Hence, electromagnetic-guided placement may represent a promising alternative to endoscopic-guided placement, especially in settings where endoscopy and radiographic facilities are unavailable or difficult to access.

OBJECTIVES

To assess the efficacy and safety of electromagnetic-guided placement of postpyloric nasoenteral feeding tubes compared to endoscopic-guided placement.

SEARCH METHODS

We searched the Cochrane Library, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey until February 2021. We screened the reference lists of relevant review articles and current treatment guidelines for further literature. We contacted the study authors for missing data.

SELECTION CRITERIA

We included randomised trials comparing electromagnetic-guided placement with endoscopic-guided placement of nasoenteral feeding tubes. We excluded prospective cohort studies, retrospective cohort studies, (nested) case-control studies, cross-sectional studies, and case series or case reports.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the methodological quality of potentially eligible trials and extracted data from the included trials. The primary outcomes were technical success in insertion and aspiration pneumonitis. The secondary outcomes were the time for postpyloric placement of nasoenteral feeding tubes, direct healthcare costs, and adverse events. We performed a random-effects meta-analysis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. We evaluated the certainty of evidence based on the GRADE approach.

MAIN RESULTS

We identified four randomised controlled trials with 541 participants which met our inclusion criteria. All trials had methodological limitations, and lack of blinding of participants and investigators was a major source of bias. We had 'some concerns' for the overall risk of bias in all trials.  Electromagnetic-guided postpyloric placement of nasoenteral feeding tubes may result in little to no difference in technical success in insertion compared to endoscopic-guided placement (RR 1.09, 95% CI 0.88 to 1.35; I2 = 81%; low-certainty evidence). Electromagnetic-guided placement may result in a difference in the proportion of participants with aspiration pneumonitis compared to endoscopic-guided placement, but these results are unclear (RR 0.24, 95% CI 0.03 to 2.18; I2 = 0%; low-certainty evidence).  Electromagnetic-guided placement may result in little to no difference in the time for postpyloric placement of nasoenteral feeding tubes compared to endoscopic-guided placement (MD 4.06 minutes, 95% CI -0.47 to 8.59; I2 = 97%; low-certainty evidence). Electromagnetic-guided placement likely reduces direct healthcare costs compared to endoscopic-guided placement (MD -127.69 US dollars, 95% CI -135.71 to -119.67; moderate-certainty evidence). Electromagnetic-guided placement likely results in little to no difference in adverse events compared with endoscopic-guided placement (RR 0.78, 95% CI 0.41 to 1.49; moderate-certainty evidence).

AUTHORS' CONCLUSIONS

We found low-certainty evidence that electromagnetic-guided placement at the bedside results in little to no difference in technical success in insertion and aspiration pneumonitis, compared to endoscopic-guided placement. The heterogeneity of the healthcare professionals who performed the procedures and the small sample sizes limited our confidence in the evidence. Future research should be based on large studies with well-defined endpoints to potentially elucidate the differences between these two procedures.

An automatic framework for estimating the pose of the catheter distal section using a coarse-to-fine network

BACKGROUND AND OBJECTIVE

During percutaneous coronary intervention procedures, generally only 2D X-ray images are provided. The consequent lack of depth perception makes it difficult for interventionists to visually estimate the pose of medical tools inside the vasculature, especially for novices. Although some automatic methods have been developed to aid interventionists, it is still a challenging task to obtain stable and accurate pose estimation. In this paper, we describe a learning-based framework for estimating the pose of the catheter distal section (CDS). The main innovation of this framework is the proposal of a coarse-to-fine fusion network (CFF-Net) which can achieve the shape and orientation estimation for the CDS.

METHODS

By adopting a two-step fusion, CFF-Net progressively solves the shape and orientation ambiguities. The first step is the early fusion where the 2D projection image fuses with the shape prior before input, which makes the estimated result own a specific catheter distal shape. The second step is the late fusion where CFF-Net fuse feature maps and the orientation data from Electromagnetic (EM) sensors to confirm the overall orientation of the CDS. Finally, the estimated pose in the EM space will be obtained after we combine the estimated shape and orientation from CFF-Net with the position information from the EM sensor.

RESULTS

The effectiveness of CFF-Net has been verified in a simulated environment where RMSE of CFF-Net is 0.706 ± 0.121 mm. This approach was further transferred from simulation to reality using the real-world data, where RMSE of CFF-Net is 1.121 ± 0.124 mm and RMSE of the whole proposed framework is 1.577 ± 0.144 mm.

CONCLUSION

In simulated and real-world experiments, our proposed approach has been proven to achieve high accuracy while ensuring real-time processing for estimating the pose of the CDS.

A Wearable Capsule Endoscope Electromagnetic Localization System Based on a Novel WCL Algorithm

The wearable localization system for wireless capsule endoscopy (WCE) is a potential technology to realize rapid diagnosis and treatment of the gastrointestinal (GI). However, the electromagnetic localization accuracy of WCE still needs to be improved. In this paper, based on RSSI electromagnetic fading model, the accurate fitting parameter values are obtained by Kalman filter and the least square method. A novel weighted centroid localization (WCL) algorithm based on exponential weights is proposed, which can achieve high-accuracy localization by using only sparse reception matrix. The simulation results show that when the standard deviation of the localization data is 7.85, the localization root mean square error (RMSE) is 25.4 mm; when the standard deviation of the localization data is 5.475, the localization RMSE is 2.5 mm. These two localization RMSEs are 38% and 79% less than those of the conventional centroid localization algorithm, respectively. An experimental platform of wearable wireless communication and localization system using 24 array receiving antennas is developed in human phantom environment. The experimental results show that the wearable WCE electromagnetic localization system based on the proposed algorithm achieves a localization RMSE of 36.3 mm, which is 17% lower than that of the conventional centroid localization algorithm and meets the needs of clinical diagnosis.

[Study on Test Method of Radiation Emission of Proton Therapy Equipment]

Electromagnetic compatibility testing of proton therapy system is different from that of traditional products in an anechoic chamber. It has high requirements on the division of sample composition, the understanding of applicable standards, the formulation of operation mode, the selection of test location, and the test of ambient noise. According to the requirements of GB 4824-2019 standard, the test method of radiation emission of proton therapy equipment was developed to provide reference advice for the industry, and the problems encountered in the actual test were studied.

Electromagnetic Controlled Closed-Head Model of Mild Traumatic Brain Injury in Mice

Highly reproducible animal models of traumatic brain injury (TBI), with well-defined pathologies, are needed for testing therapeutic interventions and understanding the mechanisms of how a TBI alters brain function. The availability of multiple animal models of TBI is necessary to model the different aspects and severities of TBI seen in people. This manuscript describes the use of a midline closed head injury (CHI) to develop a mouse model of mild TBI. The model is considered mild because it does not produce structural brain lesions based on neuroimaging or gross neuronal loss. However, a single impact creates enough pathology that cognitive impairment is measurable at least 1 month after injury. A step-by-step protocol to induce a CHI in mice using a stereotaxically guided electromagnetic impactor is defined in the paper. The benefits of the mild midline CHI model include the reproducibility of the injury-induced changes with low mortality. The model has been temporally characterized up to 1 year after the injury for neuroimaging, neurochemical, neuropathological, and behavioral changes. The model is complementary to open skull models of controlled cortical impact using the same impactor device. Thus, labs can model both mild diffuse TBI and focal moderate-to-severe TBI with the same impactor.

Collective Behaviors of Magnetic Microparticle Swarms: From Dexterous Tentacles to Reconfigurable Carpets

Microrobot swarms have promising prospects in biomedical applications ranging from targeted cargo delivery to minimally invasive surgery. However, such potential is constrained by the small output force and low efficiency of the current microrobot swarms. To address this challenge, we report a tentacle-like reconfigurable microrobot swarm by programming paramagnetic microparticles into reconfigurable carpets with numerous cilia. This wirelessly controlled microrobot swarm is constructed via a strong gradient magnetic field in combination with a programmable oscillating magnetic field. The gradient magnetic field is supplied by a permanent magnet, which enables fast formation of a microrobot swarm with powerful collective behaviors via cooperative physical structures within the swarm. The oscillating magnetic field is produced by a custom-built electromagnetic coil system, which is adopted as an actuation device for conducting dexterous manipulation via controllable oscillation motion. Using the proposed microrobot swarming strategy, a milligram-level magnetic carpet achieves a millinewton-level output force. By applying different types of magnetic fields, the magnetic carpet accomplishes dexterous manipulation tasks, lesion removal, and controllable drug diffusion with a high-efficiency response in microscale executions. The formation and control mechanisms of the microrobot swarm reported here provide a practical candidate for in vivo biomedical treatment.